Scottish Intercollegiate Guidelines Network Checklist Research Articles

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review.

BACKGROUNDThe literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIMTo perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (i.e., prescription, misuse, and abuse).METHODSWe conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.RESULTSA total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSIONOpioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.

An Integrative Review of Job Stress and Mental Health Intervention Programs for Experienced Nurses

Purpose: The purpose of this study was to review intervention programs for experienced nurses’ job stress and mental health. Methods: Searches of literature were conducted through four electronic databases (RISS, KISS, PubMed, and CINAHL), focusing on the recent 5-year publications in English or Korean. Thirteen studies were selected for the final analysis and Scottish Intercollegiate Guidelines Network checklist was used to assess methodological rigor and quality. Results: Randomized controlled trials were used in five studies and quasi-experimental designs in eight studies. Cognitive-Behavioral Therapy (CBT) and group approach were the most frequent types of interventions in six and nine studies respectively. On average, the intervention was required for eight weeks and 60~120 minutes per session. After evaluating the effects of CBT, complementary alternative therapy, informative training, simulation training and stimuli control, most of the tested interventions reduced experienced nurses’ job stress and improved mental health, but informative training did not. Conclusion: Despite the obvious importance of experienced nurses in quality of nursing care, it has not been well studied due to limited numbers of studies with less rigorous design. Study findings provide a basis for developing intervention programs to reduce job stress and improve mental health for experienced nurses.

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: a systematic review and meta-analysis of cohort studies

BackgroundIn 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers.MethodsCohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger’s test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309).ResultsEleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I2 = 99.7; P = 0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR = 0.56, 95% CI = 0.37 to 0.84), abdominal injuries (RR = 0.87; 95% CI = 0.78 to 0.98) and, spinal injuries (RR = 0.56, 95% CI = 0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR = 0.49; 95% CI = 0.22 to 1.08), neck injuries (RR = 0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR = 1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR = 0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers.ConclusionIn sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type.

Nutritional screening in hospitalized pediatric patients: systematic review

malnutrition in the pediatric population has been associated with a great number of physiological problems and complications, which lead to a longer period of hospitalization, a higher risk of infections, a rise in mortality rate, and hence, a rise in assistance expenses. to collect available evidence on tools of nutritional screening frequently used in pediatrics that allow identifying, preventing and intervening hospital malnutrition, as well as providing guidelines regarding the appropriate application instant. a systematic review of literature was carried out in accordance with the PRISMA Declaration (Preferred Reporting Items in Systematic Reviews and Meta-Analyses) and in the main databases, search in ClinicalTrials and gray literature in Open Gray and TRIP Database. Then, the articles were selected and classified depending on the type of study. The quality assessment was done in accordance with the Scottish Intercollegiate Guidelines Network (SIGN) checklists. one hundred and ten articles were identified, following the parameters of the PRISMA declaration. Twenty-one articles were analyzed and evaluated through the SIGN methodology; 19 met the high quality criteria and were included in the present review. Six nutritional screening tools in pediatrics were identified, STRONGkids being the tool referred by 63% of the studies for the detection of malnutrition risk. the present systematic review allowed us to conclude that STRONGkids is the best screening tool for hospitalized children since it is practical, quick, easy to use and it reliably predicts the risk of malnutrition. However, further studies are required to validate the use of this in the Colombian context.

Pesticides as risk factors for head and neck cancer: A review

Humans may be exposed to pesticides such as fungicides, herbicides, and insecticides, during occupational and non-occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science, and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred and thirty-two studies were identified. Thirty-two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high-quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure, and type of pesticide.

European Hernia Society guidelines on prevention and treatment of parastomal hernias.

International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.

Interventions Targeting the Prescribing and Monitoring of Vancomycin for Hospitalized Patients: A Systematic Review Protocol.

IntroductionVancomycin remains one of our essential antibiotics after fifty years of treating serious infections such as methicillin-resistant Staphylococcus aureus. Vancomycin, unlike many other antibiotic agents, requires individualized dosing and monitoring of serum drug levels to ensure it is efficacious, to minimize toxicity, and to limit the development of antibiotic resistance. These issues have led to numerous vancomycin clinical practice guidelines being published in recent years including several key national guidelines. Significant resources are invested during the development of such guidelines; however, there is often little or no information about how such guidelines or other vancomycin practice improvement initiatives should be implemented. The aim of this systematic review is to identify and evaluate the effect of interventions using education, guideline implementation, and dissemination of educational resources that have sought to improve therapeutic drug monitoring and dosing of vancomycin.MethodsA systematic review of the literature will be conducted for RCTs and observational studies where a vancomycin guideline or practice improvement initiative has been implemented. Electronic databases to be searched are PubMed, Medline, CINAHL, EMBASE and the Cochrane Library of Systematic Reviews. The population will be patients who have had intravenous vancomycin prescribed and monitored in hospital. The interventions will be education, implementation of guidelines or protocols, dissemination of educational materials (printed or electronic) or multifaceted interventions of the above. The comparator will be patients who have had standard-care prescribing and monitoring of vancomycin. Outcomes will be changes in prescribing and ordering of vancomycin serum tests, and serum levels attained in patients as well as reported nephrotoxicity. Two reviewers will be involved in the quality assessment and extraction of data. The Scottish Intercollegiate Guidelines Network checklist for RCTs will be used. Studies that are not randomized will be assessed for quality using the validated ROBINS-I (risk of bias in non-randomized studies of interventions) tool.DiscussionThis systematic review will identify interventions that have been used to implement guidelines and clinical practice initiatives for vancomycin. The findings of this review may be informative to those involved with the implementation of vancomycin clinical practice guidelines. Systematic review registration: PROSPERO: CRD42016049147.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-017-0177-7) contains supplementary material, which is available to authorized users.

What Is the Impact of Bariatric Surgery on Erectile Function? ASystematic Review and Meta-Analysis.

Obesity is a worldwide public health issue that has severe psychological and social implications. Erectile dysfunction also is a prevalent clinical situation, and obesity is one of the primary risk factors for its development. To determine whether bariatric surgery can lessen erectile dysfunction in obese men because of evidence showing that weight loss in obese men contributes to decreasing erectile dysfunction and bariatric surgery contributes to significant weight loss. A search was conducted using Medline, LILACS, Cochrane, Scopus, CINAHL, Embase, Web of Science, Eric, and EBM up to April 13, 2016. The authors selected by title, abstract, and full text. Scottish Intercollegiate Guidelines Network checklists were used for comparative studies to show the limitations and biases of each article. RevMan 5.3 software from the Cochrane Library was used for meta-analyses. Results were demonstrated with forest plots. The outcome selected was resolution of erectile dysfunction, which was analyzed by improvement in the International Index of Erectile Function (IIEF) score. Of 185 articles analyzed, 7 were selected for systematic review. Meta-analysis of two articles that evaluated erectile function showed a 5.66-point increase in the five-item IIEF score of patients who underwent bariatric surgery (95% CI= 7.88-3.45, I2= 35%, P < .00001), demonstrating statistical significance. Meta-analysis of three articles showed a 4.10-point increase in the IIEF erectile function score of patients who underwent bariatric surgery (95% CI= 6.10-2.10, I2= 0%, P < .0001), demonstrating statistical significance. Bariatric surgery leads to an improvement of erectile function. Glina FPI, de Freitas Barboza JW, Nunes VM, etal. What Is the Impact of Bariatric Surgery on Erectile Function? A Systematic Review and Meta-Analysis. Sex Med Rev 2017;5:393-402.

Effect of Cognitive Improvement Programs for Mild Cognitive Impairment in Korean Elderly: A Meta-Analysis

Purpose: A meta-analysis was conducted to identify the effect of cognitive improvement programs for the elderly with mild cognitive impairment (MCI) in Korea. Methods: Five databases, as well as relevant reference lists, of studies published from 2000 to 2016, were searched. Fourteen studies were identified. Quality assessments of included studies were conducted using the Scottish Intercollegiate Guidelines Network checklist. An R program was used to analyze effect sizes and to identify possible sources of heterogeneity among studies. The potential for publication bias was investigated using a funnel plot, Egger"s regression test and sensitivity analysis. Results: The total effect size was large (Standardized Mean Difference [SMD]=1.44, 95% CI: 1.11~1.77), with cognition based intervention (SMD= 1.77, 95% CI: 1.26~2.29) and exercise intervention (SMD=1.13, 95% CI: 0.82~1.44). Statistically significant moderators were identified intervention type by meta-ANOVA analyses. Finally, no significant evidence of publication bias was found. Conclusion: There is clear evidence that cognitive improvement programs can greatly enhance cognition in elderly with MCI. Future research should examine the effects of non-pharmacological interventions targeting elderly populations with mild-to-severe cognitive impairment in order to develop and enhance the effectiveness of cognitive improvement programs in Korea.

Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review

ObjectiveThe objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers.DesignA systematic review of randomised and non-randomised...

무릎 골관절염 환자를 대상으로 한 수중 운동과 지상운동 비교: 체계적 문헌고찰 및 메타분석

본 연구는 무릎 골관절염 환자를 대상으로 수중운동과 지상운동의 효과를 비교하기 위해 수행된 체계적 문헌고찰 및 메타분석 연구이다. 문헌은 Ovid-Medline, Cochrane Library CENTRAL, CINAHL과 국내 DB인 RISS와 KISS를 통해 ((osteoarthriti* OR OA) AND (aqua* OR water OR hydrotherap*)), (골관절염 AND 수중운동) 등을 주요어로 조합하여 검색하였으며, 선택배제과정을 거쳐 최종 7편(n=449)의 문헌이 분석에 포함되었다. 문헌에 대한 질 평가는 SIGN의 무작위임상시험평가도구를 사용하였으며, 질 평가 결과는 6편에서 ++, 1편에서 +로 평가되어 전반적으로 비뚤림 위험은 없는 것으로 판단하였다. 메타분석결과 운동 중재 후 수중운동군과 지상운동군의 통증변화에 대한 차이는 Standardized mean difference (SMD) -0.26(95% CI -0.49, -0.03, p=0.03, <TEX>$I^2=14%$</TEX>)으로 수중운동군이 지상운동군에 비해 통증이 통계적으로 유의하게 감소하는 것으로 나타났으나, 그 외 두 군간 굴곡 관절가동범위, 신전 관절가동범위, 신체기능, 삶의 질의 SMD는 각각 -0.12(95% CI -0.51, 0.27, p=0.53, <TEX>$I^2=0%$</TEX>), -0.04(95% CI -0.55, 0.48, p=0.89, <TEX>$I^2=43%$</TEX>), -0.12(-0.44, 0.19, p=0.44, <TEX>$I^2=0%$</TEX>), -0.15(-0.54, 0.24, p=0.46, <TEX>$I^2=0%$</TEX>)로 두 군간 통계적으로 유의한 차이가 없는 것으로 나타났다. 현재 시점에서 무릎 골관절염환자를 대상으로 수중운동과 지상운동의 효과를 분석한 무작위 대조군 실험 연구 수가 비교적 적어 효과크기에 대한 확증적 결과를 얻는 데에는 다소 제한이 있었으므로 향후 이와 관련된 무작위 임상시험연구와 장기적인 효과검증에 대한 노력이 지속적으로 이루어져야 할 것으로 사료된다. This study was a systematic review and meta-analysis comparing the effects of aquatic exercise and land-based exercise in the treatment of knee osteoarthritis. 7 studies (n=449) met selection and exclusion criteria out of 287 potential studies obtained from the literature search via Ovid-Medline, Cochrane Library CENTRAL, CINAHL, RISS and KISS. The overall risk of bias of selected studies using SIGN (Scottish Intercollegiate Guidelines Network) checklist for randomized controlled trials (RCT) was regarded as low. As a result of meta analysis, Standardized Mean Difference (SMD) for pain was -0.26(95% CI -0.49, -0.03, p=0.03, <TEX>$I^2=14%$</TEX>), which implies that aquatic exercise groups had significant less pain than land-based exercise groups. On the other hand, there was no significant difference between aquatic exercise groups and land based exercise groups for flexion Range of Motion (ROM) (-0.12, 95% CI -0.51, 0.27, p=0.53, <TEX>$I^2=0%$</TEX>), extension ROM (-0.04, 95% CI -0.55, 0.48, p=0.89, <TEX>$I^2=43%$</TEX>), physical function (-0.12, 95% CI -0.44, 0.19, p=0.44, <TEX>$I^2=0%$</TEX>), Quality of Life (QOL) (-0.15, 95% CI -0.54, 0.24, p=0.46, <TEX>$I^2=0%$</TEX>). This study has some limitations due to few RCTs comparing aquatic exercise groups and land-based exercise groups in the treatment of knee osteoarthritis. Therefore, further RCTs should be conducted along with long-term outcomes.

Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis.

BackgroundPhysical therapy for the treatment of lateral epicondylitis (LE) often comprises movement therapies, extracorporeal shockwave therapy (ECSWT), low level laser therapy (LLLT), low frequency electrical stimulation or pulsed electromagnetic fields. Still, only ECSWT and LLLT have been meta-analytically researched.MethodsPUBMED, EMBASE and Cochrane database were systematically searched for randomized controlled trials (RCTs). Methodological quality of each study was rated with an adapted version of the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pain reduction (the difference between treatment and control groups at the end of trials) and pain relief (the change in pain from baseline to the end of trials) were calculated with mean differences (MD) and 95 %-Confidence intervals (95 % CI).ResultsOne thousand one hundred thirty eight studies were identified. One thousand seventy of those did not meet inclusion criteria. After full articles were retrieved 16 studies met inclusion criteria and 12 studies reported comparable outcome variables. Analyses were conducted for overall pain relief, pain relief during maximum handgrip strength tests, and maximum handgrip strength. There were not enough studies to conduct an analysis of physical function or other outcome variables.ConclusionsDifferences between treatment and control groups were larger than differences between treatments. Control group gains were 50 to 66 % as high as treatment group gains. Still, only treatment groups with their combination of therapy specific and non-therapy specific factors reliably met criteria for clinical relevance. Results are discussed with respect to stability and their potential meaning for the use of non-therapy specific agents to optimize patients’ gain.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0665-4) contains supplementary material, which is available to authorized users.

Efficacy of Physical Exercise Therapy as a Treatment for Fibromyalgia Patients An Evaluation of the Evidence

Background: Fibromyalgia (FM) is a chronic pain disorder characterized by widespread pain. Recent hypotheses regarding the pathogenesis of FM has primarily focused upon the concept of central sensitization (CS). The musculoskeletal system has been suggested to act as a potential source of pain contributing to CS, suggesting that in theory physical therapy, including manual therapy, may be useful in treating some of the pain associated with FM. Presently, no known cure exists for FM, and current primary care management may include a mixture of pharmacological treatments, as well as manual and physical therapy, including the use of aerobic and strengthening exercises. Objective: As manual and physical therapy are often conducted in conjunction with prescribed exercises, this article examines evidence in regard to the efficacy of employing physical exercise therapy within a manual/physical therapy clinical setting as a potential intervention for patients with FM. Methods: Databases and reference sections of original studies and systematic reviews on physical exercise therapy in FM were reviewed (for relevant literature from 2009 to 2014). The author was solely responsible for the selection of studies for inclusion based on defined inclusion and exclusion criteria. Following critical appraisal using The Critical Skills Appraisal Program (CASP), evidence ratings were applied to the studies using The Oxford Rating Scale developed by the Centre for Evidence-Based Medicine (CEBM) and The Scottish Intercollegiate Guidelines Network (SIGN) checklist. Results: The studies reviewed suggested that physical exercise therapy, including aerobic exercise (AE) and strength training, could benefit FM patients in terms of pain amelioration and improvement of range of motion (ROM), improving health-related quality of life (HQoL) by improving sleep patterns and reducing medication usage, as well as reducing depression and improving psychological wellbeing. Conclusion: There is evidence to support the use of physical exercise therapy as a therapy for FM sufferers. However, there remains a lack of certainty regarding the most efficacious exercise intervention, mainly due to the methodological constraints affecting the available studies, as well as the heterogeneity and lack of standardization with regard to available exercise-based treatment programmes for FM sufferers, which makes the act of comparing the studies available challenging. KeywordsFibromyalgia; Fibromyalgia Syndrome; Physical Therapy; Physiotherapy; Exercise Therapy; Physical Exercise Therapy

A Systematic Review of Risk Factors for Delirium in the ICU*

Although numerous risk factors for delirium in the ICU have been proposed, the strength of evidence supporting each risk factor remains unclear. This study systematically identifies risk factors for delirium in critically ill adults where current evidence is strongest. CINAHL, EMBASE, MEDLINE, the Cochrane Central Register for Controlled Trials, and the Cochrane Database of Systematic Reviews. Studies published from 2000 to February 2013 that evaluated critically ill adults, not undergoing cardiac surgery, for delirium, and used either multivariable analysis or randomization to evaluate variables as potential risk factors for delirium. Data were abstracted in duplicate, and quality was scored using Scottish Intercollegiate Guidelines Network checklists (i.e., high, acceptable, and low). Using a best-evidence synthesis each variable was evaluated using 3 criteria: the number of studies investigating it, the quality of these studies, and whether the direction of association was consistent across the studies. Strengths of association were not summarized. Strength of evidence was defined as strong (consistent findings in ≥2 high quality studies), moderate (consistent findings in 1 high quality study and ≥1 acceptable quality studies), inconclusive (inconsistent findings or 1 high quality study or consistent findings in only acceptable quality/low quality studies) or no evidence available. Among 33 studies included, 70% were high quality. There was strong evidence that age, dementia, hypertension, pre-ICU emergency surgery or trauma, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, metabolic acidosis, delirium on the prior day, and coma are risk factors for delirium, that gender is not associated with delirium, and that use of dexmedetomidine is associated with a lower delirium prevalence. There is moderate evidence that multiple organ failure is a risk factor for delirium. Only 11 putative risk factors for delirium are supported by either strong or moderate level of evidence. These factors should be considered when designing delirium prevention strategies or controlling for confounding in future etiologic studies.

P53 Expression as a Prognostic Factor in Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Objective: To conduct a meta-analysis examining p53 expression as a potential risk factor in upper urinary tract urothelial carcinoma (UUT-UC) and to systematically review the available data. Methods: A comprehensive literature review was performed from January 1991 to August 2012, using search engines such as PubMed, EMBASE, Cochrane Library and KoreaMed. All retrieved references were manually reviewed, and two authors independently extracted the data. The quality of case-control and cohort studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) checklists. Heterogeneity among studies was examined using the Q statistics and Higgins' I² statistic. Results: Of 302 abstracts of original research studies, nine case-control trials fit our criteria for inclusion in the analysis. Of the nine articles included, four scored ‘low' and five scored ‘modest' in the quality assessment performed according to the SIGN checklists. Analysis of the correlation between different factors and p53 expression in UUT-UC showed that pathologic stage (≥pT3 or <pT3) differed significantly between the p53 and non-p53 groups (OR = 2.720, p < 0.001). Statistically significant correlations were also detected between p53 expression and histologic grade (OR = 4.507, p < 0.001) and female gender (OR = 2.724, p < 0.001). Conclusion: The results of our meta-analysis suggest that p53 expression in UUT-UC was correlated with advanced pathologic stage, high histologic grade and female gender.

Reducing inappropriate accident and emergency department attendances:

Inappropriate attendances may account for up to 40% of presentations at accident and emergency (A&E) departments. There is considerable interest from health practitioners and policymakers in interventions to reduce this burden. To review the evidence on primary care service interventions to reduce inappropriate A&E attendances. Systematic review of UK and international primary care interventions. Studies published in English between 1 January 1986 and 23 August 2011 were identified from PubMed, the NHS Economic Evaluation Database, the Cochrane Collaboration, and Health Technology Assessment databases. The outcome measures were A&E attendances, patient satisfaction, clinical outcome, and intervention cost. Two authors reviewed titles and abstracts of retrieved results, with adjudication of disagreements conducted by the third. Studies were quality assessed using the Scottish Intercollegiate Guidelines Network checklist system where applicable. In total, 9916 manuscripts were identified, of which 34 were reviewed. Telephone triage was the single best-evaluated intervention. This resulted in negligible impact on A&E attendance, but exhibited acceptable patient satisfaction and clinical safety; cost effectiveness was uncertain. The limited available evidence suggests that emergency nurse practitioners in community settings and community health centres may reduce A&E attendance. For all other interventions considered in this review (walk-in centres, minor injuries units, and out-of-hours general practice), the effects on A&E attendance, patient outcomes, and cost were inconclusive. Studies showed a negligible effect on A&E attendance for all interventions; data on patient outcomes and cost-effectiveness are limited. There is an urgent need to examine all aspects of primary care service interventions that aim to reduce inappropriate A&E attendance.

The relation between endometriosis and ovarian cancer – a review

Endometriosis is known to harbor characteristics substantiating its possible role as a precursor of ovarian cancer. To assess the quality of the literature regarding the association between endometriosis and ovarian cancer and to estimate the extent of this relation. An electronic literature search was conducted in PubMed and 1112 articles dealing with the relation between endometriosis and ovarian cancer were identified. Original articles based on case-control studies, cohort studies and cross-sectional studies were included. Studies consisting of populations with self-reported endometriosis were excluded, as were articles with fewer than 20 cases of ovarian cancer. Twenty-eight studies underwent detailed quality assessments based on the checklists developed by the Scottish Intercollegiate Guidelines Network (SIGN). Meta-analyses were conducted on selected subgroups of ovarian cancer with coexisting endometriosis. None of the 28 studies was given the highest possible rating using the SIGN checklists. The risk of ovarian cancer in women with endometriosis was reported to be a standardized incidence ratio of 1.43-8.95, a rate ratio of 1.6-2.88, an odds ratio of 1.34, with a prevalence of ovarian cancer in 2.0-17.0% of women with endometriosis. Conversely, the prevalence of endometriosis in women with ovarian cancer ranged from 3.4 to 52.6%. Meta-analysis results were weakened by heterogeneity. There is sufficient evidence to conclude that there is an increased risk of developing clear-cell and endometrioid epithelial ovarian cancer for women with histologically verified endometriosis. Nonetheless, prospective cohort studies assessing the relation between endometriosis and ovarian cancer will increase knowledge in this field.

699 RISK OF P53 EXPRESSION IN UPPER URINARY TRACT UROTHELIAL CARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013699 RISK OF P53 EXPRESSION IN UPPER URINARY TRACT UROTHELIAL CARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS Joo Yong Lee, Ki-Seok Jang, Kang Su Cho, Seung Wook Lee, Hong Sang Moon, Yong Tae Kim, Young Deuk Choi, Hae Young Park, Tchun Yong Lee, and Hong Yong Choi Joo Yong LeeJoo Yong Lee Seoul, Korea, Republic of More articles by this author , Ki-Seok JangKi-Seok Jang Seoul, Korea, Republic of More articles by this author , Kang Su ChoKang Su Cho Seoul, Korea, Republic of More articles by this author , Seung Wook LeeSeung Wook Lee Seoul, Korea, Republic of More articles by this author , Hong Sang MoonHong Sang Moon Seoul, Korea, Republic of More articles by this author , Yong Tae KimYong Tae Kim Seoul, Korea, Republic of More articles by this author , Young Deuk ChoiYoung Deuk Choi Seoul, Korea, Republic of More articles by this author , Hae Young ParkHae Young Park Seoul, Korea, Republic of More articles by this author , Tchun Yong LeeTchun Yong Lee Seoul, Korea, Republic of More articles by this author , and Hong Yong ChoiHong Yong Choi Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.255AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The tumor suppressor gene p53 is a key inhibitor of human carcinogenesis and mutations of p53 have been identified in approximately 50% of all human cancers. Previous studies showed correlation between p53 and other factors including high grade, advanced stage or lymphovascular invasion upper urinary tract urothelial carcinoma (UUT-UC). We conducted to determine p53 as a potential risk factor in UUT-UC and systematically reviewed the available evidence. METHODS A comprehensive literature review was performed, from Jan 1991 to Aug 2012, using search engines including PubMed, EMBASE, Cochrane Library, CINAHL and KoreaMed. We manually reviewed references, and two authors independently extracted the data. To assess the quality of the studies, the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist for case-control studies and cohort studies were used. Heterogeneity amongst studies was explored using the Q statistics and HigginsÆs I2 statistic and Begg-Mazumdar rank-correlation test and EggerÆs regression-intercept test were used to provide evidence of publication bias, which was shown as a funnel plot. RESULTS We identified nine case-control trials that fit our criteria from 302 abstracts of original researches. Of the 9 enrolled articles, final assessment results quality was ôlowö in four articles and ômodestö in five articles according to the SIGN checklists. Pathologic stage, histologic grade and gender were evaluated between p53 and non-p53 expression groups in our meta-analysis. For pathologic stage (≥pT3 or <pT3), there was a significant difference between p53 and non-p53 group (OR =0.370, p<0.001). There was also a statistical difference between low and high histologic grade in two groups (OR=0.255, p<0.001). Female patients had significantly higher risk rate than male patients. (OR=2.736, p<0.001) (Figure 1). CONCLUSIONS This meta-analysis suggests that p53 expression in UUT-UC may be correlated with high pathologic stage, high histologic stage and female patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e287-e288 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joo Yong Lee Seoul, Korea, Republic of More articles by this author Ki-Seok Jang Seoul, Korea, Republic of More articles by this author Kang Su Cho Seoul, Korea, Republic of More articles by this author Seung Wook Lee Seoul, Korea, Republic of More articles by this author Hong Sang Moon Seoul, Korea, Republic of More articles by this author Yong Tae Kim Seoul, Korea, Republic of More articles by this author Young Deuk Choi Seoul, Korea, Republic of More articles by this author Hae Young Park Seoul, Korea, Republic of More articles by this author Tchun Yong Lee Seoul, Korea, Republic of More articles by this author Hong Yong Choi Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews

BackgroundCo-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology.MethodsPubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed.ResultsOf the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety.ConclusionsBased on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components.

Evidence-based protocol

Background Coronary heart disease deprives millions of lives in the world annually and this number has increased steadily in recent years. In Hong Kong, coronary heart disease claimed 4360 lives in 2009 and it is one of the major burdens of the healthcare system. In order to reduce cardiac mortality and morbidity and to enhance patients’ quality of life, cardiac rehabilitation program is developed. Exercise training is a pivotal part of the cardiac rehabilitation program. Objective The main objective of this translational nursing research is to translate quality research evidences regarding the effects of exercise training in improving quality of life of patients with coronary heart disease to the local setting. This is achieved by developing an evidence-based protocol. Methods A systematic search of literature was conducted in 5 electronic databases. 8 relevant randomized controlled trials were eventually obtained. Then, the 8 identified studies were summarized to form a table of evidence and the critical appraisal was performed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. After performing the quality assessment, evidences were assembled for synthesis and recommendations are made for developing the evidence-based protocol. Since the implementation potential of the proposed exercise training program is considered to be high, an evidence-based protocol is developed for the local context. In order to implement the evidence-based protocol smoothly, implementation plan is developed in which a communication plan and a pilot test are included. Lastly, evaluation plan is established to assess the effectiveness of the program in fulfilling its objectives. Results In total, 7 recommendations are made based on the 8 appraised studies. According to the SIGN’s “Grades of recommendation”, all the recommendations in the protocol are graded with “A”. The significance of this evidence-based protocol is that it adds a symptom-limited exercise test for evaluating participant’s level of exercise tolerance before the start of exercise training, so that exercise intensity can be tailored. It is relatively safer than the current practice. Conclusion A 6-week exercise training program for patients with coronary heart disease is effective in improving their quality of life and increasing their level of physical activity. Since the program has a high implementation potential in the local context and is safer than the current practice, the evidence-based exercise training protocol is worthwhile to be introduced to the cardiac units in Hong Kong.