Patient, Intervention, Comparison, And Outcome Research Articles

Optimal home and hospital laundering of reusable surgical scrubs: Systematic literature review.

Theatre personnel can spread healthcare-associated infections through contaminated surgical scrubs. Decontamination of surgical scrubs through optimal methods is important to minimise transmission of microorganisms from theatre personnel's clothing to different areas in the hospital and their homes. This study aimed to review the literature on the optimal home and hospital laundering methods for the decontamination of reusable surgical scrubs worn by theatre personnel. A systematic literature review of previous studies on laundering reusable surgical scrubs was performed. A review question was formulated using the patient, intervention, comparison and outcome (PICO) framework. A literature search was performed using ScienceDirect, Web of Science, ProQuest, EBSCOhost and Google Scholar. A direct link could be established between the cycle length and water temperature. The higher the water temperature, the shorter the washing cycle required. After a load has been washed in low or medium water temperatures, tumble drying and ironing should follow. Despite the water temperature, a disinfectant must be added to the load. Health professionals and hospital management should be aware of optimal laundering guidelines for hospital and home laundering as part of infection control. Water temperature, time, mechanical action, type of disinfectant and heat are factors influencing the successful removal of bacteria and other pathogens and represent the baseline of this article. Home-laundering of reusable surgical scrubs should follow strict guidelines. When these specific guidelines are applied, the effects of home-laundered scrubs will not negatively impact either the theatre or the home environment.

The 2022 PSOGI International Consensus on HIPEC Regimens for Peritoneal Malignancies: Methodology.

A group of experts from the Peritoneal Surface Oncology Group International (PSOGI) and the BIG-RENAPE group carried out a consensus among surgeons experienced in treating peritoneal malignancies from around the world to derive recommendations on indications of hyperthermic intraperitoneal chemotherapy (HIPEC), choice and details of HIPEC regimens, and areas for future research. This manuscript describes the methodology of achieving this consensus and the degree of participation of experts. The Delphi technique was used and the questionnaire comprised three categories: evidence-based recommendations using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system with the PICO (patient, intervention, comparison, and outcome) method, an opinion survey, and research recommendations. A consensus was achieved if any one option had >50% of votes, or positive or negative recommendations combined had > 70% of votes. Of the 145 experts solicited, 71.1% in round I and 72.2% in round II took the survey. Participation was highest among surgeons treating both gastrointestinal and gynecological malignancies. Of 113 questions, after round I, a consensus was achieved for 72 (63.7%) questions, and after the second round, consensus was achieved for another 22 (19.4%) questions, making a total of 94 (83.1%) questions for which a consensus was achieved. This consensus was carried out using a thorough review of literature and robust rating of evidence, and included key experts and opinion leaders from across the world. The results could guide clinicians on the use of HIPEC, both in their day-to-day clinical practice and in designing clinical trials.

Pharmacological mechanism and therapeutic efficacy of Icariside II in the treatment of acute ischemic stroke: a systematic review and network pharmacological analysis

Background and objectiveEpimedii has long been used as a traditional medicine in Asia for the treatment of various common diseases, including Alzheimer's disease, cancer, erectile dysfunction, and stroke. Studies have reported the ameliorative effects of Icariside II (ICS II), a major metabolite of Epimedii, on acute ischemic stroke (AIS) in animal models. Based on network pharmacology, molecular docking, and molecular dynamics (MD) simulations, we conducted a systematic review to evaluate the effects and neuroprotective mechanisms of ICS II on AIS.MethodsFirst, we have searched 6 databases using studies with ICS II treatment on AIS animal models to explore the efficacy of ICS II on AIS in preclinical studies. The literature retrieval time ended on March 8, 2022 (Systematic Review Registration ID: CRD42022306291). There were no restrictions on the language of the search strategy. Systematic review follows the Patient, Intervention, Comparison and Outcome (PICO) methodology and framework. SYCLE's RoB tool was used to evaluate the the risk of bias. In network pharmacology, AIS-related genes were identified and the target-pathway network was constructed. Then, these targets were used in the enrichments of Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and gene ontology (GO). Molecular docking and MD simulation were finally employed between ICS II and the potential target genes.ResultsTwelve publications were included describing outcomes of 1993 animals. The literature details, animal strains, induction models, doses administered, duration of administration, and outcome measures were extracted from the 12 included studies. ICS II has a good protective effect against AIS. Most of the studies in this systematic review had the appropriate methodological quality, but some did not clearly state the controlling for bias of potential study. Network pharmacology identified 246 targets with SRC, CTNNB1, HSP90AA1, MAPK1, and RELA as the core target proteins. Besides, 215 potential pathways of ICS II were identified, such as PI3K-Akt, MAPK, and cGMP-PKG signaling pathway. GO enrichment analysis showed that ICS II was significantly enriched in subsequent regulation such as MAPK cascade. Molecular docking and MD simulations showed that ICS II can closely bind with important targets.ConclusionsICS II is a promising drug in the treatment of AIS. However, this systematic review reveals key knowledge gaps (i.e., the protective role of ICS II in women) that ICS II must address before it can be used for the treatment of human AIS. Our study shows that ICS II plays a protective role in AIS through multi-target and multi-pathway characteristics, providing ideas for the development of drugs for the treatment of AIS.

Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence.

BackgroundAdult vaccination coverage remains low in the United States, particularly among racial and ethnic minority populations.ObjectiveTo conduct a comprehensive literature review of research studies assessing racial and ethnic disparities in adult vaccination.Search MethodsWe conducted a search of PubMed, Cochrane Library, ClinicalTrials.gov, and reference lists of relevant articles.Selection CriteriaResearch studies were eligible for inclusion if they met the following criteria: (1) study based in the United States, (2) evaluated receipt of routine immunizations in adult populations, (3) used within-study comparison of race/ethnic groups, and (4) eligible for at least one author-defined PICO (patient, intervention, comparison, and outcome) question.Data Collection and AnalysisPreliminary abstract review was conducted by two authors. Following complete abstraction of articles using a standardized template, abstraction notes and determinations were reviewed by all authors; disagreements regarding article inclusion/exclusion were resolved by majority rule. The Social Ecological Model framework was used to complete a narrative review of observational studies to summarize factors associated with disparities; a systematic review was used to evaluate eligible intervention studies.ResultsNinety-five studies were included in the final analysis and summarized qualitatively within two main topic areas: (1) factors associated with documented racial-ethnic disparities in adult vaccination and (2) interventions aimed to reduce disparities or to improve vaccination coverage among racial-ethnic minority groups. Of the 12 included intervention studies, only 3 studies provided direct evidence and were of Level II, fair quality; the remaining 9 studies met the criteria for indirect evidence (Level I or II, fair or poor quality).ConclusionsA considerable amount of observational research evaluating factors associated with racial and ethnic disparities in adult vaccination is available. However, intervention studies aimed at reducing these disparities are limited, are of poor quality, and insufficiently address known reasons for low vaccination uptake among racial and ethnic minority adults.

The Relationship between the Number of Emergency Room Patient Visits with Triage Accuracy and Emergency Nurse Response Time in the Covid 19 Pandemic Season

Handling emergency cases must not only be carried out quickly but also must be precise. Standard Operating Procedures (SOP) is one of the instruments to measure the quality of service. the number of patient visits that can affect the quality of service. Triage is a way of sorting patients based on therapy needs and available resources. Therapy is based on ABC conditions (Airway, with cervical spine control, Breathing, and Circulation with bleeding control). On the other hand, the COVID-19 pandemic greatly affects the response time, impacting the number of patient visits. Response time is the time between the beginning of a request being responded to in other words it can be called response time. A good response time for patients is 5 minutes. The purpose of this study was to identify the relationship between the number of patient visits and the accuracy of triage implementation and response time. The electronic database used is PubMed, Springer, and Google Scholar with a search strategy using the PICO (patient, intervention, comparison, and outcome) method.

Caring Community Nurses With Family Readiness to Receive Advanced Therapy Information in the Elderly


 
 
 The increase in the number of elderly indicates an increase in life expectancy. The increasing elderly population reflects an increase in health services. The application of caring by nurses in the community has not been explained. Caring is the basis for nurses to be able to analyse nursing actions that are carried out properly and appropriately for clients who are a reference in follow-up care. The literature search in this study was carried out by identifying all types of national and international articles regarding Caring for Community Nurses and the readiness of families to receive further therapy information. The electronic database used is PubMed, Springer, and Google Scholar with a search strategy using the PICO (patient, intervention, comparison and outcome) method. Participants revealed that caring is an attitude of empathy, caring for the patient's needs, providing nursing care not only when the patient comes to the public health centre, but also when the nurse does home care. Participants expressed caring behaviours such as empathy, being friendly to patients who came to the treatment centre, caring about patient needs, making patient home visits, paying attention to the health that needs by patients. Caring for community nurses as an effort to improve the performance of community nurses in providing nursing services to the elderly so as to create integrated and comprehensive care for the elderly. The increasing relationship between patients and nurses that are established in a professional manner, helped participants get to know the many patients who came for treatment at the Public health centre.
 
 

Biomarkers for the diagnosis of sepsis-associated acute kidney injury: systematic review and meta-analysis.

With the development of new techniques, blood and other humoral biomarkers have become increasingly important in the diagnosis of sepsis-associated acute kidney injury (AKI). We aimed to review and summarize the biomarkers associated with the diagnosis of sepsis-associated AKI. We performed a systematic review in PubMed, Embase, Web of Science, Cochrane and CNKI literature databases. Chinese and English articles published before January 30, 2021. We extracted information on the sensitivity and specificity of biomarkers to diagnose sepsis-associated AKI, the sample size of individuals with sepsis-associated AKI, the demographic variables, the diagnostic criteria and the sample acquisition protocol. Revman 5.3 software was used to analyze data. The sources of heterogeneity of included studies main were different diagnostic criteria for sepsis and AKI, time of sample collection and Patients came from different departments. We defined the inclusion of related studies by using PICOs (Patient, Intervention, Comparison and Outcome) criteria, in particular the design of studies to be included. P: Patients of sepsis. I: Patients of sepsis-associated AKI. C: Patients without sepsis-associated AKI. O: Diagnosis of sepsis associated kidney injury. A total of 1,227 articles, including 42 studies, were identified. Increases in urine and serum neutrophil gelatinase-related lipid carrier protein (NGAL), urinary interleukin-18, urinary Kim-1, urinary Netrin-1, urinary sCD163, serum estradiol levels, and serum soluble thrombolytic regulatory protein were most strongly correlated with the diagnosis of sepsis-associated AKI. The SROC of urinary KIM-1 ranked first, followed by the other biomarkers: urinary KIM-1 > urinary NGAL > blood NGAL > urinary IL-18. According to the sample size, the SROC values of urinary NGAL, blood NGAL, urinary IL-18 and urinary KIM-1 were 0.907, 0.857, 0.861 and 0.931, respectively. The sequence was still urinary KIM-1 > urinary NGAL > blood NGAL > urinary IL-18. According to the SROC curve area, the diagnostic sequence of sepsis-associated AKI biomarkers was urinary Kim-1 > urinary NGAL > blood NGAL > urinary IL-18. This meta-analysis provided diagnostic features of blood and urine biomarkers based on their association with the diagnosis of sepsis-associated AKI.

Accuracy of Computer-Assisted Surgery in Maxillary Reconstruction: A Systematic Review.

Computer-assisted surgery (CAS) in maxillary reconstruction has proven its value regarding more predictable postoperative results. However, the accuracy evaluation methods differ between studies, and no meta-analysis has been performed yet. A systematic review was performed in the PubMed, Embase, and Cochrane Library databases, using a Patient, Intervention, Comparison and Outcome (PICO) method: (P) patients in need of maxillary reconstruction using free osteocutaneous tissue transfer, (I) reconstructed according to a virtual plan in CAS software, (C) compared to the actual postoperative result, and (O) postoperatively measured by a quantitative accuracy assessment) search strategy, and was reported according to the PRISMA statement. We reviewed all of the studies that quantitatively assessed the accuracy of maxillary reconstructions using CAS. Twelve studies matched the inclusion criteria, reporting 67 maxillary reconstructions. All of the included studies compared postoperative 3D models to preoperative 3D models (revised to the virtual plan). The postoperative accuracy measurements mainly focused on the position of the fibular bony segments. Only approximate comparisons of postoperative accuracy between studies were feasible because of small differences in the postoperative measurement methods; the accuracy of the bony segment positioning ranged between 0.44 mm and 7.8 mm, and between 2.90° and 6.96°. A postoperative evaluation guideline to create uniformity in evaluation methods needs to be considered so as to allow for valid comparisons of postoperative results and to facilitate meta-analyses in the future. With the proper validation of the postoperative results, future research might explore more definitive evidence regarding the management and superiority of CAS in maxillary and midface reconstruction.

PP309 Accuracy Of Automated Wrist Blood Pressure Monitors: Systematic Review

IntroductionThe use of automated blood pressure monitors is recommended by current guidelines; however, the accuracy of the device must be validated according to standardized protocols. Wrist blood pressure monitors have been undergoing technical improvements; nonetheless, their reliability is not unanimously recognized. No systematic review to date has analyzed the accuracy of wrist blood pressure monitors according to standardized protocols. This study aims to summarize the evidence on the accuracy of wrist blood pressure monitors in adults.MethodsThree databases (PubMed, Scopus and SciELO) were searched on 9 September 2019. The PICO (Patient, Intervention, Comparison and Outcome) strategy was used to outline the research question: Do automated wrist blood pressure monitors have accuracy equivalent to mercury sphygmomanometers in adults? Validation studies of wrist blood pressure monitors were included. Two reviewers independently screened abstracts and full texts. Summary data was extracted for each device, including mean difference of systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the monitor and the mercury sphygmomanometer.ResultsThe review identified twenty-nine validation studies. Most of them were developed in China (44.82%), followed by Italy (20.68%). The most commonly used validation protocol was from the British Society of Hypertension. The mean difference between the devices and the mercury sphygmomanometers was 0.47 (±5.75) mmHg for SBP and 0.17 (±4.75) mmHg for DBP. The percentage of wrist blood pressure monitors that passed validation protocols was 93.1.ConclusionsMost automated wrist blood pressure monitors showed accuracy equivalent to the reference standard for blood pressure measurement, with mean differences less than 0.5 mmHg for SBP and 0.2 for DBP. This evidence supports the recommendation to adopt this technology for the measurement of blood pressure in adults. However, wrist blood pressure monitors have patient positioning specificities, which, if not followed, may lead to measurement errors. Therefore, the adoption of these monitors should consider not only their accuracy, but also aspects of patient use and preferences.

Structural Analysis of NiTi Endodontic Instruments: A Systematic Review.

Irregularities and defects on NiTi endodontic instruments originating from the manufacturing process can lead to the structural collapse and fracture of these instruments during treatment. To assess the cause of instrument wear and fracture, as well as increasing fracture incidence, destructive and non-destructive methods have been used for the analysis of surfaces and internal structures of new and used NiTi instruments. The aim of this systematic review was to undertake a detailed analysis of the methods used to evaluate the surface and internal microstructure of endodontic instruments. The scientific literature was comprehensively and systematically searched in the MEDLINE (PubMed), Web of Science, Cochrane Library, Scopus, and LILACS/BBO databases for studies published up to June 9, 2019. The eligibility criteria was based on the PICO (Patient, Intervention, Comparison, and Outcome) strategy with the question "What is the best method for structural analysis of endodontic files?" Two aspects were considered for inclusion in this study: (i) endodontic instruments and (ii) methods for structural analysis of NiTi instruments. . The systematic review was performed according to the PRISMA statement. Based on the inclusion criteria, 94 articles were selected. The results showed that although specific methods have been used for qualitative and/or quantitative structural analysis of NiTi instruments, no study addressed both the surface and internal structure of the instruments at the same time. According to this review, the need to compare the methodologies used in the selected articles has been identified; however, each type of method used has its own limitation on the analysis of both the surface and the internal structure of the instruments. The comparison between the different types of methodologies used in the studies revealed the reliability and the limitations of the methods employed for structural analysis of endodontic instruments; thus assisting us in determining their validity.

16 Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review with Stakeholders’ Consultation

Abstract Introduction Stroke is a serious problem in Southeast Asia. Falls are common among stroke survivors especially within one-year post-stroke and the implication is devastating. Rehabilitation for stroke survivors is important especially to prevent falls. However, literature in Southeast Asia pertaining to the topic is sparse. This study aims to systematically identify literature related to stroke and falls in Southeast Asia. Methods This scoping review followed Levac, Colquhoun and O’Brien’s framework. Systematic searching was conducted on four databases (MEDLINE, CINAHL, Scopus, ASEAN Citation Index) on August 2019. Generation of review question and keyword, and selection criteria were developed according to the Patient Intervention Comparison and Outcome (PICO) method. Consultation via several focus group discussions with stakeholders (i.e. stroke survivors, caregivers and therapists) were conducted and integrated with the synthesis of the review. Results Initial search yielded 2412 articles after removing the duplicates; however, only 19 were accepted in the final analysis. Most of the articles focused on physical rehabilitation and using conventional therapies. While the literatures may reflect the practice in Southeast Asia, stakeholders perceived that the literature is inadequate to show the true practice, lack to inform and missed several aspects such as functional, cognitive and psychological intervention in managing falls. Home hazards are considered as contributing factors but not deemed important. Discussion Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Only several articles were mainly written by physiotherapists while others are from medical physicians and engineers but negligible from other healthcare practitioners (i.e. occupational therapists, speech therapists, psychologists) or other disciplines interested with falls. Conclusion Falls prevention among stroke survivors received lack of attention and just an indirect goal in stroke rehabilitation. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.

PCN234 DEVELOPMENT AND VALIDATION STUDY OF ARTIFICIAL INTELLIGENCE SUPPORTING SYSTEMATIC LITERATURE REVIEW FOR CONDUCTING COST-EFFECTIVENESS ANALYSIS

Systematic literature review is an essential step to identify available evidence for cost-effectiveness evaluations. Recent development of artificial intelligence (AI) may help such pre-work which usually takes time and effort. This study aimed to develop the AI on-board efficient and comprehensive literature search system to support cost-effectiveness analysis. We developed Named Entity (NE) extraction and document classifier engine and scoring engine with document classifier with AI. Firstly, we used NE extraction engine (Method-1) to extract specific terms as PICO (Patient, Intervention, Comparison, and Outcome) from the text data. Secondly, the terms labeled with the diseases and drugs were extracted, then screened the description with outcomes and costs. Thirdly, we used scoring engine with document classifier (Method-2) scoring the relevance to cost-effectiveness research by the specific sentences. Finally, the abstracts with higher total scores were selected. We used abstracts in PubMed database for the evaluation. Systematic literature search has conducted on the articles published until January 2017 on MEDLINE®, MEDLINE® In-Process, Embase® and Cochrane collaboration. PICO was settled with hepatocellular carcinoma (Patient), antineoplastic systemic therapy (Intervention/Comparators) for health economic and related studies (Outcomes). This manual work identified 22 health economic and related studies out of 3,884 records identified by search term algorisms. Method-1 identified 538 studies (include 2,690 expected identified words). The precision rate, recall rate and accuracy rate (F-measure) was 0.900, 0.820, and 0.859, respectively, compared with the studies identified by manual. Method-2 identified 10 studies (include 135 sentences). The precision rate, recall rate and accuracy rate was 0.810, 0.810, and 0.808, respectively, compared with the studies identified by manual. Our study suggested that AI have a progress of contributing systematic literature review required for cost-effectiveness analysis. Improving the precision and recall rates will allow us use the AI system widely to various diseases and drugs.

Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis.

Does the use of metformin have an influence on the outcomes of preeclampsia (PE)? The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study. Total number of journals in the initial search (n = 824); exclusions from repeated articles on different search engines (n = 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n = 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n = 185), exclusion of articles with lower correlation with the objective of the present study (n = 187); and final bibliographic selection (n = 35). At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region. The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE. Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.

SECT Clinical Practice Guideline on the Management of Patients With Spontaneous Pneumothorax

This clinical practice guideline (CPG) emerges as an initiative of the scientific committee of the Spanish Society of Thoracic Surgery.We formulated PICO (patient, intervention, comparison, and outcome) questions on various aspects of spontaneous pneumothorax.For the evaluation of the quality of evidence and preparation of recommendations we followed the guidelines of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group.

A systematic review to assess the effectiveness and safety of nerve reconstruction using absorbable synthetic nerve conduit

This study aimed to assess the effectiveness and safety of absorbable synthetic nerve conduit through systematic review. The search strategy was embodied according to PICO (patient, intervention, comparison, and outcome). The patients were with peripheral nerve damage and neuroma. The intervention was nerve reconstruction with absorbable synthetic nerve conduit. Comparisons were autologous nerve graft and end-to-end suturing. The safety outcome was procedure-related complications. The effectiveness outcomes were nerve function tests, procedure failure rate, and subjective assessment. A total number of 434 papers were searched, five studies included. The safety outcomes reported higher in the intervention group in clinical trial including wound healing problems and debridement of the wound. The effectiveness results were improved in the intervention group, but not significant in comparative study. In case series and case reports, the efficacy outcomes were different among articles. Nerve reconstruction using absorbable synthetic nerve conduit was needed further study, nevertheless it is expected to be clinically useful.

Guía de práctica clínica de la SECT sobre el manejo de pacientes con neumotórax espontáneo

This clinical practice guideline (CPG) emerges as an initiative of the scientific committee of the Spanish Society of Thoracic Surgery.We formulated PICO (patient, intervention, comparison, and outcome) questions on various aspects of spontaneous pneumothorax.For the evaluation of the quality of evidence and preparation of recommendations we followed the guidelines of the Grading of recommendations, Assessment, Development and Evaluation (GRADE) working group.

Practising evidence-based medicine (EBM): a descriptive analysis of medical students’ whole-task EBM assignments

Researchers have suggested whole-task learning activities to practice and teach evidence-based medicine (EBM); however, limited description exists of their use in EBM curricula. This article describes medical students' execution of...

Psychological Responses to Acute Aerobic, Resistance, or Combined Exercise in Healthy and Overweight Individuals: A Systematic Review.

Introduction:Psychological distress and depression are risk factors for cardiovascular disease (CVD). As such, a reduction in psychological distress and increase in positive well-being may be important to reduce the risk for future development of CVD. Exercise training may be a good strategy to prevent and assist in the management of psychological disorders. The psychological effects of the initial exercise sessions may be important to increase exercise adherence. The aims of this systematic review were (a) to examine whether acute aerobic, resistance, or a combination of the 2 exercises improves psychological well-being and reduces psychological distress in individuals with healthy weight and those who are overweight/obese but free from psychological disorders, and (b) if so, to examine which form of exercise might yield superior results.Methods:The online database PubMed was searched for articles using the PICO (patient, intervention, comparison, and outcome) framework for finding scientific journals based on key terms.Results:Forty-two exercise studies met the inclusion criteria. A total of 2187 participants were included (age: 18-64 years, body mass index [BMI]: 21-39 kg/m2). Only 6 studies included participants with a BMI in the overweight/obese classification. Thirty-seven studies included aerobic exercise, 2 included resistance exercise, 1 used a combination of aerobic and resistance, and 2 compared the effects of acute aerobic exercise versus the effects of acute resistance exercise. The main findings of the review were that acute aerobic exercise improves positive well-being and have the potential to reduce psychological distress and could help reduce the risks of future CVD. However, due to the limited number of studies, it is still unclear which form of exercise yields superior psychological benefits.Conclusions:Obese, overweight, and healthy weight individuals can exhibit psychological benefits from exercise in a single acute exercise session, and these positive benefits of exercise should be used by health professionals as a tool to increase long-term participation in exercise in these populations.

Development of research priorities in paediatric pain and palliative care.

Priority setting for healthcare research is as important as conducting the research itself because rigorous and systematic processes of priority setting can make an important contribution to the quality of research. This project aimed to prioritise clinical therapeutic uncertainties in paediatric pain and palliative care in order to encourage and inform the future research agenda and raise the profile of paediatric pain and palliative care in the United Kingdom. Clinical therapeutic uncertainties were identified and transformed into patient, intervention, comparison and outcome (PICO) format and prioritised using a modified Nominal Group Technique. Members of the Clinical Studies Group in Pain and Palliative Care within National Institute for Health Research (NIHR) Clinical Research Network (CRN)-Children took part in the prioritisation exercise. There were 11 clinically active professionals spanning across a wide range of paediatric disciplines and one parent representative. The top three research priorities related to establishing the safety and efficacy of (1) gabapentin in the management of chronic pain with neuropathic characteristics, (2) intravenous non-steroidal anti-inflammatory drugs in the management of post-operative pain in pre-schoolers and (3) different opioid formulations in the management of acute pain in children while at home. Questions about the long-term effect of psychological interventions in the management of chronic pain and various pharmacological interventions to improve pain and symptom management in palliative care were among the 'top 10' priorities. The results of prioritisation were included in the UK Database of Uncertainties about the Effects of Treatments (DUETS) database. Increased awareness of priorities and priority-setting processes should encourage clinicians and other stakeholders to engage in such exercises in the future.

Effects of exercise in the whole spectrum of chronic kidney disease: a systematic review.

Chronic kidney disease (CKD) is a public health problem. Although physical activity is essential for the prevention and treatment of most chronic diseases, exercise is rarely prescribed for CKD patients. The objective of the study was to search for and appraise evidence on the effectiveness of exercise interventions on health endpoints in CKD patients. A systematic review was performed of randomized clinical trials (RCTs) designed to compare exercise with usual care regarding effects on the health of CKD patients. MEDLINE, EMBASE, Cochrane Central, Clinical Trials registry, and proceedings of major nephrology conference databases were searched, using terms defined according to the PICO (Patient, Intervention, Comparison and Outcome) methodology. RCTs were independently evaluated by two reviewers. A total of 5489 studies were assessed for eligibility, of which 59 fulfilled inclusion criteria. Most of them included small samples, lasted from 8 to 24 weeks and applied aerobic exercises. Three studies included only kidney transplant patients, and nine included pre-dialysis patients. The remaining RCTs allocated hemodialysis patients. The outcome measures included quality of life, physical fitness, muscular strength, heart rate variability, inflammatory and nutritional markers and progression of CKD. Most of the trials had high risk of bias. The strongest evidence is for the effects of aerobic exercise on improving physical fitness, muscular strength and quality of life in dialysis patients. The benefits of exercise in dialysis patients are well established, supporting the prescription of physical activity in their regular treatment. RCTs including patients in earlier stages of CKD and after kidney transplantation are urgently required, as well as studies assessing long-term outcomes. The best exercise protocol for CKD patients also remains to be established.