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Necrotizing enterocolitis ( NEC ) is one of the most serious gastrointestinal emergencies in very low birth weight ( VLBW ) preterm neonates , affecting 7 - 14 % of these neonates . Due to the seriousness of the disease , prevention of NEC is the most important goal . Current evidence from systematic review and meta- analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates . As per the evidence , prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and /or the stimulation of bifidobacterial growth , decreased stool viscosity , reduced gastrointestinal transit time , and better feed tolerance . Prebiotics may be potential alternatives or adjunctive therapies to probiotics , despite a lack of evidence supporting its clinical efficacy in prevention of NEC . In this article , we discuss evidence -based physiological effects of prebiotics and its therapeutic role in prevention of NEC | [
"ABSTRACT A healthy intestinal microbiota is considered to be important for priming of the infants ' mucosal and systemic immunity . Breast-fed infants typically have an intestinal microbiota dominated by different Bifidobacterium species . It has been described that allergic infants have different levels of sp... | 4115d8f6-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Several clinical trials have investigated the impact of glucomannan on plasma lipids , body weight , fasting blood glucose ( FBG ) , and blood pressure ( BP ) , but have yielded conflicting results and had only modest sample sizes . OBJECTIVE The objective was to perform a meta- analysis of r and omized controlled trials of glucomannan to better characterize its impact on plasma lipids , FBG , body weight , and BP . DESIGN A systematic literature search of MEDLINE , EMBASE , CINAHL , Web of Science , the Cochrane Library , and the Natural Medicines Comprehensive Data base was conducted from the earliest possible date through November 2007 . A r and om-effects model was used to calculate the weighted mean difference ( WMD ) and 95 % CIs as the difference between the mean for the glucomannan and control groups . St and ard methods for assessing statistical heterogeneity and publication bias were used . RESULTS Fourteen studies ( n = 531 ) met the inclusion criteria . The use of glucomannan significantly lowered total cholesterol [ weighted mean difference ( WMD ) : -19.28 mg/dL ; 95 % CI : -24.30 , -14.26 ] , LDL cholesterol ( WMD : -15.99 mg/dL ; 95 % CI : -21.31 , -10.67 ) , triglycerides ( WMD : -11.08 mg/dL ; 95 % CI : -22.07 , -0.09 ) , body weight ( WMD : -0.79 kg ; 95 % CI : -1.53 , -0.05 ) , and FBG ( WMD : -7.44 mg/dL ; 95 % CI : -14.16 , -0.72 ) . The use of glucomannan did not appear to significantly alter any other study endpoints . Pediatric patients , patients receiving dietary modification , and patients with impaired glucose metabolism did not benefit from glucomannan to the same degree . CONCLUSIONS Glucomannan appears to beneficially affect total cholesterol , LDL cholesterol , triglycerides , body weight , and FBG , but not HDL cholesterol or BP | [
"The effects of the soluble fiber konjac glucomannan ( GM ) on serum cholesterol concentrations were investigated in 63 healthy men in a double-blind crossover , placebo-controlled study . After a 2-wk baseline period , the subjects were given 3.9 g GM or placebo daily for 4 wk . After a washout period of... | 4115dbee-06ff-11f0-808a-c43d1ab1c353 |
PURPOSE The goal of this meta- analysis was to determine the clinical utility of acute mountain sickness ( AMS ) history to predict future incidents of AMS . METHOD 17 studies ( n=7921 participants ) were included following a systematic review of the literature . A bivariate r and om-effects model was used to calculate the summary sensitivity and specificity of the diagnostic test , and moderator variables were tested to explain the heterogeneity across studies . The Quality Assessment of Diagnostic Accuracy Studies ( QUADAS-2 ) method was used to assess concerns for bias and applicability for the included studies . RESULTS The history of AMS had a low diagnostic accuracy for the prediction of future AMS incidents : the summary sensitivity was 0.50 ( 95 % CI ( 0.40 to 0.59 ) ) and the summary specificity was 0.72 ( 95 % CI ( 0.66 to 0.78 ) ) . There was significant heterogeneity in the sensitivity and specificity across studies , which we modelled using moderator analysis . Studies that restricted the use of acetazolamide and dexamethasone had not only a higher sensitivity ( 0.66 ) relative to those that did not ( 0.44 ; p=0.03 ) but also an increased false-positive rate ( 0.39 vs 0.23 , p=0.03 ) . The QUADAS-2 analysis showed that AMS histories were insufficiently detailed , and few studies controlled for prophylactic medication use or recent altitude exposure , leading to high risks of bias and concerns for applicability . CONCLUSIONS The use of AMS history to guide prophylactic strategies for high-altitude ascent is not supported by the literature ; however , the low sensitivity and specificity of this diagnostic test could reflect the quality of the available studies . Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history | [
"The aims of this study were 1 ) to evaluate whether subjects suffering from acute mountain sickness ( AMS ) during exposure to high altitude have signs of autonomic dysfunction and 2 ) to verify whether autonomic variables at low altitude may identify subjects who are prone to develop AMS . Forty-one mountainee... | 4115dc8e-06ff-11f0-808a-c43d1ab1c353 |
The purpose of the current study was to clarify the role of the quadriceps tendon ( QT ) autograft for primary ACL reconstruction . Thus , a Bayesian network meta- analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon ( PT ) and hamstring tendon ( HT ) autografts was conducted . This Bayesian network meta- analysis was conducted according to the PRISMA extension statement for reporting systematic review s incorporating network meta-analyses of health care interventions . In January 2020 , the main data bases were accessed . Articles comparing the outcomes of the QT autograft versus HT autograft and /or PT autograft for primary ACL reconstruction were included in the present study . The statistical analysis was performed with STATA Software/MP , through a Bayesian hierarchical r and om-effect model analysis . Data from a total of 2603 knees were analysed . The overall mean follow-up was 35.0 months . Among the different grafts were evidence d comparable values of IKDC , Tegner and Lysholm score . The QT autograft detected comparable rate of Lachman test > 3 mm , Pivot shift test > 3 m and instrumental laxity > 3 mm . The QT autograft showed a lower rate of autograft failure above all . The QT autograft detected the reduced rate of AKP than the PT . Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction . These results must be interpret within the limitations of the present network meta-anlaysis | [
"Abstract . This study documented postoperative morbidity during the first 4 months following anterior cruciate ligament ( ACL ) reconstruction using either patellar tendon or hamstring tendon autograft . Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction w... | 4115dcde-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVES to determine the effect of drugs with anti-cholinergic properties on relevant health outcomes . DESIGN electronic published and unpublished literature /trial registries were systematic ally review ed . Studies evaluating medications with anti-cholinergic activity on cognitive function , delirium , physical function or mortality were eligible . RESULTS forty-six studies including 60,944 participants were included . Seventy-seven percent of included studies evaluating cognitive function ( n = 33 ) reported a significant decline in cognitive ability with increasing anti-cholinergic load ( P delirium and increasing anti-cholinergic drug load ( P > 0.05 ) . Five of the eight included studies reported a decline in physical function in users of anti-cholinergics ( P mortality reported that the use of drugs with anti-cholinergic properties was associated with a trend towards increased mortality , but this was not statistically significant . The method ological quality of the evidence -base ranged from poor to very good . CONCLUSION medicines with anti-cholinergic properties have a significant adverse effect on cognitive and physical function , but limited evidence exists for delirium or mortality outcomes | [
"OBJECTIVES To investigate the effects of darifenacin controlled-release ( CR ) and oxybutynin extended-release ( ER ) on cognitive function ( particularly memory ) in older subjects . METHODS Healthy subjects ( n=150 ) > /=60 years were r and omised to darifenacin , oxybutynin ER or placebo in a multic... | 4115dd2e-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Observational and some experimental data suggest that low intake of vitamin K may be associated with an increased risk of fracture . OBJECTIVE To assess whether oral vitamin K ( phytonadione and menaquinone ) supplementation can reduce bone loss and prevent fractures . DATA SOURCES The search included the following electronic data bases : MEDLINE ( 1966 to June 2005 ) , EMBASE ( 1980 to June 2005 ) , the Cochrane Library ( issue 2 , 2005 ) , the ISI Web of Science ( 1945 to June 2005 ) , the National Research Register ( inception to the present ) , Current Controlled Trials , and the Medical Research Council Research Register . STUDY SELECTION R and omized controlled trials that gave adult participants oral phytonadione and menaquinone supplements for longer than 6 months were included in this review . DATA EXTRACTION Four authors extracted data on changes in bone density and type of fracture . All articles were double screened and double data extracted . DATA SYNTHESIS Thirteen trials were identified with data on bone loss , and 7 reported fracture data . All studies but 1 showed an advantage of phytonadione and menaquinone in reducing bone loss . All 7 trials that reported fracture effects were Japanese and used menaquinone . Pooling the 7 trials with fracture data in a meta- analysis , we found an odds ratio ( OR ) favoring menaquinone of 0.40 ( 95 % confidence interval [ CI ] , 0.25 - 0.65 ) for vertebral fractures , an OR of 0.23 ( 95 % CI , 0.12 - 0.47 ) for hip fractures , and an OR of 0.19 ( 95 % CI , 0.11 - 0.35 ) for all nonvertebral fractures . CONCLUSIONS This systematic review suggests that supplementation with phytonadione and menaquinone-4 reduces bone loss . In the case of the latter , there is a strong effect on incident fractures among Japanese patients | [
"We have recently demonstrated that glucocorticoid ( GC ) suppresses bone formation and enhances bone resorption , with result ant bone loss . This altered bone turnover is not due to the action of parathyroid hormone ( PTH ) , but appears to be related to the suppression of osteoprotegerin ( OPG ) . As vitamin ... | 4115dd74-06ff-11f0-808a-c43d1ab1c353 |
A systematic review of r and omised controlled trials was undertaken to evaluate the effectiveness of workplace interventions to prevent low back pain . Potential trials were located by a computerised search supplemented with citation tracking . The method ological quality of the trials was assessed on 11 criteria and the level of evidence for each intervention was determined , based upon the amount , consistency and quality of evidence from the trials . The review located 13 trials that were generally of moderate quality . The trials suggest that work place exercise is effective , braces and education are ineffective , and workplace modification plus education is of unknown value in preventing low back pain | [
"To compare the use of r and omized controls ( RCTs ) and historical controls ( HCTs ) for clinical trials , we search ed the literature for therapies studied by both methods . We found six therapies for which 50 RCTs and 56 HCTs were reported . Forty-four of 56 HCTs ( 79 percent ) found the therapy bet... | 4115ddb0-06ff-11f0-808a-c43d1ab1c353 |
Maternal obesity is associated with increased risk of pregnancy complications such as gestational diabetes , stillbirth , preterm birth , and congenital malformations . While small studies have looked into the effect of prepregnancy bariatric surgery on gestational diabetes , these studies have been inconclusive and have not considered presurgery body mass index ( BMI ) as a confounder . Some systematic review s have found a lower risk of neonatal complications after bariatric surgery but included heterogeneous studies with small sample sizes . Taking presurgery BMI into account , this study aims to investigate the risks of adverse perinatal outcomes including gestational diabetes in womenwho have had bariatric surgery versus women who have not . This population -based study used data from Swedish registries nationwide , which include prenatal , obstetric , and neonatal records . Of 627,693 singleton pregnancies between 2006 and 2011 , 670 were in women who had undergone bariatric surgery with presurgery weight documented . Up to 5 control pregnancies in obese women were matched for BMI , age , level of education , years , and smoking history for each pregnancy in the intervention cohort . For controls , weight during early pregnancy was used to calculate BMI . For the study group , BMI was calculated with weight and height measurements at the time of surgery . Outcomes included gestational diabetes , low birth weight , macrosomia , stillbirth , large and small-for-gestational-age , preterm birth , neonatal death , and major congenital malformations detected during the first year of life . Gestational diabetes was diagnosed by a 2-hour plasma glucose level of 10.0 mmol/L or higher during a glucose tolerance test ( with a 75-g loading dose ) or a fasting plasma glucose level of 7.0 mmol/L or higher . In the study , 1.9 % of the postsurgery pregnancies versus 6.8 % of the control pregnancies had gestational diabetes ( odds ratio , 0.25 ; 95 % confidence interval [ CI ] , 0.13–0.47 ; P median gestation time of the diagnosis was 32 weeks for both groups , considering women for whom the diagnosis date was available . The surgery cohort , compared with controls , was associated with an increased risk of small-for-gestational-age infants ( 15.6 % vs 7.6 % ; odds ratio , 2.20 ; 95 % Health , Inc. All rights reserved . 376 Obstetrical and Gynecological Survey CI , 1.64–2.95;P for low birth weight , although that was not statistically significant ( 6.8 % vs 4.5 % ; odds ratio , 1.34 ; 95 % CI , 0.88–2.04 ; P = 0.17 ) . Alternatively , the surgery group had a lower risk for large-for-gestational-age infants compared with the control group ( 8.6 % vs 22.4 % ; odds ratio , 0.33 ; 95 % CI , 0.24–0.44 ; P lower risk of macrosomia ( 1.2 % vs 9.5 % ; odds ratio , 0.11 ; 95 % CI , 0.05–0.24 ; P of risk of preterm birth ( 10.0 % vs 7.5 % ; odds ratio , 1.28 ; 95 % CI , 0.92–1.78 ; P = 0.15 ) , nor in terms of congenital malformations . One limitation of this study was that nearly all ( 98 % ) of the surgery procedures were gastric bypass surgery , so it is not clear as to whether these findings apply to other types of bariatric surgery . While the study found that bariatric surgery was associated with reduced risks of large-for-gestational-age infants as well as gestational diabetes , bariatric surgery was also associated with increased odds of small-for-gestational age infants , so increased attention during these pregnancies is recommended | [
"IMPORTANCE Short-term studies show that bariatric surgery causes remission of diabetes . The long-term outcomes for remission and diabetes-related complications are not known . OBJECTIVES To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diab... | 4115ddec-06ff-11f0-808a-c43d1ab1c353 |
Background . A number of studies have computed the minimally important difference ( MID ) for health-related quality of life instruments . Objective . To determine whether there is consistency in the magnitude of MID estimates from different instruments . Methods . We conducted a systematic review of the literature to identify studies that computed an MID and contained sufficient information to compute an effect size ( ES ) . Thirty-eight studies fulfilled the criteria , result ing in 62 ESs . Results . For all but 6 studies , the MID estimates were close to one half a SD ( mean = 0.495 , SD = 0.155 ) . There was no consistent relationship with factors such as disease-specific or generic instrument or the number of response options . Negative changes were not associated with larger ESs . Population -based estimation procedures and brief follow-up were associated with smaller ESs , and acute conditions with larger ESs . An explanation for this consistency is that research in psychology has shown that the limit of people ’s ability to discriminate over a wide range of tasks is approximately 1 part in 7 , which is very close to half a SD . Conclusion . In most circumstances , the threshold of discrimination for changes in health-related quality of life for chronic diseases appears to be approximately half a SD | [
"BACKGROUND There is some evidence that quality of life ( QOL ) in patients with chronic obstructive pulmonary disease ( COPD ) may predict clinical outcomes and use of re sources . This study examined whether QOL scores could prospect ively predict re-admission for COPD or death within 12 months of an origin... | 4115de32-06ff-11f0-808a-c43d1ab1c353 |
Many aspects of long-term pharmacological treatments for anxiety disorders ( AnxDs ) are still debated . We undertook an up date d systematic review of long-term pharmacological studies on panic disorder ( PD ) , generalized anxiety disorder ( GAD ) , and social anxiety disorder ( SAD ) . Relevant studies dating from January 1 , 2012 to August 31 , 2015 were identified using the PubMed data base and a review of bibliographies . Of 372 records identified in the search , five studies on PD and 15 on GAD were included in the review . No studies on SAD were found . Our review confirms the usefulness of long-term pharmacological treatments for PD and GAD and suggests that they can provide further improvement over that obtained during short-term therapy . Paroxetine , escitalopram , and clonazepam can be effective for long-term treatment of PD . However , further studies are needed to draw conclusions about the long-term benzodiazepine use in PD , particularly for the possible cognitive side-effects over time . Pregabalin and quetiapine can be effective for long-term treatment of GAD , while preliminary suggestions emerged for agomelatine and vortioxetine . We did not find any evidence for determining the optimal length and /or dosage of medications to minimize the relapse risk . Few investigations have attempted to identify potential predictors of long-term treatment response . Personalized treatments for AnxDs can be implemented using predictive tools to explore those factors affecting treatment response/tolerability heterogeneity , including neurobiological functions/ clinical profiles , comorbidity , biomarkers , and genetic features , and to tailor medications according to each patient ’s unique features | [
"Abstract This long-term extension of an 8-week r and omized , naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam ( n = 47 ) and paroxetine ( n = 37 ) over a 3-year total treatment duration . Target doses for all patients were 2 ... | 4115de6e-06ff-11f0-808a-c43d1ab1c353 |
This study aim ed to investigate whether atrial fibrillation ( AF ) predicts myocardial infa rct ion ( MI ) or cardiovascular ( CV ) death . AF is a well-established risk factor for thrombotic stroke and all-cause mortality . PubMed , EmBase , and Cochrane Central were search ed for articles comparing the incidence rates of MI , CV death , or CV events between AF and non-AF patients . Relative risk ratio ( RR ) was used as effect estimate . Crude and adjusted RRs were calculated . Data were pooled using a r and om-effects model . The meta- analysis included 27 studies . In the unadjusted analysis , AF patients had a nonsignificant trend toward a higher risk of MI compared with non-AF patients ; however , a significant association was found . The crude data analysis showed that AF was associated with increased risk of CV death ( P CV events ( P < 0.05 ) . These associations remained significant after pooling data from adjusted models ( CV death : RR = 1.95 , 95 % CI 1.51–2.51 , P < 0.05 ; CV events : RR = 2.10 , 95 % CI 1.50–2.95 , P < 0.05 ) . These results showed that AF is an independent risk factor for MI , CV death , and CV events | [
"Aim Anticoagulation prophylaxis for stroke is recommended for at-risk patients with either persistent or paroxysmal atrial fibrillation ( AF ) . We compared outcomes in patients with persistent vs. paroxysmal AF receiving oral anticoagulation . Methods and results Patients r and omized in the Rivaroxaban Onc... | 4115deb4-06ff-11f0-808a-c43d1ab1c353 |
Background Many interventions delivered to improve health may benefit not only direct recipients but also people in close physical or social proximity . Our objective was to review all published literature about the spillover effects of interventions on health outcomes in low-middle income countries and to identify methods used in estimating these effects . Methods We search ed 19 electronic data bases for articles published before 2014 and h and - search ed titles from 2010 to 2013 in five relevant journals . We adapted the Cochrane Collaboration 's quality grading tool for spillover estimation and rated the quality of evidence . Results A total of 54 studies met inclusion criteria . We found a wide range of terminology used to describe spillovers , a lack of st and ardization among spillover methods and poor reporting of spillovers in many studies . We identified three primary mechanisms of spillovers : reduced disease transmission , social proximity and substitution of re sources within households . We found the strongest evidence for spillovers through reduced disease transmission , particularly vaccines and mass drug administration . In general , the proportion of a population receiving an intervention was associated with improved health . Most studies were of moderate or low quality . We found evidence of publication bias for certain spillover estimates but not for total or direct effects . To facilitate improved reporting and st and ardization in future studies , we developed a reporting checklist adapted from the CONSORT framework specific to reporting spillover effects . Conclusions We found the strongest evidence for spillovers from vaccines and mass drug administration to control infectious disease . There was little high quality evidence of spillovers for other interventions | [
"Vaccination of one person may prevent the infection of another either because the vaccine prevents the first from being infected and from infecting the second , or because , even if the first person is infected , the vaccine may render the infection less infectious . We might refer to the first of these mechanis... | 4115def0-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Information technology-based interventions are increasingly being used to manage health care . However , there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes . OBJECTIVE The objective of this study was to conduct a systematic review and meta- analysis of clinical trials , assessing the impact of information technology on changes in the levels of hemoglobin A1c ( HbA1c ) and mapping the interventions with chronic care model ( CCM ) elements . METHODS Electronic data bases PubMed and EMBASE were search ed to identify relevant studies that were published up until July 2016 , a method that was supplemented by identifying articles from the references of the articles already selected using the electronic search tools . The study search and selection were performed by independent review ers . Of the 1082 articles retrieved , 32 trials ( focusing on a total of 40,454 patients ) were included . A r and om-effects model was applied to estimate the pooled results . RESULTS Information technology-based interventions were associated with a statistically significant reduction in HbA1c levels ( mean difference -0.33 % , 95 % CI -0.40 to -0.26 , P HbA1c ( 0.50 % ) , followed by those with electronic medical records ( 0.17 % ) , an electronic decision support system ( 0.15 % ) , and a diabetes registry ( 0.05 % ) . In addition , the more CCM-incorporated the information technology-based interventions were , the more improvements there were in HbA1c levels . CONCLUSIONS Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes . No clinical ly relevant impact was observed on low-density lipoprotein levels and blood pressure , but there was evidence that the cost of care was lower | [
"Sustained improvement in blood glucose control is the only treatment outcome which will reduce or eliminate the long term complications of diabetes mellitus . We have design ed and evaluated an electronic information system which facilitates this task . The system is voice-interactive , physician directed an... | 4115df36-06ff-11f0-808a-c43d1ab1c353 |
IMPORTANCE OF THE FIELD Cobalamin ( vitamin B12 ) deficiency is particularly common in the elderly ( > 15 % ) . Management of cobalamin deficiency with cobalamin injections is well codified at present , but new routes of cobalamin administration ( oral and nasal ) are being studied , especially oral cobalamin therapy for food-cobalamin malabsorption . AREAS COVERED IN THIS REVIEW The objective of this review is to evaluate the efficacy of oral cobalamin treatment in elderly patients . To reach this objective , PubMed data were systematic ally search ed for English and French articles published from January 1990 to July 2008 . Data from our research group on cobalamin deficiency ( Groupe d'Etude des CAREnce vitamine B12 - CARE B12 ) were also analyzed . WHAT THE READER WILL GAIN Three prospect i ve r and omized studies , a systematic review by the Cochrane group and five prospect i ve cohort studies were found and provide evidence that oral cobalamin treatment may adequately treat cobalamin deficiency . The efficacy was particularly highlighted when looking at the marked improvement in serum vitamin B12 levels and hematological parameters , for example hemoglobin level , mean erythrocyte cell volume and reticulocyte count . The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented . Oral cobalamin treatment avoids the discomfort , inconvenience and cost of monthly injections . TAKE HOME MESSAGE Our experience and the present analysis support the use of oral cobalamin therapy in clinical practice | [
"BACKGROUND The st and ard treatment for cobalamin ( vitamin B(12 ) ) deficiency involves regular intramuscular cobalamin injection . It has been suggested that oral cobalamin therapy may be effective for treating patients who have food-cobalamin malabsorption . SUBJECTS AND METHODS We prospect ively studied ... | 4115df72-06ff-11f0-808a-c43d1ab1c353 |
The purpose of this article is to disseminate the st and ard of antiemetic therapy for Japanese clinical oncologists . On the basis of the Appraisal of Guidelines for Research and Evaluation II instrument , which reflects evidence -based clinical practice guidelines , a working group of the Japanese Society of Clinical Oncology ( JSCO ) review ed clinical practice guidelines for antiemesis and performed a systematic review of evidence -based domestic practice guidelines for antiemetic therapy in Japan . In addition , because health-insurance systems in Japan are different from those in other countries , a consensus was reached regarding st and ard treatments for chemotherapy that induce nausea and vomiting . Current evidence was collected by use of MEDLINE , from material s from meetings of the American Society of Clinical Oncology National Comprehensive Cancer Network , and from European Society of Medical Oncology/Multinational Association of Supportive Care in Cancer guidelines for antiemesis . Initially , 21 clinical questions ( CQ ) were selected on the basis of CQs from other guidelines . Patients treated with highly emetic agents should receive a serotonin ( 5-hydroxytryptamine ; 5HT3 ) receptor antagonist , dexamethasone , and a neurokinin 1 receptor antagonist . For patients with moderate emetic risk , 5HT3 receptor antagonists and dexamethasone were recommended , whereas for those receiving chemotherapy with low emetic risk dexamethasone only is recommended . Patients receiving high-emetic-risk radiation therapy should also receive a 5HT3 receptor antagonist . In this paper the 2010 JSCO clinical practice guidelines for antiemesis are presented in English ; they reveal high concordance of Japanese medical circumstances with other antiemetic guidelines that are similarly based on evidence | [
"PURPOSE AND METHODS Although a high prevalence of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy ( CT ) has been reported , little has been done to develop strategies to prevent these problems . A double-blind , placebo-controlled study was therefore design ed to assess the u... | 4115dfb8-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Necrotizing enterocolitis ( NEC ) is the most common emergency involving the gastrointestinal tract occurring in the neonatal period . There have been published reports that suggest that oral immunoglobulins (Ig)A and IgG produce an immunoprotective effect in the gastrointestinal mucosa . OBJECTIVES To determine the effect of oral immunoglobulin on the incidence of necrotizing enterocolitis and other complications in preterm or low birth weight ( or both ) neonates . SEARCH METHODS We used the st and ard search strategy of the Cochrane Neonatal Group . We search ed the Cochrane Central Register of Controlled Trials ( CENTRAL , The Cochrane Library 2016 , Issue 1 ) , PubMed ( 1966 to January 2016 ) , CINAHL ( 1982 to January 2016 ) and EMBASE ( 1980 to January 2016 ) and conference proceedings . SELECTION CRITERIA All r and omized or quasi-r and omised controlled trials where oral immunoglobulins were used as prophylaxis against NEC in preterm ( less than 37 weeks ' gestation ) or low birth weight ( less than 2500 gram ) , or both , neonates . DATA COLLECTION AND ANALYSIS We performed data collection and analysis in accordance with the st and ard methods of the Cochrane Neonatal Review Group . MAIN RESULTS The search identified five studies on oral immunoglobulin for the prevention of NEC of which three met the inclusion criteria . In this review of the three eligible trials ( including 2095 neonates ) , the oral administration of IgG or an IgG/IgA combination did not result in a significant reduction in the incidence of definite NEC ( typical risk ratio ( RR ) 0.84 , 95 % confidence interval ( CI ) 0.57 to 1.25 ; typical risk difference ( RD ) -0.01 , 95 % CI -0.03 to 0.01 ; 3 studies , 1840 infants ) , suspected NEC ( RR 0.84 , 95 % CI 0.49 to 1.46 ; RD -0.01 , 95 % CI -0.02 to 0.01 ; 1 study , 1529 infants ) , need for surgery ( typical RR 0.21 , 95 % CI 0.02 to 1.75 ; typical RD -0.03 , 95 % CI -0.06 to 0.00 ; 2 studies , 311 infants ) or death from NEC ( typical RR 1.10 , 95 % CI 0.47 to 2.59 ; typical RD 0.00 , 95 % CI -0.01 to 0.01 ; 3 studies , 1840 infants ) . AUTHORS ' CONCLUSIONS Based on the available trials , the evidence does not support the administration of oral immunoglobulin for the prevention of NEC . There are no r and omized controlled trials of oral IgA alone for the prevention of NEC | [
"In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failur... | 4115dffe-06ff-11f0-808a-c43d1ab1c353 |
Summary A systematic review was conducted to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women . Evidence available indicates that such interventions are effective in improving the quality of life , medication compliance , and calcium intake , but effect on other outcomes is less conclusive . Introduction The purpose of this study is to conduct a systematic review to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women . Methods R and omized controlled trials ( RCTs ) published in English between year 1990 and 2009 were identified . Types of patient outcome used as assessment included quality of life ( QOL ) , bone mineral density ( BMD ) , medication compliance and persistence , knowledge level , and lifestyle modification . Results Twenty four RCTs met the inclusion criteria . Seven studies assessed interventions by physiotherapists , six by physicians , seven by nurses , three by multi-disciplinary teams and one by dietitians . Variability in the types and intensity of interventions made comparison between each study difficult . Collectively , these studies provided some evidence to show that interventions by healthcare professionals improved the QOL medication compliance and calcium intake of patients but its effects on BMD , medication persistence , knowledge , and other lifestyle modifications were less conclusive . Conclusions From this review , it was found that some outcome measures of such non-drug interventions still required further studies . Future studies should use vali date d instruments to assess the outcomes , with focus on common definitions of interventions and outcome measures , more intensive one-to-one interventions , appropriate control groups , adequate r and omization procedures , and also provide information on effect size | [
"Abstract : The aim of this placebo-controlled , r and omized , single-masked study was to establish the effects of a 10-week ambulatory exercise programme for osteoporotic patients on pain , use of analgesics , functional status , quality of life , balance and muscle strength . Fifty-three ambulatory post... | 4115e03a-06ff-11f0-808a-c43d1ab1c353 |
Background Much research has been undertaken to establish the important benefits of physical activity in persons with multiple sclerosis ( MS ) . There is disagreement regarding the strength of this research , perhaps because the majority of studies on physical activity and its benefits have not undergone initial and systematic feasibility testing . We aim to address the feasibility processes that have been examined within the context of physical activity interventions in MS . Method A systematic scoping review was conducted based on a literature search of five data bases to identify feasibility processes described in preliminary studies of physical activity in MS . We read and extracted methodology from each study based on the following feasibility metrics : process ( e.g. recruitment ) , re source ( e.g. monetary costs ) , management ( e.g. personnel time requirements ) and scientific outcomes ( e.g. clinical /participant reported outcome measures ) . We illustrate the use of the four feasibility metrics within a r and omised controlled trial of a home-based exercise intervention in persons with MS . Results Twenty-five studies were identified . Re source feasibility ( e.g. time and re sources ) and scientific outcomes feasibility ( e.g. clinical outcomes ) method ologies were applied and described in many studies ; however , these metrics have not been systematic ally addressed . Metrics related to process feasibility ( e.g. recruitment ) and management feasibility ( e.g. human and data management ) are not well described within the literature . Our case study successfully enabled us to address the four feasibility metrics , and we provide new information on management feasibility ( i.e. estimate data completeness and estimate data entry ) and scientific outcomes feasibility ( i.e. determining data collection material s appropriateness ) . Conclusion Our review highlights the existing research and provides a case study which assesses important metrics of study feasibility . This review serves as a clarion call for feasibility trials that will substantially strengthen the foundation of research on exercise in MS | [
"Pilot studies for phase III trials - which are comparative r and omized trials design ed to provide preliminary evidence on the clinical efficacy of a drug or intervention - are routinely performed in many clinical areas . Also commonly know as \" feasibility \" or \" vanguard \" studies , they are design ed to ... | 4115e076-06ff-11f0-808a-c43d1ab1c353 |
Background Neck and shoulder disorders may be linked to the presence of myofascial trigger points ( MTrPs ) . These disorders can significantly impact a person ’s activities of daily living and ability to work . MTrPs can be involved with pain sensitization , contributing to acute or chronic neck and shoulder musculoskeletal disorders . The aim of this review was to synthesis e evidence on the prevalence of active and latent MTrPs in subjects with neck and shoulder disorders . Methods We conducted an electronic search in five data bases . Five independent review ers selected observational studies assessing the prevalence of MTrPs ( active or latent ) in participants with neck or shoulder disorders . Two review ers assessed risk of bias using a modified Downs and Black checklist . Subject characteristics and prevalence of active and latent MTrPs in relevant muscles was extracted from included studies . Results Seven articles study ing different conditions met the inclusion criteria . The prevalence of MTrPs was compared and analysed . All studies had low method ologic quality due to small sample sizes , lack of control groups and blinding . Findings revealed that active and latent MTrPs were prevalent throughout all disorders , however , latent MTrPs did not consistently have a higher prevalence compared to healthy controls . Conclusions We found limited evidence supporting the high prevalence of active and latent MTrPs in patients with neck or shoulder disorders . Point prevalence estimates of MTrPs were based on a small number of studies with very low sample sizes and with design limitations that increased risk of bias within included studies . Future studies , with low risk of bias and large sample sizes may impact on current evidence | [
"The aim of this case series was to investigate changes in pain and pressure pain sensitivity after manual treatment of active trigger points ( TrPs ) in the shoulder muscles in individuals with unilateral shoulder impingement . Twelve patients ( 7 men , 5 women , age : 25 ± 9 years ) diagnosed with unilateral... | 4115e0b2-06ff-11f0-808a-c43d1ab1c353 |
Background Resistant starch ( RS ) is a starch that can be fermented by the microbial flora within gut lumen . Insulin resistance ( IR ) is a pathophysiological condition related to diabetes and obesity . RS could reduce blood glucose and ameliorate IR in animals , but its effect in human population is controversial . Objective The authors conducted a systematic literature review to evaluate the effect of RS diet supplement on ameliorating IR in patients with T2DM and simple obesity . Methods Data bases that supplemented with RS in ameliorating IR in T2DM and simple obesity were queried for studies on or before August 15 , 2018 . Parameters including fasting insulin , fasting glucose , body mass index ( BMI ) , homeostatic model assessment ( HOMA ) etc . were extracted from studies to systemically evaluate effects of RS . Results The data base search yielded 14 parallel or crossover studies that met the inclusion criteria . The results indicated that there was no significant difference in the amelioration of BMI , HOMA-%S and HOMA-%B in T2DM patients between RS and the non-RS supplementation . However , the fasting blood glucose , fasting insulin and HOMA-IR in T2DM with obesity who supplemented RS were lower than control group , and the subgroup analysis according to the dose of RS supplementation was inconsistency . There was no significant difference between RS and non-RS supplements in patients with simple obesity . Conclusion RS supplementation can ameliorate IR in T2DM , especially for the patients of T2DM with obesity , but not in simple obesity | [
"Background High-amylose maize resistant starch type 2 ( HAM-RS2 ) stimulates gut-derived satiety peptides and reduces adiposity in animals . Human studies have not supported these findings despite improvements in glucose homeostasis and insulin sensitivity after HAM-RS2 intake which can lower adiposity-relat... | 4115e0f8-06ff-11f0-808a-c43d1ab1c353 |
Animal and human observational studies suggest that iron deficiency impairs physical exercise performance , but findings from r and omized trials on the effects of iron are equivocal . Iron deficiency and anemia are especially common in women of reproductive age ( WRA ) . Clear evidence of benefit from iron supplementation would inform clinical and public health guidelines . Therefore , we performed a systematic review and meta- analysis to determine the effect of iron supplementation compared with control on exercise performance in WRA . We search ed the Cochrane Central Register of Clinical Trials , MEDLINE , Scopus ( comprising Embase and MEDLINE ) , WHO regional data bases , and other sources in July 2013 . R and omized controlled trials that measured exercise outcomes in WRA r and omized to daily oral iron supplementation vs. control were eligible . R and om-effects meta- analysis was used to calculate mean differences ( MDs ) and st and ardized MDs ( SMDs ) . Risk of bias was assessed using the Cochrane risk-of-bias tool . Of 6757 titles screened , 24 eligible studies were identified , 22 of which contained extractable data . Only 3 studies were at overall low risk of bias . Iron supplementation improved both maximal exercise performance , demonstrated by an increase in maximal oxygen consumption ( VO2 max ) [ for relative VO2 max , MD : 2.35 mL/(kg ⋅ min ) ; 95 % CI : 0.82 , 3.88 ; P = 0.003 , 18 studies ; for absolute VO2 max , MD : 0.11 L/min ; 95 % CI : 0.03 , 0.20 ; P = 0.01 , 9 studies ; for overall VO2 max , SMD : 0.37 ; 95 % CI : 0.11 , 0.62 ; P = 0.005 , 20 studies ] , and submaximal exercise performance , demonstrated by a lower heart rate ( MD : -4.05 beats per minute ; 95 % CI : -7.25 , -0.85 ; P = 0.01 , 6 studies ) and proportion of VO2 max ( MD : -2.68 % ; 95 % CI : -4.94 , -0.41 ; P = 0.02 , 6 studies ) required to achieve defined workloads . Daily iron supplementation significantly improves maximal and submaximal exercise performance in WRA , providing a rationale to prevent and treat iron deficiency in this group . This trial was registered with PROSPERO ( http://www.crd.york.ac.uk/ PROSPERO / prospero .asp ) as CRD42013005166 | [
"Our objective was to investigate the effects of iron depletion on adaptation to aerobic exercise , assessed by time to complete a 15-km cycle ergometer test . Forty-two iron-depleted ( serum ferritin 12 g/dl ) women ( 18 - 33 yr old ) received 100 mg of ferrous sulfate ( S ) or placebo ( P ) per day for 6 wk ... | 4115e134-06ff-11f0-808a-c43d1ab1c353 |
CONTEXT AND OBJECTIVE A growing body of literature suggests that mindfulness techniques may be beneficial in fibromyalgia . A recent systematic review and meta- analysis of six trials indicated improvement in depressive symptoms and quality of life , calling for increased rigor and use of st and ardized measures in future trials . The purpose of the study was to examine the relationship between mindfulness [ as measured by the Five Facet Mindfulness Question naire ( FFMQ ) ] and fibromyalgia impact [ as measured by the Revised Fibromyalgia Impact Question naire ( FIQR ) ] . DESIGN , SETTING , AND PARTICIPANTS A cross-sectional survey was conducted with adults diagnosed with fibromyalgia from a national fibromyalgia advocacy foundation e-mail list . RESULTS A total of 4986 respondents represented all 50 states in the United States and 30 countries . FIQR scores demonstrated moderate to severe fibromyalgia with the majority of subjects ( 59 % ) scoring ≤60 . Scores on the FFMQ subscales ranged from 20.8 to 27.3 , with highest scores for the observe subscale . All subscale correlations were small to moderate and indicated that more severe fibromyalgia impact was associated with less mindfulness except in the observe scale ( r = .15 , P > .000 ) . No clinical or demographics explained as much variance in the FIQR total as any of the mindfulness subscales . CONCLUSIONS Fibromyalgia patients experience symptoms that may be alleviated by mindfulness interventions . Baseline values for the observe subscale of the FFMQ were unexpectedly high . Further research is needed to know if this may be due to non-mindful observations and should be noted when the FFMQ is used in fibromyalgia clinical trials | [
"Objectives : Published preliminary findings from a r and omized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms , functional deficits , and coping abilities in fibromyalgia . The primary aims of this study were to evaluate the same intervention ’s ... | 4115e170-06ff-11f0-808a-c43d1ab1c353 |
Academic improvement is amongst the most common treatment targets when prescribing stimulants to children with ADHD . Previous review s on stimulant-related academic improvements are inconclusive and focus on task engagement . Recent literature suggests outcome -domain-specific medication effects that are larger for productivity than for accuracy . The aims of this study are quantifying methylpheni date effects on academic productivity and accuracy for math , reading , spelling ; exploring the mediating or moderating effects of symptom improvements , demographic- , design - and disorder-related variables . PubMed , EMBASE , ERIC and PsycINFO were search ed for articles reporting methylpheni date effects on academic productivity and accuracy . Thirty-four studies met entry criteria . Methylpheni date improved math productivity ( 7.8 % increase , p math accuracy ( 3.0 % increase , p = .001 ) ; increased reading speed ( SMD .47 , p reading accuracy . None of the mediators or moderators tested affected methylpheni date efficacy . Academic improvements were small compared to symptom improvements ; qualitative changes limited to math . Clinicians should take this discrepancy into account when prescribing medication for ADHD | [
"Objective : Stimulant medications , such as methylpheni date ( MPH ) , improve the academic performance of children with attention-deficit hyperactivity disorder ( ADHD ) . However , the mechanism by which MPH exerts an effect on academic performance is unclear . We examined MPH effects on math performance... | 4115e1ac-06ff-11f0-808a-c43d1ab1c353 |
Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency . Hence , long-term estrogen replacement therapy is the cornerstone treatment . The estimates of its effect and optimal use , however , remain uncertain . We aim ed to summarize the benefits and harms of estrogen replacement therapy on bone , cardiovascular , vasomotor and quality of life outcomes in patients with Turner syndrome . A comprehensive search of four data bases was performed from inception through January 2016 . R and omized clinical trials and observational cohort studies study ing the effect of estrogen replacement therapy in patients with Turner syndrome under the age of 40 were included . Independently and in duplicate review ers selected studies , extracted data and assessed risk of bias . Subgroup analyses were based on route of administration and type of estrogen formulation . Twenty-five studies at moderate to high risk of bias ( 12 r and omized trials , 13 cohort studies ) with 771 patients were included . Using r and om-effects models , estrogen replacement therapy showed an increase in bone mineral density [ weighted mean change from baseline 0.09 g/cm2 ( 0.04–0.14 ) ] that differed by type of estrogen but not route of administration . Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [ weighted mean difference 9.33 mg/dl ( 4.82–13.85 ) ] with no significant effect on other lipid fractions . The current evidence suggests possible benefit of estrogen replacement therapy on bone mineral density and high density lipoprotein cholesterol . Whether this improvement translates into changes in patient important outcomes ( cardiovascular events or fractures ) remains uncertain . Larger r and omized clinical trials with direct comparisons on patient important outcomes are necessary | [
"A population -based cohort study was done to estimate the incidence of different types of injuries and to evaluate certain risk factors in an urban slum ; 4333 slum dwellers in Madras city in India were r and omly selected by cluster sampling , of whom 1.7 per cent were lost during the 12 months of f... | 4115e1f2-06ff-11f0-808a-c43d1ab1c353 |
Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . Setting General practice and other primary care facilities . Participants Adults ( > 18 years ) with a subacute ( ≤3-month ) non-malignant pain condition . Eligibility criteria were cohort studies investigating the prediction of disability or long-term sick leave in adults with a subacute pain condition in a primary care setting . 19 studies were included , referring to a total of 6266 patients suffering from pain in the head , neck , back and shoulders . Primary and secondary outcome measures The primary outcome was long-term disability ( > 3 months ) due to a pain condition . The secondary outcome was sick leave , defined as ‘ absence from work ’ or ‘ return-to-work ’ . Results PubMed , EMBASE , CINAHL and PEDro data bases were search ed from 16 January 2003 to 16 January 2014 . The quality of evidence was presented according to the GRADE WG recommendations . Several factors were found to be associated with disability at follow-up for at least two different pain symptoms . However , owing to insufficient studies , no generic risk factors for sick leave were identified . Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites . There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . Quality of evidence was moderate , low or very low , implying that confidence in the results is limited . Large prospect i ve prognostic factor studies are needed with sufficient study population s and transparent reporting of all factors examined . Trial registration number CRD42014008914 | [
"& NA ; A series of health surveys are conducted every sixth to seventh year in Denmark . In the most recent survey of 2000 , a national r and om sample ( > 16 years ) was drawn from the Danish Central Personal Register . Out of the original sample 12,333 ( 74 % ) were interviewed and of these 10,066 retur... | 4115e22e-06ff-11f0-808a-c43d1ab1c353 |
This systematic review examines and compares the bone mineral changes in children and adolescents , as measured by dual energy x ray absorptiometry , reported in exercise intervention studies . The effects of hormonal factors and growth on bone mineral change during puberty are examined , and the possibility of a critical period during which bone is especially adaptable to exercise is discussed | [
"This paper examines structured opportunities for student physical activity in Ontario elementary and secondary schools . R and om sample s of elementary and secondary schools were selected , and telephone surveys of 353 elementary and 360 secondary school personnel were conducted in 1998 . The findings i... | 4115e26a-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists . Static and awkward working postures are considered as major risk factors . Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits . The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . METHODS The review was conducted according to the PRISMA guidelines . The review protocol was registered with PROSPERO ( CRD42017058580 ) . The Medline via Ovid , CINHAL via EBSCO , Web of Science , OpenGrey and EThOS electronic data bases were search ed . Prospect i ve experimental studies were considered for inclusion . The Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) was used to assess the method ological quality of the included studies . RESULTS Eight studies were included in the review . Four investigated the effect of loupes on posture and musculoskeletal pain , 4 the effect of the saddle seats on posture and one of the latter explored the combined effect of magnification and use of saddle seats on posture . CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures . The use of loupes appears to relieve shoulder , arm and h and pain . However , their effect on neck pain is scarce . None of the studies reported on the effect of the saddle seats on musculoskeletal pain . Future well-powered prospect i ve longitudinal studies are deemed necessary to confirm the conclusions of this review | [
"The chair-side work posture of dental hygienists has long been a concern because of health-related problems potentially caused or exacerbated by poor posture . The purpose of this study was to investigate if using magnification loupes improved dental hygiene students ' posture during provision of treatment . T... | 4115e2b0-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . METHODS One hundred and fifteen publications were identified through an electronic and manual search and 20 of those studies were chosen based on the inclusion criteria : r and omized clinical trials , systematic review s or meta-analyses whose objective was to analyse the effect of mud pack therapy on perceived pain , function and quality of life , with a sample size of ≥20 subjects , published since 2000 and showing conclusive results . RESULTS In the studies that met the inclusion criteria , 12 analyse functionality , 17 perceived pain , 5 quality of life and all showed a significant improvement in the three analysed variables . The method ological quality of the studies had a moderate risk of bias . CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . Studies with better methodology are needed to prove its scope | [
"Several authors have demonstrated the pivotal role of proinflammatory cytokines in inducing progressive cartilage degradation and secondary inflammation of the synovial membrane in osteoarthritis ( OA ) . It has recently been established that tumor necrosis factor (TNF)-alpha plays a well-defined role in the p... | 4115e2f6-06ff-11f0-808a-c43d1ab1c353 |
Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate . The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . A comprehensive review of r and omized controlled trials ( RCTs ) evaluating the use of anticonvulsants for the treatment of acute bipolar depression up to June 2011 was conducted by means of the PubMed - Medline data base . Eligibility criteria included active comparator-controlled or placebo-controlled r and omized studies involving monotherapy or combination therapy . A total of 18 RCTs fulfilled the inclusion criteria . Studies supported the efficacy of divalproex as monotherapy in acute bipolar depression but small sample size was a common method ological limitation . Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect . Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant . All anticonvulsants were generally well tolerated . No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression . To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . However , available data for most other anticonvulsants are inconclusive and further RCTs with larger sample sizes are needed before drawing firm conclusions | [
"There is a pressing need for additional treatment options for refractory mood disorders . This controlled comparative study evaluated the efficacy of lamotrigine ( LTG ) and gabapentin ( GBP ) monotherapy versus placebo ( PLC ) . Thirty-one patients with refractory bipolar and unipolar mood disorders partic... | 4115e332-06ff-11f0-808a-c43d1ab1c353 |
Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities . This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota . Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists . Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . Data sources PRISMA guidelines ensured transparent reporting of evidence . PICOS criteria defined the research question for the systematic review . A systematic keyword search in PubMed and EMBASE identified 25 studies : 9 assessed prebiotic , 11 assessed probiotic , and 7 assessed symbiotic therapies for a total of 1309 patients . Data extraction Basic population characteristics , the primary variables of aspartate aminotransferase ( AST ) and alanine aminotransferase ( ALT ) ( utilized for NAFLD diagnosis ) , and the secondary variables of body mass index ( BMI ) , gamma-glutamyl transferase ( γ-GT ) , tumor necrosis factor alpha ( TNF-α ) , C-reactive protein ( CRP ) , total cholesterol , high-density lipoprotein cholesterol ( HDL-c ) , low-density lipoprotein cholesterol ( LDL-c ) , and triglyceridges ( TAG ) were extracted . Pooled effect sizes of these variables were calculated by meta- analysis . No publication bias was identified using Begg 's and Egger 's tests or Cochrane bias assessment tool . Results Meta- analysis indicated that microbial therapies significantly reduced BMI ( -0.37 kg/m2 ; 95 % confidence interval [ CI ] , -0.46 to -0.28 ; P 0.001 ) , hepatic enzymes ( ALT , -6.9 U/L [ 95%CI , -9.4 to -4.3 ] ; AST , -4.6 U/L [ 95%CI , -6.6 to -2.7 ] ; γ-GT , -7.9 U/L [ 95%CI , -11.4 to -4.4 ] ; P ( -10.1 mg/dL 95%CI , -13.6 to -6.6 ; P ( -4.5 mg/dL ; 95%CI , -8.9 to -0.17 ; P TAG ( -10.1 mg/dL ; 95%CI , -18.0 to -2.3 ; P , but not inflammation ( TNF-α , -2.0 ng/mL ; [ 95%CI , -4.7 to 0.61 ] ; CRP , -0.74 mg/L [ 95%CI , -1.9 to 0.37 ] ) . Subgroup analysis by treatment category indicated similar effects of prebiotics and probiotics on BMI and liver enzymes but not total cholesterol , HDL-c , and LDL-c . Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . Further research into these treatments should consider the limitations of biomarkers currently used for the diagnosis and progression of NAFLD , in addition to the inherent challenges of personalized microbial-based therapies | [
"Cassia tora fiber supplement consisting of 2 g of soluble fiber extracted from Cassia semen ( C. tora L. ) , 200 mg of alpha-tocopherol , 500 mg of ascorbic acid , and 300 mg of maltodextrin was formulated in a pack , and given to 15 type II diabetic subjects ( seven men and eight women 57.1 + /- 2.9 years ... | 4115e36e-06ff-11f0-808a-c43d1ab1c353 |
Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . Methods We search ed data bases for studies published by April 2018 . A total of 34 trials ( 44 analyses ) involving 8461 participants and 16 intervention arms were eligible . The study was registered with PROSPERO International prospect i ve register of systematic review s ( CRD42017081053 ) . Results Metformin was found to significantly decrease body mass index percentile ( BMI ) and had a tendency to decrease BMI ( kg/m2 ) and weight ( kg ) . Significant efficacy was observed in many subgroups . The metaregression may have identified the causes of heterogeneity as metformin dosage , control type , and intervention period . Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents . For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults . Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | [
"Objectives . The prevalence of type 2 diabetes in American adolescents has increased markedly during the past generation . Although the factors that contribute to the development of type 2 diabetes are complex and not wholly eluci date d , the triad of severe obesity , hyperinsulinemia , and a family history of ... | 4115e3b4-06ff-11f0-808a-c43d1ab1c353 |
INTRODUCTION Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals . Design -related bias in evaluations of tool predictive accuracy could lead to overoptimistic results , which would then contribute to program failure in practice . METHODS A systematic review was undertaken . Two blind review ers assessed the methodology of relevant publications into a four-point classification system adapted from multiple sources . The association between study design classification and reported results was examined using linear regression with clustering based on screening tool and robust variance estimates with point estimates of Youden Index (= sensitivity + specificity - 1 ) as the dependent variable . Meta- analysis was then performed pooling data from prospect i ve studies . RESULTS Thirty-five publications met inclusion criteria , containing 51 evaluations of fall risk screening tools . Twenty evaluations were classified as retrospective validation evaluations , 11 as prospect i ve ( temporal ) validation evaluations , and 20 as prospect i ve ( external ) validation evaluations . Retrospective evaluations had significantly higher Youden Indices ( point estimate [ 95 % confidence interval ] : 0.22 [ 0.11 , 0.33 ] ) . Pooled Youden Indices from prospect i ve evaluations demonstrated the STRATIFY , Morse Falls Scale , and nursing staff clinical judgment to have comparable accuracy . DISCUSSION Practitioners should exercise caution in comparing validity of fall risk assessment tools where the evaluation has been limited to retrospective classifications of methodology . Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular setting s , but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment | [
"OBJECTIVES To investigate the predictive validity and reliability of the STRATIFY falls risk assessment tool as applied to patients recovering from acute stroke . DESIGN Prospect i ve cohort study . SETTING Six stroke rehabilitation units in the North of Engl and . SUBJECTS All patients with a diagnosis of ... | 4115e3f0-06ff-11f0-808a-c43d1ab1c353 |
This systematic review attempts to plug the gap in current evidence by addressing two distinct clinical questions : ( i ) Does community-based vitamin A supplementation in children prevent the occurrence of pneumonia and /or its complications ? and ( ii ) Does addition of vitamin A to st and ard therapeutic protocol s improve the clinical outcome in childhood ( community acquired ) pneumonia ? The relevant outcomes for the latter include cure rate , severity , duration , and complications of pneumonia ; and adverse events following supplementation | [
"Abstract Objective : To evaluate the effect of simultaneous zinc and vitamin A supplementation on diarrhoea and acute lower respiratory infections in children . Study design : R and omised double blind placebo controlled trial . Setting : Urban slums of Dhaka , Bangladesh . Participants and methods : 80... | 4115e436-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade . Most total hip arthroplasties being performed in North America currently use cementless acetabular components . The objective of this systematic review and meta- analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty . METHODS A primary literature search in PubMed identified 3488 articles , of which 3407 did not meet the inclusion criteria and were excluded . Only English- language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of ten years of follow-up were included . The present study analyzed forty-five articles reporting the long-term outcome of cementless acetabular components , twenty-nine reporting the outcome of cemented acetabular components , and seven comparing cemented and cementless acetabular components . Meta- analysis ( with a r and om-effects model ) was performed on the data from the seven comparative studies , and study -level logistic regression analysis ( with a quasibinomial model ) was performed on the pooled data on the eighty-one included articles to determine a consensus . The studies were weighted according to the number of total hip arthroplasties performed . RESULTS The meta- analysis did not reveal any effect of the type of acetabular component fixation on either survivorship or revision rate . The regression analysis revealed the estimated odds ratio for survivorship of a cemented acetabular component to be 1.60 ( 95 % confidence interval , 1.32 to 2.40 ; p = 0.002 ) when adjustments for factors including age , sex , and mean duration of follow-up were made . CONCLUSIONS The preference for cementless acetabular components on the basis of improved survivorship is not supported by the published evidence . Although concerns regarding aseptic loosening of cemented acetabular components may have led North American surgeons toward the nearly exclusive use of cementless acetabular components , the available literature suggests that the fixation of cemented acetabular components is more reliable than that of cementless components beyond the first postoperative decade | [
"We selected r and omly a consecutive series of 162 patients requiring hip replacement to receive either a cementless , hemispherical , modular , titanium acetabular cup or a cemented , all-polyethylene cup . These replacements were performed by two surgeons in four general hospitals . The same surgical techn... | 4115e47c-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Fibromyalgia is characterized by chronic widespread pain , tenderness at muscle and tendon insertions point when digital pressure is applied , sleep disorders , chronic fatigue , depressive episodes , anxiety , and other functional somatic syndromes . OBJECTIVE The aim of this study was to determine whether balneotherapy with mineral waters and mineral-water containing mud is effective in the management of fibromyalgia . METHODS We conducted a systematic review of the literature regarding spa therapy in the treatment of the fibromyalgia . We search ed many data bases for articles published between 2000 and 2012 and we selected 7 studies among 65 articles retrieved . A total of 142 patients received balneotherapy and 129 were controls . CONCLUSION Study data confirms that spa therapy could improve the symptoms of fibromyalgia including pain , depression and minor symptoms | [
"Several authors have demonstrated the pivotal role of proinflammatory cytokines in inducing progressive cartilage degradation and secondary inflammation of the synovial membrane in osteoarthritis ( OA ) . It has recently been established that tumor necrosis factor (TNF)-alpha plays a well-defined role in the p... | 4115e4b8-06ff-11f0-808a-c43d1ab1c353 |
In low- and middle-income countries ( LMICs ) , naturally occurring social networks may be particularly vital to health outcomes as extended webs of social ties often are the principal source of various re sources . Underst and ing how social network structure , and influential individuals within the network , may amplify the effects of interventions in LMICs , by creating , for example , cascade effects to non-targeted participants , presents an opportunity to improve the efficiency and effectiveness of public health interventions in such setting s. We conducted a systematic review of PubMed , Econlit , Sociological Abstract s , and PsycINFO to identify a sample of 17 sociocentric network papers ( arising from 10 studies ) that specifically examined health issues in LMICs . We also separately selected to review 19 sociocentric network papers ( arising from 10 other studies ) on development topics related to wellbeing in LMICs . First , to provide a method ological re source , we discuss the sociocentric network study design s employed in the selected papers , and then provide a catalog of 105 name generator questions used to measure social ties across all the LMIC network papers ( including both ego- and sociocentric network papers ) cited in this review . Second , we show that network composition , individual network central ity , and network structure are associated with important health behaviors and health and development outcomes in different context s across multiple levels of analysis and across distinct network types . Lastly , we highlight the opportunities for health research ers and practitioners in LMICs to 1 ) design effective studies and interventions in LMICs that account for the sociocentric network positions of certain individuals and overall network structure , 2 ) measure the spread of outcomes or intervention externalities , and 3 ) enhance the effectiveness and efficiency of aid based on knowledge of social structure . In summary , human health and wellbeing are connected through complex webs of dynamic social relationships . Harnessing such information may be especially important in context s where re sources are limited and people depend on their direct and indirect connections for support | [
"We develop novel mixed effects models to examine the role of health traits on the status of peoples ' close friendship nominations in the Framingham Heart Study . The health traits considered are both mutable ( body mass index ( BMI ) , smoking , blood pressure , body proportion , muscularity , and depression ... | 4115e4fe-06ff-11f0-808a-c43d1ab1c353 |
Purpose - We performed a systematic review and meta-analyses to evaluate the early and long-term migration patterns of tibial components of TKR of all known RSA studies . Methods - Migration pattern was defined as at least 2 postoperative RSA follow-up moments . Maximal total point motion ( MTPM ) at 6 weeks , 3 months , 6 months , 1 year , 2 years , 5 years , and 10 years were considered . Results - The literature search yielded 1,167 hits of which 53 studies were included , comprising 111 study groups and 2,470 knees . The majority of the early migration occurred in the first 6 months postoperatively followed by a period of stability , i.e. , no or very little migration . Cemented and uncemented tibial components had different migration patterns . For cemented tibial components there was no difference in migration between all-poly and metal-backed components , between mobile bearing and fixed bearing , between cruciate retaining and posterior stabilized . Furthermore , no difference existed between TKR measured with model-based RSA or marker-based RSA methods . For uncemented TKR there was some variation in migration with the highest migration for uncoated TKR . Interpretation - The results from this meta- analysis on RSA migration of TKR are in line with both the survival analyses results from joint registries of these TKRs as well as revision rates results from meta-analyses , thus providing further proof for the association between early migration and late revision for loosening . The pooled migration patterns can be used both as benchmarks and for defining migration thresholds for future evaluation of new TKR | [
"Background We have previously reported that 6 months of oral treatment with clodronate reduced the migration of the NexGen total knee prosthesis during the first postoperative year , as measured by radiostereometry ( RSA ) . We now report the 4-year results . Methods This was a double-blind r and omized ... | 4115e53a-06ff-11f0-808a-c43d1ab1c353 |
INTRODUCTION The treatment strategy for appendiceal mass is controversial , ranging from operation or image-guided drainage to conservative treatment with or without antibiotics . The aim of this study was to assess the various treatment modalities with respect to complications and treatment failure . METHODS The analysis was based on the principles of a qualitative systematic review . The literature was search ed in PubMed for the period from 1966 to March 2014 . The articles were review ed with respect to complications , treatment failure and hospital stay . Papers on post-operative intra-abdominal abscesses and abscesses of any cause other than appendicitis were excluded as were also studies only describing recurrent appendicitis and /or interval appendectomy . Sub-analyses were performed in children , adults , and in mixed population s. RESULTS A total of 48 studies were found eligible ; they included in total 3,772 patients . Operation for appendiceal mass was beset with a moderate to high risk of complications of up to 57 % and a risk of intestinal resection of up to 25 % . Major complications were observed in up to 18 % of cases . Conservative treatment with or without antibiotics was associated with a treatment failure rate of 8 - 15 % . Drainage was beset with a risk of complications of 2 - 15 % and a risk of treatment failure of 2 - 13 % . CONCLUSION Operation with appendectomy for appendiceal mass carries a high risk of complications compared with conservative treatment or drainage . Drainage may lower the risk of treatment failure but entails a risk of complications . Based on the best evidence , we propose a step-down treatment strategy . FUNDING Not relevant . TRIAL REGISTRATION Not relevant | [
"OBJECTIVE Given the perceived technical dem and s of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess , initial percutaneous drainage has become an attractive option in this patient population . This strategy allows for a laparoscopic appendectomy to ... | 4115e580-06ff-11f0-808a-c43d1ab1c353 |
ABSTRACT Introduction : Results of previous clinical trials evaluating the effect of resveratrol supplementation on blood pressure ( BP ) are controversial . Purpose : We aim ed to assess the impact of resveratrol on BP through systematic review of literature and meta- analysis of available r and omized , controlled clinical trials ( RCTs ) . Methods : Literature search included SCOPUS , PubMed - Medline , ISI Web of Science and Google Scholar data bases up to 17th October 2017 to identify RCTs investigating the impact of resveratrol on BP . Two review authors independently extracted data on study characteristics , methods and outcomes . Overall , the impact of resveratrol on BP was reported in 17 trials . Results : Administration of resveratrol did not significantly affect neither systolic BP [ weighted mean difference ( WMD ) : −2.5 95 % CI:(-5.5 , 0.6 ) mmHg ; p=0.116 ; I2=62.1 % ] , nor diastolic BP [ WMD : −0.5 95 % CI:(-2.2 , 1.3 ) mmHg ; p=0.613 ; I2=50.8 ] , nor mean BP [ MAP ; WMD : −1.3 95 % CI:(-2.8 , 0.1 ) mmHg ; p=0.070 ; I2=39.5 % ] nor pulse pressure [ PP ; WMD : −0.9 95 % CI:(-3.1 , 1.4 ) mmHg ; p=0.449 ; I2=19.2 % ] . However , significant WMDs were detected in subsets of studies categorized according to high resveratrol daily dosage ( ≥300 mg/day ) and presence of diabetes . Meta-regression analysis revealed a positive association between systolic BP-lowering resveratrol activity ( slope : 1.99 ; 95 % CI : 0.05 , 3.93 ; two-tailed p= 0.04 ) and Body Mass Index ( BMI ) at baseline , while no association was detected neither between baseline BMI and MAP-lowering resveratrol activity ( slope : 1.35 ; 95 % CI : −0.22 , 2.91 ; two-tailed p= 0.09 ) nor between baseline BMI and PP-lowering resveratrol activity ( slope : 1.03 ; 95 % CI : −1.33 , 3.39 ; two-tailed p= 0.39 ) . Resveratrol was fairly well-tolerated and no serious adverse events occurred among most of the eligible trials . Conclusion : The favourable effect of resveratrol emerging from the current meta- analysis suggests the possible use of this nutraceutical as active compound in order to promote cardiovascular health , mostly when used in high daily dose ( ≥300 mg/day ) and in diabetic patients | [
"ABSTRACT Objective “ The obesity epidemic ” has led to an increase in obesity-related conditions including non-alcoholic fatty liver disease ( NAFLD ) , for which effective treatments are in dem and . The polyphenol resveratrol prevents the development of experimental NAFLD through modulation of cellular pathway... | 4115e5bc-06ff-11f0-808a-c43d1ab1c353 |
QUESTIONS In people with Parkinson 's disease , does home-based prescribed exercise improve balance-related activities and quality of life compared with no intervention ? Are the effects of home-based exercise similar to those of equivalent centre-based exercise ? DESIGN Systematic review and meta- analysis of r and omised and quasi-r and omised controlled trials . PARTICIPANTS Adults diagnosed with idiopathic Parkinson 's disease . INTERVENTION Predominantly home-based prescribed exercise ( defined as a minimum of two-thirds of the exercise being completed at home ) . The intervention had to primarily involve physical practice of exercises targeting gait and /or st and ing balance compared with either control ( ie , usual care only , a sham intervention or no physiotherapy ) or equivalent predominantly centre-based exercise . OUTCOME MEASURES The primary outcome was balance-related activities and the secondary outcomes were gait speed , Berg Balance Scale , Functional Reach test , and quality of life . RESULTS Sixteen trials met the inclusion criteria and all contributed to the meta-analyses . Twelve trials compared home-based prescribed exercise with control , and four trials compared home-based prescribed exercise with equivalent centre-based exercise . Home-based prescribed exercise improved balance-related activities ( SMD 0.21 , 95 % CI 0.10 to 0.32 ) and gait speed ( SMD 0.30 , 95 % CI 0.12 to 0.49 ) , but not quality of life ( SMD 0.11 , 95 % CI -0.01 to 0.23 ) compared with control . Home-based and centre-based exercise had similar effects on balance-related activities ( SMD -0.04 , 95 % CI -0.36 to 0.27 ) and quality of life ( SMD -0.08 , 95 % CI -0.41 to 0.24 ) . CONCLUSION Home-based prescribed exercise improves balance-related activities and gait speed in people with Parkinson 's disease , and these improvements are similar to improvements with equivalent centre-based exercise . REGISTRATION PROSPERO CRD 42018107331 | [
"Objective : To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors , i.e. , poor balance , reduced leg muscle strength , and freezing of gait , in people with Parkinson disease . Methods : Two hundred thirty-one people with Parkinson... | 4115e5f8-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Several lines of evidence have indicated the insulin-sensitizing , anti-diabetic and anti-atherosclerotic properties of adiponectin , as well as the inverse association between circulating levels of this adipokine and development of cardiovascular outcomes . Improvement of adiponectin status has been reported as a pleiotropic effect of fibrate therapy , but the findings have not been conclusive . OBJECTIVE To systematic ally review and meta-analyze available evidence from r and omized placebo-controlled trials ( RCTs ) on the impact of fibrate therapy on circulating levels of adiponectin . METHODS A comprehensive literature search in Medline was carried out to identify RCTs comparing the effect of fibrate therapy vs. placebo on circulating concentrations of adiponectin . A meta- analysis of eligible studies was performed using a r and om-effects model . Quality assessment , sensitivity analysis and publication bias evaluations were conducted using st and ard methods . RESULTS Twelve RCTs comprising 443 cases and 437 controls met the selection criteria for systematic review , out of which 9 RCTs ( 399 cases and 401 controls ) were included in the meta- analysis . Quantitative data synthesis revealed a significant effect for fibrate therapy in increasing circulating adiponectin levels ( weighed mean difference : 0.38 μg/mL ; 95 % confidence interval : 0.13 - 0.63 μg/mL ; p = 0.003 ) . The effect size remained statistically significant when restricting the analysis to fenofibrate trials [ 0.31 ( 0.21 - 0.42 ) μg/mL ; p for fibrate therapy [ 0.53 ( 0.24 - 0.82 ) μg/mL ] . CONCLUSION The present meta- analysis suggests that fibrate therapy increases circulating levels of adiponectin . Whether increase in adiponectin levels contributes to reduction of cardiovascular effects in subjects with dyslipidemia treated with fibrates merits further investigation | [
"Obese AT ( adipose tissue ) exhibits increased macrophage number . Pro-inflammatory CD16 + peripheral monocyte numbers are also reported to increase with obesity . The present study was undertaken to simultaneously investigate obesity-associated changes in CD16 + monocytes and ATMs ( AT macrophages ) . I... | 4115e634-06ff-11f0-808a-c43d1ab1c353 |
Importance Vitamin D and calcium supplements are recommended for the prevention of fracture , but previous r and omized clinical trials ( RCTs ) have reported conflicting results , with uncertainty about optimal doses and regimens for supplementation and their overall effectiveness . Objective To assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D ( 25[OH]D ) in observational studies and the risks of fracture associated with supplementation with vitamin D alone or in combination with calcium in RCTs . Data Sources PubMed , EMBASE , Cochrane Library , and other RCT data bases were search ed from data base inception until December 31 , 2018 . Search es were performed between July 2018 and December 2018 . Study Selection Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included . R and omized clinical trials compared vitamin D or vitamin D and calcium with control . Data Extraction and Synthesis Two research ers independently extracted data according to the Preferred Reporting Items for Systematic Review s and Meta-analyses ( PRISMA ) guidelines and assessed possible bias . Rate ratios ( RRs ) were estimated using fixed-effects meta- analysis . Data extraction and synthesis took place between July 2018 and June 2019 . Main Outcomes and Measures Any fracture and hip fracture . Results In a meta- analysis of 11 observational studies ( 39 141 participants , 6278 fractures , 2367 hip fractures ) , each increase of 10.0 ng/mL ( ie , 25 nmol/L ) in 25 (OH)D concentration was associated with an adjusted RR for any fracture of 0.93 ( 95 % CI , 0.89 - 0.96 ) and an adjusted RR for hip fracture of 0.80 ( 95 % CI , 0.75 - 0.86 ) . A meta- analysis of 11 RCTs ( 34 243 participants , 2843 fractures , 740 hip fractures ) of vitamin D supplementation alone ( daily or intermittent dose of 400 - 30 000 IU , yielding a median difference in 25[OH]D concentration of 8.4 ng/mL ) did not find a reduced risk of any fracture ( RR , 1.06 ; 95 % CI , 0.98 - 1.14 ) or hip fracture ( RR , 1.14 ; 95 % CI , 0.98 - 1.32 ) , but these trials were constrained by infrequent intermittent dosing , low daily doses of vitamin D , or an inadequate number of participants . In contrast , a meta- analysis of 6 RCTs ( 49 282 participants , 5449 fractures , 730 hip fractures ) of combined supplementation with vitamin D ( daily doses of 400 - 800 IU , yielding a median difference in 25[OH]D concentration of 9.2 ng/mL ) and calcium ( daily doses of 1000 - 1200 mg ) found a 6 % reduced risk of any fracture ( RR , 0.94 ; 95 % CI , 0.89 - 0.99 ) and a 16 % reduced risk of hip fracture ( RR , 0.84 ; 95 % CI , 0.72 - 0.97 ) . Conclusions and Relevance In this systematic review and meta- analysis , neither intermittent nor daily dosing with st and ard doses of vitamin D alone was associated with reduced risk of fracture , but daily supplementation with both vitamin D and calcium was a more promising strategy | [
"Vitamin D insufficiency and low calcium intake contribute to increase parathyroid function and bone fragility in elderly people . Calcium and vitamin D supplements can reverse secondary hyperparathyroidism thus preventing hip fractures , as proved by Decalyos I. Decalyos II is a 2-year , multicenter , r and om... | 4115e67a-06ff-11f0-808a-c43d1ab1c353 |
Recommendations for zinc intake during childhood vary widely across Europe . The EURRECA project attempts to consoli date the basis for the definition of micronutrient requirements , taking into account relationships among intake , status and health outcomes , in order to harmonise these recommendations . Data on zinc intake and biomarkers of zinc status reported in r and omised controlled trials ( RCTs ) can provide estimates of dose-response relationships which may be used for underpinning zinc reference values . This systematic review included all RCTs of apparently healthy children aged 1–17 years published by February 2010 which provided data on zinc intake and biomarkers of zinc status . An intake-status regression coefficient ( ) was calculated for each individual study and calculated the overall pooled and SE ( ) using r and om effects meta- analysis on a double log scale . The pooled dose-response relationship between zinc intake and zinc status indicated that a doubling of the zinc intake increased the serum/plasma zinc status by 9 % . This evidence can be utilised , together with currently used balance studies and repletion/depletion studies , when setting zinc recommendations as a basis for nutrition policies | [
"Background / Objectives : Zinc is an essential micronutrient and deficiency can lead to an increased risk for infectious diseases and growth retardation among children under 5 years of age . We aim ed to estimate disease-specific and all-cause mortality attributable to zinc deficiency . Subject/ Methods : We... | 4115e6b6-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE To up date the evidence on the effectiveness of lumbar supports , education and exercise in the primary prevention of low back pain at the workplace . METHODS A computerized search for controlled clinical trials published between 1997 and 2002 was conducted , and the method ological quality of the studies was assessed using a criteria list . The available evidence was grade d with a rating system for the level of evidence . Effect sizes of individual studies were combined if the studies were sufficiently similar . RESULTS Five new papers were identified for the up date . These trials were added to the previously available trials ( n = 11 ) . The method ological quality of most studies was low . Since three of four RCTs on lumbar supports reported no effect , there is no evidence for the effectiveness of lumbar supports . No evidence for education could be found either , since all six RCTs showed negative results . The four RCTs on exercise consistently reported a positive effect , indicating limited evidence for the effectiveness of exercise . CONCLUSION There is no evidence for the effectiveness of lumbar supports or education in the primary prevention of low back pain at the workplace . There is limited evidence for the efficacy of exercise , and the effect that can be obtained is moderate . There is still a need for method ologically sound studies and studies on the cost-effectiveness of exercise . Also the possible effect of lumbar supports in the treatment of back pain needs further investigation | [
"A clinical trial , aim ed at secondary prevention of low-back pain , was performed in 142 hospital employees reporting at least three annual episodes of this condition . Participants were r and omly assigned to one of three groups : a calisthenics program ( CAL ) for 3 months with biweekly sessions of flexi... | 4115e6fc-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE Structured patient education programs can reduce the risk of diabetes-related complications . However , people appear to have difficulties attending face-to-face education and alternatives are needed . This review looked at the impact of computer-based diabetes self-management interventions on health status , cardiovascular risk factors , and quality of life of adults with type 2 diabetes . RESEARCH DESIGN AND METHODS We search ed The Cochrane Library , Medline , Embase , PsycINFO , Web of Science , and CINAHL for relevant trials from inception to November 2011 . Reference lists from relevant published studies were screened and authors contacted for further information when required . Two authors independently extracted relevant data using st and ard data extraction templates . RESULTS Sixteen r and omized controlled trials with 3,578 participants met the inclusion criteria . Interventions were delivered via clinics , the Internet , and mobile phones . Computer-based diabetes self-management interventions appear to have small benefits on glycemic control : the pooled effect on HbA1c was −0.2 % ( −2.3 mmol/mol [ 95 % CI −0.4 to −0.1 % ] ) . A subgroup analysis on mobile phone – based interventions showed a larger effect : the pooled effect on HbA1c from three studies was −0.50 % ( −5.46 mmol/mol [ 95 % CI −0.7 to −0.3 % ] ) . There was no evidence of improvement in depression , quality of life , blood pressure , serum lipids , or weight . There was no evidence of significant adverse effects . CONCLUSIONS Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control , and this effect was larger in the mobile phone subgroup . There was no evidence of benefit for other biological , cognitive , behavioral , or emotional outcomes | [
"OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with st and ard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A cluster-r and omized clinical t... | 4115e738-06ff-11f0-808a-c43d1ab1c353 |
Background The relationship between training load and musculoskeletal injury is a rapidly advancing area of research in need of an up date d systematic review . Objective This systematic review examined the evidence for the relationship between training load and musculoskeletal injury risk in athlete , military , and first responder ( i.e. law enforcement , firefighting , rescue service ) population s. Methods The CINAHL , EMBASE , MEDLINE , SportD ISCUS , and SCOPUS data bases were search ed using a comprehensive strategy . Studies published prior to July 2017 were included if they prospect ively examined the relationship between training load and injury risk . Study quality was assessed using the Newcastle – Ottawa Quality Assessment Scale ( NOS ) and Oxford Centre for Evidence -Based Medicine levels of evidence . A narrative synthesis of findings was conducted . Results A total of 2047 articles were examined for potential inclusion . Forty-six met the inclusion criteria and 11 known to the authors but not found in the search were added , for a total of 57 articles . Overall , 47 studies had at least partially statistically significant results , demonstrating a relationship between training load and injury risk . Included articles were rated as poor ( n = 15 ) , fair ( n = 6 ) , and good ( n = 36 ) based on NOS score . Articles assessed as ‘ good ’ were considered level 2b evidence on the Oxford Centre for Evidence -Based Medicine Model , and articles assessed as ‘ fair ’ or ‘ poor ’ were considered level 4 evidence . Conclusions Our results demonstrate that the existence of a relationship between training load and injury continues to be well supported in the literature and is strongest for subjective internal training load . The directionality of this relationship appears to depend on the type and timeframe of load measured | [
"Objective In this study , the injury incidence and association with type and volume of training in international rowers were described . Design A prospect i ve cohort design was used over a 12-month period . Patients 20 international rowers who were competing as part of the Irish Amateur Rowing Union squad sy... | 4115e774-06ff-11f0-808a-c43d1ab1c353 |
Background Poor wound healing and scar formation remain critical problems in daily surgical practice . Generally , most attention is paid to intra- and postoperative interventions to improve wound healing after surgery , while preoperative interventions remain unsatisfactorily explored . Objectives In this systematic review , the available literature on the beneficial effects of preoperative interventions on wound healing and scar formation have been summarized and compared . Methods A comprehensive and systematic search has been conducted in MEDLINE , Pubmed , Embase , Web of Science , and Cochrane , supplemented by reference and citation tracking . All preoperative interventions and all clinical ly relevant outcome parameters have been considered for inclusion , due to the expected limited availability of literature . Results A total of 13 studies were included , which were all r and omized trials . No cohort studies or retrospective studies have been identified . All studies described different preoperative interventions and outcome parameters and could hence not be pooled and compared . Eight studies showed significantly better wound healing after a preoperative intervention . The individual studies have been summarized in this review . Conclusions This systemic review shows that preoperative interventions can be beneficial in improving wound healing and scar formation . In selected cases , wound healing was found to benefit from a higher preoperative body temperature , topical vitamin E application , and low patient stress levels . Level of Evidence | [
"Abstract Although medical hypnosis has a long history of myriad functional applications ( pain reduction , procedural preparation etc . ) , it has been little tested for site-specific effects on physical healing per se . In this r and omized controlled trial , we compared the relative efficacy of an adjunctive hy... | 4115e7b0-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE The effect of fructose on cardiometabolic risk in humans is controversial . We conducted a systematic review and meta- analysis of controlled feeding trials to clarify the effect of fructose on glycemic control in individuals with diabetes . RESEARCH DESIGN AND METHODS We search ed MEDLINE , EMBASE , and the Cochrane Library ( through 22 March 2012 ) for relevant trials lasting ≥7 days . Data were aggregated by the generic inverse variance method ( r and om-effects models ) and expressed as mean difference ( MD ) for fasting glucose and insulin and st and ardized MD ( SMD ) with 95 % CI for glycated hemoglobin ( HbA1c ) and glycated albumin . Heterogeneity was assessed by the Cochran Q statistic and quantified by the I2 statistic . Trial quality was assessed by the Heyl and method ological quality score ( MQS ) . RESULTS Eighteen trials ( n = 209 ) met the eligibility criteria . Isocaloric exchange of fructose for carbohydrate reduced glycated blood proteins ( SMD −0.25 [ 95 % CI −0.46 to −0.04 ] ; P = 0.02 ) with significant intertrial heterogeneity ( I2 = 63 % ; P = 0.001 ) . This reduction is equivalent to a ∼0.53 % reduction in HbA1c . Fructose consumption did not significantly affect fasting glucose or insulin . A priori subgroup analyses showed no evidence of effect modification on any end point . CONCLUSIONS Isocaloric exchange of fructose for other carbohydrate improves long-term glycemic control , as assessed by glycated blood proteins , without affecting insulin in people with diabetes . Generalizability may be limited because most of the trials were longer fructose feeding trials assessing both possible glycemic benefit and adverse metabolic effects are required | [
"BACKGROUND Excessive energy intake tends to increase circulating levels of insulin and free insulin-like growth factor-1 ( IGF-I ) , which may increase risk of some cancers that are common in Western countries . However , the relative importance of these hormonal factors during pre-adulthood and adulthood is unkno... | 4115e7ec-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures . DESIGN Systematic review of r and omised controlled trials and observational studies of calcium intake with fracture as an endpoint . Results from trials were pooled with r and om effects meta-analyses . DATA SOURCES Ovid Medline , Embase , PubMed , and references from relevant systematic review s. Initial search es undertaken in July 2013 and up date d in September 2014 . ELIGIBILITY CRITERIA FOR SELECTING STUDIES R and omised controlled trials or cohort studies of dietary calcium , milk or dairy intake , or calcium supplements ( with or without vitamin D ) with fracture as an outcome and participants aged > 50 . RESULTS There were only two eligible r and omised controlled trials of dietary sources of calcium ( n=262 ) , but 50 reports from 44 cohort studies of relations between dietary calcium ( n=37 ) , milk ( n=14 ) , or dairy intake ( n=8 ) and fracture outcomes . For dietary calcium , most studies reported no association between calcium intake and fracture ( 14/22 for total , 17/21 for hip , 7/8 for vertebral , and 5/7 for forearm fracture ) . For milk ( 25/28 ) and dairy intake ( 11/13 ) , most studies also reported no associations . In 26 r and omised controlled trials , calcium supplements reduced the risk of total fracture ( 20 studies , n=58,573 ; relative risk 0.89 , 95 % confidence interval 0.81 to 0.96 ) and vertebral fracture ( 12 studies , n=48,967 . 0.86 , 0.74 to 1.00 ) but not hip ( 13 studies , n=56,648 ; 0.95 , 0.76 to 1.18 ) or forearm fracture ( eight studies , n=51,775 ; 0.96 , 0.85 to 1.09 ) . Funnel plot inspection and Egger 's regression suggested bias toward calcium supplements in the published data . In r and omised controlled trials at lowest risk of bias ( four studies , n=44,505 ) , there was no effect on risk of fracture at any site . Results were similar for trials of calcium monotherapy and co-administered calcium and vitamin D. Only one trial in frail elderly women in residential care with low dietary calcium intake and vitamin D concentrations showed significant reductions in risk of fracture . CONCLUSIONS Dietary calcium intake is not associated with risk of fracture , and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures . Evidence that calcium supplements prevent fractures is weak and inconsistent | [
"Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of hip fracture . During the years 1977 - 1983 , wo... | 4115e832-06ff-11f0-808a-c43d1ab1c353 |
The paper refers to the recently published empirical data and systematic review s on the impact of diets , foods , nutrients and bioactive substance exposures in pregnancy and in early infancy , on the development of atopic disorders . The results of studies referring to a broad range on dietary factors are mostly conflicting . There are several limitations of these research es . Based on the existing information , it is not possible to establish the role of antioxidants and vitamin D supplementation in atopic disease development . There is no evidence of major effects of prenatal use of folic acid on asthma or allergies . The association of some nutritional interventions with less atopic sensitization seems rather speculative even if such an effect has not been found for some other foods . The findings indicate rather a balanced and diverse diet without restrictions than a special dietary protocol . Farming-related exposures may protect against the development of atopic disorders in children . The hypothesis that the early introduction of complementary food , including the potentially allergenic foods , may reduce the risk of food allergy and atopic dermatitis is currently tested . Long-chain polyunsaturated fatty acids and probiotics seem to be promising c and i date s for allergy prevention . But specific recommendations regarding pre- and postnatal supplementation strategies , dose , treatment duration etc . , are still undetermined . Longitudinal intervention studies in cohorts of pregnant women or newborn infants are needed to match the proper strategies in these issues | [
"BACKGROUND AND OBJECTIVE : Relative deficiency of dietary omega 3 polyunsaturated fatty acids ( n-3 PUFA ) has been implicated in the rising allergy prevalence in Westernized countries . Fish oil supplementation may provide an intervention strategy for primary allergy prevention . The objective of this study was... | 4115e86e-06ff-11f0-808a-c43d1ab1c353 |
Resistance training ( RT ) is thought to be effective in preventing muscle depletion , whereas endurance training ( ET ) is known to improve exercise capacity and health-related quality of life ( HRQoL ) in chronic obstructive pulmonary disease ( COPD ) . Our objectives were to assess the efficiency of combining RT with ET compared with ET alone . We identified eligible studies through a systematic multi- data base search . One author checked titles and abstract s for relevance using broad inclusion criteria , whilst two independent authors checked the full-text copies for eligibility . Two authors independently extracted data , and we assessed the risk of bias and quality of evidence according to the Grading of Recommendations Assessment , Development and Evaluation guidelines . We included 11 r and omized controlled trials ( 331 participants ) and 2 previous systematic review s. The meta-analyses showed equal improvements in HRQoL , walking distance and exercise capacity . However , we found moderate quality evidence of a significant increase in leg muscle strength favouring a combination of RT and ET ( st and ardized mean difference of 0.69 ( 95 % confidence interval : 0.39–0.98 ) . In conclusion , we found significantly increased leg muscle strength favouring a combination of RT with ET compared with ET alone . Therefore , we recommend that RT should be incorporated in rehabilitation of COPD together with ET | [
"PURPOSE The primary goal of pulmonary rehabilitation ( PR ) is for patients to achieve and maintain their maximum level of independence and functioning in the community . Traditional PR uses a predominantly aerobic/endurance approach to rehabilitation with little or no inclusion of exercises to increase st... | 4115e8aa-06ff-11f0-808a-c43d1ab1c353 |
Objective : We undertook a meta- analysis of published R and omized Controlled Trials ( RCT ) with semi-active control and sham-NF groups to determine whether Electroencephalogram-neurofeedback ( EEG-NF ) significantly improves the overall symptoms , inattention and hyperactivity/impulsivity dimensions for probably unblinded assessment ( parent assessment ) and probably blinded assessment ( teacher assessment ) in children with Attention Deficit Hyperactivity Disorder ( ADHD ) . Data sources : A systematic review identified independent studies that were eligible for inclusion in a r and om effects meta- analysis . Data extraction : Effect sizes for ADHD symptoms were expressed as st and ardized mean differences ( SMD ) with 95 % confidence intervals . Results : Five identified studies met eligibility criteria , 263 patients with ADHD were included , 146 patients were trained with EEG-NF . On parent assessment ( probably unblinded assessment ) , the overall ADHD score ( SMD = −0.49 [ −0.74 , −0.24 ] ) , the inattention score ( SMD = −0.46 [ −0.76 , −0.15 ] ) and the hyperactivity/impulsivity score ( SMD = −0.34 [ −0.59 , −0.09 ] ) were significantly improved in patients receiving EEG-NF compared to controls . On teacher assessment ( probably blinded assessment ) , only the inattention score was significantly improved in patients receiving EEG-NF compared to controls ( SMD = −0.30 [ −0.58 , −0.03 ] ) . Conclusions : This meta- analysis of EEG-NF in children with ADHD highlights improvement in the inattention dimension of ADHD symptoms . Future investigations should pay greater attention to adequately blinded studies and EEG-NF protocol s that carefully control the implementation and embedding of training | [
"Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder ( ADHD ) in several , mostly uncontrolled studies . This pilot study is design ed to test the feasibility and safety of using a double-blind placebo feedback-con... | 4115e8f0-06ff-11f0-808a-c43d1ab1c353 |
Objective To evaluate the potential effects of proprotein convertase subtilisin/kexin type 9 monoclonal antibody ( PCSK9-mAb ) on high-sensitivity C reactive protein ( hs-CRP ) concentrations . Design A systematic review and meta- analysis of r and omised controlled trials . Data sources PubMed , MEDLINE , the Cochrane Library data bases , Clinical Trials.gov and recent conferences were search ed from inception to May 2018 . Eligibility criteria for selecting studies All r and omised controlled trials that reported changes of hs-CRP were included . Results Ten studies involving 4198 participants were identified . PCSK9-mAbs showed a slight efficacy in reducing hs-CRP ( −0.04 mg/L , 95 % CI : −0.17 to 0.01 ) which was not statistically different . The results did not altered when subgroup analyses were performed including PCSK9-mAb types ( alirocumab : 0.12 mg/L , 95 % CI : −0.18 to 0.43 ; evolocumab : 0.00 mg/L , 95 % CI : −0.07 to 0.07 ; LY3015014 : −0.48 mg/L , 95 % CI : −1.28 to 0.32 ; RG7652 : 0.35 mg/L , 95 % CI : −0.26 to 0.96 ) , treatment duration ( ≤12w : 0.00 mg/L , 95 % CI : −0.07 to 0.07 ; > 12w : −0.11 mg/L , 95 % CI : −0.45 to −0.23 ) , participant characteristics ( familial hypercholesterolaemia : 0.00 mg/L , 95 % CI : −0.07 to 0.07 ; non-familial hypercholesterolaemia : 0.07 mg/L , 95 % CI : −0.12 to 0.26 ; mix : −0.48 mg/L , 95 % CI : −1.28 to 0.32 ) and treatment methods ( monotherapy : 0.00 mg/L , −0.08 to 0.07 ; combination therapy : −0.08 mg/L , −0.37 to 0.21 ) . Meta-regression analyses suggested no significant linear correlation between baseline age ( p=0.673 ) , sex ( p=0.645 ) and low-density lipoprotein cholesterol reduction ( p=0.339 ) . Conclusions Our up date d meta- analysis suggested that PCSK9-mAbs had no significant impact on circulating hs-CRP levels irrespective of PCSK9-mAb types , participant characteristics and treatment duration or methods | [
"BACKGROUND Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events . Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol , we hypothesized that people with elevated high-sensitivity C-reactive protein levels but withou... | 4115e92c-06ff-11f0-808a-c43d1ab1c353 |
Purpose No study has summarized earlier findings on the effect of probiotic supplementation on inflammatory biomarkers . This systematic review and meta- analysis was conducted to systematic ally review the available placebo-controlled clinical trials about the effect of probiotic supplementation on several inflammatory biomarkers in adults . Methods Relevant papers published up to March 2018 were search ed up through PubMed , MEDLINE , SCOPUS , EMBASE , and Google Scholar , using following suitable keywords . Clinical trials that examined the effect of probiotic supplementation on inflammation in adults were included . Results Overall , 42 r and omized clinical trials ( 1138 participants in intervention and 1120 participants in control groups ) were included . Combining findings from included studies , we found a significant reduction in serum hs-CRP [ st and ardized mean difference ( SMD ) − 0.46 ; 95 % CI − 0.73 , − 0.19 ] , TNF-a ( − 0.21 ; − 0.34 , − 0.08 ) , IL-6 ( − 0.37 ; − 0.51 , − 0.24 ) , IL-12 ( − 0.47 ; − 0.67 , − 0.27 ) , and IL-4 concentrations ( − 0.48 ; − 0.76 , − 0.20 ) after probiotic supplementation . Pooling effect sizes from 11 studies with 12 effect sizes , a significant increase in IL-10 concentrations was seen ( 0.21 ; 0.04 , 0.38 ) . We failed to find a significant effect of probiotic supplementation on serum IL-1B ( − 0.17 ; − 0.37 , 0.02 ) , IL-8 ( − 0.01 ; − 0.30 , 0.28 ) , and IFN-g ( − 0.08 ; − 0.31 , 0.15 ) and IL-17 concentrations ( 0.06 ; − 0.34 , 0.46 ) . Conclusions Probiotic supplementation significantly reduced serum concentrations of pro-inflammatory cytokines including , hs-CRP , TNF-a , IL-6 , IL-12 , and IL-4 , but it did not influence IL-1B , IL-8 , IFN-g , and IL-17 concentrations . A significant increase in serum concentrations of IL-10 , as a anti-inflammatory cytokine was also documented after probiotic supplementation | [
"BACKGROUND According to previous studies , probiotic and prebiotic supplementation have desirable effects on glycemic parameters . Thus far , the effect of supplementation on the glycemic parameters and adipokines in non-alcoholic fatty liver disease ( NAFLD ) has not been assessed . Therefore , the aim of t... | 4115e986-06ff-11f0-808a-c43d1ab1c353 |
Genetic risk prediction of chronic conditions including obesity , diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest . We aim ed to underst and whether the latter is indeed true by conducting a systematic review and meta- analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification . We included all r and omised controlled trials ( RCT ) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease , without restrictions on age , duration of intervention or language . We conducted r and om-effects meta-analyses for perceived motivation for behaviour change and clinical changes ( weight loss ) and a narrative analysis for other outcomes . Within the thirteen studies review ed , five were vignette studies ( hypothetical RCT ) and seven were clinical RCT . There was no consistent effect of genetic risk on actual motivation for weight loss , perceived motivation for dietary change ( control v. genetic risk group st and ardised mean difference ( smd ) −0·15 ; 95 % CI −1·03 , 0·73 , P=0·74 ) or actual change in dietary behaviour . Similar results were observed for actual weight loss ( control v. high genetic risk SMD 0·29 kg ; 95 % CI −0·74 , 1·31 , P=0·58 ) . This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults . Of thirteen studies , eight were at high or unclear risk of bias . Additional larger-scale , high- quality clinical RCT are warranted | [
"Type 2 diabetes ( T2D ) is associated with increased risk of morbidity and premature mortality . Among those at high risk , incidence can be halved through healthy changes in behaviour . Information about genetic and phenotypic risk of T2D is now widely available . Whether such information motivates behaviour ... | 4115e9d6-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND People with fragile X syndrome ( FXS ) have an intellectual dysfunction that can range from very mild to severe . Symptoms can include speech and language delays and behavioural difficulties such as aggression or self injurious behaviours , emotional lability , and anxiety-related problems ( for example obsessive-compulsive symptoms and perseverative behaviours ) . In some cases , affected people may have an additional diagnosis of attention deficit hyperactivity disorder or an autism spectrum disorder . OBJECTIVES To review the efficacy and safety of L-acetylcarnitine in improving the psychological , intellectual , and social performance of people with FXS . SEARCH METHODS In May 2015 we search ed the Cochrane Central Register of Controlled Trials ( CENTRAL ) , MEDLINE , Embase , PsycINFO , Web of Science , and two other data bases . We also search ed three trials registers , four theses data bases , and the reference lists of relevant studies and review s. SELECTION CRITERIA R and omised controlled trials ( RCTs ) that assessed the efficacy of L-acetylcarnitine , at any dose , in people of any age diagnosed with FXS compared with placebo . DATA COLLECTION AND ANALYSIS For each trial , two review authors independently extracted data on the children included and interventions compared , and assessed the risk of bias of the studies across the following domains : r and omisation sequence generation , allocation concealment , blinding ( of participants , personnel , and outcome assessors ) , incomplete outcome data , selective outcome reporting , and other potential sources of bias . MAIN RESULTS We found only two RCTs that compared oral L-acetylcarnitine ( LAC ) with oral placebo in children with FXS . The studies included a total of 83 participants , all of them male , who were treated and followed for one year . The age of participants at the start of treatment ranged from 6 to 13 years , with a mean age of 9 years . Neither study provided information on r and omisation , allocation concealment procedures , or blinding of outcome assessment , and we received no responses from the authors we emailed for clarification . We therefore rated studies as being at unclear risk of bias on these domains . We judged both studies to be at low risk of bias for blinding of participants and personnel , incomplete outcome data , and selective reporting , but to be at high risk of other bias , as at least one study was funded by a drug company , and in both studies people working for the company were part of the research team . We used the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to rate the quality of the available evidence . Overall , the quality of the evidence was low due to the imprecision of results and high risk of other bias . Regarding the primary outcome of psychological and learning capabilities , both studies assessed the effect of interventions on children 's verbal and non-verbal intellectual functioning using the Wechsler Intelligence Scale for Children - Revised . The authors did not provide detailed data on those results but said that they found no important differences between treatment and placebo . Both studies evaluated the impact of the treatment on hyperactive behaviour using the Conners ' Abbreviated Parent-Teacher Question naire . In one study , teachers ' assessment s of the children found no clear evidence of a difference ( mean difference ( MD ) 0.50 , 95 % confidence interval ( CI ) -5.08 to 6.08 , n = 51 ; low- quality evidence ) . The other study stated that there were no differences between treated and untreated participants , but did not provide detailed data for inclusion in the meta- analysis .Parents ' assessment s favoured LAC in one study ( MD -0.57 , 95 % CI -0.94 to -0.19 , n = 17 ; low- quality evidence ) , but not in the other ( MD -2.80 , 95 % CI -7.61 to 2.01 , n = 51 ; low- quality evidence ) , though changes were not large enough to be considered clinical ly relevant . Regarding social skills , one study reported no clear evidence of a difference in Vinel and Adaptive Behavior composite scores ( MD 8.20 , 95 % CI -0.02 to 16.42 , n = 51 ; low- quality evidence ) , yet results in the socialisation domain favoured LAC ( MD 11.30 , 95 % CI 2.52 to 20.08 , n = 51 ; low- quality evidence ) .Both studies assessed the safety of the active treatment and recorded no side effects . Neither of the included studies assessed the secondary outcome of caregiver burden . AUTHORS ' CONCLUSIONS Low- quality evidence from two small trials showed that when compared to placebo , LAC may not improve intellectual functioning or hyperactive behaviour in children with FXS | [
"OBJECTIVE To determine whether acetyl-L-carnitine ( ALC ) , a metabolite necessary for energy metabolism and essential fatty acid anabolism , might help attention-deficit/hyperactivity disorder ( ADHD ) . Trials in Down 's syndrome , migraine , and Alzheimer 's disease showed benefit for attention . A prelimin... | 4115ea12-06ff-11f0-808a-c43d1ab1c353 |
The comparison between haemorrhoidal treatments is still unclear . Attempts have been made to adopt a unifying postoperative scoring system and thus ensure adequate comparison between clinical trials . We aim ed to systematic ally review the available outcome scores of haemorrhoidal treatment . MEDLINE / Pubmed , Web of science , Embase and Cochrane were search ed from data base implementation until the December 6th 2019 . All studies describing or referencing a score to assess haemorrhoidal disease treatment were included . Likert scale alone , incontinence score alone , general assessment of quality of life or scores developed for other proctologic disorders were excluded . The main outcome measures were validation of the scores and correlation of the score items to the core outcome set for haemorrhoidal disease developed by the European Society of Coloproctology . From the 633 records initially screened , 22 studies were included : 8 original articles describing a scoring system and 14 referencing a previously described scoring system . Only 1 score was vali date d by an external prospect i ve cohort . All the scores evaluated the symptoms of haemorrhoidal disease . No score integrated the disease recurrences or patient ’s satisfaction . Scores values tended to decrease postoperatively . The scores described by Gerjy et al. and by Shanmugan et al. are available question naires , which have been vali date d and used in various studies . These scores might help research ers for comparative studies between treatment modalities and optimize haemorrhoids treatment | [
"Abstract Background The aim of the study was to compare ligation anopexy ( LA ) and conventional hemorrhoidectomy ( CH ) in treatment of second- and third-degree hemorrhoids . Methods A prospect i ve controlled r and omized clinical trial included 100 patients who underwent CH ( CH group ) and 100 patie... | 4115ea4e-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE The use of behavioral interventions has been shown to improve glycemic control , however , the effectiveness of different behavioral interventions in one of the most high risk population s , African Americans , remains unclear . Our systematic review identified and examined findings of published behavioral interventions targeted at African Americans to improve glycemic control . The goal of our study was to distinguish which interventions were effective and identify areas for future research . DESIGN Medline , PsychInfo , and CINAHL were search ed for articles published from January 2000 through January 2012 using a reproducible strategy . Study eligibility criteria included interventions aim ed at changing behavior in adult African Americans with type 2 diabetes and measured glycemic control . RESULTS Ten studies met the inclusion criteria , of which five showed a statistically significant change in HbA1c in the intervention group when compared to the control group . Summary information and characteristics of the review ed studies are provided . CONCLUSIONS Characteristics of successful interventions included using problem solving with the patient , culturally tailoring the intervention , and using a nurse educator . Limitations include the limited number of intervention studies available using glycemic control as the outcome measure . Clinical trials are needed to determine how best to tailor interventions to this largely underserved population and studies should describe details of cultural tailoring to provide information for future programs | [
"OBJECTIVE To evaluate associations between psychosocial and social-environmental variables and diabetes self-management , and diabetes control . RESEARCH DESIGN AND METHODS Baseline data from a type 2 diabetes self-management r and omized trial with 463 adults having elevated BMI ( M = 34.8 kg/m2 ) were used... | 4115ea8a-06ff-11f0-808a-c43d1ab1c353 |
Purpose Fatigue is a subjective complaint that is believed to be multifactorial in its etiology and multidimensional in its expression . Fatigue may be experienced by individuals in different dimensions as physical , mental , and emotional tiredness . The purpose s of this study were to review and characterize the use of the 30-item Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) in published studies and to evaluate the available evidence for its psychometric properties . Methods A systematic review was conducted to identify published articles reporting results for the MFSI-SF . Data were analyzed to characterize internal consistency reliability of multi-item MFSI-SF scales and test-retest reliability . Correlation coefficients were summarized to characterize concurrent , convergent , and divergent validity . St and ardized effect sizes were calculated to characterize the discriminative validity of the MFSI-SF and its sensitivity to change . Results Seventy articles were identified . Sample sizes reported ranged from 10 to 529 and nearly half consisted exclusively of females . More than half the sample s were composed of cancer patients ; of those , 59 % were breast cancer patients . Mean alpha coefficients for MFSI-SF fatigue subscales ranged from 0.84 for physical fatigue to 0.93 for general fatigue . The MFSI-SF demonstrated moderate test-retest reliability in a small number of studies . Correlations with other fatigue and vitality measures were moderate to large in size and in the expected direction . The MFSI-SF fatigue subscales were positively correlated with measures of distress , depressive , and anxious symptoms . Effect sizes for discriminative validity ranged from medium to large , while effect sizes for sensitivity to change ranged from small to large . Conclusions Findings demonstrate the positive psychometric properties of the MFSI-SF , provide evidence for its usefulness in medically ill and nonmedically ill individuals , and support its use in future studies | [
"OBJECTIVES Complaints of fatigue are frequent in patients with obstructive sleep apnea ( OSA ) ; however , the impact of continuous positive airway pressure ( CPAP ) on fatigue remains unclear . METHODS Fifty-nine men and women with OSA were r and omly assigned to therapeutic or placebo CPAP in a double-... | 4115ead0-06ff-11f0-808a-c43d1ab1c353 |
Background and purpose : Among members of the health care team , nurses play a large role in actively engaging stroke survivors in secondary stroke prevention programs . This systematic review and meta- analysis examines the effectiveness of interventions in which nurses have a primary role on modification of risk factors among stroke survivors . Methods : We systematic ally search ed for r and omized controlled trials in relevant data bases investigating the role of nurses in secondary stroke prevention . Meta-analyses were conducted using Cochrane Review Manager Software . The mean pooled effect size , a 95 % confidence interval ( CI ) , and I-squared ( I2 ) for heterogeneity were calculated . Results : Sixteen r and omized controlled trials were included with a total of 3568 stroke and transient ischemic attack patients . After removing one outlier , the models demonstrated a statistically significant effect on reducing systolic blood pressure ( SMD = −0.14 ( 95 % CI = −0.23 , –0.05 ) , I2 = 0 % ; p = 0.002 , six studies , n = 1885 ) and diastolic blood pressure ( SMD = −0.16 ( 95 % CI = −0.27 , –0.05 ) , I2 = 0 % ; p = 0.003 , four studies , n = 1316 ) . The interventions also significantly improved physical activity ( five studies , n=1234 ) , diet ( three studies , n=425 ) , medication adherence ( two studies , n=270 ) , and knowledge of risk factors ( three studies , n=516 ) . However , there was no effect on smoking cessation or reduction in use of alcohol . Conclusion : We found that interventions in which nurses had a primary role were effective on improving medical and behavioral risk factors , as well as knowledge of risk factors as part of secondary prevention of stroke | [
"Background Enhanced secondary preventive follow-up after stroke or transient ischemic attack ( TIA ) is necessary for improved adherence to recommendations regarding blood pressure ( BP ) and low-density lipoprotein cholesterol ( LDL-C ) levels . We investigated whether nurse-led , telephone-based follow-up ... | 4115eb0c-06ff-11f0-808a-c43d1ab1c353 |
Anxiety disorders ( generalized anxiety disorder , panic disorder/agoraphobia , social anxiety disorder , and others ) are the most prevalent psychiatric disorders , and are associated with a high burden of illness . Anxiety disorders are often underrecognized and undertreated in primary care . Treatment is indicated when a patient shows marked distress or suffers from complications result ing from the disorder . The treatment recommendations given in this article are based on guidelines , meta-analyses , and systematic review s of r and omized controlled studies . Anxiety disorders should be treated with psychological therapy , pharmacotherapy , or a combination of both . Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence . First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors . Benzodiazepines are not recommended for routine use . Other treatment options include pregabalin , tricyclic antidepressants , buspirone , moclobemide , and others . After remission , medications should be continued for 6 to 12 months . When developing a treatment plan , efficacy , adverse effects , interactions , costs , and the preference of the patient should be considered | [
"OBJECTIVE This study evaluates the efficacy of agomelatine , the first antidepressant that is an agonist at MT(1)/MT(2 ) receptors and an antagonist at 5-HT(2C ) receptor , in the prevention of relapse of depression following successful response . METHOD Patients with DSM-IV-TR major depressive disorder who... | 4115eb48-06ff-11f0-808a-c43d1ab1c353 |
The aim of this systematic review and dose-response meta- analysis was to determine the effect of Nigella Sativa ( N.S ) supplementation on liver and kidney parameters . We search ed PubMed , Scopus , ISI Web of Science , Cochrane central register for controlled trials and Google Scholar from data base inception to April 2019 for relevant controlled trials . Mean differences and st and ard deviations for each outcome were pooled using a r and om-effects model and a dose-response analysis was performed using a fractional polynomial model . Quality of evidence was evaluated using Cochrane Collaboration Risk of Bias tool and the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) methodology . Nineteen trials ( n = 1295 participants ) were included in the meta- analysis . We observed that N.S supplements had significant reducing effects on alkaline-phosphatase ( ALP ) [ 9 trials , n = 710 participants , weighted mean difference (WMD)= -10.825 ; 95%CI : -19.658 , -1.992 U/L ; P = 0.016 ; I2 = 75.7 % ; P-heterogeneity = 0.000 ) and blood urea nitrogen ( BUN ) ( 12 trials , n = 821 participants , WMD= -1.016 ; 95 % CI : -1.760 , -0.273 U/L ; P = 0.007 ; I2 = 87.7 % ; P-heterogeneity = 0.000 ) concentrations . Subgroup analysis showed that , an intervention of more than 12 weeks was found to have a reducing effect on aspartate- aminotransferase ( AST ) measures ( 2 trials , n = 201 participants , WMD= -11.317 ; 95%CI : -15.007 , -7.626 ; P = 0.000 ; I2 = 0.0 % ; P-heterogeneity = 0.977 ) . Creatinine levels increased significantly in studies that considered adjusted analysis based on covariates ( 3 trials , n = 152 participants , WMD = 0.070 ; 95 % CI : 0.027 , 0.112 U/L ; P = 0.001 ; I2 = 0.0 % ; P-heterogeneity = 0.788 ) . A daily dose of 1100 - 1500 mg of N.S supplements was observed to have a substantial reducing effect on ALP levels ( 5 trials , n = 340 participants , WMD= -11.323 ; 95 % CI : -21.418 , -1.229 U/L ; P = 0.028 ; I2 = 0.00 % ; P-heterogeneity = 0.686 ) , while a dosage of more than 2000 mg per day led to a significant increase in BUN concentrations ( 2 trials , n = 101 participants , WMD= -1.016 ; 95 % CI : -1.760 , -0.273 U/L ; P = 0.007 ; I2 = 87.7 % ; P-heterogeneity = 0.000 ) . Our data suggested that N.S supplementation had significant impacts on liver and kidney parameters leading to a decrease in ALP and BUN levels . Longer duration of intervention and normal daily dosages of N.S supplements led to significant reductions in ALP and AST concentrations , respectively , while higher daily dosages increased BUN levels . Hence , in spite of favorable impacts of N.S supplements on liver and kidney parameters , due to the herbal nature of N.S , more studies with high- quality , large-scale , long-term intervention and precise baseline characteristics are needed to assess the exact effective dose , duration and efficacy of N.S supplementation on kidney and liver parameters | [
"Background Adjustment for prognostic covariates can lead to increased power in the analysis of r and omized trials . However , adjusted analyses are not often performed in practice . Methods We used simulation to examine the impact of covariate adjustment on 12 outcomes from 8 studies across a range of th... | 4115eb84-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE The aim of this systematic review was to perform a meta- analysis of r and omized controlled trials ( RCTs ) examining the efficacy of fibrate therapy in reducing plasma concentration or activity of plasminogen activator inhibitor 1 ( PAI-1 ) . METHODS Scopus and MEDLINE data bases were search ed ( up to October 15 , 2014 ) to identify RCTs investigating whether fibrates lower plasma PAI-1 concentration or activity . A r and om-effects model and the generic inverse variance method were used for quantitative data synthesis . Sensitivity analyses were conducted using the one- study remove approach . R and om-effects meta-regression was performed to assess the impact of potential moderators on the estimated effect sizes . RESULTS A total of 14 RCTs examining the effects of gemfibrozil ( 6 trials ) , bezafibrate ( 4 trials ) , and fenofibrate ( 5 trials ) were included . Meta- analysis suggested that fibrate therapy did not significantly reduce plasma PAI-1 concentration ( weighed mean difference [ WMD ] : -11.39 ng/mL , 95 % CI : -26.64 , 3.85 , p=0.143 ) or activity ( WMD : 2.02 U/mL , 95 % CI : -0.87 , 4.90 , p=0.170 ) . These results remained unchanged after subgroup analysis according to duration of treatment ( ( fenofibrate , bezafibrate or gemfibrozil ) . The estimated effects of fibrate therapy on plasma concentration and activity of PAI-1 were independent of treatment duration and changes in plasma triglyceride levels in the meta-regression analysis . CONCLUSION This meta- analysis of RCTs suggested that fibrate therapy does not reduce plasma concentration or activity of PAI-I. The putative benefits of fibrate therapy in patients with cardiovascular disease appear to be exerted via mechanisms independent of effects on PAI-1 | [
"Abstract Background : The lipid-lowering effect of fenofibrate is accompanied by a rise in plasma homocysteine ( HCY ) , a potential risk factor for venous thromboembolism ( VTE ) . This study investigated the relationship between HCY and the risk of VTE in patients treated with fenofibrate . Methods :... | 4115ebc0-06ff-11f0-808a-c43d1ab1c353 |
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life . The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) . For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % . The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown . Our objective was to determine the volume of data supporting combination therapy in treating OAB . METHODS We systematic ally review ed PubMed , EMBASE , the Cochrane Library , and Google Scholar for articles published before October 2018 . Each was independently review ed by two review ers and examined in detail if they met inclusion criteria . RESULTS A total of 32 studies met inclusion criteria and were review ed . Most large prospect i ve studies evaluated combinations of medications with behavioral therapy or medications together . Combination therapy studies of third-line treatments were rare and centered on medication with PTNS . No studies examined intradetrusor botulinum toxin injections in combination with another therapy and only one retrospective study briefly examined SNM therapy in combination with medication . CONCLUSION Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious . There is a further need for carefully design ed combination therapy studies , particularly those including third line modalities | [
"Objective To verify whether the combination of transcutaneous electrical neural stimulation ( TENS ) with oxybutynin in the treatment of women with overactive bladder ( OAB ) would be more effective than isolated treatments . Methods We r and omized 75 women with OAB , in three groups : GI—30 min TENS , twi... | 4115ebfc-06ff-11f0-808a-c43d1ab1c353 |
formation of large informatic data bases , or clinical quality registries , linking preoperative and intraoperative clinical data , imaging , genomics , and cancer and drug prescription data bases . From a clinical perspective , we forsee patients undergoing the same operation receiving a different anaesthetic depending on their outcome risk . Taking knee arthroplasty as an example , patients deemed at low risk of experiencing outcomes such as postoperative pain or chronic pain may receive intra-articular local anaesthesia infiltration ; patients at medium risk may obtain additional analgesia via a saphe-nous nerve catheter ; and patients at high risk may also receive nerve blocks and anti-hyperalgesics . Best possible treatment in low- and high-risk groups , based on the clinical balance of efficacy and side-effects , would be determined by stratified RCTs . We believe that , by adopting this philosophy , a stratified , holistic approach to research will bring a more personalized approach to anaesthesia . References 1 Fischer HB , Simanski CJ , Sharp C , et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty . Postoperative pain management : number-needed-to-treat approach versus procedure-specific pain management approach . pain and function after fast-track hip and knee arthroplasty . catastrophizing , response to experimental heat stimuli , and post-cesarean section pain . In 1946 , Mendelson 1 showed that pulmonary complications and death could arise in pregnant women because of aspiration of gastric contents . Since then , prevention of aspiration of gastric contents has contributed significantly to a decrease in maternal deaths . Aspiration of gastric contents also impacts other areas of anaesthetic practice , particularly emergency surgery . Warner and colleagues 2 demonstrated in a large series from the Mayo Clinic that no aspiration occurred in pregnant or post-partum women ( probably because of the routine use of prophylactic measures ) , while both its occurrence and severity were significant in emergency procedures . An important risk factor for aspiration is gastric volume , determined in large part by gastric emptying . Unfortunately , measuring gastric volume over time is not easy , and scintigraphy has Editorials BJA | [
"Underst and ing the impact of rheological properties of food on postpr and ial appetite and glycemic response helps to design novel functional products . It has been shown that solid foods have a stronger satiating effect than their liquid equivalent . However , whether a subtle change in viscosity of a semi-sol... | 4115ec38-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Increasing age and post-menopausal status are associated with decreasing and rogen concentrations in females . Women with premature loss of ovarian function , such as primary ovarian insufficiency ( POI ) or iatrogenic menopause may be at increased risk for diminished testosterone levels at a relatively young age . Differentiation between a hypo and rogenic or normo and rogenic state in women with premature loss of ovarian function is problematic due to trueness and precision problems using various testosterone assays . The current meta- analysis was conducted to evaluate current literature reporting serum total testosterone concentrations under these conditions , including stratification for various testosterone assays . METHODS A systematic review and meta- analysis of controlled observational studies were performed . The electronic data bases of Pubmed , Embase and the Cochrane Library were systematic ally search ed until October 2011 for comparative studies on total testosterone concentrations in women with spontaneous POI or iatrogenic menopause compared with controls . The literature search , data extraction and critical appraisal , using the Newcastle-Ottawa Scale , were performed by two independent investigators . The effect measure was the weighted mean difference ( WMD ) with 95 % confidence interval ( 95 % CI ) in a r and om effects model . RESULTS A total of 206 articles for spontaneous POI and 1358 for iatrogenic menopause were review ed , of which 9 and 17 papers , respectively , were selected for final analysis . Both groups demonstrated significantly lower total testosterone concentrations compared with controls [ WMD ( 95 % CI ) -0.38 ( -0.55 to -0.22 ) nmol/l , and -0.29 ( -0.39 to -0.18 ) nmol/l , respectively ] , but with substantial between- study heterogeneity . Subgroup analysis for assay type was statistically significant for spontaneous POI only . Sensitivity analyses of high- quality studies did not change the results , and result ed in a substantial decrease in heterogeneity in spontaneous POI studies . CONCLUSIONS The current meta- analysis demonstrates that total testosterone concentrations are decreased in women with spontaneous POI or iatrogenic menopause . The potential implication s of hypo and rogenism in these women remain to be eluci date | [
"The hypothalamo-pituitary-adrenal ( HPA ) axis is modulated by sex hormones . Few data exist on the relation between acute estrogen deficit and HPA axis response to corticotropin-releasing hormone ( CRH ) . The effects of a sudden drop in estradiol levels on basal and CRH-stimulated levels of ACTH , cortisol ... | 4115ec74-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE To develop an evidence -based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists ( BZRAs ) ; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development , review , and endorsement processes . METHODS The overall team comprised 8 clinicians ( 1 family physician , 2 psychiatrists , 1 clinical psychologist , 1 clinical pharmacologist , 2 clinical pharmacists , and 1 geriatrician ) and a method ologist ; members disclosed conflicts of interest . For guideline development , a systematic process was used , including the GRADE ( Grading of Recommendations Assessment , Development and Evaluation ) approach . Evidence was generated by conducting a systematic review of BZRA deprescribing trials for insomnia , as well as performing a review of review s of the harms of continued BZRA use and narrative syntheses of patient preferences and re source implication s. This evidence and GRADE quality of evidence ratings were used to generate recommendations . The team refined guideline content and recommendations through consensus and synthesized clinical considerations to address front-line clinician questions . The draft guideline was review ed by clinicians and stakeholders . RECOMMENDATIONS We recommend that deprescribing ( tapering slowly ) of BZRAs be offered to elderly adults ( ≥ 65 years ) who take BZRAs , regardless of duration of use , and suggest that deprescribing ( tapering slowly ) be offered to adults aged 18 to 64 who have used BZRAs for more than 4 weeks . These recommendations apply to patients who use BZRAs to treat insomnia on its own ( primary insomnia ) or comorbid insomnia where potential underlying comorbidities are effectively managed . This guideline does not apply to those with other sleep disorders or untreated anxiety , depression , or other physical or mental health conditions that might be causing or aggravating insomnia . CONCLUSION Benzodiazepine receptor agonists are associated with harms , and therapeutic effects might be short term . Tapering BZRAs improves cessation rates compared with usual care without serious harms . Patients might be more amenable to deprescribing conversations if they underst and the rationale ( potential for harm ) , are involved in developing the tapering plan , and are offered behavioural advice . This guideline provides recommendations for making decisions about when and how to reduce and stop BZRAs . Recommendations are meant to assist with , not dictate , decision making in conjunction with patients | [
"Abstract Twenty-four volunteers ( 19 women and five men ) with insomnia and a history of chronic use of benzodiazepine hypnotics participated in a r and omized , double blind , controlled clinical trial . The study was design ed to assess the effects of substituting zopiclone ( ZOP ) – as an hypnotic – a... | 4115ecba-06ff-11f0-808a-c43d1ab1c353 |
Objectives : To systematic ally review and meta-analyse existing evidence on the association between folate/B12 , and depression among the aged people . Methods : Following PRISMA /STROBE guidelines , the Medline abstract s were retrieved using an algorithm comprising relevant MeSH terms . Publications on the association of folate/B12 serum measurements with depression were abstract ed independently by two review ers and included in both gender and gender-specific meta-analyses , following recarculations of published data as appropriate . The Newcastle-Ottawa scale was used to evaluate the quality of included studies . Results : Both gender data were contributed by 11 folate-related ( 7949 individuals ) and 9 B12-related studies ( 6308 individuals ) , whereas gender-specific data by 4 folate-related ( 3409 individuals ) and 3 B12-related studies ( 1934 individuals ) . A statistically significant overall association between both exposures of interest ( low folate and B12 levels ) and depression was observed ( ORfolate:1.23 , 95%CI:1.07–1.43 , ORB12:1.20 , 95%CI:1.02–1.42 ) . Gender-specific estimates pointed to a statistically significant positive association between low B12 levels and depression only among women ( OR:1.33 , 95%CI:1.02–1.74 ) ; the gender specific associations of low folate levels with depression were , however , non-significant and of counter-direction ( ORfemales:1.37 , 95%CI:0.90–2.07 ; ORmales:0.84 , 95%CI:0.57–1.25 ) . Conclusion : Low folate and B12 serum levels seem to be associated with depression in the aged . The gender-specific analyses are confined to a positive association of low B12 with depression among older women and call for further research in this direction | [
"BACKGROUND Depression is common and the efficacy of antidepressants is suboptimal . High plasma homocysteine has been consistently associated with depression , and treatment with certain B vitamins demonstrably reduces its concentration . AIMS To determine whether vitamins B6 , B12 and folic acid enhance resp... | 4115ecec-06ff-11f0-808a-c43d1ab1c353 |
Purpose of Review Purpose of Review Management of treatment-resistant ( TR ) panic disorder ( PD ) is an unresolved issue . In this paper , we provide a brief summary of previous findings , an up date d ( 2015–2017 ) systematic review of pharmacological/non-pharmacological studies , and our personal perspective on this topic . Recent Findings Recent Findings We found a very limited number of recent findings . Quetiapine extended-release augmentation has not been found to be beneficial , in comparison to placebo , in non-responders to previously recommended pharmacotherapy . In non-responders to cognitive behavioral therapy ( CBT ) , switching to paroxetine/citalopram has been found to be more effective than continuing CBT . Acceptance and commitment therapy ( ACT ) has shown some improvement in patients ’ resistance to previous psychological/pharmacological interventions compared with a waiting-list condition . Summary Summary Previous and recent findings regarding the treatment of TR PD suffer from several method ological limitations . Available studies provide insufficient evidence to support the use of medications alternative to the recommended medications ; the efficacy of ACT needs confirmation with more rigorous methodology . Prolonged pharmacotherapy may produce significant improvement in patients with unsatisfactory response to short-term pharmacotherapy , while switching to pharmacotherapy may help non-responders to CBT . We discuss our personal perspective on the definition of “ treatment resistance ” as it relates to PD and provide personalized intervention strategies to increase favorable clinical outcomes based on our clinical expertise and review of experimental studies on the pathophysiology of PD | [
"Background Open-label quetiapine coadministration with SSRI therapy , in a diagnostically mixed sample of comorbid anxiety patients , offered additional anxiolytic benefit . Therefore , we design ed the following controlled trial to confirm these findings in a comorbid , SSRI-resistant , panic disorder ( PD )... | 4115ed32-06ff-11f0-808a-c43d1ab1c353 |
Background : Evidence from r and omized controlled trials ( RCTs ) suggests the consumption of konjac glucomannan ( KJM ) , a viscous soluble fiber , for improving LDL-cholesterol concentrations . It has also been suggested that the cholesterol-lowering potential of KJM may be greater than that of other fibers . However , trials have been relatively scarce and limited in sample size and duration , and the effect estimates have been inconsistent . The effect of KJM on new lipid targets of cardiovascular disease ( CVD ) risk is also unknown . Objective : This systematic review and meta- analysis aim ed to assess the effect of KJM on LDL cholesterol , non-HDL cholesterol , and apolipoprotein B. Design : Medline , Embase , CINAHL , and the Cochrane Central data bases were search ed . We included RCTs with a follow-up of ≥3 wk that assessed the effect of KJM on LDL cholesterol , non-HDL cholesterol , or apolipoprotein B. Data were pooled by using the generic inverse-variance method with r and om-effects models and expressed as mean differences ( MDs ) with 95 % CIs . Heterogeneity was assessed by the Cochran Q statistic and quantified by the I2 statistic . Results : Twelve studies ( n = 370 ) , 8 in adults and 4 in children , met the inclusion criteria . KJM significantly lowered LDL cholesterol ( MD : -0.35 mmol/L ; 95 % CI : -0.46 , -0.25 mmol/L ) and non-HDL cholesterol ( MD : -0.32 mmol/L ; 95 % CI : -0.46 , -0.19 mmol/L ) . Data from 6 trials suggested no impact of KJM on apolipoprotein B. Conclusions : Our findings support the intake of ∼3 g KJM/d for reductions in LDL cholesterol and non-HDL cholesterol of 10 % and 7 % , respectively . The information may be of interest to health agencies in crafting future dietary recommendations related to reduction in CVD risk . This study was registered at clinical trials.gov as NCT02068248 | [
"OBJECTIVES Changes in body composition and blood chemistries between overweight adult subjects receiving a supplement containing either 3 g of konjac glucomannan/300 mg calcium carbonate or a placebo containing only 300 mg of calcium carbonate were compared as the primary objective . A secondary objectiv... | 4115ed78-06ff-11f0-808a-c43d1ab1c353 |
INTRODUCTION Ovarian cancer ( OC ) is the third most common gynecologic malignancy worldwide . Most of cases it is of epithelial origin . At the present time there is not a st and ardized screening method , which makes difficult the early diagnosis . The 5-year survival is 90 % for early stages , however most cases present at advanced stages , which have a 5-year survival of only 5 - 20 % . GICOM collaborative group , under the auspice of different institutions , have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia . MATERIAL AND METHODS The following recommendations were made by independent professionals in the field of Gynecologic Oncology , questions and statements were based on a comprehensive and systematic review of literature . It took place in the context of a meeting of two days in which a debate was held . These statements are the conclusions reached by agreement of the participant members . RESULTS No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population . Staging is surgical , according to FIGO . In regards to the pre-surgery evaluation of the patient , it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast . According to the histopathology of the tumor , in order to consider it as borderline , the minimum percentage of proliferative component must be 10 % of tumor 's surface . The recommended st and ardized treatment includes primary surgery for diagnosis , staging and cytoreduction , followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75 % of cases . In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10 - 30 % of all cases , and systematic limphadenectomy , necessary to be able to obtain an adequate surgical staging . Fertility-sparing surgery will be performed in certain cases , the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy . Until now , laparoscopy for diagnostic-staging surgery is not well known as a recommended method . The recommended chemotherapy is based on platin and taxanes for 6 cycles , except in Stage IA , IB and grade 1 , which have a good prognosis . In advanced stages , primary cytoreduction is recommended as initial treatment . Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer . Radiotherapy can be used to palliate symptoms . Follow up of the patients every 2 - 4 months for 2 years , every 3 - 6 months for 3 years and anually after the 5th year is recommended . Evaluation of quality of life of the patient must be done periodically . CONCLUSIONS In the present , there is not a st and ardized screening method . Diagnosis in early stages means a better survival . St and ardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient . Radiotherapy can be indicated to palliate symptoms | [
"A hospital-based case-control study of ovarian cancer was conducted in London and Oxford between October 1978 and February 1983 . Menstrual characteristics , reproductive and contraceptive history and history of exposure to various environmental factors were compared between 235 women with histologically diag... | 4115edb4-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND ACE inhibitors are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure ( BP ) , heart rate and withdrawals due to adverse effects ( WDAE ) . OBJECTIVES To quantify the dose-related systolic and /or diastolic BP lowering efficacy of ACE inhibitors versus placebo in the treatment of primary hypertension . SEARCH STRATEGY We search ed CENTRAL ( The Cochrane Library 2007 , Issue 1 ) , MEDLINE ( 1966 to February 2007 ) , EMBASE ( 1988 to February 2007 ) and reference lists of articles . SELECTION CRITERIA Double-blind , r and omized , controlled trials evaluating the BP lowering efficacy of fixed-dose monotherapy with an ACE inhibitor compared with placebo for a duration of 3 to 12 weeks in patients with primary hypertension . DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias and extracted data . Study authors were contacted for additional information . WDAE information was collected from the trials . MAIN RESULTS Ninety two trials evaluated the dose-related trough BP lowering efficacy of 14 different ACE inhibitors in 12 954 participants with a baseline BP of 157/101 mm Hg . The data do not suggest that any one ACE inhibitor is better or worse at lowering BP . A dose of 1/8 or 1/4 of the manufacturer 's maximum recommended daily dose ( Max ) achieved a BP lowering effect that was 60 to 70 % of the BP lowering effect of Max . A dose of 1/2 Max achieved a BP lowering effect that was 90 % of Max . ACE inhibitor doses above Max did not significantly lower BP more than Max . Combining the effects of 1/2 Max and higher doses gives an estimate of the average trough BP lowering efficacy for ACE inhibitors as a class of drugs of -8 mm Hg for SBP and -5 mm Hg for DBP . ACE inhibitors reduced BP measured 1 to 12 hours after the dose by about 11/6 mm Hg . AUTHORS ' CONCLUSIONS There are no clinical ly meaningful BP lowering differences between different ACE inhibitors . The BP lowering effect of ACE inhibitors is modest ; the magnitude of trough BP lowering at one-half the manufacturers ' maximum recommended dose and above is -8/-5 mm Hg . Furthermore , 60 to 70 % of this trough BP lowering effect occurs with recommended starting doses . The review did not provide a good estimate of the incidence of harms associated with ACE inhibitors because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials | [
"Fourteen patients with mild to moderate essential hypertension were r and omized , after a baseline placebo period of 4 weeks , to receive the angiotensin converting enzyme ( ACE ) inhibitor quinapril or a placebo . During a 12 week , double-blind phase , the dosage of quinapril was increased from 10 to ... | 4115edf0-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND : Hormone therapy ( HT ) is widely provided for control of menopausal symptoms and has been used for the management and prevention of cardiovascular disease , osteoporosis and dementia in older women . This is an up date d version of a Cochrane review first published in 2005 . OBJECTIVES : To assess effects of long-term HT ( at least 1 year 's duration ) on mortality , cardiovascular outcomes , cancer , gallbladder disease , fracture and cognition in perimenopausal and postmenopausal women during and after cessation of treatment . SEARCH METHODS : We search ed the following data bases to September 2016 : Cochrane Gynaecology and Fertility Group Trials Register , Cochrane Central Register of Controlled Trials ( CENTRAL ) , MEDLINE , Embase and PsycINFO . We search ed the registers of ongoing trials and reference lists provided in previous studies and systematic review s. SELECTION CRITERIA : We included r and omised double-blinded studies of HT versus placebo , taken for at least 1 year by perimenopausal or postmenopausal women . HT included oestrogens , with or without progestogens , via the oral , transdermal , subcutaneous or intranasal route . DATA COLLECTION AND ANALYSIS : Two review authors independently selected studies , assessed risk of bias and extracted data . We calculated risk ratios ( RRs ) for dichotomous data and mean differences ( MDs ) for continuous data , along with 95 % confidence intervals ( CIs ) . We assessed the quality of the evidence by using GRADE methods . MAIN RESULTS : We included 22 studies involving 43,637 women . We derived nearly 70 % of the data from two well-conducted studies ( HERS 1998 ; WHI 1998 ) . Most participants were postmenopausal American women with at least some degree of comorbidity , and mean participant age in most studies was over 60 years . None of the studies focused on perimenopausal women . In relatively healthy postmenopausal women ( i.e. generally fit , without overt disease ) , combined continuous HT increased the risk of a coronary event ( after 1 year 's use : from 2 per 1000 to between 3 and 7 per 1000 ) , venous thromboembolism ( after 1 year 's use : from 2 per 1000 to between 4 and 11 per 1000 ) , stroke ( after 3 years ' use : from 6 per 1000 to between 6 and 12 per 1000 ) , breast cancer ( after 5.6 years ' use : from 19 per 1000 to between 20 and 30 per 1000 ) , gallbladder disease ( after 5.6 years ' use : from 27 per 1000 to between 38 and 60 per 1000 ) and death from lung cancer ( after 5.6 years ' use plus 2.4 years ' additional follow-up : from 5 per 1000 to between 6 and 13 per 1000).Oestrogen-only HT increased the risk of venous thromboembolism ( after 1 to 2 years ' use : from 2 per 1000 to 2 to 10 per 1000 ; after 7 years ' use : from 16 per 1000 to 16 to 28 per 1000 ) , stroke ( after 7 years ' use : from 24 per 1000 to between 25 and 40 per 1000 ) and gallbladder disease ( after 7 years ' use : from 27 per 1000 to between 38 and 60 per 1000 ) but reduced the risk of breast cancer ( after 7 years ' use : from 25 per 1000 to between 15 and 25 per 1000 ) and clinical fracture ( after 7 years ' use : from 141 per 1000 to between 92 and 113 per 1000 ) and did not increase the risk of coronary events at any follow-up time . Women over 65 years of age who were relatively healthy and taking continuous combined HT showed an increase in the incidence of dementia ( after 4 years ' use : from 9 per 1000 to 11 to 30 per 1000 ) . Among women with cardiovascular disease , use of combined continuous HT significantly increased the risk of venous thromboembolism ( at 1 year 's use : from 3 per 1000 to between 3 and 29 per 1000 ) . Women taking HT had a significantly decreased incidence of fracture with long-term use . Risk of fracture was the only outcome for which strong evidence showed clinical benefit derived from HT ( after 5.6 years ' use of combined HT : from 111 per 1000 to between 79 and 96 per 1000 ; after 7.1 years ' use of oestrogen-only HT : from 141 per 1000 to between 92 and 113 per 1000 ) . Research ers found no strong evidence that HT has a clinical ly meaningful impact on the incidence of colorectal cancer . One trial analysed subgroups of 2839 relatively healthy women 50 to 59 years of age who were taking combined continuous HT and 1637 who were taking oestrogen-only HT versus similar-sized placebo groups . The only significantly increased risk reported was for venous thromboembolism in women taking combined continuous HT : Their absolute risk remained low , at less than 1/500 . However , other differences in risk can not be excluded , as this study was not design ed to have the power to detect differences between groups of women within 10 years of menopause . For most studies , risk of bias was low in most domains . The overall quality of evidence for the main comparisons was moderate . The main limitation in the quality of evidence was that only about 30 % of women were 50 to 59 years old at baseline , which is the age at which women are most likely to consider HT for vasomotor symptoms . AUTHORS ' CONCLUSIONS : Women with intolerable menopausal symptoms may wish to weigh the benefits of symptom relief against the small absolute risk of harm arising from short-term use of low-dose HT , provided they do not have specific contraindications . HT may be unsuitable for some women , including those at increased risk of cardiovascular disease , increased risk of thromboembolic disease ( such as those with obesity or a history of venous thrombosis ) or increased risk of some types of cancer ( such as breast cancer , in women with a uterus ) . The risk of endometrial cancer among women with a uterus taking oestrogen-only HT is well documented . HT is not indicated for primary or secondary prevention of cardiovascular disease or dementia , nor for prevention of deterioration of cognitive function in postmenopausal women . Although HT is considered effective for the prevention of postmenopausal osteoporosis , it is generally recommended as an option only for women at significant risk for whom non-oestrogen therapies are unsuitable . Data are insufficient for assessment of the risk of long-term HT use in perimenopausal women and in postmenopausal women younger than 50 years of age | [
"Currently raloxifene , a selective estrogen receptor modulator , is being investigated as a potential alternative for postmenopausal hormone replacement to prevent osteoporosis and cardiovascular disease . We compared the 2-year effects of raloxifene on a wide range of cardiovascular risk factors with those ... | 4115ee36-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Previous studies have yielded conflicting results and substantial uncertainty about any independent association of Helicobacter pylori infection with dyspepsia , and about any benefits of antibiotic treatments for nonulcer or uninvestigated dyspepsia . OBJECTIVES To perform a systematic review of the literature to determine whether chronic infection with H pylori is relevant to nonulcer or uninvestigated dyspepsia . METHODS Observational studies of associations between H pylori and dyspepsia published before April 1999 and r and omized trials of the effects of H pylori eradication on dyspepsia published before January 2000 were identified by computer-assisted literature search es of relevant journals , reference lists , and discussion s with authors . Relevant data were abstract ed from the published reports by 2 investigators according to a fixed protocol . RESULTS Thirty relevant observational studies were identified involving approximately 3392 patients with nonulcer dyspepsia , and 11 separate observational studies were identified , involving 6426 patients with uninvestigated dyspepsia . Reports of strong associations in small observational studies without appropriate adjustment for potential confounding factors were not generally confirmed by larger and better- design ed studies . No studies have been reported , however , that can reliably confirm or exclude the existence of any weak associations . Twenty-two r and omized trials of treatments against H pylori were found involving a total of 2340 patients with nonulcer dyspepsia , almost all with positive H pylori test results . Only a few of these trials involved effective antibacterial regimens with prolonged follow-up , and even these studies were too small to assess the possibility of moderate benefits . CONCLUSION The available evidence indicates that there is no strong association between H pylori and dyspepsia , but there is insufficient evidence to confirm or refute the existence of a modest association | [
"The aim of this study was to determine the effect of colloidal bismuth subcitrate ( De Nol ) on symptoms and gastric histology in patients with non-ulcer dyspepsia . In a single centre trial , patients with food related upper abdominal pain not caused by ulcer disease were r and omised to receive one table... | 4115ee72-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE To compile and critique research on the diagnostic accuracy of individual orthopaedic physical examination tests in a manner that would allow clinicians to judge whether these tests are valuable to their practice . METHODS A computer-assisted literature search of MEDLINE , CINAHL , and SPORTD iscus data bases ( 1966 to October 2006 ) using keywords related to diagnostic accuracy of physical examination tests of the shoulder . The Quality Assessment of Diagnostic Accuracy Studies ( QUADAS ) tool was used to critique the quality of each paper . Meta- analysis through meta-regression of the diagnostic odds ratio ( DOR ) was performed on the Neer test for impingement , the Hawkins-Kennedy test for impingement , and the Speed test for superior labral pathology . RESULTS Forty-five studies were critiqued with only half demonstrating acceptable high quality and only two having adequate sample size . For impingement , the meta- analysis revealed that the pooled sensitivity and specificity for the Neer test was 79 % and 53 % , respectively , and for the Hawkins-Kennedy test was 79 % and 59 % , respectively . For superior labral ( SLAP ) tears , the summary sensitivity and specificity of the Speed test was 32 % and 61 % , respectively . Regarding orthopaedic special tests ( OSTs ) where meta- analysis was not possible either due to lack of sufficient studies or heterogeneity between studies , the list that demonstrates both high sensitivity and high specificity is short : hornblowers 's sign and the external rotation lag sign for tears of the rotator cuff , biceps load II for superior labral anterior to posterior ( SLAP ) lesions , and apprehension , relocation and anterior release for anterior instability . Even these tests have been under-studied or are from lower quality studies or both . No tests for impingement or acromioclavicular ( AC ) joint pathology demonstrated significant diagnostic accuracy . CONCLUSION Based on pooled data , the diagnostic accuracy of the Neer test for impingement , the Hawkins-Kennedy test for impingement and the Speed test for labral pathology is limited . There is a great need for large , prospect i ve , well- design ed studies that examine the diagnostic accuracy of the numerous physical examination tests of the shoulder . Currently , almost without exception , there is a lack of clarity with regard to whether common OSTs used in clinical examination are useful in differentially diagnosing pathologies of the shoulder | [
"Purpose To evaluate a new clinical test , the resisted supination external rotation test , for the diagnosis of superior labral anterior posterior lesions of the shoulder . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods Forty athletes ( average age , 23.9 years ) with activity-relat... | 4115eeb8-06ff-11f0-808a-c43d1ab1c353 |
Background Obesity is a growing global health concern that may lead to cardiovascular disease , type II diabetes , and cancer . Several systematic review s have shown that technology is successful in combating obesity through increased physical activity , but there is no known review on interventions that use an electronic activity monitor system ( EAMS ) . EAMSs are defined as a wearable device that objective ly measures lifestyle physical activity and can provide feedback , beyond the display of basic activity count information , via the monitor display or through a partnering application to elicit continual self-monitoring of activity behavior . These devices improve upon st and ard pedometers because they have the ability to provide visual feedback on activity progression , verbal encouragement , and social comparison . This systematic review aim ed to synthesize the efficacy and feasibility results of EAMSs within published physical activity interventions . Methods Electronic data bases and journal references were search ed for relevant articles . Data sources included CINAHL , Cochrane CENTRAL , Medline Ovid , PsycINFO , and clinical trials.gov . Out of the 1,574 retrieved , 11 articles met the inclusion criteria . These articles were review ed for quality and content based on a risk of bias tool and intervention components . Results Most articles were determined to be of medium quality while two were of low quality , and one of high quality . Significant pre-post improvements in the EAMS group were found in five of nine studies for physical activity and in four of five studies for weight . One found a significant increase in physical activity and two studies found significant weight loss in the intervention group compared with the comparator group . The EAMS interventions appear to be feasible with most studies reporting continual wear of the device during waking hours and a higher retention rate of participants in the EAMS groups . Conclusion These studies provide preliminary evidence suggesting that EAMS can increase physical activity and decrease weight significantly , but their efficacy compared to other interventions has not yet been demonstrated . More high- quality r and omized controlled trials are needed to evaluate the overall effect of EAMS , examine which EAMS features are most effective , and determine which population s are most receptive to an EAMS | [
"Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( ... | 4115eef4-06ff-11f0-808a-c43d1ab1c353 |
Hydrotherapy is often used in the treatment of fibromyalgia syndrome ( FMS ) , however there has been limited evaluation of its effectiveness . The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS . AMED , BNI , CINAHL , The Cochrane Library , EMBASE , MEDLINE , ProQuest , PubMed , Science Direct and Web of Science were search ed ( 1990–July 2006 ) . Key words used ‘ fibromyalgia ’ and ‘ hydrotherapy ’ , ‘ balneotherapy ’ , ‘ aqua therapy ’ , ‘ pool therapy ’ , ‘ water therapy ’ , ‘ swimming ’ , ‘ hydrogalvanic ’ , ‘ spa therapy ’ , ‘ physiotherapy ’ , ‘ physical therapy ’ and ‘ rehabilitation ’ . Search es were supplemented with h and search es of selected journals . R and omised controlled trials ( RCTs ) were assessed for method ological quality using the van Tulder scale . Ten RCTs met the inclusion criteria . Mean method ological quality was 4.5/9 on the van Tulder scale . Positive outcomes were reported for pain , health-status and tender point count . There is strong evidence for the use of hydrotherapy in the management of FMS | [
"OBJECTIVES To study the effect of a combination of thalassotherapy , exercise and patient education in people with fibromyalgia . METHODS Patients with fibromyalgia , selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association , were pre-r and omized to r... | 4115ef3a-06ff-11f0-808a-c43d1ab1c353 |
Atrial fibrillation is the most common supraventricular arrhythmia . Its prevalence increases with age and preferentially affects male patients . Over 75 years of age , however , female patients being more prevalent , the absolute number of patients affected is similar between sexes . Despite this , few data are available in the literature concerning sex-related differences in atrial fibrillation patients . The present systematic review therefore considers comorbidities , referring symptoms , quality of life , pharmacological approaches and trans-catheter ablation in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome . In brief , female atrial fibrillation patients more commonly present comorbidities , leading to a higher prevalence of persistent atrial fibrillation ; moreover , they refer to hospital care later and with a longer disease history . Atrial fibrillation symptoms relate to low quality of life in female patients ; in fact , atrial fibrillation paroxysm usually presents higher heart rate , leading to preferentially adopt a rate rather than a rhythm-control strategy . Female atrial fibrillation patients present an increased risk of stroke , worsened by the lower oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile . Trans-catheter ablation is under-used in female patients and , on the contrary , they are more commonly affected by anti-arrhythmic drug side effects | [
"BACKGROUND Amiodarone use was associated with an increased need for pacemaker insertion in a retrospective study of patients with atrial fibrillation ( AF ) and prior myocardial infa rct ion . The aims of this study were to determine prospect ively whether amiodarone increases the need for pacemakers in ... | 4115ef76-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVES Resin composite sealants are retained longer than low-viscosity glass-ionomer sealants . Nevertheless , a systematic review showed that there is no evidence that resin composite sealants are superior to low-viscosity glass-ionomers in preventing dentine carious lesion development . This case study aim ed to investigate reasons for this . METHODS 4 teeth were sealed with 2 br and s of high-viscosity glass-ionomer according to the ART technique in 2 children aged 10 and 11.5 years , having a low caries-risk status , and followed clinical ly for between 8 and 13 years . At the final year , impressions were taken for SEM images that were assessed by two evaluators . RESULTS Pits and fissures that were clinical ly diagnosed as free of sealant material appeared to contain remnants of high-viscosity glass-ionomer sealant material in the deeper parts of pits and fissures , on SEM images of 3 teeth . CONCLUSION This study confirms the likelihood that remnants of high-viscosity glass-ionomer sealant material are retained and block the deeper parts of pits and fissures even after the sealant appears to have disappeared clinical ly , exercising their carious lesion preventive effect | [
"The aim of the present trial was to ( 1 ) compare the caries-preventive effect of glass ionomer sealants , placed according to the atraumatic restorative treatment ( ART ) procedure , with composite resin sealants over time and ( 2 ) investigate the caries-preventive effect after complete disappearance of ... | 4115efb2-06ff-11f0-808a-c43d1ab1c353 |
Background Implant survivorship is reported to be lower and complications , particularly bearing dislocation , are reported to be more frequent in Asian than in Western patients with medial knee osteoarthritis ( OA ) undergoing Oxford ® Phase III unicompartmental knee arthroplasty ( UKA ) . To date , however , these complications have not been compared between these groups of patients . Questions / purpose s The purpose of this study was to perform a meta- analysis comparing the st and ardized incidence rates of ( 1 ) all-cause reoperation ; ( 2 ) reoperation related to bearing dislocation ; and ( 3 ) reoperation related to progression of lateral compartment arthritis in Asian and Western patients with medial knee OA who underwent Oxford Phase III UKA . Methods We search ed MEDLINE ® ( January 1 , 1976 , to May 31 , 2017 ) , EMBASE ® ( January 1 , 1985 , to May 31 , 2017 ) , and the Cochrane Library ( January 1 , 1987 , to May 31 , 2017 ) for studies that reported complications of Oxford Phase III UKAs . Studies were included if they reported reoperation rates attributable to bearing dislocation and /or progression of lateral knee OA after surgery with this implant . Twenty-seven studies were included in this systematic review and 16 studies with followups > 5 years were included in the meta- analysis . These rates were converted to st and ardized incidence rate ( that is , reoperations per 100 observed component years ) based on mean followup and number of involved knees in each study . After applying prespecified inclusion and exclusion criteria , the studies were categorized into two groups , Asian and Western , based on hospital location . Twenty-five studies , containing 3152 Asian patients and 5455 Western patients , were evaluated . Study quality was assessed by the modified Coleman Methodology score ( MCMS ) . Although all studies were Level IV , their mean MCMS score was 66.92 ( SD , 8.7 ; 95 % confidence interval [ CI ] , 63.5–70.3 ) , indicating fair quality . Because the heterogeneity of all subgroup meta-analyses was high , a r and om-effects model was used with estimations using the restricted maximum likelihood method . Results There was no difference in the proportion of Asian patients versus Western patients undergoing reoperation for any cause calculated as 100 component observed years ( 1.022 of 3152 Asian patients ; 95 % CI , 0.810 - 1.235 versus 1.300 of 5455 Western patients ; 95 % CI , 1.067 - 1.534 ; odds ratio , 0.7839 ; 95 % CI , 0.5323 - 1.1545 ; p = 0.178 ) . The mean reoperation rate attributable to bearing dislocation per 100 observed years was higher in Asian than in Western patients ( 0.525 ; 95 % CI , 0.407 - 0.643 versus 0.141 ; 95 % CI , 0.116 - 0.166 ; odds ratio , 3.7378 ; 95 % CI , 1.694 - 8.248 ; p = 0.001 ) Conversely , the mean reoperation rate attributable to lateral knee OA per 100 observed years was lower in Asian than in Western patients ( 0.093 ; 95 % CI , 0.070 - 0.115 versus 0.298 ; 95 % CI , 0.217 - 0.379 ; odds ratio , 0.3114 ; 95 % CI , 0.0986 - 0.9840 ; p total reoperation rates did not differ in the two population s , reoperation for bearing dislocation was more likely to occur in Asian than in Western patients , whereas reoperation for lateral knee OA progression was more likely to occur in Western than in Asian patients after Oxford Phase III UKA . Although possible explanations for these findings may be hypothesized , additional r and omized , prospect i ve comparative studies are needed . However , better survival outcomes after UKA may require consideration of ethnicity and lifestyle choices in addition to traditional surgical technique and perioperative care . Level of Evidence Level III , therapeutic study | [
"& NA ; This prospect i ve study was performed to investigate whether postoperative alternate flexion and extension splinting ( daily change in position of immobilization by splinting ) was useful in restoring full range of motion ( ROM ) after total knee arthroplasty as compared with continuous passive motio... | 4115efee-06ff-11f0-808a-c43d1ab1c353 |
Introduction : The aim of the present study was to investigate the influence of root‐end preparation and filling material on endodontic surgery outcome . A systematic review and meta‐ analysis was conducted to determine the outcome of resin‐based endodontic surgery ( RES , the use of high‐magnification preparation of a shallow and concave root‐end cavity and bonded resin‐based root‐end filling material ) versus endodontic microsurgery ( EMS , the use of high‐magnification ultrasonic root‐end preparation and root‐end filling with SuperEBA [ Keystone Industries , Gibbstown , NJ ] , IRM [ Dentsply Sirona , York , PA ] , mineral trioxide aggregate [ MTA ] , or other calcium silicate cements ) . Methods : An exhaustive literature search was conducted to identify prognostic studies on the outcome of root‐end surgery . Human studies conducted from 1966 to the end of December 2016 in 5 different language s ( ie , English , French , German , Italian , and Spanish ) were search ed in 4 electronic data bases ( ie , Medline , Embase , PubMed , and Cochrane Library ) . Relevant review articles on the subject were scrutinized for cross‐references . In addition , 5 dental and medical journals ( Journal of Endodontics ; International Endodontic Journal ; Oral Surgery , Oral Medicine , Oral Pathology , Oral Radiology , and Endodontics ; Journal of Oral and Maxillofacial Surgery ; and International Journal of Oral and Maxillofacial Surgery ) were h and checked dating back to 1975 . All abstract s were screened by 3 independent review ers ( H.B. , M.K. , and F.S. ) . Strict inclusion ‐exclusion criteria were defined to identify relevant articles . Raw data were extracted from the full‐text review of these selected articles independently by each of the 3 review ers . In case of disagreement , an agreement was reached by discussion , and qualifying articles were assigned to group RES . For EMS , the same search strategy was performed for the time frame October 2009 to December 2016 , whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy . Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated . To make a comparison between groups , a r and om effects model was used . Results : Sixty‐eight articles were eligible for full‐text review . Of these , per strict inclusion exclusion criteria , 14 studies qualified , 3 for RES ( n = 862 ) and 11 for EMS ( n = 915 ) . Weighted pooled success rates for RES were 82.20 % ( 95 % confidence interval [ CI ] , 0.7965–0.8476 ) and 94.42 % for EMS ( 95 % CI , 0.9295–0.9590 ) . This difference was statistically significant ( P probability for success for EMS proved to be significantly greater than the probability for success for RES , providing best available evidence on the influence of cavity preparation with ultrasonic tips and /or SuperEBA ( Keystone Industries , Gibbstown , NJ ) , IRM ( Dentsply Sirona , York , PA ) , MTA , or silicate cements as root‐end filling material instead of a shallow cavity preparation and placement of a resin‐based material . Additional large‐scale r and omized clinical trials are needed to assess other predictors of outcome . HIGHLIGHTSEndodontic microsurgery ( EMS ) with the use of high‐magnification ultrasonic root‐end preparation and root‐end filling with SuperEBA , IRM , MTA , or other calcium silicate cements has a high probability of success . Resin‐based endodontic surgery with the use of high‐magnification preparation of a shallow concave root‐end cavity with bonded resin‐based root‐end filling material performed less favorably than EMS | [
"INTRODUCTION Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing . However , the information is mainly based on 1- to 2-year follow-up data . The present prospect i ve study was design... | 4115f02a-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Tree nut consumption has been associated with reduced diabetes risk , however , results from r and omized trials on glycemic control have been inconsistent . OBJECTIVE To provide better evidence for diabetes guidelines development , we conducted a systematic review and meta- analysis of r and omized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes . DATA SOURCES MEDLINE , EMBASE , CINAHL , and Cochrane data bases through 6 April 2014 . STUDY SELECTION R and omized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c , fasting glucose , fasting insulin , and HOMA-IR . DATA EXTRACTION AND SYNTHESIS Two independent review er 's extracted relevant data and assessed study quality and risk of bias . Data were pooled by the generic inverse variance method and expressed as mean differences ( MD ) with 95 % CI 's . Heterogeneity was assessed ( Cochran Q-statistic ) and quantified ( I2 ) . RESULTS Twelve trials ( n = 450 ) were included . Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c ( MD = -0.07 % [ 95 % CI:-0.10 , -0.03 % ] ; P = 0.0003 ) and fasting glucose ( MD = -0.15 mmol/L [ 95 % CI : -0.27 , -0.02 mmol/L ] ; P = 0.03 ) compared with control diets . No significant treatment effects were observed for fasting insulin and HOMA-IR , however the direction of effect favoured tree nuts . LIMITATIONS Majority of trials were of short duration and poor quality . CONCLUSIONS Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes , supporting their inclusion in a healthy diet . Owing to the uncertainties in our analyses there is a need for longer , higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates . TRIAL REGISTRATION Clinical Trials.gov NCT01630980 | [
"Walnuts are rich in polyunsaturated fatty acids and have been shown to improve various cardiometabolic risk factors . We aim ed to investigate the association between walnut intake and incident type 2 diabetes in 2 large cohort studies : the Nurses ’ Health Study ( NHS ) and NHS II . We prospect ively foll... | 4115f070-06ff-11f0-808a-c43d1ab1c353 |
Background Overtraining syndrome ( OTS ) , functional ( FOR ) and non-functional overreaching ( NFOR ) are conditions diagnosed in athletes with decreased performance and fatigue , triggered by metabolic , immune , hormonal and other dysfunctions and result ed from an imbalance between training stress and proper recovery . Despite previous descriptions , there is a lack of a review that discloses all hormonal findings in OTS/FOR/NFOR . The aim of this systematic review is to evaluate whether and which roles hormones play in OTS/FOR/NFOR . Methods A systematic search up to June 15th , 2017 was performed in the PUBMED , MEDLINE and Cochrane data bases following PRISMA protocol , with the expressions : (1)overtraining , (2)overreaching , (3)overtrained , (4)overreached , or (5)underperformance , and ( plus ) (a)hormone , (b)hormonal , (c)endocrine , (d)adrenal , (e)cortisol , (f)GH , (g)ACTH , (h)testosterone , (i)IGF-1 , (j)TSH , (k)T4 , (l)T3 , (m)LH , (n)FSH , (o)prolactin , ( p ) IGFBP-3 and related articles . Results A total of 38 studies were selected . Basal levels of hormones were mostly normal in athletes with OTS/FOR/NFOR compared with healthy athletes . Distinctly , stimulation tests , mainly performed in maximal exercise conditions , showed blunted GH and ACTH responses in OTS/FOR/NFOR athletes , whereas cortisol and plasma catecholamines showed conflicting findings and the other hormones responded normally . Conclusion Basal hormone levels are not good predictor but blunted ACTH and GH responses to stimulation tests may be good predictors of OTS/FOR/NFOR | [
"The present investigation compared responses in previously identified physiological , biochemical , and psychological markers of overreaching in triathletes . Sixteen experienced male triathletes ( .VO(2max ) [ mean + /- SD ] = 55.7 + /- 4.9 mL . kg ( -1 ) . min ( -1 ) , age = 31.3 + /- 11.7 yr ) were divided in... | 4115f0ac-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE The objective of this systematic review was to assess the effectiveness of different physical exercise interventions on the lipid profile ( high-density lipoprotein cholesterol ( HDL-C ) , low-density lipoprotein cholesterol ( LDL-C ) , total cholesterol ( TC ) , and triglycerides ( TG ) ) of obese children . METHOD A computerized search was made of seven data bases using keywords . Effect sizes ( ES ) and 95 % confidence intervals were calculated , and the heterogeneity ( I(2 ) ) of the studies was estimated using Cochran 's Q-statistic applied to the effect size means . The studies were grouped according to the intervention program-aerobic alone or combined ( aerobic fitness , strength , and flexibility ) . RESULTS Seven studies were selected for review as satisfying the inclusion criteria . Six were r and omized controlled trials ( n=318 ) and one was a controlled clinical trial ( groups not r and omly assigned ) ( n=38 ) . The main cumulative evidence indicates that the programs based on aerobic exercise alone have a moderate ( ES=-0.49 ; I²=87 ) and a large effect ( ES=-0.55 ; I²=77 ) on LDL-C and TG concentrations , respectively ; and the programs based on combined exercise have a moderate effect ( ES=0.50 ; I²=0 ) on HDL-C concentration . CONCLUSIONS The programs based on aerobic exercise ( 60 min , 3 times/week , ≤75 % maximum heart rate ) improve the LDL-C and TG concentrations . Moreover , the programs based on combined exercise ( ≥60 min , > 75 % maximum heart rate ) also improve the HDL-C concentration | [
"INTRODUCTION The purpose of this study was to test the hypothesis that physical training ( PT ) , especially high-intensity PT , would have a favorable effect on components of the insulin resistance syndrome ( IRS ) in obese adolescents . METHODS Obese 13- to 16-yr-olds ( N = 80 ) were r and omly assigned ... | 4115f0e8-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Iodine deficiency is the leading preventable cause of intellectual impairment in the world . Although iodine supplementation is generally considered to be safe , there is a possibility of high doses of iodine suppressing maternal thyroid function . OBJECTIVES The objective of this review was to assess the effects of iodine supplementation before or during pregnancy in areas of iodine deficiency . SEARCH STRATEGY We search ed the Cochrane Pregnancy and Childbirth Group trials register . SELECTION CRITERIA All acceptably controlled trials of maternal iodine supplementation during pregnancy with clinical outcomes . DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by two review ers . MAIN RESULTS Three trials involving 1551 women were included . In two trials , iodine supplementation was associated with a statistically significant reduction in deaths during infancy and early childhood ( relative risk 0.71 , 95 % confidence interval 0 . 56 to 0.90 ) . Iodine supplementation was associated with decreased prevalence of endemic cretinism at the age of four years ( relative risk 0.27 , 95 % confidence interval 0.12 to 0.60 ) and better psychomotor development scores between four to 25 months of age . REVIEW ER 'S CONCLUSIONS Iodine supplementation in a population with high levels of endemic cretinism results in an important reduction in the incidence of the condition with no apparent adverse effects | [
"Reduced maternal thyroid hormone concentrations during pregnancy can adversely affect fetal neurological development . In the context of national iodine supplementation programmes , concern has been expressed over the theoretical possibility that iodine supplementation during pregnancy might adversely affect f... | 4115f12e-06ff-11f0-808a-c43d1ab1c353 |
CONTEXT Sedentary time spent with screen media is associated with obesity among children and adults . Obesity has potentially serious health consequences , such as heart disease and diabetes . This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aim ed at reducing recreational ( i.e. , neither school- nor work-related ) sedentary screen time , as measured by screen time , physical activity , diet , and weight-related outcomes . EVIDENCE ACQUISITION For this review , an earlier ( " original " ) review ( search period , 1966 through July 2007 ) was combined with up date d evidence ( search period , April 2007 through June 2013 ) to assess effectiveness of behavioral interventions aim ed at reducing recreational sedentary screen time . Existing Community Guide systematic review methods were used . Analyses were conducted in 2013 - 2014 . EVIDENCE SYNTHESIS The review included 49 studies . Two types of behavioral interventions were evaluated that either ( 1 ) focus on reducing recreational sedentary screen time only ( 12 studies ) ; or ( 2 ) focus equally on reducing recreational sedentary screen time and improving physical activity or diet ( 37 studies ) . Most studies targeted children aged ≤13 years . Children 's composite screen time ( TV viewing plus other forms of recreational sedentary screen time ) decreased 26.4 ( interquartile interval= -74.4 , -12.0 ) minutes/day and obesity prevalence decreased 2.3 ( interquartile interval= -4.5 , -1.2 ) percentage points versus a comparison group . Improvements in physical activity and diet were reported . Three study arms among adults found composite screen time decreased by 130.2 minutes/day . CONCLUSIONS Among children , these interventions demonstrated reduced screen time , increased physical activity , and improved diet- and weight-related outcomes . More research is needed among adolescents and adults | [
"BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To c... | 4115f16a-06ff-11f0-808a-c43d1ab1c353 |
ABSTRACT Virtual environments ( VEs ) have demonstrated promise as a neuropsychological assessment modality and may be well suited for the evaluation of children suspected of having an autism spectrum disorder ( ASD ) . Some recent studies indicate their potential for enhancing reliability , ecologically validity , and sensitivity over traditional neuropsychological evaluation measures . Although research using VEs with ASD is increasing to the degree that several review s of the literature have been conducted , the review s to date lack rigor and are not necessarily specific to cognitive or neuropsychological assessment as many focus on intervention . The aim of this project was to comprehensively examine the current literature status of neuropsychological assessment in pediatric ASD using VEs by conducting a systematic review . Specifically , psychometric comparisons of VEs to traditional neuropsychological assessment measures that examined reliability , validity , and /or diagnostic accuracy for pediatric individuals , age 18 and below , with ASD were sought . The search using key words yielded 899 manuscripts , 894 of which were discarded for not meeting inclusion criteria . The remaining five met exclusion criteria . Therefore , the systematic review was modified to a brief report . These findings ( or lack thereof ) indicate a significant gap in the literature in that psychometric comparisons of these tools for the neuropsychological assessment of pediatric individuals with ASD are lacking . An important future direction of research will be extending the demonstrated incremental validity of VE neuropsychological assessment with other neurodevelopmental ( e.g. , attention-deficit/hyperactivity disorder ) and adult population s to pediatric ASD population | [
"In this initial pilot study , a controlled clinical comparison was made of attention perforance in children with attention deficit-hyperactivity disorder ( ADHD ) in a virtual reality ( VR ) classroom . Ten boys diagnosed with ADHD and ten normal control boys participated in the study . Groups did not signifi... | 4115f1a6-06ff-11f0-808a-c43d1ab1c353 |
The clinical efficacy and safety of bariatric surgery trials were systematic ally review ed . MEDLINE , EMBASE , CENTRAL were search ed to February 2009 . A basic PubCrawler alert was run until March 2010 . Trial registries , HTA websites and systematic review s were search ed . Manufacturers were contacted . R and omized trials comparing bariatric surgeries and /or st and ard care were selected . Evidence -based items potentially indicating risk of bias were assessed . Network meta- analysis was performed using Bayesian techniques . Of 1838 citations , 31 RCTs involving 2619 patients ( mean age 30 - 48 y ; mean BMI levels 42 - 58 kg/m(2 ) ) met eligibility criteria . As compared with st and ard care , differences in BMI levels from baseline at year 1 ( 15 trials ; 1103 participants ) were as follows : jejunoileal bypass [ MD : -11.4 kg/m(2 ) ] , mini-gastric bypass [ -11.3 kg/m(2 ) ] , biliopancreatic diversion [ -11.2 kg/m(2 ) ] , sleeve gastrectomy [ -10.1 kg/m(2 ) ] , Roux-en-Y gastric bypass [ -9.0 kg/m(2 ) ] , horizontal gastroplasty [ -5.0 kg/m(2 ) ] , vertical b and ed gastroplasty [ -6.4 kg/m(2 ) ] , and adjustable gastric b and ing [ -2.4 kg/m(2 ) ] . Bariatric surgery appears efficacious compared to st and ard care in reducing BMI . Weight losses are greatest with diversionary procedures , intermediate with diversionary/restrictive procedures , and lowest with those that are purely restrictive . Compared with Roux-en-Y gastric bypass , adjustable gastric b and ing has lower weight loss efficacy , but also leads to fewer serious adverse effects | [
" Eighty-seven morbidly obese patients were prospect ively r and omized to two operations : gastric bypass was performed on 42 and gastric partition on 45 . Gastric bypass proved to be more effective ; gastric bypass patients lost 15 % more of their original weight at 12 months and 21 % more at 18 mont... | 4115f1e2-06ff-11f0-808a-c43d1ab1c353 |
Study design : Systemic review Objective : We carried out a systematic review and meta- analysis to assess the efficacy and safety of phosphodieterase-5 ( PDE5 ) inhibitors on erectile dysfunction ( ED ) secondary to spinal cord injury ( SCI ) . Methods : A literature review was performed to identify all published r and omized , double-blind , placebo-controlled trials of PDE5 inhibitors for treatment of ED secondary to SCI . The search included the following data base : MEDLINE , EMBASE and the Cochrane Library . The outcomes and complications analyzed involved the Global Efficacy Question ( GEQ ) , sexual encounter profile diary question 2 and 3 ( SEP2 and SEP3 ) and adverse events . All statistical analysis was performed using Stata 12.0 software ( Stata Corp. , College Station , TX , USA ) . Results : Six publications were used in analysis , including six r and omized controlled trials that compared PDE5 inhibitors with placebo . Compared with placebo , PDE5 inhibitors were associated with significant improvements in GEQ ( OR 11.997 , 95 % CI 8.073–17.830 , P SEP2 ( RR 1.847 , 95 % CI 1.561–2.185 , P ( headache : RR 3.717 , 95 % CI 2.309–5.982 , P flushing : RR 9.281 , 95 % CI 2.858–30.147 , P gastrointestinal discomfort : RR 9.064 , 95 % CI 2.116–38.827 , P=0.003 ) , most adverse events were mild to moderate and transient . Conclusions : This systematic review and meta- analysis indicate that PDE5 inhibitors are effective and well tolerated to treat ED secondary to SCI compared with placebo , as measured by response to GEQ , SEP2 , SEP3 and incidence of adverse events . PDE5 inhibitors could be considered as the first choice in the treatment of ED patients with SCI | [
"Abstract Objectives : Approximately one third to one half of the penis is embedded in the pelvis and can be felt through the scrotum and in the perineum . The main arteries and nerves enter the penis through this perineal part of the penis , which seems to represent a highly sensitive area . We investigated the hy... | 4115f228-06ff-11f0-808a-c43d1ab1c353 |
The aim of this systematic review was to find evidence -based support in the literature to allow immediate unrestricted weight bearing after primary uncemented total hip arthroplasty ( THA ) . Accelerated rehabilitation programs for THA are becoming increasingly popular to shorten hospital stay and to facilitate rapid restoration of function . The goals of these rehabilitation programs could be more easily achieved if immediate unrestricted weight bearing ( UWB ) could be allowed after a THA . So far , however , immediate weight bearing is frequently contraindicated in widely accepted protocol s for uncemented THA due to fear for subsidence and absence of osseous integration of the femoral stem . Thus , frequently protected weight bearing and restricted activities are still advocated for at least 6 weeks after surgery . In addition , we analyzed the literature to come to a recommendation on gait pattern and walking aid . From a systematic search in several electronic data bases 13 studies met the inclusion criteria . These studies were review ed according to the Cochrane methodology . We found moderate to strong evidence that no adverse effects on subsidence and osseous integration of the femoral stem after uncemented THA occur after immediate UWB . Based on this literature review , we recommend early rehabilitation after uncemented THA with a reciprocally gait pattern using crutches , one cane for independency in ADL in case patients walk limp-free and walking without crutches as soon as possible . During the first weeks after surgery only stair climbing should be performed with protected weight bearing because of high torsion loads on the hip | [
"Background In uncemented total hip arthroplasty with hydroxyapatite coating , early weight bearing is frequently practice d but there is still not much evidence to support this recommendation . Method In a prospect i ve r and omized study we evaluated the effect of partial and full weight bearing after cemen... | 4115f264-06ff-11f0-808a-c43d1ab1c353 |
Importance Atrial fibrillation is the most common arrhythmia and increases the risk of stroke . Objective To review the evidence on screening for nonvalvular atrial fibrillation with electrocardiography ( ECG ) and stroke prevention treatment in asymptomatic adults 65 years or older to inform the US Preventive Services Task Force . Data Sources MEDLINE , Cochrane Library , and trial registries through May 2017 ; references ; experts ; literature surveillance through June 6 , 2018 . Study Selection English- language r and omized clinical trials ( RCTs ) , prospect i ve cohort studies evaluating detection rates of atrial fibrillation or harms of screening , and systematic review s evaluating stroke prevention treatment . Eligible treatment studies compared warfarin , aspirin , or novel oral anticoagulants ( NOACs ) with placebo or no treatment . Studies were excluded that focused on persons with a history of cardiovascular disease . Data Extraction and Synthesis Dual review of abstract s , full-text articles , and study quality . When at least 3 similar studies were available , r and om-effects meta-analyses were conducted . Main Outcomes and Measures Detection of previously undiagnosed atrial fibrillation , mortality , stroke , stroke-related morbidity , and harms . Results Seventeen studies were included ( n = 135 300 ) . No studies evaluated screening compared with no screening and focused on health outcomes . Systematic screening with ECG identified more new cases of atrial fibrillation than no screening ( absolute increase , from 0.6 % [ 95 % CI , 0.1%-0.9 % ] to 2.8 % [ 95 % CI , 0.9%-4.7 % ] over 12 months ; 2 RCTs , n = 15 803 ) , but a systematic approach using ECG did not detect more cases than an approach using pulse palpation ( 2 RCTs , n = 17 803 ) . For potential harms , no eligible studies compared screening with no screening . Warfarin ( mean , 1.5 years ) was associated with a reduced risk of ischemic stroke ( relative risk [ RR ] , 0.32 [ 95 % CI , 0.20 - 0.51 ] ) and all-cause mortality ( RR , 0.68 [ 95 % CI , 0.50 - 0.93 ] ) and with increased risk of bleeding ( 5 trials , n = 2415 ) . Participants in treatment trials were not screen detected , and most had long-st and ing persistent atrial fibrillation . A network meta- analysis reported that NOACs were associated with a significantly lower risk of a composite outcome of stroke and systemic embolism ( adjusted odds ratios compared with placebo or control ranged from 0.32 - 0.44 ) ; the risk of bleeding was increased ( adjusted odds ratios , 1.4 - 2.2 ) , but confidence intervals were wide and differences between groups were not statistically significant . Conclusions and Relevance Although screening with ECG can detect previously unknown cases of atrial fibrillation , it has not been shown to detect more cases than screening focused on pulse palpation . Treatments for atrial fibrillation reduce the risk of stroke and all-cause mortality and increase the risk of bleeding , but trials have not assessed whether treatment of screen-detected asymptomatic older adults results in better health outcomes than treatment after detection by usual care or after symptoms develop | [
"BACKGROUND AND PURPOSE Although the efficacy of anticoagulant therapy for primary prevention of stroke in patients with nonvalvular atrial fibrillation ( NVAF ) has been established , efficacy of antiplatelet therapy for low-risk patients is disputable in Japanese patients because of the frequent hemorrhag... | 4115f2a0-06ff-11f0-808a-c43d1ab1c353 |
There is an ongoing debate about the possible influences of nonnutritive sweeteners ( NNS ) on body weight . We conducted a systematic review and meta- analysis of r and omized controlled trials ( RCTs ) with NNS to assess their impact on body weight . We systematic ally search ed for RCTs at least 4 weeks in duration , evaluating the effect of NNS on body weight , both in subjects with healthy weight and in subjects with overweight/obesity at any age , and compared the effects of NNS vs caloric and noncaloric comparators . The primary outcome was the difference in body weight between NNS and comparators . Twenty studies were eligible ( n = 2914 ) . Participants consuming NNS showed significant weight/ BMI differences favouring NNS compared with nonusers . Grouping by nature of comparator revealed that NNS vs placebo/no intervention and NNS vs water produced no effect . When comparing NNS vs sucrose , significant weight/ BMI differences appeared favouring NNS . Consumption of NNS led to significantly negative weight/ BMI differences in unrestricted energy diets , but not in weight-reduction diets . Participants with overweight/obesity and adults showed significant favourable weight/ BMI differences with NNS . Data suggest that replacing sugar with NNS leads to weight reduction , particularly in participants with overweight/obesity under an unrestricted diet , information that could be utilized for evidence -based public policy decisions | [
"Objective To evaluate the effects of water versus beverages sweetened with non‐nutritive sweeteners ( NNS ) on body weight in subjects enrolled in a year‐long behavioral weight loss treatment program . Methods The study used a r and omized equivalence design with NNS or water beverages as the main factor i... | 4115f2dc-06ff-11f0-808a-c43d1ab1c353 |
Background The cumulative effect of too much sedentary behavior may contribute to weight gain and obesity . Objective The aim of this study was to conduct a systematic review and meta- analysis of prospect i ve cohorts and r and omized controlled studies to determine the association between sedentary behavior and body weight and obesity in adults . Data Sources and Study Selection Relevant studies were identified from search es of the MEDLINE , Embase , AMED and PubMed data bases up to May 2017 , and by manual search es of in-text citations . Studies that evaluated the association in adults between sedentary behavior and body weight or obesity , while controlling for physical activity , were included . Overall , 31 publications met the eligibility criteria , including 23 prospect i ve cohort studies with data that could be extracted for a quantitative meta- analysis , and a single r and omized controlled trial . Results There were no significant associations between sedentary behavior and any measure of body weight or obesity , with the exception of waist circumference . For the latter outcome , over a 5-year follow-up period , each 1 h per day increase — from baseline to follow-up — in sedentary behavior was associated with a 0.02 mm [ 95 % confidence interval ( CI ) 0.01–0.04 ; p = 0.001 ) increase in waist circumference . The odds ratio of becoming overweight or obese was 1.33 ( 95 % CI 1.11–1.60 ; p = 0.001 ) in the highest compared with lowest categories of sedentary behavior . Conclusions Meta- analysis of data from prospect i ve cohort studies showed small , inconsistent and non-significant associations between sedentary behavior and body weight | [
"Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( ... | 4115f3c2-06ff-11f0-808a-c43d1ab1c353 |
The aim of this study was to systematic ally review the available studies measuring the bond strength of orthodontic bracket-adhesive system under different experimental conditions in vivo . Literature search was performed in four different data bases : PubMed , Web of Science , Cochrane , and Scopus using the keywords – bond strength , orthodontic brackets , bracket-adhesive , and in vivo . A total of six full-text articles were selected based on the inclusion and exclusion criteria of our study after a careful assessment by the two independent review ers . Data selection was performed by following PRISMA 2009 guidelines . Five of the selected studies were clinical trials ; one study was a r and omized clinical trial . From each of the selected articles , the following data were extracted – number of sample s , with the type of tooth involved material s under experiment methods of measurement , the time interval between bonding and debonding orthodontic brackets , mode of force application , and the bond strength results with the overall outcome . The method ological quality assessment of each article was done by the modified Downs and Black checklist method . The qualitative analyses were done by two independent review ers . Conflicting issues were resolved in a consensus meeting by consulting the third review er ( MKA ) . Meta- analysis could not be performed due to the lack of homogenous study results . The review reached no real conclusion apart from the lack of efforts to clinical ly evaluate the bonding efficiency of a wide range of orthodontic bracket-adhesive systems in terms of debonding force compared to laboratory-based in vitro and ex vivo studies | [
"Objective To evaluate the shear bond strength of precoated orthodontic brackets bonded with self-etching primer relative to that of noncoated conventionally-bonded brackets at two different time intervals . Methods Twenty-one subjects were selected for r and omized split-mouth bonding of two types of brackets t... | 4115f43a-06ff-11f0-808a-c43d1ab1c353 |
CONTEXT GH deficiency ( GHD ) of the adult is a clinical condition characterized by the presence of several traditional and emerging cardiovascular risk factors that can significantly increase cardiovascular morbidity and mortality . It is still an open issue whether GH replacement is able not only to improve cardiovascular risk factors but also to decrease cardiovascular morbidity and mortality . EVIDENCE ACQUISITION The major source of data acquisition included PubMed research strategies . Original articles , systematic review s and meta-analyses , and included relevant citations were screened . EVIDENCE SYNTHESIS In untreated GHD , cardiovascular risk is increased due to abnormal lipid profile ( increased total and low-density lipoprotein cholesterol , increased triglycerides , and reduced high-density lipoprotein cholesterol ) and impaired glucose metabolism . Emerging cardiovascular risk factors/markers such as proinflammatory cytokines , C-reactive protein , and adipokines are also increased in GHD patients . Increased cardiovascular morbidity and mortality have also been reported in GHD . GH treatment has been shown to improve both traditional and emerging cardiovascular risk factors and markers . However , evidence on the effects of GH replacement on cardiovascular events and mortality is limited . CONCLUSION The GHD population may be considered at high cardiovascular risk , and GH substitution may be expected to bring an added value to patients with hypopituitarism in terms of cardiovascular protection . However , there is too limited evidence ( rarely coming from r and omized and controlled studies ) to recommend GH treatment based on the cardiovascular status of the patients | [
"1 . In adult humans with growth hormone deficiency , treatment with growth hormone has recently been shown to have major anabolic effects and to improve exercise performance . The cardiovascular effects of growth hormone in adults with growth hormone deficiency were examined in 24 patients treated with ... | 4115f4a8-06ff-11f0-808a-c43d1ab1c353 |
OBJECTIVE Several antiepileptic drugs ( AEDs ) have been associated with a detrimental effect on bone health through a reduction in serum vitamin D. Subsequently , several studies have investigated the effect of vitamin D supplementation in persons with epilepsy being treated with AEDs . The present systematic review of published literature was conducted to determine the effect of vitamin D intervention on bone health in adults with epilepsy . METHODS The following data bases were search ed using keywords including but not limited to epilepsy , bone , and vitamin D : PubMed , Medline , Embase , Scopus , Cochrane Clinical Trials , International Pharmaceutical Abstract s , Health Canada Clinical Trials Data base , Clinical Trials.gov , EU Clinical Trials , and Google . Studies were eligible if there was an epilepsy diagnosis , participants were adults ( 18 + years old ) , and vitamin D treatment and bone outcome were provided . Articles were screened independently by 2 review ers . Method ological quality was assessed using the Cochrane Collaboration 's tool and a modified Newcastle Ottawa Scale for nonr and omized studies . RESULTS Nine studies were found to be eligible for this review . After vitamin D treatment , there appeared to be positive changes in bone turnover markers ; 3 of 8 studies found the increase in serum calcium to be significant , 6 of 8 studies found the decrease in alkaline phosphatase to be significant , and 2 of 4 studies found the decrease in parathyroid hormone to be significant . All 6 studies that investigated bone mineralization had significant findings ; however , due to varying method ologies , the impact of vitamin D on bone mineralization was inconclusive . SIGNIFICANCE Vitamin D does appear to have some benefit to bone health in adults with epilepsy , and therefore supplementation could potentially be a requisite to using some AEDs . To clarify the role of vitamin D supplementation to manage the adverse effect of AEDs on bone health in adults with epilepsy , long-term trials that use higher doses ( > 1800 IU ) and measure bone mineral density are necessary | [
"Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more",
"The bone mineral content ( B.M.C. ) in bot... | 4115f4ee-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Physical activity ( PA ) practice has been inversely associated to body fat ( BF ) and recommended as a way to reduce and prevent obesity . The objective of this study was to conduct a systematic review on the association of PA and BF in adolescence . METHODS The review includes 18 longitudinal studies found in the PubMed data base , comprising papers published from January 1990 to July 2014 . Studies assessing BF only through body mass index were excluded . RESULTS Among the outcomes analyzed , waist circumference , skinfolds , and absolute and relative fat mass measurement were identified . Question naires were the more predominant way to evaluate PA . Most studies showed that PA promotes a protective effect against a higher BF gain . CONCLUSION It was concluded that PA has a protective effect against BF with differences between the genders and according to the BF marker or measurement assessed ; higher intensity PA leads to a greater effect against BF gain in both genders ; and the maintenance or increase of PA level on BF observed through analysis of change in PA level yielded more consistent findings in the relation between PA and BF | [
"Overweight and obesity affects more than 66 % of the adult population and is associated with a variety of chronic diseases . Weight reduction reduces health risks associated with chronic diseases and is therefore encouraged by major health agencies . Guidelines of the National Heart , Lung , and Blood Institute ( ... | 4115f52a-06ff-11f0-808a-c43d1ab1c353 |
BACKGROUND Fibromyalgia is a chronic disorder characterized by widespread muscular tenderness , pain , fatigue , and cognitive difficulties . Nonpharmacological treatment options , such as physical activity , are important for people with fibromyalgia . There are strong recommendations to support engagement in physical activity for symptom management among adults with fibromyalgia . Dance is a mode of physical activity that may allow individuals with fibromyalgia to improve their physical function , health , and well-being . Dance has the potential to promote improved pain processing while simultaneously providing the health and social benefits of engaging in physical activity that contributes to symptom management . However , we are unaware of current evidence on dance as a nonpharmacological/physical activity intervention for adults with fibromyalgia . OBJECTIVE The aims of the study are to provide an overview of the extant evidence to underst and how dance is used for individuals with fibromyalgia ; to examine the extent , range , and nature of research activity in the area ; and to determine the value of undertaking a full systematic review . METHODS Scoping review s are useful to comprehensively and systematic ally map the literature and identify key evidence , or research gaps . The search strategy will involve electronic data bases including Medline , Embase , Cochrane Library , PsycInfo , Cumulative Index of Nursing and Allied Health Literature ( CINAHL ) , Literature in the Health Sciences in Latin America and the Caribbean ( LILACS ) , Allied and Complementary Medicine ( AMED ) , International Bibliography of Theatre and Dance , Physiotherapy Evidence Data base ( PEDro ) , Trip , Proquest Theses/Dissertations , Web of Science , World Health Organization International Clinical Trials Registry Platform , and Clinical Trials.gov . The study will be mapped in seven stages : ( 1 ) identifying the research questions , ( 2 ) identifying relevant studies , ( 3 ) selecting the studies , ( 4 ) charting the data , ( 5 ) collating , summarizing and reporting the results , ( 6 ) consulting , and ( 7 ) disseminating the knowledge . RESULTS The search , title , and abstract are now completed ; full text screening was carried out and authors are awaiting interlibrary loans and translations . Data extraction will start shortly after full text ' screening ' is completed . Completion is expected in Fall 2017 . CONCLUSIONS To our knowledge this will be the first attempt to systematic ally identify knowledge of dance as a potential intervention for adults with fibromyalgia . This scoping review offers a feasible means for describing the evidence specific to dance and fibromyalgia ; results will provide unique insights concerning the breadth and depth of literature in the area . An analysis of this body of literature as a whole may reveal new research directions or unknown ways this intervention could strengthen current management approaches of the disease | [
"Background —There is evidence that aerobic exercise improves functional capacity in patients with New York Heart Association ( NYHA ) class II and III chronic heart failure . However , it is unknown whether dancing is safe and able to improve functional capacity in patients with chronic heart failure . ... | 4115f566-06ff-11f0-808a-c43d1ab1c353 |
We developed an evidence -based practice guideline to support occupational safety and health ( OSH ) professionals in assessing the risk due to lifting and in selecting effective preventive measures for low back pain ( LBP ) in the Netherl and s. The guideline was developed at the request of the Dutch government by a project team of experts and OSH professionals in lifting and work-related LBP . The recommendations for risk assessment were based on the quality of instruments to assess the risk on LBP due to lifting . Recommendations for interventions were based on a systematic review of the effects of worker- and work directed interventions to reduce back load due to lifting . The quality of the evidence was rated as strong ( A ) , moderate ( B ) , limited ( C ) or based on consensus ( D ) . Finally , eight experts and twenty-four OSH professionals commented on and evaluated the content and the feasibility of the preliminary guideline . For risk assessment we recommend loads heavier than 25 kg always to be considered a risk for LBP while loads less than 3 kg do not pose a risk . For loads between 3–25 kg , risk assessment shall be performed using the Manual h and ling Assessment Charts (MAC)-Tool or National Institute for Occupational Safety and Health ( NIOSH ) lifting equation . Effective work oriented interventions are patient lifting devices ( Level A ) and lifting devices for goods ( Level C ) , optimizing working height ( Level A ) and reducing load mass ( Level C ) . Ineffective work oriented preventive measures are regulations to ban lifting without proper alternatives ( Level D ) . We do not recommend worker-oriented interventions but consider personal lift assist devices as promising ( Level C ) . Ineffective worker-oriented preventive measures are training in lifting technique ( Level A ) , use of back-belts ( Level A ) and pre-employment medical examinations ( Level A ) . This multidisciplinary evidence -based practice guideline gives clear criteria whether an employee is at risk for LBP while lifting and provides an easy-reference for (in)effective risk reduction measures based on scientific evidence , experience , and consensus among OSH experts and practitioners | [
" Nursing staff are at risk for musculoskeletal injuries because of the physical nature of patient h and ling . The purpose of this study is to examine the effectiveness of a multifaceted minimal-lift environment on reported equipment use , musculoskeletal injury rates , and workers ’ compensation costs for ... | 4115f5a2-06ff-11f0-808a-c43d1ab1c353 |
Objective To reveal the effects of consumer-oriented health information technologies ( CHITs ) on patient outcomes in diabetes management over time through systematic review and meta- analysis . Methods We search ed 5 electronic data bases ( from data base inception to July 2016 ) for studies that reported on r and omized controlled trials examining the effects of CHITs on glycemic control and other patient outcomes in diabetes management . Data were analyzed using either meta- analysis or a narrative synthesis approach . Results Eighty r and omized controlled trial studies , representing 87 individual trials , were identified and included for analysis . Overall , the meta- analysis showed that the use of CHITs result ed in significant improvement in glycemic control compared to usual care ( st and ardized mean difference = -0.31 % , 95 % confidence interval -0.38 to -0.23 , P patients with diabetes . Specifically , improvement in glycemic control was significant at intervention duration s of 3 , 6 , 8 , 9 , 12 , 15 , 30 , and 60 months , while no significant differences were found at other time points reported . The narrative synthesis provided mixed effects of CHITs on other clinical , psychosocial , behavioral , and knowledge outcomes . Conclusions The use of CHITs appears to be more effective than usual care in improving glycemic control for patients with diabetes . However , their effectiveness did not remain consistent over time and in other patient outcomes . Further efforts are required to examine long-term effects of CHITs and to explore factors that can moderate the effects over time | [
"Background To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus ( T1DM ) . Methods Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c ( HbA1c ) ≥8.0 % were r and omized to mentored ( glucometer transmission w... | 4115f5de-06ff-11f0-808a-c43d1ab1c353 |
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