Methodological Quality Of Articles Research Articles

The effect of kangaroo mother care or skin-to-skin contact on infant vital signs: A systematic review and meta-analysis

BackgroundIt has been reported that kangaroo mother care/skin-to-skin contact immediately after birth facilitates the newborn's physiological and psychological adaptation to extrauterine life. ObjectiveTo examine the effect of kangaroo mother care/skin-to-skin contact on infants’ body temperature, oxygen saturation, respiratory rate and heart rate. DesignSystematic review and meta-analysis. MethodsPubMed, ScienceDirect, SpringerLink, Wiley Online Library and Taylor & Francis Online were searched for the period 1 January 2015 to 30 November 2021 for studies published in the English language. The methodological quality of articles was assessed using the modified Jadad scale and the Newcastle–Ottawa scale. Effect size calculations were made using the fixed effects and random effects models. FindingsThis meta-analysis included 13 studies, with a total of 891 infants. Kangaroo mother care/skin-to-skin contact was effective for maintaining infants’ body temperature (p = 0.000). Infants’ heart rate decreased (p = 0.015) and oxygen saturation was higher (p = 0.040) following kangaroo mother care/skin-to-skin contact. Kangaroo mother care/skin-to-skin contact did not affect infants’ respiratory rate (p = 0.896), but infants’ respiratory rate decreased after kangaroo mother care/skin-to-skin contact (p = 0.047). Key conclusions and implications for practiceKangaroo mother care/skin-to-skin contact is effective for improving the vital signs of newborns. Kangaroo mother care/skin-to-skin contact is recommended for all neonates, and standardization of this approach would be beneficial.

The Impact of Blenderized Tube Feeding on Gastrointestinal Symptoms, a Scoping Review

Severe gastrointestinal symptoms are one of the main reasons for switching from conventional artificial tube feeding to blenderized tube feeding (BTF). This study aimed to describe and quantify the impact of BTF on gastrointestinal symptoms in children and adults. We analyzed four databases (PubMed, Scopus, Cochrane Library, and Google Scholar). The review was performed following the PRISMA extension for Scoping Reviews checklist. The methodological quality of articles was assessed following the NIH quality assessment tools. The initial search yielded 535 articles and, after removing duplicates and off-topic articles, 12 met the inclusion criteria. All included papers unanimously converged in defining an improvement of gastrointestinal symptoms during blenderized feeding: the eight studies involving pediatric cohorts report a decrease from 30 to over 50% in gagging and retching after commencing BTF. Similar rates are reported for constipation and diarrhea improvement in most critically ill adults. Experimental studies and particularly randomized controlled trials are needed to develop robust evidence on the effectiveness of BTF in gastrointestinal symptom improvement with prolonged follow-up and adequate medical monitoring.

Model systems informing mechanisms and drug discovery: a systematic review of POLG-related disease models

Introduction Pathogenic variants in the gene encoding the catalytic subunit of DNA polymerase gamma (POLG), comprise an important single-gene cause of inherited mitochondrial disorders. Clinical manifestations are now recognised as an array of overlapping clinical features rather than discrete syndromes as originally conceptualised. Animal and cellular models have been used to address numerous scientific questions, from basic science to the development and assessment of novel therapies. Here, we sought to perform a systematic review of the existing models used in mitochondrial research and their effectiveness in recapitulating POLG-related disease. Methods Four databases were searched from inception to May 31, 2022: MEDLINE, Scopus, Web of Science, and Cochrane Review. Original articles available in English, reporting the use of a model system designed to recapitulate POLG­-related disease, or related pathogenicity, were eligible for inclusion. Risk of bias and the methodological quality of articles were assessed by an adapted version of the Cochrane Risk of Bias Tool, with the quality of evidence synthesized across each model. Results A total of 55 articles, including seven model organisms (Human, yeast [Saccharomyces cerevisiae and Schizosaccharomyces pombe], Drosophila, Mouse, Nematoda, and Zebrafish) with 258 distinct variants were included. Of these, 66% (N=38) of articles recapitulated mitochondrial DNA (mtDNA) depletion and 42% (N=23) recapitulated POLG-related disease. Thirty-three percent of articles (N=18/55) utilised tissue-specific models of POLG-related dysfunction, while 13% (N=7) investigated the effect of potential therapeutics in POLG-related mitochondrial disorders. Discussion The available evidence supporting the ability of models for POLG-related disease to recapitulate molecular mechanisms and phenotype is limited, inconsistent and of poor methodologic quality. Further success in examining and translating novel therapies into effective treatments will be enhanced by the availability of more robust models that better recapitulate the entire spectrum of POLG-related disease. PROSPERO registration: CRD42021234883

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review.

The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.

P14.71 An assessment of the reporting and methodological quality of meningioma systematic reviews and meta-analyses

Abstract BACKGROUND Systematic reviews and meta-analyses constitute the highest level of research evidence and for a disease with limited clinical trial activity, are often relied upon to help inform clinical practice. This review of reviews evaluates both the reporting & methodological quality of meningioma evidence syntheses. MATERIAL AND METHODS Potentially eligible meningioma reviews published between 1st January 1990 and 31st December 2020 were identified from eight electronic databases. Inclusion required the study to meet the Cochrane guideline definition of a systematic review or meta-analysis. Reviews concerning neurofibromatosis type 2, spinal and pediatric meningiomas were excluded. The reporting and methodological quality of articles were assessed against the following modified guidelines: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) and the Risk of Bias in Systematic Reviews (ROBIS) guidelines. RESULTS 117 systematic reviews were identified, 57 of which included meta-analysis (48.7%). The number of meningioma systematic reviews published each year has increased with 63 studies (53.9%) published between 01/2018 and 12/2020. A median of 17 studies (IQR 9–29) were included per review. Impact factor of journals publishing a systematic review with or without a meta-analysis was similar (median 2.3 vs 1.8, P=0.397). The mean PRISMA scores for systematic reviews with a meta-analysis was 21.11 (SD 4.1, 78% adherence) and without was 13.89 (SD 3.4, 63% adherence). Twenty-nine systematic reviews with meta-analysis (51%) and 11 without meta-analysis (18%) achieved greater than 80% adherence to PRISMA recommendations. Methodological quality assessment using AMSTAR2 revealed one study (0.9%) as high quality whilst 111 (94.8%) studies were graded as critically low. One hundred and two articles (87.2%) did not utilize a comprehensive search strategy as defined by the AMSTAR2 tool. Ninety-nine studies (84.6%) obtained a high level of concern for potential bias as per the ROBIS assessment. One hundred and eight articles (92.3%) failed to present information that a protocol had been established prior to study commencement and 76 articles (65.0%) did not conduct a risk of bias assessment. Across the three tools, domains relating to the establishment of a protocol prior to review commencement and conducting appropriate risk of bias assessments were frequently low scoring. CONCLUSION Overall reporting and methodological quality of meningioma systematic reviews was sub-optimal. Established critical appraisal tools and reporting guidelines should be utilized a priori to assist in producing high-quality systematic reviews.

Sero-epidemiology and associated factors of HIV, HBV, HCV and syphilis among blood donors in Ethiopia: a systematic review and meta-analysis

BackgroundTransfusion transmissible infections (TTIs) remain a major public health problem in developing countries including Ethiopia. In Ethiopia, comprehensive information about sero-epidemiology of major TTIs is lacking at the national level. Therefore, this systematic review and meta-analysis was aimed at providing the pooled estimate of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among blood donors in Ethiopia.MethodsRelevant studies published until May 31, 2019 were searched through PubMed/Medline, EMBASE, SCOPUS, HINARI, Cochrane database library, Web of Science, Google Scholar and Google. The methodological quality of articles was assessed using Joanna Brigg’s Institute critical appraisal checklist for prevalence and analytical studies. The pooled sero-epidemiology of HIV, HBV, HCV and syphilis were determined using the random-effects model. Heterogeneity between the studies was assessed using the I2 statistics. Publication bias was assessed by visual inspection of the funnel plot and Egger's statistics.ResultsA total of 7921 articles were retrieved, and 7798 were screened for eligibility after duplicates removed. Forty-nine full-text articles were assessed for eligibility; of which 45 were eligible for qualitative and quantitative synthesis: categorized as 36, 34, 31 and 23 studies for estimations of HBV, HIV, HCV and syphilis, respectively. In the random-effects model, the pooled sero-epidemiology of HBV, HIV, HCV and syphilis was 5.20, 2.83, 0.93 and 1.50%, respectively. Moreover, being a male blood donor was significantly associated with HBV and syphilis infection, whereas being a replacement blood donor was significantly associated with a high burden of HIV, HBV and HCV infections.ConclusionThe pooled sero-epidemiology of major TTIs among blood donors was high. Therefore, there is a need to design prevention and control strategies in a comprehensive approach to reduce the burden.

Chemotherapy Treatments for Burkitt Lymphoma: Systematic Review of Interventional Studies

BackgroundBurkitt lymphoma (BL) is an aggressive hematologic cancer. This study synthetized the evidence about the efficacy and safety of chemotherapy treatments used in patients with BL using the World Health Organization classification. Materials and MethodsA systematic review of interventional studies was performed. A search was carried out in PubMed, Scopus, and Web of Science, with additional manual and gray literature searches. The methodological quality of articles was assessed with the Newcastle-Ottawa scale. ResultsWe identified 1358 studies; 9 nonrandomized studies satisfied the eligibility criteria (n = 544 patients). The BL epidemiologic variants were sporadic BL (44.5%), endemic BL (47.2%), and immunodeficiency-associated BL (8.3%). Regarding chemotherapy protocols, 4 groups were identified: based on CODOX-M/IVAC (n = 4), EPOCH (n = 1), BFM (n = 1), and simplified treatment schemes used in African countries (n = 3). Most studies had moderate quality. Empirically and qualitatively, the best options for adults with sporadic BL were ‘DA-EPOCH-R’ (7-year overall survival [OS], 100%; 95% confidence interval [CI], 82-100), ‘HDR + LD into CODOX-M/IVAC’ (2-year OS, 84%), and ‘RD-CODOX-M/IVAC’ (4-year progression-free survival, 92%; 95% CI, 77-100); in pediatric patients, the ‘BFM-NHL-90-like’ showed promising results (3-year OS, 90%). For immunodeficiency-associated BL, the ‘SC-EPOCH-RR’ demonstrated a good therapeutic profile (6-year OS, 90%; 95% CI, 60-98). The ‘Malawi 2012-2014′ (1-year OS, 73%; 95% CI, 61-85) could be the treatment choice in endemic BL (African countries). The main adverse events were hematologic. ConclusionSelecting chemotherapy protocols for BL should be grounded in its epidemiologic variants. Further studies with greater methodological quality are needed to strengthen the evidence.

Sexual violence against women by so-called Islamic state of Iraq and Syria (ISIS): protocol for a systematic review

BackgroundViolence against women and girls (VAWG) has been significantly increased by the rise of conflict and insecurity in the territories under controlling so-called Islamic State of Iraq and Syria (ISIS). This review aims to provide an understanding of the consequences of ISIS sexual violence against women.MethodsElectronic databases including MEDLINE, Cochrane Central Register of Controlled Trials, JSTOR, Web of Science, Scopus, Science Direct, ProQuest, and Google Scholar are searched for the articles published from 2014 to 2020. Then, two reviewers will systematically identify the articles which will meet the inclusion criteria. Using a standard checklist, methodological quality of articles is assessed. The findings will be summarized, and a narrative synthesis of data will be reported.DiscussionThis systematic review with a narrative synthesis approach will provide the important information about the gap in knowledge and detailed summary of the existing evidence on consequences of ISIS's systematic sexual violence against women. The evidence is useful for the international health organizations to plan and develop clinical guidelines with interest to reduce the consequences of sexual violence in the armed conflict territories.Systematic review registrationPROSPERO CRD42019124215

Prevention of Autologous Costal Cartilage Graft Warping in Secondary Rhinoplasty.

Autogenous costal cartilage grafts (ACCG) are frequently used in secondary rhinoplasty; however, these grafts tend to warp. The objective of this study is to systematically evaluate current interventions to prevent warping of ACCGs and to assess long-term outcomes with their use. A systematic review was undertaken using a computerized search. Eligible articles assessed adult patients undergoing secondary rhinoplasty with ACCGs. Interventions to reduce warping were examined. Publication descriptors were extracted, heterogeneity was examined, and methodological quality of articles was assessed. Eighteen studies were included. Most studies were published after 2010 (83.3%), assessed a single intervention (83.3%), and were of levels of evidence III and IV. Mean patient age was 30 (range 5-95 years) and studies included a mean of 64 cases (range 9-357). Nine of the 15 non-comparative studies were considered of high methodological quality, while all 3 comparative studies were considered high quality. Secondary rhinoplasties which did not describe a method to address warping showed increased rates of warping compared to counter balancing techniques, chimeric grafts, titanium microplating, Kirschner wire and suture usage, irradiation, and various carving techniques. Rates of warping remained low with no major complications with the use of a variety of approaches. ACCG warping during secondary rhinoplasty can be alleviated with a variety of techniques with no clear difference in outcomes between approaches. Plastic surgeons may consider adopting one of the various techniques described in order to reduce warping, maximize aesthetic outcomes and patient satisfaction.

Treatment of Displaced Olecranon Fractures: A Systematic Review.

The incidence of olecranon fractures is rising. Displaced fractures are usually operated either by tension band wiring or plate fixation. The aim of this review is to evaluate the best current evidence on the management of displaced olecranon fractures. Randomized controlled trials were systematically gathered in May 2018 from CENTRAL, MEDLINE, Embase, CINAHL, Scopus, and PEDro databases. The methodological quality of articles was assessed according to the Cochrane Collaboration's domain-based framework. Prospero database registration number: CRD42018096650. Of 1518 identified records, finally, 5 were relevant. Four trials were found on tension band wiring: two compared tension band wiring with plate fixation (n = 108), one compared plate fixation with an olecranon memory connector (n = 40), and one trial compared tension band wiring with a modified tension band wiring called Cable Pin System (n = 62). In addition, one trial compared operative and conservative treatment in elderly (n = 19). The risk of bias was considered low in two and high in three of the trials. The follow-up time was 5-36 months, and outcome measures varied from patient-rated and physician-rated measures to radiological outcomes. In the analysis, there was no difference between tension band wiring and plate fixation. The data were insufficient for further quantitative analysis. No differences were found in clinical or patient-rated outcome measures between the two most frequent fixation methods (tension band wiring and plate fixation) of displaced olecranon fractures. Current data are not sufficient to evaluate other treatment methods; however, conservative treatment might serve as an option for selected patients in the elderly population.

Health assessments and screening tools for adults experiencing homelessness: a systematic review

BackgroundHomelessness is increasing globally. It results in poorer physical and mental health than age matched people living in permanent housing. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations.The aim of this review was to identify assessment tools that are valid, reliable and appropriate to measure the health status of people who are homeless.MethodsData sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. The protocol was registered with PROSPERO. The National Health and Medical Research Council of Australia (NHMRC) hierarchy of evidence was applied; methodological quality of included articles was assessed using the McMaster critical appraisal tools and psychometric properties of the tools were appraised using the International Centre for Allied Health Evidence Ready Reckoner.ResultsDiverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. Eleven assessment tools in 13 studies had evidence of appropriate psychometric testing for the target population in domains of quality of life and health status, injury, substance use, mental health, psychological and cognitive function. Methodological quality of articles and tools were assessed as moderate to good. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured with clinical indicators in the same manner as people living in permanent dwellings.ConclusionsThis review highlighted the need to develop consistent and comprehensive health assessment tools validated with, and tailored for, adults experiencing homelessness.

The Effects of Needling Therapies on Muscle Force Production: A Systematic Review and Meta-analysis.

Needling has been shown to decrease pain in the short term; however, its effects on muscle force production are unclear. To evaluate the evidence regarding the comparative effects of needling on muscle force production. In this systematic review, an electronic search was performed using key words related to needling. Methodological quality of articles was appraised and effect sizes were calculated. The strength of evidence was determined, and meta-analysis was performed when similar methods were used in studies for similar conditions. Twenty-one studies were included in this review, of which 9 were deemed to be of high quality (greater than 6/10 on the Physiotherapy Evidence Database [PEDro] scale), 11 of fair quality (5 to 6/10), and 1 of poor quality (less than 5/10). Three meta-analyses were performed. There was moderate strength of evidence and medium effect sizes for needling therapy to enhance force production in those with neck pain, and very low strength of evidence of no effect for individuals with nonspecific and postoperative shoulder pain and those with lateral epicondylalgia. Other studies not included in the 3 meta-analyses demonstrated no significant effect of needling on force production. These studies included individuals with carpal tunnel syndrome, knee osteoarthritis, ankle sprains, knee arthroscopy, or delayed-onset muscle soreness. The majority of studies suggest no effect of dry needling on force production. High-quality studies with adequate power that control for the placebo effect and follow accepted reporting standards could make valuable contributions to the literature. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42017080318). Therapy, level 1a. J Orthop Sports Phys Ther 2019;49(3):154-170. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8270.

Prevalence of depression among Iranian patients under hemodialysis: a systematic review and meta-analysis

Context: Depression is a highly prevalent and debilitating mental disorder, particularly among patients under hemodialysis, who are more susceptible to depression due to their complex treatment regimens, dietary limitations, side effects of medications and fear of disease outcomes. This systematic review and meta-analysis explored the prevalence of depression in Iranian hemodialysis patients. Evidence Acquisitions: In this systematic review and meta-analysis, search was done in national and international databases, including SID, MagIran, Google Scholar, Web of Science, Medline (via PubMed), and Scopus from inception to March 2018. Key search terms included hemodialysis, renal replacement therapy, dialysis, end-stage renal disease, renal failure, depression and Iran along with all their possible combinations. Data were combined for metaanalysis using random effects model. Heterogeneity between studies was analyzed by I2 test, and data were analyzed by STATA (version 12) software. Results: The included 24 articles had a sample size of 2941 participants; the overall prevalence of depression in hemodialysis patients in Iran was 56.8% (95% CI: 50.5-63). The results of the univariate meta-regression analysis showed no significant correlation between prevalence of depression and methodological quality of articles (P=0.524), duration of hemodialysis (P=0.885), publication year (P=0.116), mean age of participants (P=0.224) and sample size (P=0.194). Conclusions: More than half of the hemodialysis patients in Iran suffer from depression. Given the overlap of depression symptoms with uremia in this group of patients, it is necessary to identify depression in these patients for early management and interventions.

Effectiveness of wearable upper limb assistive devices in hemiparesis for improvement of functional abilities: A systematic review

Assess short-term benefits of wearable devices in activities of daily living (ADLs) and functional tasks, for people suffering from upper-limb impairment due to acquired brain injuries (ABI). Two independent reviewers conducted a systematic review across Cochrane Database of Clinical Trials, Medline, Web Of Science, PEDro, OT-Seeker and Open Grey databases until November 2017, identifying citations in included studies and systematic reviews. Inclusion criteria included: adults with hemiparesis due to all causes of ABI; wearable devices such as orthosis, prosthesis, exoskeleton, electrical stimulation devices, neuroprosthetics; use of functional outcome measures assessing ADLs and functional tasks with and without device. Methodological quality of articles was assessed according to the Joanna Brigs Institute (JBI) scale for case series. From 1452 titles initially selected, eleven studies were finally selected ( n = 95 participants), all focusing on post-stroke hemiparesis. Nine were self-controlled case-series and two were single-case reports. Six studies described functional electrical stimulation devices, three described use of exoskeletons and two passive devices. Command of the nine active devices included electromyography, kinematic data, push-button, inertial unit measurement and force sensors. Quality assessment using JBI Scale found low quality evidence of all studies with heterogeneity of outcomes. One of the two studies describing passive assistive devices demonstrated significant improvement in the size of block lifted during the box and block test (BBT). Only one of the three studies using exoskeleton found significant improvement in the BBT and various functional tasks. Four of the six neuroprosthetics studies found moderate to significant improvement across outcomes. Considering high heterogeneity of studied assistive devices, small samples sizes and study designs implicating insufficient high quality evidence, it is not possible to either support or reject the use of assistive devices on the ABI population. Further research is needed to investigate the use of these devices on functional outcomes.

Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review

Objective: To evaluate the evidence on the effectiveness of myofascial release therapy to relieve chronic musculoskeletal pain and to improve joint mobility, functioning level, and quality of life in pain sufferers. Data sources and review: Randomized controlled trials were systematically gathered from CENTRAL, Medline, Embase, CINAHL, Scopus, and PEDro databases. The methodological quality of articles was assessed according to the Cochrane Collaboration’s domain-based framework. In addition, the effect sizes of main outcomes were calculated based on reported means and variances at baseline and in follow-up. Results: Of 513 identified records, 8 were relevant. Two trials focused on lateral epicondylitis (N = 95), two on fibromyalgia (N = 145), three on low back pain (N = 152), and one on heel pain (N = 65). The risk of bias was considered low in three and high in five trials. The duration of therapy was 30–90 minutes 4 to 24 times during 2–20 weeks. The effect sizes did not reach the minimal clinically important difference for pain and disability in the studies of low back pain or fibromyalgia. In another three studies with the high risk of bias, the level of minimal clinically important difference was reached up to two-month follow-up. Conclusion: Current evidence on myofascial release therapy is not sufficient to warrant this treatment in chronic musculoskeletal pain.

Endovascular treatment of traumatic thoracic aortic lesions: a systematic review and meta-analysis.

To provide an overview of the experience of endovascular treatment for traumatic thoracic aortic lesions (TTAL). Thoracic aortic injury secondary to high-energy chest trauma constitutes an emergency situation with potentially devastating outcome. In the present time, the majority of patients are treated with thoracic endovascular aortic repair. The aim of this study was to provide a systematic overview of endovascular aortic repair in patients with TTAL with special attention to perioperative mortality, paraplegia, stroke, influence of left subclavian artery (LSA) coverage herein, and long-term stent-related complications. PubMed and Embase were searched for studies describing endovascular treatment of TTAL in the period between January 1st, 2000 and January 30th, 2016. The methodological quality of articles was assessed using the MINORS score and PRISMA guidelines. Data on early mortality, perioperative complications, and long-term stent-related complications were extracted. A total of 2005 reports were screened, and 74 publications were finally included in the analysis describing treatment of 1882 patients. Early mortality rate, paraplegia rate, and stroke rate were 7.5%, 0.4%, and 1.5%, respectively. LSA coverage did not increase the risk of stroke. The severity of injuries had a positive association on early mortality. Late stent related mortality and morbidity were uncommon. TTAL can be treated endovascularly with low mortality and (neurological) morbidity. LSA coverage does not increase the risk of neurological complications but is associated with a moderate risk of left arm ischemia. Long-term stent-related complications are rare, but the available data is limited.

Role of Physical Therapy Intervention in Patients With Life-Threatening Illnesses.

Physical therapy encompasses the skilled treatment and care for patients across the life span through a multitude of different practice settings. This includes caring for individuals within end-of-life or palliative care settings. The goal of treatment in this stage of care is to relieve physical, social, psychological, and spiritual suffering in order to improve overall quality of life in patients with terminal illnesses. There has been limited research conducted to investigate the utilization of physical therapy interventions in palliative care settings. The purpose of this study was to contribute to the current research involving physical therapy and end-of-life care in terms of its efficacy, value, and how this value is perceived by patients and their caregivers. This was completed by independently screening and reviewing the studies that were published between the years 1994 and 2014 and related to this topic. The databases and journals searched included CINAHL, PUBMED, MEDLINE, Cochrane, PEDro, the Journal of Palliative Care, the American Journal of Hospice and Palliative Medicine, and Google Scholar. Thirteen qualitative articles were selected which met all inclusion criteria and discussed the role of physical therapy intervention in the palliative care setting. Methodological quality of articles were assessed using the QASP, scale and their findings were summarized and presented in table format. These articles support the utilization of physical therapy in palliative care settings and emphasizes the impact of physical therapy on improving patients' physical, social, and emotional well-being.

A Systematic Review of Ultrasound Imaging As a Tool for Evaluating Hemophilic Arthropathy in Children and Adults

PURPOSE:To semi-quantitatively assess the evidence on the value of ultrasound (US) for assessment of hemophilic arthropathy (HA) in children and adults. We sought to provide the answer to the following questions: (1) Are currently available US techniques accurate for early diagnosis of pathological findings? (2) Can treatment reduce the incidence of US-detectable findings in HA? (3) Do US scores correlate with clinical/radiological constructs in the evaluation of HA? (4) Are US findings associated with functional status of joints?METHODS:Articles were screened using MEDLINE (n= 519), EMBASE (n= 493), and the Cochrane Library (n=24) (1946-2015). Two independent reviewers assessed the reporting quality and the methodological quality of articles by using the Standards for Reporting of Diagnostic Accuracy (STARD) and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tools respectively. 4 different US scanning protocols for assessment of hemophilic joints were compared based on scanning times and anatomical landmarks. 6 US scoring systems were also compared according to number of soft-tissue and osteochondral parameters evaluated.RESULTS:Out of 16 full-text articles, 9 diagnostic accuracy studies (417 patients with hemophilia A, B and von Willebrand's disease) were evaluated for reporting and methodological quality using STARD and QUADAS-2 assessment tools respectively. Seven studies were of moderate reporting quality and 2 of low reporting quality. When using QUADAS-2, 1 study was of high, 3 of moderate, 2 of low, and 3 of very low methodological quality. Out of 9 diagnostic accuracy studies, 1 evaluated HA in ankles, knees, elbows, and shoulders while 3 evaluated ankles, knees, and elbows and only 2 evaluated ankles and knees. 2 more studies focused solely on knees and 1 on shoulders.Six US interpretation scores were reviewed and compared. All 6 articles included synovial hypertrophy in their evaluation. 5 articles incorporated cartilage modification while only 2 articles assessed hemosiderin deposition in their evaluation. Among these 6 scores, 4 were of moderate reporting quality, 1 of low and 1 of very low reporting quality. When using QUADAS-2 however, only 1 study was of high, 1 of moderate, 2 of of low, and 2 of very low methodological quality.Four US scanning protocols were also assessed, all evaluated the joints in both prone and supine positions. 3 suggested an extended scanning procedure of up to 30 minutes per joint, while 1 proposed a more simplified procedure. Two scanning protocols evaluated knees and ankles, while one focused on elbows. Only one scanning protocol included ankles, knees, and elbows in its assessment.CONCLUSIONS:There is insufficient evidence (Grade I) to recommend US as an accurate technique for early diagnosis of pathologic findings, to demonstrate that US scores correlate with clinical/radiological constructs, that treatment can reduce the incidence of US-detectable findings in HA, and to prove an association between US findings and the functional status of the joint. Further studies are required to establish standardized US scanning protocols and scoring systems and to determine US as a valuable tool for early diagnosis of hemophilic arthropathy (HA) in children and adults.ACKNOWLEDGEMENTS:This work was funded by Novo Nordisk Health Care AG. DisclosuresAbadeh:Novo Nordisk Health Care AG: Other: Funding. Blanchette:Bayer Healthcare: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Octapharma: Other: Data Safety Monitoring Board; Novo Nordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees; Baxter Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Data Safety Monitoring Board, Research Funding. Doria:Novo Nordisk Health Care AG: Other: Funding.

Update on the Methodological Quality of Research Published in The American Journal of Sports Medicine

Background: In recent years, the number of articles in The American Journal of Sports Medicine (AJSM) has risen dramatically, with an increasing emphasis on evidence-based medicine in orthopaedics and sports medicine. Hypothesis: Despite the increase in the number of articles published in AJSM over the past decade, the methodological quality of articles in 2011-2013 has improved relative to those in 2001-2003 and 1991-1993. Study Design: Meta-analysis. Methods: All articles published in AJSM during 2011-2013 were reviewed and classified by study design. For each article, the use of pertinent methodologies, such as prospective data collection, randomization, control groups, and blinding, was recorded. The frequency of each article type and the use of evidence-based techniques were compared relative to 1991-1993 and 2001-2003 by use of Pearson χ2 testing. Results: The number of research articles published in AJSM more than doubled from 402 in 1991-1993 and 423 in 2001-2003 to 953 in 2011-2013. Case reports decreased from 15.2% to 10.6% to 2.1% of articles published over the study period (P < .001). Cadaveric/human studies and meta-analysis/literature review studies increased from 5.7% to 7.1% to 12.4% (P < .001) and from 0.2% to 0.9% to 2.3% (P = .01), respectively. Randomized, prospective clinical trials increased from 2.7% to 5.9% to 7.4% (P = .007). Fewer studies used retrospective compared with prospective data collection (P < .001). More studies tested an explicit hypothesis (P < .001) and used controls (P < .001), randomization (P < .001), and blinding of those assessing outcomes (P < .001). Multi-investigator trials increased (P < .001), as did the proportion of articles citing a funding source (P < .001). Conclusion: Despite a dramatic increase in the number of published articles, the research published in AJSM shifted toward more prospective, randomized, controlled, and blinded designs during 2011-2013 compared with 2001-2003 and 1991-1993, demonstrating a continued improvement in methodological quality.

Methodological quality of clinical trials in pediatric dentistry research published in ISI journals, 2008-2012.

There are many studies about the methodological quality of articles in pediatric dentistry. However, there is no up-to-date information or the use of measurement guidelines designed and validated for this purpose. The aim of this article is to determine the methodological quantity and quality of clinical trials (CT) in pediatric dentistry published in four Web of Knowledge (ISI-indexed journals) between 2008 and 2012. Clinical trials published in four ISI pediatric dentistry journals were evaluated. Name of the journal, year of publication, country of the corresponding author, type of CT and main subject were registered. A scale of methodological quality (MINCIR) from 11 to 36 points was applied to evaluate each article, establishing 18 points as the cutoff for “good methodological quality”. The quality was calculated by country, subject area and journal. Of 1,151 published articles, 149 (12.5%) clinical trials were selected. Their methodological quality was 15.7±2.7 points. 17% of the CT achieved a score equal to or greater than a methodological quality considered “acceptable”. One in every 6 published clinical trials was of good methodological quality. This would actually make it difficult to adopt the results of these investigations into routine clinical practice or to include them in future systematic reviews and meta-analyses.