Systematic Review Of Current Evidence Research Articles

Dupilumab in prurigo nodularis: a systematic review of current evidence and analysis of predictive factors to response

Introduction Dupilumab has been shown effective for prurigo nodularis (PN). However, precise data about efficacy of dupilumab as off-label use in PN is missing. We aggregated current evidence to assess efficacy of dupilumab in PN and to identify possible response predictors Material and methods Five electronic databases were searched. Our primary outcome was improvement in pruritus measured by numerical rating scale (NRS). We collected data on NRS before (NRSpre) and after (NRSpost) the dupilumab therapy and designed two categorical variables: ‘NRS_50’ and ‘NRS_100’ defined as whether one patient reaches 50% and 100% reduction of the NRSpre. Secondary outcomes included: time until patient perceived any improvement (Time_First) and time until patient reported absence of pruritus (Time_Final). Results Data on 45 patients from eleven articles were analyzed. The NRSpre was 8.58 ± 1.89 and the NRSpost was 1.78 ± 2.29. Time_First was 10.15 ± 10.56 weeks, while Time_Final was 19.28 ± 13.71 weeks. 22/45 patients (48.88%) presented with complete resolution (NRS_100) and 37/45 patients (82.22%) had itch half dropped (NRS_50). Time_First was significantly longer in subjects that did not reach NRS_100 (13.13 ± 13.77) than in subjects that did (7.34 ± 7.86, p= .05). Time_First was significantly longer in atopic dermatitis (AD) patients (16.08 ± 16.18) than in subjects without AD (7.02 ± 5.69, p=.01). NRS_50 and NRS_100 presented with a significant association (p=.05) Conclusion Dupilumab is an effective target-to-treat agent. In comparison with AD, the clinical response to dupilumab initiates later and, two months of therapy are required until significant itch relieves. Complete remission is rarely observed before 4 months of therapy. Notably, AD-related PN patients need longer treatment than non-AD related PN patients to find any relief. Two early signs of improvement are promising predictors of response to dupilumab: The Time_First and NRS_50. What's already known about this topic? Dupilumab has been shown to be an efficacious treatment for prurigo nodularis (PN) However, literature data on this topic are scattered. What does this study add? This work presents the largest cohort of PN patients treated with dupilumab. Our findings demonstrate dupilumab is a novel and effective choice In comparison with atopic dermatitis, the clinical response to dupilumab initiates later. Two months of therapy are required until the itch relieves. Complete remission is rarely observed before 4 months of therapy. Atopic dermatitis-related PN patients need more weeks of treatment than non-atopic dermatitis-related PN patients

Direct Observation of Searching for Online Health Information: A Systematic Review of Current Evidence

Few studies have been conducted to explore how individuals objectively attempt to retrieve health information using some type of observational method. Therefore, the purpose of this review was to systematically describe and summarize studies employing a direct observational method, and/or video/audio recording program, to examine how individuals actively search for online health information. Eleven articles were found to be acceptable. Overall, studies contained fairly small sample sizes, used mostly college students, and no study explicitly recruited any racial or minority groups. Implications for future research and practice is discussed.

The effect of obesity, macronutrients, fasting and nutritional status on drug-metabolizing cytochrome P450s: a systematic review of current evidence on human studies.

Cytochrome P450s (CYPs) are a class of hemoproteins involved in drug metabolism. It has been reported that body composition, proportion of dietary macronutrients, fasting and nutritional status can interfere with the activity of drug-metabolizing CYPs. The present systematic review was conducted to summarize the effect of obesity, weight reduction, macronutrients, fasting and malnutrition on the CYP-mediated drug metabolism. PubMed (Medline), Scopus, Embase and Cochrane Library databases and Google Scholar were searched up to June 2020 to obtain relevant studies. The PRISMA guidelines were employed during all steps. Two reviewers independently extracted the information from the included studies. Studies investigating CYPs activity directly or indirectly through pharmacokinetics of probe drugs, were included. Increase in clearance (CL) or decrease in elimination half-life (t½) and area under the curve (AUC) of probe drugs were considered as increase in CYPs activity. A total of 6545 articles were obtained through searching databases among which 69 studies with 126 datasets fully met the inclusion criteria. The results indicated that obesity might decrease the activity of CYP3A4/5, CYP1A2 and CYP2C9 and increase the activity of CYP2E1. The effect of obesity on CYP2D6 is controversial. Also, weight loss increased CYP3A4 activity. Moreover, CYP1A2 activity was decreased by high carbohydrate diet, increased by high protein diet and fasting and unchanged by malnutrition. The activity of CYP2C19 was less susceptible to alterations compared to other CYPs. The activity of drug-metabolizing CYPs are altered by body composition, dietary intake and nutritional status. This relationship might contribute to drug toxicity or reduce treatment efficacy and influence cost-effectiveness of medical care.

ANGIOEDEMA REFRACTORY TO STANDARD MEDICAL MANAGEMENT: THE USE OF FRESH FROZEN PLASMA IN THE ICU SETTING TO PREVENT INTUBATION AND MECHANICAL VENTILATION

SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Angioedema is a self-limiting swelling of the lips, tongue, oropharynx, and larynx that can develop rapidly due to localized vascular vasodilation. The two main mechanisms of angioedema are histamine-mediated and bradykinin-mediated; the latter of which is a known side effect of angiotensin-converting enzyme inhibitors. Despite the two different mechanisms, angioedema is treated the same no matter the cause with steroids, epinephrine, and antihistamines. However, there is growing evidence that fresh frozen plasma (FFP) has shown beneficial results when treating refractory bradykinin-mediated angioedema caused by ACEI use. Given the risk for potential airway compromise and obstruction, FFP should be considered early to prevent the need for intubation. CASE PRESENTATION: A 51 year old male presented with acute onset lower lip swelling. He was started on lisinopril 5mg daily 2 days prior to arrival and had never been on an ACE inhibitor or ARB before. On presentation, his swelling was limited to lower lip; upper lip and tongue were not involved as well as no involvement of airway. In the ED, he was given epinephrine 0.3 mg (1:1000) IM, methylprednisolone 125 mg IV, diphenhydramine 50 mg IV, famotidine 20 mg IV. These interventions did not significantly improve patient’s status so he was admitted to the IICU for airway monitoring. His swelling was noted to advance, now involving the upper lip as well. Discussion regarding concerns for intubation were expressed. Patient at this time continued to deny any difficulty in breathing or sensation that throat was swelling. Due to increasing in noticeable swelling, decision was made to move the patient into the ICU and transfuse 2 units FFP. Resolution of symptoms was observed immediately afterwards and he did not require intubation. He was safely discharged the next morning. DISCUSSION: ACE-inhibitors limit the degradation of serum bradykinin which leads to potent vasodilation of venules. Capillary leakage causes edema of the face, mouth, oropharynx, and larynx, which if large enough, can lead to airway compromise and the need for intubation. ACE inhibitor-induced angioedema can occur in any patient at any time during their treatment course and can be difficult to differentiate from other angioedemas. FFP contains kininase-II, which breaks down bradykinin. Current guidelines still recommend steroids, antihistamines, and epinephrine as first line treatments; however, in refractory cases or those pending imminent respiratory collapse, FFP should be considered. The risk of administering FFP include allergic and transfusion reactions, infection transmission, volume overload, and delay in time of treatment. CONCLUSIONS: In this case, 2 units of FFP were given to a patient with ACEI-induced angioedema refractory to standard therapy, and we were able to successfully avoid intubation as well as limit hospital and ICU lengths of stay to 1 day. Reference #1: Saeb, A., Hagglund, K. H., & Cigolle, C. T. (2016). Using Fresh Frozen Plasma for Acute Airway Angioedema to Prevent Intubation in the Emergency Department: A Retrospective Cohort Study. Emergency Medicine International, 2016, 1-6. doi:10.1155/2016/6091510 Reference #2: Riha, H. M., Summers, B. B., Rivera, J. V., & Berkel, M. A. (2017). Novel Therapies for Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema: A Systematic Review of Current Evidence. The Journal of Emergency Medicine, 53(5), 662-679. doi:10.1016/j.jemermed.2017.05.037 Reference #3: Chaaya, G., Afridi, F., Faiz, A., Ashraf, A., Ali, M., & Castiglioni, A. (2017). When Nothing Else Works: Fresh Frozen Plasma in the Treatment of Progressive, Refractory Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema. Cureus. doi:10.7759/cureus.972 DISCLOSURES: No relevant relationships by Justin Bahoora, source=Web Response No relevant relationships by John Berquist, source=Web Response No relevant relationships by Sapna Kher, source=Web Response

Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines.

The 2017 international classification system for periodontal diseases characterises periodontitis patients based upon disease extent, severity and past experience, and in stage IV includes a treatment complexity component. In addition, taking into account well-established risk factors, it aims to estimate the risk for future attachment loss. This classification system draws upon current understanding of disease pathobiology and reflects the complex, multifactorial nature of the periodontitis. It also acknowledges individual patients' risk profiles.Classification and diagnosis are distinct but linked entities, and the inclusion of established risk factors in the system helps signpost the clinician and patient towards a more personalised approach to care provision. The European Federation of Periodontology (EFP) has recently developed an S3-level clinical treatment guideline for stages I to III periodontitis, based upon a rigorous standardised process involving 15 systematic reviews of current evidence and their synthesis by a representative group of experts and stakeholders. The aim is to guide the practitioner through the complex plethora of periodontal management options and to facilitate pragmatic decision-making in full knowledge of the evidence base.Here, we present the structured, stepwise treatment protocols developed by the EFP guideline group and highlight selected specific clinical recommendations. The adapted guidelines for the UK healthcare system will be published in early 2021.

1248P Immune checkpoint inhibition with chemoradiotherapy (CRT) in stage III non-small cell lung cancer: A systematic review of current evidence and meta-analysis of safety results

1248P Immune checkpoint inhibition with chemoradiotherapy (CRT) in stage III non-small cell lung cancer: A systematic review of current evidence and meta-analysis of safety results

The autism advantage at work: A critical and systematic review of current evidence

BackgroundDespite difficulties entering the workforce, people on the autism spectrum are often successful. Furthermore, they are suggested to bring unique abilities (e.g., attention to detail, tolerance for repetitive tasks) related to the repetitive and restrictive behaviours and interests (RRBI) diagnostic domain, that may be advantageous in employment. AimsThis critical and systematic review examined evidence supporting the superior workplace performance of employees on the autism spectrum, particularly regarding the RRBI domain. Method and proceduresA systematic review (PRISMA guidelines) evaluated empirical peer-reviewed studies that assess employees on the autism spectrum’s performance in the workplace or on work-specific tasks. Nine databases were searched, with additional papers identified from reference lists and consultation. Outcomes and resultsTwo quantitative and four qualitative papers met criteria. Results reflect themes; attention to detail, tolerance of repetitive tasks, special/circumscribed interests, other RRBI related advantages/concerns. Conclusions and implicationsDue to the nature and quality of the identified studies there is currently no strong evidence supporting or negating a workplace autism advantage. This review highlights the need for more research and urges constraint in utilising stereotypes that may not apply to all on the autism spectrum, arguing an individual differences approach to supporting autism strengths at work.

Prediction of mucositis risk secondary to cancer therapy: a systematic review of current evidence and call to action.

Despite advances in personalizing the efficacy of cancer therapy, our ability to identify patients at risk of severe treatment side effects and provide individualized supportive care is limited. This is particularly the case for mucositis (oral and gastrointestinal), with no comprehensive risk evaluation strategies to identify high-risk patients. We, the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) Mucositis Study Group, therefore aimed to systematically review current evidence on that factors that influence mucositis risk to provide a foundation upon which future risk prediction studies can be based. We identified 11,018 papers from PubMed and Web of Science, with 197 records extracted for full review and 113 meeting final eligibility criteria. Data were then synthesized into tables to highlight the level of evidence for each risk predictor. The strongest level of evidence supported dosimetric parameters as key predictors of mucositis risk. Genetic variants in drug-metabolizing pathways, immune signaling, and cell injury/repair mechanisms were also identified to impact mucositis risk. Factors relating to the individual were variably linked to mucositis outcomes, although female sex and smoking status showed some association with mucositis risk. Mucositis risk reflects the complex interplay between the host, tumor microenvironment, and treatment specifications, yet the large majority of studies rely on hypothesis-driven, single-candidate approaches. For significant advances in the provision of personalized supportive care, coordinated research efforts with robust multiplexed approaches are strongly advised.

Role of Terlipressin in Cirrhotic Patients with Ascites and without Hepatorenal Syndrome: A Systematic Review of Current Evidence.

Ascites, a common complication in cirrhosis, is prone to the development of acute kidney injury or hepatorenal syndrome and can be complicated by circulatory dysfunction after paracentesis. Terlipressin has not been considered as the mainstay treatment option for ascites in cirrhosis yet. The present work aimed to systematically review the current evidence regarding the use of terlipressin in cirrhosis with ascites and without hepatorenal syndrome. PubMed, EMBASE, and Cochrane Library databases were searched for relevant studies. Twelve studies were eligible. In 3 studies (1 randomized controlled trial and 2 single-arm studies without controls) involving 32 patients who received terlipressin for nonrefractory ascites, terlipressin improved hemodynamics by decreasing the heart rate and cardiac output and increasing the mean arterial pressure and systemic vascular resistance. In 5 studies (1 randomized controlled trial, 2 single-arm studies without controls, and 2 comparative studies with controls) involving 67 patients who received terlipressin for refractory ascites, terlipressin improved renal function by increasing the glomerular filtration rate, renal blood flow, urinary sodium, and urine output and decreasing serum creatinine. In 4 studies (4 randomized controlled trials) involving 71 patients who received terlipressin for preventing from paracentesis-induced circulatory dysfunction, terlipressin prevented from paracentesis-induced circulatory dysfunction by increasing the mean arterial pressure and systemic vascular resistance and decreasing plasma renin. Terlipressin may improve hemodynamics, severity of ascites, and renal function and prevent from paracentesis-induced circulatory dysfunction in cirrhosis with ascites and without hepatorenal syndrome. However, no study has evaluated the effect of terlipressin for prevention of acute kidney injury.

Post-colonoscopy appendicitis: Systematic review of current evidence.

Appendicitis after colonoscopy is an exceedingly rare complication. It remains to be explored if this entity is truly a complication of colonoscopy or a coincidental occurrence of appendicitis post-colonoscopy. The aim of this study was to systematically review all the available evidence since it was first described in 1988. The literature on post-colonoscopy appendicitis was searched using PubMed, EMBASE, and Cochrane databases. Additional manual search was performed and cross-checked for additional references. The search was performed up to November 2019. Data collected included demographics, reason for colonoscopy, time to diagnosis, imaging performed, management, and outcome. Fifty-three cases were found in the systematic review with a median age of 55years (24-84years). The time to diagnosis post-colonoscopy was mostly within 24-48h. Clinical features mimicked those of common acute appendicitis. In the past decade, computed tomography scan has been the imaging choice to investigate abdominal pain after colonoscopy, mainly to rule out perforation. The mainstay of management was appendectomy (open or laparoscopy). Four of the 12 cases (33.3%) were treated successfully with antibiotics alone. There has been a twofold increase in cases reported in the past decade (2009-2019, n=31 vs 1999-2008, n=15). There is a considerable variation in the definition of post-colonoscopy appendicitis in the current literature. Regardless of whether post-colonoscopy appendicitis is a true entity, it should be considered as a differential diagnosis in any patient presenting with acute abdomen following colonoscopy.

Efficacy and safety of Chinese patent medicine injection for COVID-19

Background:Corona Virus Disease 2019 (COVID-19) has caused a worldwide epidemic since its discovery. The outbreak of virus infection has aroused great concern of the World Health Organization (WHO). COVID-19 is highly infectious and has a high infection rate. So far, no specific drug has been found to cure it. China as one of the first countries attacked by epidemic has shown outstanding in fighting against the COVID-19. The contribution of traditional Chinese medicine can not be ignored. As a kind of representative of traditional Chinese medicine, the Chinese patent medicine injection has significant effect in reducing the clinical symptoms of patients and preventing the deterioration of the disease. However, there is no systematic review of its efficacy and safety. The purpose of this study is to evaluate the efficacy and safety of Chinese patent medicine injection in the treatment of COVID-19.Methods:All randomized controlled trials of Chinese patent medicine injection for COVID-19 will be included. The following electronic databases will be searched: PubMed, Web of Science, the Cochrane Library, EMBASE, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature database and some clinical trial registration websites. Two researchers will independently screen titles, abstracts, full texts, and extract data, then assess the bias risk of each study. We will conduct meta-analyses to assess all the available evidence of the efficacy and safety.Results:Systematic review of current evidence will be provided from the indexes of efficacy and safety.Conclusion:Evidence regarding the efficacy and safety of Chinese patent medicine injection in the treatment of COVID-19 will be provided to clinicians.PROSPERO registration number: CRD42020182725

The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences.

Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedures that are used for the treatment of postpartum hemorrhage due to AIP and suggest recommendations based on current evidences. Owing to a high rate of adverse events, prophylactic occlusion of internal iliac arteries should be used with caution and applied when the endpoint is hysterectomy. On the opposite, when a conservative management is considered to preserve future fertility, uterine artery embolization should be the preferred option as it is associated with a hysterectomy rate of 15.5% compared to 76.5% with prophylactic balloon occlusion of the internal iliac arteries and does not result in fetal irradiation. Limited data are available regarding the application of systematic prophylactic embolization and no comparative studies with arterial embolization are available.

Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence.

The novel coronavirus, also known as SARS-Cov-2 or COVID-19 has become a worldwide threat and the major healthcare concern of the year 2020. Cancer research was directly affected by the emerging of this disease. According to some Chinese studies, cancer patients are more vulnerable to COVID-19 complications. This observation led many oncologists to change their daily practice in cancer care, without solid evidence and recommendations. Moreover, the COVID-19 manifestations as well as its diagnosis are particular in this special population. In this review paper we expose the challenges of cancer management in the era of SARS-CoV-2, the epidemiological, clinical, pathological and radiological characteristics of the disease in cancer patients and its outcomes on this population. Finally, we focus on strategies that are followed in cancer management with review of national and international guidelines.

Clinical Presentation of COVID-19: A Systematic Review Focusing on Upper Airway Symptoms.

Pharyngodynia, nasal congestion, rhinorrhea, smell, and taste dysfunctions could be the presenting symptoms of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2. The aim was to perform a systematic review of current evidences on clinical presentation of COVID-19, focusing on upper airway symptoms in order to help otolaryngologists identifying suspected cases. We searched PubMed and Web of Science electronic databases. We included 5 retrospective clinical studies for a total of 1556 hospitalized patients with COVID-19, 57.5% were male and mean age was 49.1 years. Pooled data revealed that pharyngodynia was present in 12.4% of patients, nasal congestion in 3.7%, and rhinorrhea was rare. No reports on COVID-19 and olfactory/gustative disorders matched inclusion criteria but preliminary evidences suggested they could be present. Common symptoms were fever (85.6%), cough (68.7%), and fatigue (39.4%). Frequent comorbidities were hypertension (17.4%), diabetes (3.8%), and coronary heart disease (3.8%); 83% of patients had alterations on chest computed tomography that were bilateral in 89.5% of cases. Ground-glass opacity was the most common finding (50%). Lymphopenia (77.2%) and leucopenia (30.1%) were common. Critical cases with complications were 9%, intensive care unit admission was required in 7.3%, invasive ventilation in 3.4%, and mortality was 2.4%. Otolaryngologists should know that pharyngodynia, nasal congestion, olfactory, and gustative disorders could be the presenting symptoms of COVID-19. Clinical presentation together with radiological and laboratory findings could help to identify suspected cases.

Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence.

BackgroundCancer and transplant patients with COVID-19 have a higher risk of developing severe and even fatal respiratory diseases, especially as they may be treated with immune-suppressive or immune-stimulating drugs. This review focuses on the effects of these drugs on host immunity against COVID-19.MethodsUsing Ovid MEDLINE, we reviewed current evidence for immune-suppressing or -stimulating drugs: cytotoxic chemotherapy, low-dose steroids, tumour necrosis factorα (TNFα) blockers, interlukin-6 (IL-6) blockade, Janus kinase (JAK) inhibitors, IL-1 blockade, mycophenolate, tacrolimus, anti-CD20 and CTLA4-Ig.Results89 studies were included. Cytotoxic chemotherapy has been shown to be a specific inhibitor for severe acute respiratory syndrome coronavirus in in vitro studies, but no specific studies exist as of yet for COVID-19. No conclusive evidence for or against the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of COVID-19 patients is available, nor is there evidence indicating that TNFα blockade is harmful to patients in the context of COVID-19. COVID-19 has been observed to induce a pro-inflammatory cytokine generation and secretion of cytokines, such as IL-6, but there is no evidence of the beneficial impact of IL-6 inhibitors on the modulation of COVID-19. Although there are potential targets in the JAK-STAT pathway that can be manipulated in treatment for coronaviruses and it is evident that IL-1 is elevated in patients with a coronavirus, there is currently no evidence for a role of these drugs in treatment of COVID-19.ConclusionThe COVID-19 pandemic has led to challenging decision-making about treatment of critically unwell patients. Low-dose prednisolone and tacrolimus may have beneficial impacts on COVID-19. The mycophenolate mofetil picture is less clear, with conflicting data from pre-clinical studies. There is no definitive evidence that specific cytotoxic drugs, low-dose methotrexate for auto-immune disease, NSAIDs, JAK kinase inhibitors or anti-TNFα agents are contraindicated. There is clear evidence that IL-6 peak levels are associated with severity of pulmonary complications.

Port-site metastasis and atypical recurrences after robotic-assisted radical cystectomy (RARC): an updated comprehensive and systematic review of current evidences.

The objective of this systematic review is to evaluate the current evidence regarding atypical metastases in patients undergoing robotic-assisted radical cystectomy (RARC). A review of the current literature was conducted through the Medline and NCBI PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases in October 2019. From the literature search using the cited keys and after a careful evaluation of the full texts, we included 31 articles in the study. Fourteen studies (45.2%) reported at least an atypical recurrence during the follow-up period with a rate between 4 and 40% of all the recurrences. Overall, 105 (1.63%) of the 6720 patients who have been evaluated in the included studies developed an atypical recurrence. Sixty-three (60%) of these atypical metastases were peritoneal carcinomatosis, 16 (15.2%) extrapelvic lymph nodes metastases, 11 (10.5%) port-site metastases, 10 (9.5%) retroperitoneal nodal metastases, while 5 (3.8%) patients developed more than one type of atypical recurrence. In literature, there is a low but not negligible incidence of atypical recurrences after RARC. However, publication bias and retrospective design of most studies could influence the evidences. Further prospective randomized studies are needed to clarify the real risk of patients undergoing RARC to develop atypical metastases.

Two-hole versus four-hole plate dynamic hip screw: a systematic review of current evidence

The dynamic hip screw (DHS) is a common device used in the fixation of hip fractures. Traditionally, this involves the use of a four-hole side plate. Reducing the length of the side plate would theoretically reduce the amount of surgical exposure required, decrease surgery duration, and decrease perioperative morbidity and mortality. Our study aims to review the current evidence regarding the use of two-hole side plates, their use and potential complications. Using PRISMA guidelines, two independent reviewers performed a search to collate the available literature from medical databases PubMed, EMBASE, Web of Science, and the Cochrane library. Only clinical and biochemical studies were included. The reference lists of articles included for full text review were searched for any additional primary or review publications. Four online libraries were searched, with a combined total of 5344 titles reviewed. Following title, abstract, and full text review, 8 articles were considered suitable for inclusion in qualitative analysis. There was a trend towards equal efficiency between two- and four-hole plates when used in stable fractures in terms of blood loss, failure/revision rates, operative and hospital stay durations, collapse loading testing, maximum stress, and fragment migration. The results of this study show that DHS constructs with two- or four-hole side plates have comparable outcomes when used in patients with stable fracture patterns. However, the majority of the clinical data regarding the use of two-hole DHS plates come from retrospective case series; further prospective, randomised control trials would be of significant benefit. Level II; systematic review of all levels of evidence.

Association Between Intra-Hospital Uncontrolled Glycemia and Health Outcomes in Patients with Diabetes: A Systematic Review of Observational Studies.

Many people are still getting affected by uncontrolled glycemic events during hospital admission, which encompasses hypoglycemia, hyperglycemia, and high glycemic variability. Primary studies have shown an association of glycemic dysregulation with increased length of hospital stay and mortality among overall patients, however, there is no systematic review of current evidence on the association between uncontrolled in-hospital glycemia in patients with diabetes and health outcomes. This study aimed to systematically review the current evidence on the association between uncontrolled in-hospital glycemia in patients with diabetes and health outcomes. The association between glycemic dysregulation and health outcomes for inpatients with diabetes was systematically reviewed. PubMed, Embase, and LILACS databases were searched. Two independent reviewers were involved in each of the following steps: screening titles, abstracts, and fulltexts; assessing the methodological quality; and extracting data from included reviews. Descriptive analysis method was used. Seven cohort studies were included, and only two had a prospective design, consisting of 7,174 hospitalized patients with diabetes. In-hospital occurrence of hypoglycemia, hyperglycemia, and glycemic variability were assessed, and outcomes were mortality, infections, renal complications, and adverse events. Among the exposure and outcomes, an association was observed between severe hypoglycemia and mortality, hyperglycemia and infection, and hyperglycemia and adverse events. In-hospital uncontrolled glycemia in patients with diabetes is associated with poor health outcomes. More studies should be conducted for proper investigation because diabetes is a complex condition. Effects of glycemic dysregulation should be investigated on the basis of overall health of a patient instead from only organ-target perspective, which makes the investigation difficult.

Strength Training to Improve Performance in Athletes With Cerebral Palsy: A Systematic Review of Current Evidence.

Fleeton, JRM, Sanders, RH, and Fornusek, C. Strength training to improve performance in athletes with cerebral palsy: A systematic review of current evidence. J Strength Cond Res 34(6): 1774-1789, 2020-Persons with cerebral palsy (CP) can partake in many different forms of organized sport including elite competition at state and international levels. There is limited evidence on how CP athletes should train to enhance performance. The purposes of this article were to conduct a systematic review of the current evidence on ambulatory individuals with CP for (a) strength and functional improvement through strength training; (b) potential sports performance improvement through strength training; (c) the identification of risk and special considerations associated with strength and conditioning for this population, and; (d) the identification of future research foci to educate strength and conditioning coaches on specific program design for elite CP athletes. Seven electronic databases were searched for studies investigating resistance training interventions. The databases were also searched for training interventions or investigations into sports performance in athletes with CP competing at regional level or above. Thirty articles were included in the systematic review of strength training, and 23 articles included in the narrative review of training for sports performance. High-quality evidence indicates that resistance training can improve muscular strength in individuals with CP, with some preliminary evidence of structural and neurological adaptations. However, there is limited evidence for functional improvements. Limited research has examined the performance capacity of athletes with CP, and no training interventions have been conducted. Coaches should employ existing guidelines when designing programs while considering specific athlete limitations. Initially, the focus should be increasing athlete muscular strength before considering specific sport demands.

P.461 Behavioral economics to improve medication adherence in severe mental illness: A systematic review of current evidence

P.461 Behavioral economics to improve medication adherence in severe mental illness: A systematic review of current evidence