OVID Interface Research Articles

Does Kinematic Alignment Improve Short-Term Functional Outcomes after Total Knee Arthroplasty Compared with Mechanical Alignment? A Systematic Review and Meta-analysis.

This meta-analysis was conducted to study whether kinematically aligned total knee arthroplasty (TKA) improves short-term functional outcomes compared with mechanical alignment without changing the hip-knee-ankle angle. Prospective cohort studies were searched from electronic literature databases, including PubMed, Web of Science, Embase (Ovid interface), and Cochrane Library (Ovid interface). Total 1,159 records were identified. Six trials involving 561 patients were eligible for data extraction and meta-analysis. The included studies recorded outcomes in the follow-up range from 6 to 34 months. Primary outcomes were to assess the functional outcomes in follow-up, and KA group achieved better performance on WOMAC score (mean difference [MD] = -18.82, 95% CI: -16.06 to -5.58), knee function score (MD = 7.23, 95% CI: 0.52-13.94), Oxford knee score (MD = 4.76, 95% CI: 0.40-9.12), and knee range of flexion (MD = 4.48, 95% CI: 2.09-6.86), whereas other parameters including Knee Society score, knee range of extension, VAS pain score, and the occurrence of the complications were without significant difference (p > 0.05). Second outcomes evaluated the perioperative clinic indexes. Our meta-analysis showed that KA group had a shorter time of operation (MD = -15.44, 95% CI: -27.47 to -3.71) and a longer walk distance before discharge (MD = 53.24, 95% CI: 21.32-85.15) when compared with the MA group, whereas the change in hemoglobin, incision length, knee range of flexion before discharge, and length of stays were without significant difference (p > 0.05). Third outcomes were used to analyze the alignment data. Our study showed that KA had larger angles of femoral component and mechanical axis of the femur (MD = -1.95,95% CI: -2.77 to -1.13), tibial component and mechanical axis of tibia (MD = 2.06, 95% CI: 1.43-2.70), anatomic knee angle (MD = -0.72, 95% CI: -1.33 to -0.11), and operative limb alignment (MD = -1.97, 95% CI: -2.50 to -1.45,) compared with the MA group, but the hip-knee-ankle angles between the two groups were similar. KA provided better functional outcomes and better flexion following short-term follow-up of TKA. However, longer-term follow-up and larger sample studies are needed to put into research in the future.

Secular trends in the incidence of dementia in high-income countries: a protocol of a systematic review and a planned meta-analysis

IntroductionA global dementia epidemic is projected for the year 2050 with an ever-rising number of individuals living with the syndrome worldwide. However, increasingly, studies are emerging from high-income countries (HIC)...

The use of kinase inhibitors in solid organ transplantation.

Despite the efficacy of current immunosuppression regimes used in solid organ transplantation, graft dysfunction, graft lost and antibody-mediated rejection continue to be problematic. As a result, clear attraction in exploiting key potential targets controlled by kinase phosphorylation has led to a number of studies exploring the use of these drugs in transplantation. Aim In this review, we consider the role of tyrosine kinase as a target in transplantation and summarize the relevant studies on kinase inhibitors that have been reported to date. Narrative review of literature from inception to December 2016, using OVID interface searching EMBASE and MEDLINE databases. All studies related to kinase based immunosuppression were examined for clinical relevance with no exclusion criteria. Key ideas were extracted and referenced. The higher incidence of infections when using kinase inhibitors is an important consideration, however the number and range inhibitors and their clinical indications are likely to expand, but their exact role in transplantation is yet to be determined.

The effect of prescriber education on medication-related patient harm in the hospital: a systematic review.

Educating prescribers is a strategy to reduce prescription errors in hospitals. The present systematic review gives an overview of original research papers on the education of prescribers and reporting outcomes on (potential) patient harm. A search of the databases Embase and Medline, using the Ovid interface, was performed. Research on the effect of physician education in order to prevent medication-related problems in inpatients, and on reporting original data and outcomes on prescribing errors and/or (potential) patient harm, was included. The assessment of methodological quality and risk of bias was performed using the Methodological Index for Non-Randomized studies (MINORS) checklist and the suggested risk of bias criteria for Effective Practice and Organization of Care (EPOC) reviews. Eight studies investigated an intervention on education alone, and in seven studies education was the main part of a multifaceted intervention. All studies were small and had short follow-up periods. The educational programmes varied and were given to physicians of different specialties and levels of experience. Most studies reported intermediate process parameters as the outcome. The risk of performance and reporting bias were high. All included studies suffered from poor methodology. The majority, especially studies in which education was part of a multifaceted intervention, reported effectiveness on intermediate outcome markers as prescription errors and potential adverse drug events. However, we found no firm evidence that educating prescribers in the hospital leads to a decrease in patient harm. Further work is needed to develop educational programmes, accompanied by more high-quality research with outcomes on the improvement of patient care.

Knowledge, Attitude and Practices on Substance Use Disorders by University Students: A Review of Literature

Background: This is a systematic review of literature describing the knowledge of substance use disorders (SUDs) by university students and determines their attitude and practices towards SUDs. It compares university students in different countries.Methods: The author conducted a systematic review of selected studies on SUDs conducted among university students and published between 2014 and 2017. An extensive search of literature was performed from 13th to 17th November, 2017 using Ovid interface to search MEDLINE, ScienceDirect, RESEARCH-Open Access for indexed journals in the subject area. The study author conducted this systematic review on the subject from journals availed online.Results: Findings of nine articles were included in this review. The included articles assessed university students at various academic years and programmes. The SUDs included alcohol use disorder, nicotine dependence, legal, illegal drugs dependence and pharmaceutical drug dependence.Conclusions: The findings from the reviewed studies indicate awareness by university students on substance use disorders. However, there is need for enhanced awareness and education programmes for university students on SUDs aimed at producing a positive impact on their practices, attitudes and knowledge on this subject.

Nursing interventions in stroke care delivery: An evidence-based clinical review

Generally, nursing interventions during the acute stages following a stroke aim at preventing secondary brain injury (intracranial hypertension), maintaining the airways (due to paralysis of the pharynx muscles), providing general body support (vital signs, fluid and electrolyte balance), and anticipating the occurrence of complications (atelectasis and pneumonia). This literature review is to prioritize nursing interventions for acute stroke and to update nursing roles and input considering recommended levels of evidence of care to date. A systematic review was undertaken, and databases searched were Electronic Library Information Navigator (ELIN), Medline and the Cumulative Index to Nursing and Allied Health Literature from 1990 to 2015, using the OVID interface. The search originally yielded 400 articles of which 65 were selected for analysis and 12 of these included evidence synthesis (class I-IV, level A-Good Clinical Practice [GCP]). To facilitate early patient recovery, advanced nursing care should include the routine practice of a wide range of specific nursing interventions such as continence management, pressure area care, swallowing management, and early mobilization. Other important nursing interventions include the prevention of pulmonary thromboembolism and early antiplatelet therapy. For over 20 years, it has been established that specialized stroke care save lives, reduce disability, shorten length of stay, and generally have been associated with improved patient outcomes. Highly specialized nursing input is of paramount importance in achieving optimum patient outcomes and high quality of interdisciplinary care, providing a comprehensive, interactive, and holistic approach for both acute stroke and rehabilitation.

Intramedullary and extramedullary fixations for the treatment of unstable femoral intertrochanteric fractures: a meta-analysis of prospective randomized controlled trials.

Intramedullary and extramedullary fixation methods are widely used to treat unstable femoral intertrochanteric fractures, but the optimal surgical method remains controversial. The aim of this study was to estimate the outcomes of intramedullary fixation versus extramedullary fixation in treating unstable femoral intertrochanteric fractures. Electronic literature databases were used for searching including MEDLINE (Ovid interface), EMBASE (Ovid interface) and the Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Online Library) (up to March 30, 2016). Only human studies, which were designed as randomized controlled clinical trials, were included. Two authors independently evaluated the quality of original literature and extracted data from eligible literature. Eleven randomized controlled trials involving 1,543 patients were included. Intramedullary fixation was significantly better in functional scores (SMD 0.43, 95% CI 0.14-0.73, P = 0.004) and had less blood loss (SMD -0.96, 95% CI -1.77 to -0.11, P = 0.03) in contrast with extramedullary fixation. No obvious discrepancies were found in adverse events, operative time, blood transfusion, and hospital stay between intramedullary and extramedullary fixations. Our meta-analysis of 11 prospective randomized controlled trials suggested: no obvious discrepancies were found in adverse events, operative time, blood transfusion, and hospital stay between intramedullary and extramedullary fixations. Given the better results of intramedullary fixation in terms of functional scores and blood loss, we recommend the intramedullary fixation technique in treating unstable femoral intertrochanteric fractures. Large multi-center RCTs, which focused on unstable femoral intertrochanteric fractures, are needed to evaluate the efficiency of alternative internal fixation strategies in the future.

Use of safety-engineered devices by healthcare workers for intravenous and/or phlebotomy procedures in healthcare settings: a systematic review and meta-analysis.

BackgroundThe acquisition of needle-stick injuries (NSI) in a healthcare setting poses an occupational hazard of transmitting blood-borne pathogens from patients to healthcare workers (HCWs). The objective of this study was to systematically review the evidence about the efficacy and safety of using safety-engineered intravenous devices and safety-engineered phlebotomy devices by HCWs.MethodsWe included randomized and non-randomized studies comparing safety-engineered devices to conventional/standard devices that lack safety features for delivering intravenous injections and/or for blood-withdrawal procedures (phlebotomy). The outcomes of interest included NSI rates, and blood-borne infections rates among HCWs and patients. We conducted an extensive literature search strategy using the OVID interface in October 2013. We followed the standard methods for study selection and data abstraction. When possible, we conducted meta-analyses using a random-effects model. We used the GRADE methodology to assess the quality of evidence by outcome.ResultsWe identified twenty-two eligible studies: Twelve assessed safety-engineered devices for intravenous procedures, five for phlebotomy procedures, and five for both. Twenty-one of those studies were observational while one was a randomized trial. All studies assessed the reduction in NSIs among HCWs. For safety-engineered intravenous devices, the pooled relative risk for NSI per HCW was 0.28 [0.13, 0.59] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.34 [0.08,1.49] (low quality evidence). For safety-engineered phlebotomy devices, the pooled relative risk for NSI per HCW was 0.57 [0.38, 0.84] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.53 [0.43,0.65] (moderate quality evidence). We identified no studies assessing the outcome of blood-borne infections among healthcare workers or patients.ConclusionThere is moderate-quality evidence that the use of safety-engineered devices in intravenous injections and infusions, and phlebotomy (blood-drawing) procedures reduces NSI rates of HCWs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1705-y) contains supplementary material, which is available to authorized users.

Do Economic Evaluations in Primary Care Prevention and the Management of Hypertension Conform to Good Practice Guidelines? A Systematic Review.

Background: Results of previous research have identified the need for further investigation into the compliance with good practice guidelines for current decision-analytic modeling (DAM). Objective: To identify the extent to which recent model-based economic evaluations of interventions focused on lowering the blood pressure (BP) of patients with hypertension conform to published guidelines for DAM in health care using a five-dimension framework developed to assess compliance to DAM guidelines. Methods: A systematic review of English language articles was undertaken to identify published model-based economic evaluations that examined interventions aimed at lowering BP. The review covered the period January 2000 to March 2015 and included the following electronic bibliographic databases: EMBASE and Medline via Ovid interface and the Centre for Reviews and Dissemination’s (CRD) NHS-EED. Data were extracted based on different components of good practice across five dimensions utilizing a framework to assess compliance to DAM guidelines. Results: Thirteen articles were included in this review. The review found limited compliance to good practice DAM guidelines, which was most frequently justified by the lack of data. Conclusions: The assessment of structural uncertainty cannot yet be considered common practice in primary prevention and management of hypertension, and researchers seem to face difficulties with identifying sources of structural uncertainty and then handling them correctly. Additional guidelines are needed to aid researchers in identifying and managing sources of potential structural uncertainty. Adherence to guidelines is not always possible and it does pose challenges, in particular when there are limitations due to data availability that restrict, for example, a validation process.

Impact of Pancreas Transplant on Diabetic Complications: Retinoparhy, Gastroparesis and Automatic Dysregulation

Pancreatic transplantation remains the best opportunity to maintain normoglycaemia with full insulin independence, with the potential for stabilisation and potentially reversal of complications associated with diabetes. The aim of this review is to rigorously examine the evidence supporting a beneficial impact of pancreas transplantation on diabetic complications, with specific focus on gastroparesis, autonomic neuropathy and retinopathy. A narrative review of literature from inception to February 2016 using OVID interface searching EMBASE and MEDLINE databases. All studies related to diabetic complications and pancreas transplantation examined for clinical relevance with no exclusion criteria. Key ideas extracted and referenced. Proof of the beneficial effects on diabetic complications requires detailed long-term follow-up to clarify and validate many of the small studies performed with regard to the various comorbidities associated with diabetes.

Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance.

The objective of this meta-analysis is to assess the value of fetal cerebro-placental Doppler ratio (CPR) in predicting adverse perinatal outcome in pregnancies with fetal growth restriction (FGR). Three databases were used: MEDLINE, EMBASE (with online Ovid interface) and SCOPUS and studies from inception to April 2015 were included. Studies that reported perinatal outcomes of fetuses at risk of FGR or sonographically diagnosed FGR that were evaluated with CPR were considered eligible. Perinatal outcomes include cesarean section (CS) for fetal distress, APGAR scores at 5 min, neonatal complications and admission to neonatal intensive care unit (NICU). Pooled data were expressed as odds ratio (OR) and confidence intervals (CI), and the summary receiver operating characteristic (SROC) curve was used to illustrate the diagnostic accuracy of CPR. Seven studies were eligible (1428 fetuses). Fetuses with abnormal CPR were at higher risk of CS for fetal distress (OR=4.49, 95% CI [1.63, 12.42]), lower APGAR scores (OR=4.01, 95% CI [2.65, 6.08]), admission to NICU (OR=9.65, 95% CI [3.02, 30.85]), and neonatal complications (OR=11.00, 95% [3.64, 15.37]) than fetuses who had normal CPR. These risks were higher among studies that included fetuses diagnosed with FGR than fetuses at risk of FGR. Abnormal CPR had higher diagnostic accuracy for adverse perinatal outcomes among "sonographically diagnosed FGR" studies than "at risk of FGR" studies. Abnormal CPR is associated with substantial risk of adverse perinatal outcomes. The test seems to be particularly useful for follow up of fetuses with sonographically diagnosed FGR.

Evaluating the Effect of Ethnicity on the Risk of Venous Thromboembolism (VTE): A Systematic Review

BackgroundStudies of hospital discharge data and large observational cohorts show that the incidence of venous thromboembolism (VTE) varies by race. We sought to determine the incidence of VTE in each of the following ethnic groups Caucasians, Africans, Asians, and Hispanics.MethodsA systematic literature search strategy was used to identify potential studies in MEDLINE, EMBASE, and CENTRAL using an OVID interface. The methodological quality of eligible studies was assessed according to Newcastle-Ottawa Quality Assessment Scale. The primary outcome measure was to identify the incidence/prevalence of VTE of each ethnic group available for the study in the context of a population based study.ResultsOut of 3418 potential studies, 19 met our inclusion criteria (Table). Of these, 9 studies were population based studies: 5 reported VTE incidence per 100,000 person-years (PY), 2 measured the standardized incidence ratio, and 2 European studies assessed VTE rate according to country of origin but not ethnicity (data not shown). In addition, 7 studies measured the hospital incidence rate of VTE, and 3 assessed VTE prevalence. Data could not be pooled due to marked heterogeneity including varied periods of study. VTE incidence per 100,000 PY was found to be between 162 and 439 in Caucasians, 143 and 746 in Africans, 3.2 and 16.6 in Asians. Hospital incidence of VTE per 100,000 PY was found to be between 21 and 131 in Caucasians, 22 and 155 in Africans, 2 and 26 in Asians, 33.1 and 71 in American Indians/Alaskan Indians, and 9 in Hispanics.ConclusionsOur findings suggest a wide variation in reported incidence rates for VTE among different ethnic groups, even within the same group. In general, studies in Asian populations suggest a lower incidence of VTE. A marked heterogeneity of study designs, population settings prevent drawing firm conclusions. A significant risk of bias cannot be excluded for several studies. Further studies assessing concurrently the risk of VTE among different ethnicities in the same geographical area are needed.Table 1Summary of the included studies.StudyCountryTime Periodf/u durationSample sizeVTE incidence /Prevalence (95% CI)Zakai, 2014US439,090 person year51,149Zakai: ARICUS1987-199615,792(I) Cauc.: 166 (1.48-1.86) Afr.: 259 (2.21-3.03)Zakai: CHSUS1989-19975,888(I) Cauc.: 439 (3.13-6.16) Afr.: 746 (4.68-11.90)Zakai: REGARDS, Southeast areaUS2003-200730,239(I) Cauc.: 162 (1.26-2.07) Afr.: 224 (1.72-2.92)Zakai: REGARDS, Rest of USUS2003-200730,239(I) Cauc.: 205 (1.58-2.66) Afr.: 143 (1.02-2.00)Deitelzweig, 2010US200246,652(P) per 100,000 persons Cauc.: M 457, F NA Afr.: M 584, F NA Hisp.: M 94, F 93 Others: M 329, F 345200546,652(P) per 100,000 persons Cauc.: M 643, F 446 Afr.: M 784, F 444 Hisp.: M 149, F 154 Others: M 285, F 297DeMonaco, 2008US199737,892(HI) Cauc.: 44 Afr.: 53200137,892(HI) Cauc.: 56 Afr.: 60Heit, 2010US2003-20092,397(P) N(%) Cauc.: Total= 1381 (69) Afr.: Total=272 (69)N(%) Cauc.: VTE = 551 (27) Afr.: VTE = 75 (19)Hooper, 2003US1980-1996(HI) American Indians/Alaskan Indians: 33.1Jang, 2011Korea2004(I) Asians: VTE: 8.83, DVT: 3.91, PE: 3.742008(I) Asians: VTE: 13.8, DVT: 5.31 , PE: 7.01Kitamukai, 2003Japan2000(I) Asians: 3.2 (29.2-33.9)Klatsky, 2000US1978-19941,822,302 total person years128,934(HI) Cauc.: 21 Afr.: 22 Asians: 2 Hisp.: 9 Others (unspecified): 15Lee, 2010Taiwan2001 & 200211,566 person yearCrude Incidence per 100,000 person year: Asians: VTE=15.9Liu, 2002China1997-2000(I) Asians: 16.6Sakuma, 2009Japan2006(I) Asians: PE= 6.19 (51.7- 72.1) DVT= 11.5 (98.2-132.9)Schneider, 2006US1998-2000(HI) Cauc.: M 36.47 ; F 37.96 Afr.: M 53.64 ; F 61.53Stein, Am J Med. 2004US1990-1999(HI) Cauc.: VTE= 122 Afr.: VTE= 134 Asians: VTE= 23Stein, Arch Intern Med. 2004US1996-2001(HI) Cauc.: 131 Afr.: 155 American Indians and Alaskan Indians: 71Tan, 2007Singa-pore1998-2001271 pairs of cases and controls(P) N(%) Asians: 32.1% (29.0-35.3)White, 2005US199621,002(SIR): Cauc.: 103 (101-105) Afr.: 138 (132-145) Asians: 29 (27-32) Hisp.: 61 (59-64) Others: 72 (65-80)White, 1998US1991-199417991(SIR): Cauc.: 23 Afr.: 29.3 Asians: 6 Hisp.: 13.9Abbreviations. f/u: follow up; CI: confidence interval; (I): incidence per 100,000 PY; (P): prevalence; (HI): Hospital Incidence per 100,000 PY; (SIR): Standardized Incidence Rate; M:male; F: female; N: total number. Cauc. Caucasians, Afr. Africans, Hisp. hispanics DisclosuresLazo-Langner:Pfizer: Honoraria; Bayer: Honoraria.

Thromboprophylaxis in Multiple Myeloma Patients Treated with Lenalidomide - a Systematic Review

BackgroundLenalidomide in combination to steroid therapy, including high-dose dexamethasone (RD), low-dose dexamethasone (Rd) or triple therapy of melphalan, prednisolone, lenalidomide (MPR), has shown to be an effective and well-tolerated treatment for patients with newly diagnosed multiple myeloma (NDMM) and relapsed refractory multiple myeloma (RRMM). Lenalidomide is associated with an increased risk of venous thromboembolism, and studies have consistently demonstrated the need for venous thromboembolism (VTE) prophylaxis in patients receiving these combinations. However, the optimal approach to thromboprophylaxis has not yet been established.ObjectiveIn this systematic review we sought to compare the efficacy of aspirin (ASA) or low molecular weight heparin (LMWH) in the prevention of VTE in patients with myeloma using lenalidomide- based therapy.MethodsA systematic literature search strategy was used to identify potential studies on MEDLINE, EMBASE, and CENTRAL using an OVID interface. The methodological quality of the selected cohort studies was assessed according to Newcastle-Ottawa Quality Assessment Scale, and risk of bias of randomised controlled trials (RCTs) was assessed according to risk of bias assessment tool from the Cochrane Handbook. The primary outcome measure was the incidence rate of VTE while using ASA or LMWH.ResultsOut of 247 studies, 6 met our inclusion criteria with a total of 1126 participants including a total of 5 phase III RCTs, and one retrospective study. Overall, all studies show high quality: In 4 of the 5 RCTs type of randomization was clearly reported, outcome assessment was blinded, and withdrawal rates were reported, and the remaining RCT was an abstract. In 4 RCTs the intervention and comparator arms were related to anti-myeloma treatment regimens.Pooled data of studies of NDMM treated with lenalidomide based regimen with ASA prophylaxis show a VTE rate of 98 of 915 (10.7%) [95% CI: 8.86-12.88] (Table1). In NDMM and RRMM patients treated with lenalidomide, VTE rate on LMWH prophylaxis was 3 of 211 (1.4%) [95% CI: 0.48-4.09] (Table2). The relative risk (RR) of VTE in patients receiving ASA compared to LMWH was 7.5 (95% CI: 2.41-23.53, p =0.0005).Overall, the rate of VTE was 1.4 (95% CI: 1.14 - 1.69) per 100 patient-cycles of anti-myeloma treatment. A subgroup analysis on patient using ASA showed a similar risk of 1.5 (95% CI: 1.24 - 1.84).The incidence of VTE in those using ASA while on RD was 52 of 195 (26.6%) [95% CI: 20.9-33.2], while VTE rate in those receiving Rd was 27 of 262 (10.3%) [95% CI: 7.18-14.58] demonstrating a statistically significant higher risk for patients on RD [RR=2.5 (95% CI: 1.68- 3.96), p <0.0001]. Furthermore, VTE rate with MPR therapy while on ASA was 19 of 458 (4.1%) [95% CI: 2.67-6.38]. Pooled data of studies revealed that patients who received lenalidomide and dexamethasone alone (RD+Rd) had a significantly higher risk of VTE compared to those on MPR while on ASA (RR=6.4 [(95% CI: 4.11- 9.91), p< 0.0001]).ConclusionThe study showed that the most frequent thromboprophylaxis of choice for patients with myeloma on lenalidomide-based therapy is ASA. However, ASA may not confer appropriate protection against VTE, especially in patients using high dose dexamethasone. On the other hand, the risk of VTE in patients receiving MPR and ASA was low and ASA may be a safe option for these patients. More studies comparing the safety of ASA to other anticoagulants such as LMWH or direct oral anticoagulants are warranted.Table 1Rate of VTE using ASA in NDMM with different lenalidomide based regimens. Rx: treatment; 95% CI: 95% confidence interval.StudyDesignRxNVTE rate: N (%)95% CIZonder, 2010 Rajkumar, 2010Phase III RCTRD19552 (26.6)20.9-33.2Larocca, 2011 Rajkumar, 2010Phase III RCTRd26227 (10.3)7.18-14.58Palumbo, 2012 Stewart, 2014Phase III RCTMPR45819 (4.1)2.67-6.38Total91598 (10.7)8.86-12.88Table 2Rate of VTE using LMWH in myeloma patients (NDMM or RRMM) on lenalidomide-based regimen. 95% CI: 95% confidence interval.PaperDesignInductionSettingNVTE rate: N (%)95% CIKlein, 2008Retrospective cohortRDRRMM451(2.2)0.39-11.57Larocca, 2011Phase III RCTRdNDMM1662(1.2)0.33-4.28Total2113(1.4)0.48-4.09 DisclosuresLouzada:pfizer: Consultancy, Other: advisory board and expert opinion; janssen: Consultancy, Other: advisory board and expert opinion; Celegene: Consultancy, Other: advisory board and expert opinion.

Benefit of rectal washout for anterior resection and left sided resections

PurposeTo assess the effectiveness of rectal wash out in preventing local recurrence for patients who undergo anterior resection for recto-sigmoid cancer. Materials and methodsA best evidence topic was constructed according to a structured protocol. Medline 1948–2015 and EMBASE 1980 to 2015 using the OVID interface: ( Rectal) AND (Washout) AND (Anterior Resection). In addition, the reference lists of the relevant papers were searched. OutcomesEight papers among the 17 relevant articles were identified as representing the best evidence including 3 prospective non-randomized studies, 1 retrospective non randomized study and 4 meta-analyses. ConclusionsOn the basis of current evidence, rectal washout does not stop local recurrence of cancer after anterior resection or left sided colonic resection, but it may reduce the rate of local recurrence. A randomised controlled trial to address this issue would formally answer this question.

A Systematic Review and Meta-Analysis on the Safety of Vascular Endothelial Growth Factor (VEGF) Inhibitors for the Treatment of Retinopathy of Prematurity.

IntroductionLaser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors.MethodsThe Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library.ResultsThis meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents.DiscussionVEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

Seeking effective interventions to treat complex wounds: an overview of systematic reviews.

BackgroundNumerous, often multi-faceted regimens are available for treating complex wounds, yet the evidence of these interventions is recondite across the literature. We aimed to identify effective interventions to treat complex wounds through an overview of systematic reviews.MethodsMEDLINE (OVID interface, 1946 until October 26, 2012), EMBASE (OVID interface, 1947 until October 26, 2012), and the Cochrane Database of Systematic Reviews (Issue 10 of 12, 2012) were searched on October 26, 2012. Systematic reviews that examined adults receiving care for their complex wounds were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool.ResultsOverall, 99 systematic reviews were included after screening 6,200 titles and abstracts and 422 full-texts; 54 were systematic reviews with a meta-analysis (including data on over 54,000 patients) and 45 were systematic reviews without a meta-analysis. Overall, 44% of included reviews were rated as being of high quality (AMSTAR score ≥8). Based on data from systematic reviews including a meta-analysis with an AMSTAR score ≥8, promising interventions for complex wounds were identified. These included bandages or stockings (multi-layer, high compression) and wound cleansing for venous leg ulcers; four-layer bandages for mixed arterial/venous leg ulcers; biologics, ultrasound, and hydrogel dressings for diabetic leg/foot ulcers; hydrocolloid dressings, electrotherapy, air-fluidized beds, and alternate foam mattresses for pressure ulcers; and silver dressings and ultrasound for unspecified mixed complex wounds. For surgical wound infections, topical negative pressure and vacuum-assisted closure were promising interventions, but this was based on evidence from moderate to low quality systematic reviews.ConclusionsNumerous interventions can be utilized for patients with varying types of complex wounds, yet few treatments were consistently effective across all outcomes throughout the literature. Clinicians and patients can use our results to tailor effective treatment according to type of complex wound. Network meta-analysis will be of benefit to decision-makers, as it will permit multiple treatment comparisons and ranking of the effectiveness of all interventions.Please see related article: http://dx.doi.org/10.1186/s12916-015-0326-3Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0288-5) contains supplementary material, which is available to authorized users.

Treatment of hydrofluoric acid exposure to the eye.

To review the current evidence of the treatment of hydrofluoric acid (HF) exposure to the human cornea. A comprehensive manual search of the literature was conducted through the Ovid interface to assess the mechanism and efficacy of each irrigator through a variety of clinical cases and experimental studies. Ocular exposure to HF is extremely damaging to the eye and swift recognition and decontamination with an appropriate agent forms the basis of treatment. Although there are various decontamination solutions that have efficacy against the corrosive action of HF, irrigation with Hexafluorine proved to be the most safe and effective treatment for the eye. In conclusion emergency departments could benefit from the availability of Hexafluorine for the treatment of HF ocular burns in patients.

Management Options of Bouveret's Syndrome

Fistulation of a gall stone into stomach (cholecystogastric fistula) or duodenum (cholecystoduodenal fistula) resulting in gastric outlet obstruction is rare and was first described by Leon Bouveret in 1896 (Bouveret’s Syndrome). We carried out a literature search using the terms Bouveret’s syndrome (BS), intestinal obstruction and duodenal gall stones using OVID interface in Embase database from 1947 to 2013 and Medline data base from 1946 to 2013. Data were acquired to study published management protocols for this rare clinical entity with the aim of producing a narrative review to guide future management. The majority of the retrieved materials were case reports and narrative reviews describing various management protocols.

Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials.

To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients. A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Proquest, Web of Science, SAE digital library, and Transportation Research Board's TRID database. Searches of conference proceedings were also conducted. All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included. The primary outcomes measures included physical function, pain, health related quality of life, mortality, and the re-operation rate. Six randomized controlled trials (n = 287) were included. There was no statistically significant difference in function (MD = 1.72, 95%CI: -2.90-6.34, P = 0.47), as measured by the Constant score, between the operative and the non-operative treatment groups. There was no statistically significance difference in secondary outcomes of health related quality of life (standardized MD = 0.27, 95%CI: -0.05-0.59, P = 0.09), and mortality (relative risk 1.29, 95%CI: 0.50- 3.35, P = 0.60). Operative treatment had a statistically significant higher re-operation rate (relative risk 4.09, 95%CI: 1.50-11.15, P = 0.006), and statistically significant decreased pain (MD = 1.26, 95%CI: 0.02- 2.49, P = 0.05). There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments. Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.

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Objectives Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice. Methods MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch or German. Results Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3 to 1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ⩾80% on every domain of the AGREE II tool; two CPGs did so for 5/6 domains. Consistency was seen for: (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO 4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at 4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring. Conclusions Existing international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research. Disclosures T.E. Gillon: None. A. Pels: None. P. von Dadelszen: Consultant; Commercial Interest: Alere International. K. MacDonnell: None. L.A. Magee: None.