Moderate Level Of Evidence Research Articles

Short-term Outcomes of Acupuncture Interventions on Uterine Adenomyosis: A Systematic Review and Meta-analysis

The purpose of this systematic review is to evaluate for evidence of the association of acupuncture with relieving the symptoms of adenomyosis. We searched ten electronic databases and included randomized controlled trials (RCTs) in women with adenomyosis. The methodological quality was moderate evidence level by Cochrane risk-of-bias criteria. The results were analyzed by Review Manager 5.3 and expressed as standardized mean differences (SMD) or mean differences (MD). Eleven RCTs (942 subjects) were included in this meta-analysis. Analysis with no heterogeneity showed that acupuncture group obtained a significant better effect (95% CI, -0.48 to -0.10; I2 = 0%) on reducing the size of the uterus and was superior in the shrink of carbohydrate antigen 125 (CA125) level (95% CI, -1.13 to -0.44; I2 = 0%) than that in pharmacological medicine alone group. Moreover, acupuncturewas significantly associated with improving patients' dysmenorrheal symptoms after 3-month menstrual cycles treatment (95% CI, -1.25 to -0.13). The adverse events, especially the incidence of hot flashes, -1.25 to -0.13). The adverse events, especially the incidence of hot flashes, were less reported in acupuncture group compared to pharmacological medicine alone group (Odds Ratio, OR, 0.17; 95% CI, 0.08 to 0.35; I2 = 0%). Acupuncture therapy is a promising avenue for the development of alternatives to surgery and medicine in the treatment of adenomyosis. However, further rigorous trials are needed to confirm the claims of our results.

Comparative efficacy and safety of oral P2Y12 inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

BackgroundCurrently, potent P2Y12 inhibition with the use of prasugrel or ticagrelor is the mainstay of treatment after an acute coronary syndrome (ACS). The 2020 European Society of Cardiology (ESC) Guidelines...

Mechanical Methods for the Induction of Labour After Previous Caesarean Section - An Updated, Evidence-based Review.

There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these women because of the high risk of uterine rupture. In women with ripe cervix (Bishop Score > 6), intravenous administration of oxytocin is an effective procedure with comparable rates of uterine rupture to those with spontaneous onset of labour. Vaginal prostaglandin E 2 (PGE 2 ) and mechanical methods (balloon catheters, hygroscopic cervical dilators) are effective methods to induce labour in pregnant women with unripe cervix and previous Caesarean section. According to current guidelines, the administration of PGE 2 is associated with a higher rate of uterine rupture compared to balloon catheters. Balloon catheters are therefore a suitable alternative to PGE 2 to induce labour after previous Caesarean section, even though this is an off-label use. In addition to two meta-analyses published in 2016, 12 mostly retrospective cohort/observational studies with low to moderate levels of evidence have been published on mechanical methods of cervical ripening after previous Caesarean section. But because of the significant heterogeneity of the studies, substantial differences in study design, and insufficient numbers of pregnant women included in the studies, it is not possible to make any evidence-based recommendations based on these studies. According to a recent meta-analysis, the average rate using balloon catheters is approximately 53% and the average rate after spontaneous onset of labour is 72%. The uterine rupture rate was 0.2–0.9% for vaginal PGE 2 and 0.56–0.94% for balloon catheters and is therefore comparable to the uterine rupture rate associated with spontaneous onset of labour. According to the product informations, hygroscopic cervical dilators (Dilapan-S) are currently the only method which is not contraindicated for cervical ripening/induction of labour in women with previous Caesarean section, although data are insufficient. Well-designed, randomised, controlled studies with sufficient case numbers comparing balloon catheters and hygroscopic cervical dilators with mechanical methods and vaginal prostaglandin E 2 /oral misoprostol are therefore necessary to allow proper decision-making.

Quality and usability of clinical assessments of static standing and sitting posture: A systematic review.

A validated method to assess sitting and standing posture in a clinical setting is needed to guide diagnosis, treatment and evaluation of these postures. At present, no systematic overview of assessment methods, their clinimetric properties, and usability is available. The objective of this study was to provide such an overview and to interpret the results for clinical practice. A systematic literature review was performed according to international guidelines. Two independent reviewers assessed risk of bias, clinimetric values of the assessment methods, and their usability. Quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE). Out of 27,680 records, 41 eligible studies were included. Thirty-two assessment instruments were identified, clustered into five categories. The methodological quality of 27 (66%) of the articles was moderate to good. Reliability was most frequently studied. Little information was found about validity and none about responsiveness. Based on a moderate level of evidence, a tentative recommendation can be made to use a direct visual observation method with global posture recorded by a trained observer applying a rating scale.

Electroacupuncture for Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Background Previous studies have shown that electroacupuncture (EA) has a positive effect on motor and sensory function in patients with spinal cord injury (SCI). This review evaluated the effectiveness of EA for improvement in activities of daily living in patients with SCI. Methods We searched the Cochrane Library, PubMed, Web of Science, CNKI, WanFang Data, and VIP databases using a search strategy according to the guidelines of the Cochrane Handbook for Systematic Review of Interventions up to 30th September 2020. Only randomized controlled trials (RCTs) of EA in patients with SCI were included. We analyzed the data using RevMan (version 5.3) and graded the quality of evidence using GRADE profiler 3.6.1. Results This meta-analysis included 10 RCTs with 712 patients. Three studies revealed that the functional independence measure score for SCI patients in the EA group was higher than that in the control group (mean difference [MD] = 13.46, 95% CI: 8.00 to 18.92, P < 0.00001). Five studies showed that the modified Barthel index in the EA group was higher than that in the control group (MD = 6.92, 95% CI: 4.96 to 8.89, P < 0.00001). Five studies showed that the American Spinal Injury Association-motor score (ASIA-motor score) in the EA group was higher than that in the control group (standard MD = 0.96, 95% CI: 0.75 to 1.18, P < 0.00001). Three studies reported the ASIA-tactile and pain scores and also reported that the scores in the EA group were higher than those in the control group, with high homogeneity (tactile I2 = 86%, P = 0.0008; pain I2 = 54%, P = 0.11). The quality of evidence for the use of EA for improvement in motor and sensory function in SCIs was moderate according to the GRADE system. Conclusion This review suggested that EA improves activities of daily living and motor function in patients with SCI, with a moderate level of evidence.

Comparisons of Videolaryngoscopes for Intubation Undergoing General Anesthesia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Background: The efficacy and safety of videolaryngoscopes (VLs) for tracheal intubation is still conflicting and changeable according to airway circumstances. This study aimed to compare the efficacy and safety of several VLs in patients undergoing general anesthesia. Methods: Medline, EMBASE, and the Cochrane Library were searched until 13 January 2020. The following VLs were evaluated compared to the Macintosh laryngoscope (MCL) by network meta-analysis for randomized controlled trials (RCTs): Airtraq, Airwayscope, C-MAC, C-MAC D-blade (CMD), GlideScope, King Vision, and McGrath. Outcome measures were the success and time (speed) of intubation, glottic view, and sore throat (safety). Results: A total of 9315 patients in 96 RCTs were included. The highest-ranked VLs for first-pass intubation success were CMD (90.6 % in all airway; 92.7% in difficult airway) and King Vision (92% in normal airway). In the rank analysis for secondary outcomes, the following VLs showed the highest efficacy or safety: Airtraq (safety), Airwayscope (speed and view), C-MAC (speed), CMD (safety), and McGrath (view). These VLs, except McGrath, were more effective or safer than MCL in moderate evidence level, whereas there was low certainty of evidence in the intercomparisons of VLs. Conclusions: CMD and King Vision could be relatively successful than MCL and other VLs for tracheal intubation under general anesthesia. The comparisons of intubation success between VLs and MCL showed moderate certainty of evidence level, whereas the intercomparisons of VLs showed low certainty evidence.

The impact of incisional negative pressure wound therapy on scar quality and patient-reported outcomes: A within-patient-controlled, randomised trial.

Literature provides a moderate level of evidence for the beneficial effects of incisional negative pressure wound therapy (iNPWT) on scar quality. The purpose of this study was to establish if iNPWT results in improved scar outcomes in comparison to the standard of care. Therefore, a within‐patient randomised controlled, open‐label trial was conducted in transgender men undergoing gender‐affirming mastectomies. A unilateral side was randomised to receive iNPWT (PICO™, Smith&Nephew) without suction drains and contrastingly the standard dressing (Steri‐Strips™) with suction drain. Scar quality and questionnaires were bilaterally measured by means of objective assessments and patient‐reported outcome measures (PROM) at 1, 3 and 12 months. Objective scar outcomes were scar pliability (Cutometer®), colouration (DSM‐II) and scar width (3‐D imaging). PROM outcomes were related to scars (POSAS and SCAR‐Q) and body satisfaction (BODY‐Q). From 85 included patients, 80 were included for analyses. No significant difference between treatments was seen in the quantitative outcomes of scar pliability, colour, and width. For qualitative scar outcomes, several significant findings for iNPWT were found for several subscales of the POSAS, SCAR‐Q, and BODY‐Q. These effects could not be substantiated with linear mixed‐model regression, signifying no statically more favourable outcome for either treatment option. In conclusion, this study demonstrated that some PROM outcomes were more favourable for the iNPWT compared to standard treatment. In contrast, the quantitative outcomes showed no beneficial effects of iNPWT on scar outcomes. This suggests that iNPWT is of little benefit as a scar‐improving therapy.

Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults.

We performed a systematic review, meta‐analysis, and meta‐regression to determine if increasing daily protein ingestion contributes to gaining lean body mass (LBM), muscle strength, and physical/functional test performance in healthy subjects. A protocol for the present study was registered (PROSPERO, CRD42020159001), and a systematic search of Medline, Embase, CINAHL, and Web of Sciences databases was undertaken. Only randomized controlled trials (RCT) where participants increased their daily protein intake and were healthy and non‐obese adults were included. Research questions focused on the main effects on the outcomes of interest and subgroup analysis, splitting the studies by participation in a resistance exercise (RE), age (<65 or ≥65 years old), and levels of daily protein ingestion. Three‐level random‐effects meta‐analyses and meta‐regressions were conducted on data from 74 RCT. Most of the selected studies tested the effects of additional protein ingestion during RE training. The evidence suggests that increasing daily protein ingestion may enhance gains in LBM in studies enrolling subjects in RE (SMD [standardized mean difference] = 0.22, 95% CI [95% confidence interval] 0.14:0.30, P < 0.01, 62 studies, moderate level of evidence). The effect on LBM was significant in subjects ≥65 years old ingesting 1.2–1.59 g of protein/kg/day and for younger subjects (<65 years old) ingesting ≥1.6 g of protein/kg/day submitted to RE. Lower‐body strength gain was slightly higher by additional protein ingestion at ≥1.6 g of protein/kg/day during RE training (SMD = 0.40, 95% CI 0.09:0.35, P < 0.01, 19 studies, low level of evidence). Bench press strength is slightly increased by ingesting more protein in <65 years old subjects during RE training (SMD = 0.18, 95% CI 0.03:0.33, P = 0.01, 32 studies, low level of evidence). The effects of ingesting more protein are unclear when assessing handgrip strength and only marginal for performance in physical function tests. In conclusion, increasing daily protein ingestion results in small additional gains in LBM and lower body muscle strength gains in healthy adults enrolled in resistance exercise training. There is a slight effect on bench press strength and minimal effect performance in physical function tests. The effect on handgrip strength is unclear.

Comparative risk of anemia and related micronutrient deficiencies after Roux-en-Y gastric bypass and sleeve gastrectomy in patients with obesity: An updated meta-analysis of randomized controlled trials.

Although Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most prevalent bariatric surgical procedures, high-level evidence is scarce regarding the assessment of postoperative nutritional risk in RYGB versus SG. Therefore, we performed a systematic review and meta-analysis to compare the risk of anemia and related micronutrient deficiencies after RYGB and SG. We analyzed 10 randomized controlled trials that compared RYGB and SG with reported incidence of postoperative anemia and/or anemia-related micronutrient deficiencies (iron, vitamin B12 , or folate). There were no significant differences in the risk of postoperative anemia (moderate level of evidence), iron deficiency (high level of evidence), or folate deficiency (moderate level of evidence). Patients undergoing RYGB had a higher risk of postoperative vitamin B12 deficiency than those undergoing SG (relative risk, 1.86; 95% confidence interval, 1.15-3.02; p = 0.012; high level of evidence). Our findings imply that patients undergoing RYGB require more stringent vitamin B12 supplementation and surveillance than those undergoing SG. Additionally, our results may aid patients with high concern for anemia and related micronutrient deficiencies in making informed decisions regarding surgical methods based on nutritional risk.

Cognitive Orientation to Daily Occupational Performance (CO-OP) in Children with Cerebral Palsy: A Systematic Review with Meta-analysis.

Background: Cognitive orientation to daily occupational performance (CO-OP) is a client-centered treatment approach that was developed in the 1990s by occupational therapists. Purpose: Exploring current evidence about the effectiveness of CO-OP on children with cerebral palsy (CP). Method: Major electronic databases were searched. A narrative synthesis of current literature and meta-analyses on randomized control trials (RCTs) were conducted on changes in occupational performance. Findings: Seven studies with 103 participants were included. Four studies were RCTs with moderate levels of evidence, and three studies had single-subject designs. Although beneficial effects of CO-OP on goal achievement and transferring learned skills were reported, meta-analyses showed that CO-OP had no significant effect on the performance (WMD = 1.52, 95% CI = -1.58 to 4.63, P = .33) and satisfaction domains (WMD = 1.71, 95% CI = -1.14 to 4.57, P = .24) of Canadian Occupational Performance Measure scores compared to alternative interventions. Implications: CO-OP improves occupational performance but not more than alternative interventions. Results are inconclusive due to small sample sizes and heterogeneity of alternative interventions and participants. Therefore, research with a larger number of participants with sound RCT methods is needed.

Syndesmosis Injury Imparts A Large Negative Effect on Patient Reported Outcomes: A Systematic Review

Category:Trauma; Ankle; SportsIntroduction/Purpose:Syndesmosis injuries are common, comprising up to 25% of all ankle sprains and being present in 35% or more of ankle fractures. Within the narrative of the syndesmosis literature, the substantial negative impact of syndesmosis injury is commonly described in intuitive yet qualitative terms. Therefore, a constructive criticism of the literature is to question how often and how well these reports have characterized the magnitude of the impact of the syndesmosis injury itself compared to confounding factors like concomitant injury. Indeed, such information particularly in aggregate, has the potential to influence clinical practice. Within this context, the objective of this systematic review was to assess how often and how well the literature has characterized the magnitude of syndesmosis injury.Methods:Included reports were grouped based on the setting in which syndesmosis injury was studied: (1) isolated syndesmosis disruption compared to lateral ankle sprain, (2) isolated syndesmosis disruption, (3) ankle fracture with concomitant syndesmosis disruption compared to ankle fracture with no syndesmosis disruption, and (4) ankle fracture with concomitant syndesmosis disruption without a comparison group with no syndesmosis disruption. Literature quality was assessed via the Modified Coleman Methodology Score (MCMS). Patients with and without syndesmosis injury were compared by independent sample t-tests using pooled values for specific patient reported outcome measures. Additionally, for these datasets, effect sizes were computed using Cohen's d.Results:Mean MCMS across all four groups was 59.9, indicating a moderate level of evidence. MCMS did not differ significantly between groups (p = 0.07). Analysis of reported outcomes indicated that syndesmosis injury has a significant (p = 0.007) effect and a large negative effect (effect size = 1.77) (Figure 1) on time to return to play when comparing athletes with isolated syndesmosis sprain to those with lateral ankle sprain. Additionally, analysis of ankle fracture patients indicated that syndesmosis injury has a large negative effect on functional outcomes (effect sizes > 0.80 for Olerud Molander and AOFAS scores), but little effect on pain (effect size = 0.14 for VAS pain). Studies which reported long term outcomes (mean 87 months) showed a very large negative effect (effect size 9.24) for Olerud Molander scores across 95 patients.Conclusion:In athletic populations, days missed due to syndesmosis disruption was statistically significant with a large effect size compared to lateral ankle sprain. Further, among ankle fracture patients, Olerud Molander and AOFAS scores indicate a large negative impact of syndesmosis disruption on functional outcomes despite a small negative impact on short term pain. These results indicate that the continued impact of this injury extends beyond the initial painful period and requires more attention.These patient-reported outcomes support the qualitative assertions that syndesmosis injury potentially imparts a large negative effect on clinical outcomes.

Is There a Role for Extended Postoperative Oral Antibiotics in Primary Total Joint Arthroplasty High-Risk Individuals After Surgery for Periprosthetic Joint Infection?

With moderate level of evidence, 76% of delegates (super majority/strong consensus) of the most recent (2018) International Consensus Meeting on orthopedic infections agreed that extended oral antibiotics directed toward initial organisms after reimplantation for 3 months probably reduce the risk of failure due to periprosthetic joint infection. Nevertheless, the use of oral antibiotics becomes increasingly problematic with extended or long-term utilization. The development of antibiotic resistance and side effects are of particular concern, the most common being Clostridium difficile–associated diarrhea. Antibiotic stewardship is important when preventing and treating periprosthetic joint infection to hopefully prevent increase of bacterial antibiotic resistance. Two recent studies showed a significant difference in the incidence of surgical site infections after arthroplasty procedures in high-risk patients during short- and long-term follow-up without significant increase of adverse effects. However, another study showed no significant benefit of this practice. This summary discussed the details of those studies suggesting that the use of extended oral antibiotic prophylaxis in high-risk primary and revision hip and knee arthroplasty may reduce infection rates; nonetheless, additional higher level of evidence (level 1) is still needed to validate this practice as its potential adverse effects are not clear.

The efficacy of kinesio taping as an adjunct to physical therapy for chronic low back pain for at least two weeks: A systematic review and meta-analysis of randomized controlled trials.

AstractBackground:Kinesio taping (KT) is a relatively new treatment method for chronic low back pain (CLBP). The effectiveness of KT as an adjunct to physical therapy (PT) for CLBP remains controversial.Objective:The aim of this updated meta-analysis was to critically examine and evaluate the evidence of recent randomized controlled trials regarding the effectiveness of KT as an adjunct to PT for CLBP for at least 2 weeks.Methods:This systematic review and meta-analysis was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library were searched in September 2020 by two independent reviewers. The risk of bias was assessed using the Cochrane Collaboration's tool. Data analysis was performed with Review Manager Software.Results:Twelve randomized controlled trials with a total of 676 patients were included in our study. Mean improvements were significantly higher in the KT+PT group than the PT group for pain score (SMD, 0.73 [95% CI, 0.37–1.08], P < .00001) and disability (SMD, 1.01 [95% CI, 0.42–1.59], P = .0007). Of 12 studies based on the pain score, 7 reported KT+PT patients to have significantly less pain at latest follow-up when compared with PA patients (P < .05). Of 11 studies based on the disability, 8 reported KT+PT patients to have significantly better improvements at latest follow-up when compared with PA patients (P < .05).Conclusion:Kinesio taping combined with physical therapy provided better therapeutic effects regarding pain reduction and disability improvement compared with physical therapy alone in individuals with chronic low back pain.Limitation:1.Included studies and sample sizes were small and most studies were with moderate evidence level;2.several important outcomes such as range of motion and distance walked were lack;3.heterogeneity among the included studies was unavoidable.

The effectiveness and safety of cupping therapy for stroke survivors: A systematic review and meta-analysis of randomized controlled trials

Objectives: ncluding stroke. The aim of this study was to systematically review the clinical evidence of CT for stroke.Methods: To identify randomized controlled trials (RCTs) reporting the effectiveness and/or safety of CT, seven databases including PubMed, EMBASE, and Cochrane Library were searched for articles published from January 2000 to February 2021 without language restrictions. Meta-analysis was performed using Review Manager 5.4 software and the results were presented as mean difference (MD) or standard mean difference (SMD) for continuous variables and odds ratio (OR) for diverse variables with 95% confidence intervals (CIs). Assessment of the methodological quality of the eligible trials was conducted using the Cochrane Collaboration tool for risk of bias in RCTs.Results: Twenty-two RCTs with 1653 participants were included in the final analysis. CT provided additional benefit in improving upper limb motor function (Fugl-Meyer assessment for upper limb motor function, MD 6.91, 95% CI 4.64 to 1.67, P&lt;0.00001) and spasticity (response rate, OR 3.28, 95% CI 1.31 to 8.22, P=0.08) in stroke survivors receiving conventional medical treatment. These findings were supported with a moderate level of evidence. CT did not significantly increase the occurrence of adverse events.Conclusions: This study demonstrated the potential of CT to be beneficial in managing a variety of complications in stroke survivors. However, to compensate for the shortcomings of the existing evidence, rigorously designed large-scale RCTs are warranted in the future.

A Critical Review of Adversity Quotient Instruments: Using the Cosmin Checklist

Adversity intelligence and adversity quotient is the critical ability and robust predictor of a person’s success. However, no consensus and generalized instrument have been established. Hence, the study aims to assess the methodological quality and measurement features of the existing tools for adversity intelligence by identifying and evaluating the instruments following the consensus-based standards for selecting health measurement instruments (COSMIN) checklist. From 255 research studies, six tools were eligible by a systematic review of online databases and books. For three or more of the nine COSMIN criteria, only two of the instruments had strong to moderate levels of evidence. Meanwhile, none of the instruments met any of the criteria. These results demonstrate that no single instrument outperforms all others in all circumstances. Tools that will be refined in the future should capture the development, methodology, and quality during the development of the instrument and achieve a high measurement quality and a generalized tool of measuring adversity intelligence.

Patient-reported outcome measures for masticatory function in adults: a systematic review

ObjectiveThe aim of this systematic review was to critically evaluate the Patient-Reported Outcome Measures (PROMs) for masticatory function in adults.MethodsFive electronic databases (Medline, Embase, Web of Science Core Collection, CINAHL Plus and APA PsycINFO) were searched up to March 2021. Studies reporting development or validation of PROMs for masticatory function on adults were identified. Methodological quality of the included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Psychometric properties of the PROM in each included study were rated against the criteria for good measurement properties based on the COSMIN guideline.ResultsTwenty-three studies investigating 19 PROMs were included. Methodological qualities of these studies were diverse. Four types of PROMs were identified: questions using food items to assess masticatory function (13 PROMs), questions on chewing problems (3 PROMs), questions using both food items and chewing problems (2 PROMs) and a global question (1 PROM). Only a few of these PROMs, namely chewing function questionnaire-Chinese, Croatian or Albanian, food intake questionnaire-Japanese, new food intake questionnaire-Japanese, screening for masticatory disorders in older adults and perceived difficulty of chewing-Tanzania demonstrated high or moderate level of evidence in several psychometric properties.ConclusionsCurrently, there is no PROM for masticatory function in adults with high-level evidence for all psychometric properties. There are variations in the psychometric properties among the different reported PROMs.Trial Registration PROSPERO (CRD42020171591).

Local hormones and growth factors to enhance orthodontic tooth movement: A systematic review of animal studies.

Prolonged treatment times are the main reason capable of affecting patient compliance with orthodontic treatment. A systematic review was made to determine whether the local administration of hormones and growth factors effectively enhances orthodontic tooth movement, and to identify possible adverse effects in animal studies. Five databases (PubMed, Scopus, EMBASE, Web of Science and Cochrane Library) were checked for experimental studies reporting one of the following outcomes: orthodontic tooth movement, histological outcomes and side effects. After data extraction, orthodontic tooth movement linked to adjunctive substances was analysed using forest plots. The risk of bias and the quality of evidence were determined with the SYRCLE tool and the GRADE tool, respectively. Twenty-four studies were included in the systematic review. On a specific dose level, epidermal growth factor+liposomes, fibroblast growth factor and prostaglandin E2 +Ca were supported by a moderate level of evidence and rated as highly effective in increasing tooth movement in animal models. Likewise, there was histological evidence of increased bone remodelling after the administration of these substances. Other compounds were supported by a low to very low level of evidence. Hormones and growth factors may have a relevant impact upon orthodontic tooth movement rate. In specific formulations, prostaglandin E2 , fibroblast growth factor and epidermal growth factor showed promising results.

Cognitive-behavioral therapy and urge urinary incontinence in women. A systematic review.

UUI co-exists with numerous health conditions, having a substantial negative impact on health-related quality of life and mental health. Cognitive-behavioral therapy (CBT) could help patients manage these problems by changing the way they think and behave. We carried out a systematic review of the literature assessing the modalities and effects of CBT as a stand-alone strategy, without adding PFMT, on symptoms and clinical signs, in women with UUI. Our secondary objective was to report modalities and effects of CBT on health-related quality of life, psychological symptoms and patient-reported satisfaction. The PRISMA methodology was used to carry out this systematic review. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to December 2020. The PICO approach was used to determine the eligibility criteria. Twelve papers were included in the present review which showed beneficial effects on both symptom severity (p < 0.05) and more subjective areas such as quality of life, psychological symptoms or patient satisfaction level (p < 0.05), respectively). However, results on the effectiveness of CBT on clinical signs remains conflicting. Based on the available literature, this review suggested a high level of evidence for the effectiveness of CBT on symptom severity and a moderate level of evidence for the effectiveness of CBT on quality of life, psychological symptoms and patient satisfaction. However, we highlighted no evidence for the effects of CBT on clinical signs.

Measurement properties of grimace scales for pain assessment in nonhuman mammals: a systematic review.

Facial expressions of pain have been identified in several animal species. The aim of this systematic review was to provide evidence on the measurement properties of grimace scales for pain assessment. The protocol was registered (SyRF#21-November-2019), and the study is reported according to the PRISMA guidelines. Studies reporting the development, validation, and the assessment of measurement properties of grimace scales were included. Data extraction and assessment were performed by 2 investigators, following the COnsensus-based Standards for the Selection of Health Measurement INstruments guidelines. Six categories of measurement properties were assessed: internal consistency, reliability, measurement error, criterion and construct validity, and responsiveness. Overall strength of evidence (high, moderate, and low) of each instrument was based on methodological quality, number of studies, and studies' findings. Twelve scales for 9 species were included (mice, rats, rabbits, horses, piglets, sheep or lamb, ferrets, cats, and donkeys). Considerable variability regarding their development and measurement properties was observed. The Mouse, Rat, Horse and Feline Grimace Scales exhibited high level of evidence. The Rabbit, Lamb, Piglet and Ferret Grimace Scales and Sheep Pain Facial Expression Scale exhibited moderate level of evidence. The Sheep Grimace Scale, EQUUS-FAP, and EQUUS-Donkey-FAP exhibited low level of evidence for measurement properties. Construct validity was the most reported measurement property. Reliability and other forms of validity have been understudied. This systematic review identified gaps in knowledge on the measurement properties of grimace scales. Further studies should focus on improving psychometric testing, instrument refinement, and the use of grimace scales for pain assessment in nonhuman mammals.

Wait-there's evidence for that? Integrative medicine treatments for major depressive disorder.

Depression is one of the most common mental health disorders and currently affects over 17 million Americans. Up to two-thirds of patients with depression in the United States will seek complementary and alternative or integrative medical treatments and thus medical providers who treat depression should understand that many integrative medical treatments have evidence of efficacy either as monotherapies or as add-on adjuncts to other treatments. This review references guidelines from the Canadian Network for Mood and Anxiety Treatments and Michigan Medicine, along with an updated literature review, to provide a framework for reviewing medications or herbal formulation, as well as other therapies, which have evidence in the treatment of depression. In general, St. John's Wort, Omega-3 Fatty Acids, S-adenosyl-L-methionine, and crocus sativus (saffron) have the highest levels of evidence in the treatment of mild-to-moderate depression. Acetyl-l-carnitine, l-methylfolate, DHEA, and lavender have a moderate level of evidence in treating depression, whereas Vitamin D, one of the most common supplements in the United States, does not have evidence in treating depression. Of the non-medication-based therapies, exercise, light therapy, yoga, acupuncture, and probiotics have evidence in the treatment of depression, whereas a full review of dietary modifications for depression was out of scope for this article.