scholarly journals How to Approach Secondary Breast Reduction: International Trends and a Systematic Review of the Literature

2021 ◽  
Author(s):  
P. Niclas Broer ◽  
Nicholas Moellhoff ◽  
Thiha Aung ◽  
Antonio J. Forte ◽  
Charlotte Topka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Breast Reduction ◽  
Quality Data ◽  
Full Description ◽  
Evidence Based ◽  
Level Of Evidence ◽  
International Trends ◽  
Secondary Procedures ◽  
Primary Reduction ◽  
Geographic Regions

Abstract Background Secondary breast reduction is complex and poses significant challenges to surgeons. Complication rates exceed those of primary reduction, commonly caused by impaired vascular supply of the nipple-areolar complex (NAC). Literature on the topic is scare and provides contradicting recommendations, especially with regard to pedicle choice in cases with unknown primary reduction technique. Aim of this study was to investigate international trends and to compare findings with literature. Methods A large-scale web-based questionnaire on international trends in mammaplasty (mastopexy and breast reduction) was designed and distributed to over five thousand surgeons in eight geographic regions. The presented manuscript evaluated information regarding pedicle choice in secondary breast reduction and compared data to literature identified in a systematic review. Results The survey was completed by 1431 participants. Overall, secondary procedures were performed in less than 5% or in 5 to 10% of cases. The preferred pedicle for secondary reductions differed significantly between geographic regions (p<0.001). The majority of respondents reported to use a superior or supero-medial pedicle (34.8% and 32.2%, respectively). Residual analysis revealed a strong association between the use of an inferior pedicle and procedures performed in North America. Conclusions Secondary breast reduction is challenging and there remains international disparity with regard to pedicle choice for secondary procedures. Studies investigating outcome when the primary pedicle is unknown are scarce and provide incoherent recommendations. High-quality data is needed to provide evidence-based practice guidelines. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

scholarly journals The relationship between physical fitness attributes and sports injury in female, team ball sport players: a systematic review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Jessica B. Farley ◽  
Lily M. Barrett ◽  
Justin W. L. Keogh ◽  
Carl T. Woods ◽  
Nikki Milne
Keyword(s):  
Systematic Review ◽  
Body Composition ◽  
Physical Fitness ◽  
Sports Injury ◽  
Quality Data ◽  
Body Region ◽  
Ankle Sprains ◽  
Level Of Evidence ◽  
Data Synthesis ◽  
The Relationship

Abstract Background Understanding the relationships between physical fitness characteristics and sports injury may assist with the development of injury minimisation programs. The purpose of this systematic review was to investigate the association between physical fitness attributes and sports injury in female, team ball sport players. Methods Four scientific databases (MEDLINE, EMBASE, SPORTDiscus, Scopus) and reference lists of relevant research were searched for eligible studies up to September 2, 2019. Full-text articles examining the relationship between physical fitness and sports injury in female, team ball sport players were included. A modified Downs and Black checklist was used to assess methodological quality. Data synthesis determined summary conclusions based on the number of significant relationships divided by the total relationships investigated and reported as a percentage. Level of certainty was identified for summary conclusions based on level of evidence. Sub-analyses regarding competition level, age, and single injury types were also conducted. Results A total of 44 studies were included. Data synthesis revealed no associations (low to moderate certainty) between body composition (1/9; 11%), flexibility (18–20%), and balance (2/8; 25%) and ‘any injury’ classification. No associations (mostly of moderate certainty) were found between flexibility (0–27%), muscular strength (0–27%), and body composition (14–33%) and various body region injury classifications, whereas mixed summary conclusions were shown for balance (0-48%). Many associations between physical fitness and sports injury were deemed ‘unknown’ or with an insufficient level of certainty. Sub-analyses revealed no association between strength and noncontact ACL injuries (0/5; 0%) or ankle sprains (0/12; 0%), and between flexibility and ankle sprains (1/5; 20%); however, insufficient certainty of these results exists. Clear associations were concluded between balance and lower body injuries in female, non-elite (10/16; 63%) and junior (9/12; 75%) team ball sport players, with moderate and insufficient certainty of these results, respectively. Conclusion Limited evidence is available to demonstrate relationships between physical fitness and sports injury in female, team ball sport players. High-quality evidence investigating the multifactorial nature of sports injury, including the interactions physical fitness qualities have with other injury determinants, is needed to better understand the role of physical fitness in minimising sports injuries in female, team ball sport players. Trial Registration CRD42017077374 (PROSPERO on September 14, 2017).

scholarly journals Evidence-Based Status of Forest Healing Program in South Korea

2021 ◽  
Vol 18 (19) ◽  
pp. 10368
Author(s):  
Sujin Park ◽  
Soojin Kim ◽  
Geonwoo Kim ◽  
Yeji Choi ◽  
Eunsoo Kim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
South Korea ◽  
Psychological Health ◽  
Meta Analysis ◽  
Health Benefits ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Certification System ◽  
The Status

Various effects of forest healing on health have been reported, but a certification system to assess the effectiveness of forest healing programs does not exist. In this study, a systematic review (SR) on the “health benefits of forests” and “meta-analysis of forest therapy” was conducted after analyzing the status and level of evidence of 75 forest healing programs that were conducted post-certification in South Korea. The SR for “health benefits of forests” distinguished between activities and time, resulting in 90.9% of walking activities for more than an hour under psychological health, and 100.0% of exercise activities for less than an hour under physiological health. However, the effect of indirect activities performed for more than an hour was unknown. Thus, we confirmed that many indoor activities in the field had low effect size or no established basis regarding the feasibility of its operation. The SR on “meta-analysis of forest therapy” to check whether the program was effective. The highest number of healing effects were obtained for blood pressure (32), followed by psychological depression (24). The findings of this can serve as baseline data to facilitate future development and dissemination of evidence-based forest healing programs.

scholarly journals Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines

2019 ◽  
Vol 41 (3) ◽  
pp. 503-534
Author(s):  
Ingrid S Parry ◽  
Jeffrey C Schneider ◽  
Miranda Yelvington ◽  
Patricia Sharp ◽  
Michael Serghiou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Practice Guidelines ◽  
Practice Guideline ◽  
Burn Injury ◽  
Expert Consensus ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Rehabilitation Professionals ◽  
Adults And Children ◽  
Based Medicine

Abstract The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.

Perioperative Analgesia for Patients Undergoing Thyroidectomy and Parathyroidectomy: An Evidence-Based Review

2020 ◽  
Vol 129 (10) ◽  
pp. 949-963 ◽  
Author(s):  
Brandon K. Nguyen ◽  
James Stathakios ◽  
Daniel Quan ◽  
Jessica Pinto ◽  
Hosheng Lin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Local Anesthetics ◽  
Rating Scale ◽  
Evidence Based ◽  
Supporting Evidence ◽  
Level Of Evidence ◽  
Rescue Analgesia ◽  
Perioperative Analgesia ◽  
Analgesic Consumption ◽  
Pain Scores

Objective: To perform an evidence-based systematic review evaluating perioperative analgesia, including opioid alternatives, used for patients undergoing thyroidectomy and parathyroidectomy. Methods: A comprehensive literature search from 1997 to January 2018 of Pubmed, Cochrane, and EmBase libraries was performed for studies reporting analgesic administration following thyroid or parathyroid surgery. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were evaluated for level of evidence and given a Jadad score to assess for risk of bias. Outcomes gathered included postoperative pain scores, time to rescue analgesia, rescue analgesic consumption, and adverse events. Results: Thirty-eight randomized controlled trials met inclusion criteria. The GRADE criteria determined the overall evidence to be moderate-high. Studies utilizing NSAIDs reported reduced requirements for rescue analgesics. Acetaminophen studies presented with conflicting data on effectiveness. Gabapentinoid studies demonstrated lower pain scores and an increased time to rescue analgesic. Local anesthetics were effective at decreasing Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) pain scores while also reducing rescue analgesic consumption. Ketamine was shown to increased postoperative nausea and vomiting. NSAIDs and local anesthetic studies had an aggregate grade of evidence A, while all others had grade B evidence. Conclusion: There is significant evidence supporting the use of NSAIDs and local anesthetics in the perioperative period for pain management for thyroid and parathyroid surgeries. Acetaminophen, gabapentinoid and ketamine have some supporting evidence and may serve as adequate alternatives. Further multi-institutional RCTs are warranted to delineate optimal analgesic regimens. Level of Evidence: NA

Arthroscopic versus open excision of dorsal ganglion cysts: a systematic review

2017 ◽  
Vol 43 (6) ◽  
pp. 659-664 ◽  
Author(s):  
Catherine Crawford ◽  
Aakash Keswani ◽  
Andrew J. Lovy ◽  
Isaiah Levy ◽  
Kristina Lutz ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Recurrence Rate ◽  
Risk Of Bias ◽  
Quality Data ◽  
Q Value ◽  
Level Of Evidence ◽  
Ganglion Cysts ◽  
Arthroscopic Excision ◽  
Open Excision

We conducted a systematic review comparing recurrence and complication rate following open versus arthroscopic excision of ganglion cysts. Sixteen full-text articles were included. The pooled recurrence rate of open excision was 20% (range: 5.6–40.7%) with Q value of 27 and I2 of 82%. The pooled recurrence rate of arthroscopic excision was 9% (range: 0–17%) with Q value of 10 and I2 of 2%. Eleven of 16 studies were low quality or had a high risk of bias; however, excluding low quality studies or those with high risk of bias produced similar recurrence rates in arthroscopic and open excision (7.9% versus 9.8%). For the subset of studies with complete reporting of complications, rates were similar in open and arthroscopic excision (6% versus 4%). Our review suggests that arthroscopic and open approaches have comparable outcome profiles. Nevertheless, standardized study methods with adequate powering are required to collect high quality data, allowing for greater confidence in conclusions regarding these two approaches for existing ganglion cysts. Level of Evidence: II

Assessment of Students With Sensory Disabilities: Evidence-Based Practices

2017 ◽  
Vol 43 (2) ◽  
pp. 79-89 ◽  
Author(s):  
Susan M. Bruce ◽  
John L. Luckner ◽  
Kay A. Ferrell
Keyword(s):  
Systematic Review ◽  
Hard Of Hearing ◽  
Visually Impaired ◽  
Dynamic Assessment ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Professional Literature ◽  
Evidence Based Practices ◽  
Policy Documents ◽  
Strength Of Evidence

This article presents an overview of recommended practices for assessing students who are deaf/hard of hearing, visually impaired, or deafblind. These recommendations were originally derived from a systematic review of research studies, policy documents, and professional literature on assessment (1990–2013) for the Collaboration for Effective Educator Development, Accountability, and Reform (CEEDAR) Center. This review was then updated through 2016 on select topics identified in the original review with the addition of research on assessment accommodations, dynamic assessment, and curriculum-based assessment. The authors applied the CEEDAR Center rubric criteria for evaluating the strength of evidence for each identified practice. Across the disability groups, evidence was at the emerging to moderate levels, with the highest level of evidence for assessment accommodations specific to each disability.

scholarly journals Prognostic Models of Mortality from Accidental Severe Traumatic Brain Injury in Children and Adolescents: A Systematic Review

2021 ◽  
Vol 3 (3(September-December)) ◽  
Author(s):  
Jose Roberto Tude Melo ◽  
Marcelo Liberato Coelho Mendes de Carvalho
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Children And Adolescents ◽  
Severe Traumatic Brain Injury ◽  
Scientific Evidence ◽  
Prognostic Models ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Severe Tbi

Introduction: Prognostic models are statistical models that combine two or more items of patient data to predict clinical outcomes. Objective: Identify prognostic models of mortality developed and published in the medical literature for possible applicability in children and adolescents victims of severe traumatic brain injury (TBI). Methods: Systematic review in the Medline electronic database (PubMed platform) of scientific articles published from 2006 (year of publication of the last systematic review on prognostic models for TBI before 2017) until July 29, 2017. Results: Ten studies on prognostic models of mortality in children and adolescents victims of severe TBI were identified for final inclusion in the review. There were eight development and two validation studies conducted in different countries. Conclusion: The analysis of this systematic review makes it possible to conclude that the ten prognostic models included in the final sample provide health professionals with a scientific evidence-based understanding of the severity of pediatric victims of severe TBI. This systematic review is classified as presenting 2A and 1 level of evidence (systematic review of homogeneous cohorts), according to the 2009 and 2011 classifications, respectively, of the Oxford Center for Evidence-Based Medicine

scholarly journals Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review

2019 ◽  
Vol 11 (4) ◽  
pp. 367-374
Author(s):  
Nicole Cascia ◽  
Kelsey Picha ◽  
Carolyn M. Hettrich ◽  
Tim L. Uhl
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Study Design ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Evidence Based ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Rehabilitation Protocol ◽  
Overhead Athletes

Context: Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment. Objective: To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol. Data Sources: Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play. Study Selection: Seven retrospective, level 4 studies (n = 196) qualified for analysis. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted. Results: Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period. Conclusion: Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete’s perceived well-being should all be considered during treatment decisions.

scholarly journals The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature

2021 ◽  
Author(s):  
Y. Bachour ◽  
J. A. Kadouch ◽  
F. B. Niessen
Keyword(s):  
Systematic Review ◽  
Bacterial Contamination ◽  
Full Description ◽  
Level Of Evidence ◽  
Inflammatory Reactions ◽  
Filler Injection ◽  
Primary Indication ◽  
Number Of Patients ◽  
Immunological Factors

Abstract Background Late inflammatory reactions (LIRs) are the most challenging complications after filler use. The immune system plays a prominent role in its etiology, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for LIRs. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of LIRs. Methods We undertook a systematic literature review focused on immunological factors and microbiota in relation to LIRs after filler use. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE and the Cochrane databases were searched from inception up to August 2019. Included studies were assessed for the following variables: subject characteristics, number of patients, primary indication for filler injection, implant type/amount and injection site, type of complication, follow-up or injection duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors. Results Data on immunological factors and bacterial contamination were retrieved from 21 included studies. Notably, the presence of histocytes, giant cells and Staphylococcus epidermidis within biopsies were often associated with LIRs. Conclusion This review provides a clear overview of the immunological factors associated with LIRs and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with LIRs has been provided. Follow-up research may result in clinical recommendations to prevent LIRs. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors-www.springer.com/00266..

scholarly journals Hyaluronic Acid Fillers Enriched with Glycine and Proline in Eyebrow Augmentation Procedure

2021 ◽  
Author(s):  
Antonio Scarano ◽  
Biagio Rapone ◽  
Domenico Amuso ◽  
Francesco Inchingolo ◽  
Felice Lorusso
Keyword(s):  
Hyaluronic Acid ◽  
Full Description ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Aesthetic Result ◽  
Study Results ◽  
High Level ◽  
Based Medicine ◽  
Augmentation Procedure

Abstract Background The eyebrow area is a clinically critical district due to the anatomical complexity and the propensity to aging-related atrophy. Hyaluronic acid fillers have been proposed to recover the dermal volume of the facial and lips regions. Aim The aim of the present investigation was to evaluate hyaluronic acid fillers enriched with glycine and proline for the treatment of eyebrow augmentation. Methods A total of 15 healthy patients were treated with eyebrow augmentation procedure. The distance between mid-bipupil to lateral eyebrow and mid-eyebrow to the medial eyebrow was measured before, immediately after treatment and at follow-up of 6 months. Results The healing period was uneventful, and no evidence of inflammation or swelling associated with the treatment was reported. No macroscopical alteration was reported in the surrounding tissues with no evidences of visible wheals or lumps in the treated sites at the follow-up. Before treatment, the angle was equal to 9.32 ± 0.2°, while after treatment it was 11.21 ± 0.4° (p < 0.01); after three and 6 weeks, it was, respectively, 10.66 ± 0.2° (p<0.05) and 10.02 ± 0.3°(p > 0.05). Conclusions The study results suggest that the hyaluronic acid fillers enriched with glycine and proline treatment resulted as being a useful procedure for augmentation, contour and volume definition and elevation of the eyebrow region with a high-level aesthetic result. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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