Manual Review Of Reference Lists Research Articles

An integrative systematic review on interventions to improve layperson's ability to identify trustworthy digital health information.

Health information on the Internet has a ubiquitous influence on health consumers' behaviour. Searching and evaluating online health information poses a real challenge for many health consumers. To our knowledge, our systematic review paper is the first to explore the interventions targeting lay people to improve their e-health literacy skills. Our paper aims to explore interventions to improve laypeople ability to identify trustworthy online health information. The search was conducted on Ovid Medline, Embase, Cochrane database, Academic Search Complete, and APA psych info. Publications were selected by screening title, abstract, and full text, then manual review of reference lists of selected publications. Data was extracted from eligible studies on an excel sheet about the types of interventions, the outcomes of the interventions and whether they are effective, and the barriers and facilitators for using the interventions by consumers. A mixed-methods appraisal tool was used to appraise evidence from quantitative, qualitative, and mixed-methods studies. Whittemore and Knafl's integrative review approach was used as a guidance for narrative synthesis. The total number of included studies is twelve. Media literacy interventions are the most common type of interventions. Few studies measured the effect of the interventions on patient health outcomes. All the procedural and navigation/ evaluation skills-building interventions are significantly effective. Computer/internet illiteracy and the absence of guidance/facilitators are significant barriers to web-based intervention use. Few interventions are distinguished by its implementation in a context tailored to consumers, using a human-centred design approach, and delivery through multiple health stakeholders' partnership. There is potential for further research to understand how to improve consumers health information use focusing on collaborative learning, using human-centred approaches, and addressing the social determinants of health.

Factors Influencing the Provision of Healthcare Professional-Led Sexual Support to Patients with Cancer and Their Partners: An Integrative Review of Studies from 2017 to 2022

Abstract Introduction Patients with cancer and partners often face difficult and enduring sexual concerns. Reviews up to 2017 identified that the provision of a healthcare professional (HP)-led sexual support was not routine practice. Since 2017, there has been a burgeoning growth in research and evidenced-based interventions targeting HP’s sexual support provision in cancer care. Therefore, this review presents a synthesis of HP-led sexual support and factors impacting provision in cancer care from 2017 to 2022 to ascertain if sexual support in clinical practice has changed. Methods Using an integrative review design, searches were performed on five electronic databases (CINAHL, MEDLINE, ProQuest, PubMed and PsycInfo), Google Scholar and manual review of reference lists from 2017 to 2022. Data extracted from studies meeting predefined inclusion/exclusion criteria was synthesised using thematic analysis. Papers were appraised using the Mixed Methods Appraisal Tool. Results From the twelve empirical studies included, three themes were identified: (1) Theory–practice gap: HP’s recognition of the need to provide sexual support to patients with cancer and partners but current provision is lacking, (2) professional and organisational barriers to HPs providing sexual support for patients with cancer and (3) equipping HPs and enabling patients to discuss sexual challenges in cancer care could enhance delivery of sexual support. Conclusion Provision of HP-led sexual support in cancer care is still not routine practice and when provided is considered by HPs as sub-optimal. Policy Implications Providing HPs with education, supportive resources and referral pathways could enhance the provision of sexual support in cancer care.

Meaning of wellness in caring science based on Rodgers's evolutionary concept analysis.

Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear. To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science. Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms 'wellness', 'health', 'health care', and 'health care and wellness'; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria. Based on the findings from this concept analysis, a definition of wellness was developed: 'a holistic and multidimensional concept represented on a continuum of being well that goes beyond health'. Implications for nursing practice were correspondingly presented. Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

Catheter ablation via the left atrium for atrioventricular nodal reentrant tachycardia: A narrative review.

BackgroundSince 1996, it has been recognized that catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) may require an approach through the left atrium.ObjectiveThe purposes are to present a case report and to provide a comprehensive narrative review on this topic.MethodsA literature review of all articles that provided detailed information on patients who underwent catheter ablation via the left atrium for AVNRT was performed. The primary search queried PubMed using Medical Subject Headings (MeSH) terms “atrioventricular nodal reentrant tachycardia” and “left.” The secondary search was performed by manual review of reference lists and Google Scholar citations of manuscripts retrieved by the primary search. The review was limited to the English language.ResultsThe searches yielded 30 articles that described 79 patients. A case report was added. Therefore, the final review consisted of 80 patients. The prevalence of left atrial ablation for patients with AVNRT undergoing catheter ablation at tertiary care centers was approximately 1%. Failed right atrial ablation, with or without coronary sinus ablation, was the most common indication for left atrial ablation. Pooled data from 3 cohort studies estimated the acute success rate for radiofrequency ablation of the slow pathway at the septal or inferoparaseptal segments of the mitral valve annulus after failed right-sided ablation to be 90%. There were no reports of atrioventricular block requiring permanent pacemaker implantation.ConclusionCatheter ablation of the slow pathway via the left atrium is an important technique for AVNRT cases that are refractory to conventional ablation.

The Most Prevalent Intimate Partner Violence; Physical, Sexual, Verbal, or Emotional in Early Marriage: A Narrative Review

Context: Early marriage is relatively common in the world and has become a public concern. One of the problems seen in early marriage is the high prevalence of partner violence against women, which, along with other harmful effects of early marriage, can hurt a woman’s mental and physical health. This research is the first narrative review investigating the most prevalent type of intimate partner violence and the risk factors for violence against women who marry as a child. Evidence Acquisition: A skim and scan review related to the correlation between child marriage and any type of intimate partner violence was done. Also a comprehensive search of the Web of Science, PsycINFO, PubMed (MEDLINE), Scopus, and Google Scholar was carried out from 2000 to 2019. A comprehensive search of the Web of Science, PsycINFO, PubMed (MEDLINE), Scopus, and Google Scholar was carried out from 2000 to 2019. The second stage of the search was conducted in grey literature. To facilitate a systematic approach, we adopted the PECO framework. Results: The database search yielded 756 articles relevant to child marriage and different types of intimate partner violence, with other articles added in a manual review of reference lists. In the final review, a total of 12 articles were included as they contained the eligibility criteria. The result of this narrative review study showed the relationship between child marriage and intimate partner violence. Conclusions: ince the present study considers physical and sexual violence the most common type of violence against women and other studies have explicitly pointed to the adverse consequences of such violence, it seems necessary to make efforts to reduce early marriage by providing economic opportunities and promoting education and as a result to avoid adverse effects, including partner violence.

Self-collection of samples for HPV testing to increase participation in cervical cancer screening by immigrant women: An integrative review.

To examine methods and results of studies assessing self-collection of cervico-vaginal samples for human papillomavirus (HPV) testing by immigrant women for insights into how future research using this method with unique subpopulations of women may improve the rates of cervical cancer screening (CCS) compared to current strategies. Four electronic databases were systematically searched through March 2020, with no limits applied. A manual review of reference lists was also completed. The search resulted in 63 articles. After removal of duplicates, 36 were reviewed against inclusion criteria. A manual review of reference lists yielded two additional studies. The final sample included 15 relevant publications representing 13 unique empirical studies. Data related to study methodology and empirical results were extracted into table form. The methods of the studies were summarized and synthesized, including diversity of participants, community engagement, including collaboration with public health nurses or community health workers. In addition, methods and findings related to the educational components of the studies, and empirical findings related to various cultural groups, were described. To reduce health disparities in CCS, researchers should focus on diverse groups, such as immigrant women, to understand important individual and group-specific factors that may influence screening, including whether self-collection of samples for HPV testing along with appropriate education and support for follow-up will address these factors.

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis.

This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services. Registration: PROSPERO: CRD42018109263.

Mycobacterium tuberculosis bloodstream infection prevalence, diagnosis, and mortality risk in seriously ill adults with HIV: a systematic review and meta-analysis of individual patient data

SummaryBackgroundThe clinical and epidemiological significance of HIV-associated Mycobacterium tuberculosis bloodstream infection (BSI) is incompletely understood. We hypothesised that M tuberculosis BSI prevalence has been underestimated, that it independently predicts death, and that sputum Xpert MTB/RIF has suboptimal diagnostic yield for M tuberculosis BSI.MethodsWe did a systematic review and individual patient data (IPD) meta-analysis of studies performing routine mycobacterial blood culture in a prospectively defined patient population of people with HIV aged 13 years or older. Studies were identified through searching PubMed and Scopus up to Nov 10, 2018, without language or date restrictions and through manual review of reference lists. Risk of bias in the included studies was assessed with an adapted QUADAS-2 framework. IPD were requested for all identified studies and subject to harmonised inclusion criteria: age 13 years or older, HIV positivity, available CD4 cell count, a valid mycobacterial blood culture result (excluding patients with missing data from lost or contaminated blood cultures), and meeting WHO definitions for suspected tuberculosis (presence of screening symptom). Predicted probabilities of M tuberculosis BSI from mixed-effects modelling were used to estimate prevalence. Estimates of diagnostic yield of sputum testing with Xpert (or culture if Xpert was unavailable) and of urine lipoarabinomannan (LAM) testing for M tuberculosis BSI were obtained by two-level random-effect meta-analysis. Estimates of mortality associated with M tuberculosis BSI were obtained by mixed-effect Cox proportional-hazard modelling and of effect of treatment delay on mortality by propensity-score analysis. This study is registered with PROSPERO, number 42016050022.FindingsWe identified 23 datasets for inclusion (20 published and three unpublished at time of search) and obtained IPD from 20, representing 96·2% of eligible IPD. Risk of bias for the included studies was assessed to be generally low except for on the patient selection domain, which was moderate in most studies. 5751 patients met harmonised IPD-level inclusion criteria. Technical factors such as number of blood cultures done, timing of blood cultures relative to blood sampling, and patient factors such as inpatient setting and CD4 cell count, explained significant heterogeneity between primary studies. The predicted probability of M tuberculosis BSI in hospital inpatients with HIV-associated tuberculosis, WHO danger signs, and a CD4 count of 76 cells per μL (the median for the cohort) was 45% (95% CI 38–52). The diagnostic yield of sputum in patients with M tuberculosis BSI was 77% (95% CI 63–87), increasing to 89% (80–94) when combined with urine LAM testing. Presence of M tuberculosis BSI compared with its absence in patients with HIV-associated tuberculosis increased risk of death before 30 days (adjusted hazard ratio 2·48, 95% CI 2·05–3·08) but not after 30 days (1·25, 0·84–2·49). In a propensity-score matched cohort of participants with HIV-associated tuberculosis (n=630), mortality increased in patients with M tuberculosis BSI who had a delay in anti-tuberculosis treatment of longer than 4 days compared with those who had no delay (odds ratio 3·15, 95% CI 1·16–8·84).InterpretationIn critically ill adults with HIV-tuberculosis, M tuberculosis BSI is a frequent manifestation of tuberculosis and predicts mortality within 30 days. Improved diagnostic yield in patients with M tuberculosis BSI could be achieved through combined use of sputum Xpert and urine LAM. Anti-tuberculosis treatment delay might increase the risk of mortality in these patients.FundingThis study was supported by 10.13039/100010269Wellcome fellowships 109105Z/15/A and 105165/Z/14/A.

Culturally Adapted Psychotherapeutic Interventions for Latino Depression and Anxiety: A Meta-Analysis

Objectives: Culturally adapted psychotherapeutic interventions have been developed to treat Latino depression and anxiety. Evidence is lacking regarding the overall effectiveness and generalizability of these adapted interventions. This study conducted a systematic review and meta-analysis of psychotherapeutic interventions for Latino depression or anxiety. Method: A search of nine electronic databases and manual review of reference lists were conducted. Thirteen studies of randomized controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Results: An overall small treatment effect that is statistically significant was identified for Latino depression or anxiety of d = 0.334, 95% confidence interval [0.049, 0.619], p < .05. Discussion and Implications: More research is needed to determine the effectiveness of culturally adapted psychotherapeutic interventions for Latino depression or anxiety.

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

ObjectivesSustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. MethodsI. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium.II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. Inclusion criteria: adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). ResultsI. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles.II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days).Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. ConclusionsMultiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.

Pericardial tamponade as a complication of invasive cardiac procedures: a review of the literature.

Cardiac tamponade (CT) is a rare but often life-threatening complication after invasive cardiac procedures. Some procedures favor CT. Furthermore, the incidence depends on patients’ comorbidities, sex and age and operators’ skills. In this paper we review studies and meta-analyses concerning the rate of iatrogenic CT. We define the risk factors of CT and show concise characteristics for each invasive cardiac procedure separately. According to our analysis CT occurs especially after procedures requiring transseptal puncture or perioperative anticoagulation. The overall rate of CT after such procedures varies among published studies from 0.089% to 4.8%. For this purpose we searched the PubMed database for clinical studies published up to December 2018. We included only those studies in which a defined minimum of procedures were performed (1000 for atrial fibrillation ablation, 6000 for percutaneous coronary intervention, 900 for permanent heart rhythm devices, 90 for left atrial appendage closure, 300 for transcatheter aortic valve implantation and percutaneous mitral valve repair with the Mitra-Clip system). The search was structured around the key words and variants of these terms. In addition, secondary source documents were identified by manual review of reference lists, review articles and guidelines. The search was limited to humans and adults (18+ years).

Optimal Screening Methods to Detect Cardiac Disorders in Athletes: An Evidence-Based Review.

Which screening method should be considered best practice to detect potentially lethal cardiac disorders during the preparticipation physical examination (PE) of athletes? The authors completed a comprehensive literature search of MEDLINE, CINAHL, Cochrane Library, Embase, Physiotherapy Evidence Database (PEDro), and SPORTDiscus from January 1996 to November 2014. The following key words were used individually and in combination: ECG, athlete, screening, pre-participation, history, and physical. A manual review of reference lists and key journals was performed to identify additional studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Studies selected for this analysis involved (1) outcomes of cardiovascular screening in athletes using the history, PE, and electrocardiogram (ECG); (2) history questions and PE based on the American Heart Association recommendations and guidelines; and (3) ECGs interpreted following modern standards. The exclusion criteria were (1) articles not in English, (2) conference abstracts, and (3) clinical commentary articles. Study quality was assessed on a 7-point scale for risk of bias; a score of 7 indicated the highest quality. Articles with potential bias were excluded. Data included number and sex of participants, number of true- and false-positives and negatives, type of ECG criteria used, number of cardiac abnormalities, and specific cardiac conditions. The sensitivity, specificity, false-positive rate, and positive predictive value of each screening tool were calculated and summarized using a bivariate random-effects meta-analysis model. Fifteen articles reporting on 47 137 athletes were fully reviewed. The overall quality of the 15 articles ranged from 5 to 7 on the 7-item assessment scale (ie, participant selection criteria, representative sample, prospective data with at least 1 positive finding, modern ECG criteria used for screening, cardiovascular screening history and PE per American Heart Association guidelines, individual test outcomes reported, and abnormal screening findings evaluated by appropriate diagnostic testing). The athletes (66% males and 34% females) were ethnically and racially diverse, were from several countries, and ranged in age from 5 to 39 years. The sensitivity and specificity of the screening methods were, respectively, ECG, 94% and 93%; history, 20% and 94%; and PE, 9% and 97%. The overall false-positive rate for ECG (6%) was less than that for history (8%) or PE (10%). The positive likelihood ratios of each screening method were 14.8 for ECG, 3.22 for history, and 2.93 for PE. The negative likelihood ratios were 0.055 for ECG, 0.85 for history, and 0.93 for PE. A total of 160 potentially lethal cardiovascular conditions were detected, for a rate of 0.3%, or 1 in 294 patients. The most common conditions were Wolff-Parkinson-White syndrome (n = 67, 42%), long QT syndrome (n = 18, 11%), hypertrophic cardiomyopathy (n = 18, 11%), dilated cardiomyopathy (n = 11, 7%), coronary artery disease or myocardial ischemia (n = 9, 6%), and arrhythmogenic right ventricular cardiomyopathy (n = 4, 3%). The most effective strategy to screen athletes for cardiovascular disease was ECG. This test was 5 times more sensitive than history and 10 times more sensitive than PE, and it had a higher positive likelihood ratio, lower negative likelihood ratio, and lower false-positive rate than history or PE. The 12-lead ECG interpreted using modern criteria should be considered the best practice in screening athletes for cardiovascular disease, and the use of history and PE alone as screening tools should be reevaluated.

A systematic review of children's alcohol-related knowledge, attitudes and expectancies.

Understanding the nature of, and transitions in, young children's alcohol-related knowledge and attitudes is important to determining the age at which we should start educating children about alcohol and informing our understanding of the focus of such education. This paper aimed to explore current literature on the alcohol-related knowledge, beliefs, attitudes and expectancies of children aged 12years and under. Electronic databases were searched for papers published from January 2000-August 2016. Further papers were identified by a manual review of reference lists, and contacting corresponding authors of included papers. Papers that reported on children's knowledge or beliefs about alcohol, attitudes towards alcohol and/or expectancies regarding alcohol consumption were included. Seventeen cross-sectional, experimental or observational studies and seven longitudinal studies met the inclusion criteria. Data on key measures was tabulated. From a very young age children are aware of and able to identify alcohol, and have some knowledge of its effects; their attitudes become more positive with increasing age and these shifts appear to precede drinking initiation by some years. The small number of available studies, with different measures of knowledge, attitudes and expectancies, made assessment of bias unfeasible. Only three studies were published in the last five years. Children's knowledge of, and attitudes towards, alcohol form before they initiate alcohol use, and are likely acquired through observation. Alcohol-related education should commence before children begin drinking, and should encourage the delay of alcohol initiation, address social norms, and reduce positive expectancies.

Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors.

Context:Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.Objective:To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.Data Sources:Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.Study Selection:Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related.Study Design:Systematic review with meta-analysis.Level of evidence:Level 4.Data Extraction:Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.Results:Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.Conclusion:Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.

Pharmacological Agents Targeting γ-Secretase Increase Risk of Cancer and Cognitive Decline in Alzheimer's Disease Patients: A Systematic Review and Meta-Analysis.

Drugs targeting γ-secretase in Alzheimer's disease (AD) have failed to demonstrate efficacy in clinical trials. To perform a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of drugs targeting γ-secretase in AD. Ten trials were identified involving 5,227 patients using electronic databases and manual review of reference lists. RCTs of at least two weeks duration involving a drug targeting γ-secretase were eligible. The main outcomes examined were adverse events and cognitive measures (ADAS-cog, MMSE, ADCS-ADL, and CDR-sb). A sub-group analysis was performed, excluding the γ-secretase modulator tarenflurbil, to evaluate the safety and efficacy of γ-secretase inhibitors only. There was an increased risk of adverse events (Odds Ratio (OR) 1.38, 95% CI 1.09-1.73; p = 0.01), serious adverse events (OR 1.50, 95% CI 1.22-1.84; p < 0.001), and skin cancers (OR 4.77, 95% CI 2.83-8.06; p < 0.001). There was significantly increased risk of infections (OR 1.36, 95% CI 1.13-1.63; p < 0.001) in the subgroup analysis excluding tarenflurbil. Pooled results also revealed a worsening in ADAS-cog (difference in means 1.33, 95% CI 0.58-2.08; p < 0.001) and MMSE (difference in means -0.66, 95% CI -0.96 to 0.35; p < 0.001), but not ADCS-ADL or CDR-sb. The use of γ-secretase inhibitors is associated with significantly increased risk of serious adverse events including skin cancers, and worsening in cognitive indicators. This evidence indicates that γ-secretase may not be an appropriate target for clinical treatment of AD.

Intrahepatic pancreatic pseudocyst: A review of the world literature.

AIMTo investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).METHODSA literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.RESULTSWe found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).CONCLUSIONDiagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.

What does a diagnostic label of 'polycystic ovary syndrome' really mean in adolescence? A review of current practice recommendations.

Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder, with many women initially presenting during adolescence. Diagnosis during this period is particularly challenging, yet many emphasize the importance of an early diagnosis given the long-term metabolic and reproductive health consequences associated with the syndrome. The objective of this study was to review the current literature to determine whether the diagnostic label 'PCOS' is necessary to effectively manage adolescent girls presenting with features of the syndrome. A literature search was conducted (PubMed, Medline, Informit Health and the Cochrane Database of Systematic Reviews) identifying papers addressing the diagnosis and management of PCOS during adolescence. Articles were selected based on date of publication, relevance of material and the quality of evidence presented. A total of 427 papers were screened, with 40 of these selected from the initial search. A subsequent 154 were included from manual review of reference lists from key papers identified in the initial search. Current guidelines recommend treating the individual manifestations of PCOS. In doing so, there is good evidence identifying that this approach adequately targets the underlying metabolic and reproductive changes associated with the syndrome. This suggests that providing a diagnostic label of PCOS is not actually necessary to effectively manage adolescent girls with features of this syndrome.

Interventions to Assist Health Consumers to Find Reliable Online Health Information: A Comprehensive Review

BackgroundHealth information on the Internet is ubiquitous, and its use by health consumers prevalent. Finding and understanding relevant online health information, and determining content reliability, pose real challenges for many health consumers.PurposeTo identify the types of interventions that have been implemented to assist health consumers to find reliable online health information, and where possible, describe and compare the types of outcomes studied.Data SourcesPubMed, PsycINFO, CINAHL Plus and Cochrane Library databases; WorldCat and Scirus ‘gray literature’ search engines; and manual review of reference lists of selected publications.Study SelectionPublications were selected by firstly screening title, abstract, and then full text.Data ExtractionSeven publications met the inclusion criteria, and were summarized in a data extraction form. The form incorporated the PICOS (Population Intervention Comparators Outcomes and Study Design) Model. Two eligible gray literature papers were also reported.Data SynthesisRelevant data from included studies were tabulated to enable descriptive comparison. A brief critique of each study was included in the tables. This review was unable to follow systematic review methods due to the paucity of research and humanistic interventions reported.LimitationsWhile extensive, the gray literature search may have had limited reach in some countries. The paucity of research on this topic limits conclusions that may be drawn.ConclusionsThe few eligible studies predominantly adopted a didactic approach to assisting health consumers, whereby consumers were either taught how to find credible websites, or how to use the Internet. Common types of outcomes studied include knowledge and skills pertaining to Internet use and searching for reliable health information. These outcomes were predominantly self-assessed by participants. There is potential for further research to explore other avenues for assisting health consumers to find reliable online health information, and to assess outcomes via objective measures.

Abstract P227: Diabetes Mellitus and Venous Thromboembolism: A Systematic Review and Meta-analysis

Introduction: Reported associations of diabetes with venous thromboembolism (VTE) are inconsistent. We conducted a systematic review and meta-analysis to quantify the association between diabetes mellitus (type 1 or 2) and VTE (deep vein thrombosis or pulmonary embolism). Methods: A systematic review of observational studies was conducted using PubMed, Web of Science, and CINAHL through Dec 31, 2012. Additional studies were identified by contacting experts and through manual review of reference lists of review articles and articles eligible for the present study. We abstracted information on relative risk (RR) estimates and pooled these data using a random-effects model. We queried authors of papers that did not adjust for important confounders to request controlled RR estimates. Results: We identified 10 studies (N participants: 240,940; 7 cohort, 3 case-control: Heit, Lidegaard, and Poulter) which provided RRs adjusted for age and BMI (Figure), and 8 additional studies which did not adjust for these confounders (N participants = 150,205). The pooled RR for the association of diabetes with VTE in the 10 studies was 1.18 (95% CI, 1.03-1.34). The test for heterogeneity was not significant (I 2 = 23.8%, p = 0.22). Amongst the 10 studies, smaller studies tended to have lower RR estimates: Both the Begg and Egger tests were significant (p = 0.02 and 0.01, respectively). The other 8 studies showed evidence of significant between-study heterogeneity (I 2 = 75.5%, p &lt;0.0001), making a pooled estimate inappropriate. Conclusions: Diabetes is associated with an 18% increased risk of VTE in observational studies after accounting for age and obesity. Possible explanations for the association of diabetes with VTE include increased hypercoagulability or vascular damage caused by the metabolic derangements of diabetes or increased exposure to VTE risk factors in individuals with diabetes. Further research is needed to elucidate the mechanisms of this association and whether improved control of diabetes is associated with reduced VTE risk.

Diagnosis and Treatment of Depression in Patients With Congestive Heart Failure

Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart failure, particularly in those patients with coronary artery disease , and is associated with a poorer quality of life, increased use of health care resources, more frequent adverse clinical events and hospitalizations, and twice the risk of mortality. At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy.