Delirium point prevalence studies in inpatient settings: A systematic review

Aims: To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management. Background: Delirium—a common and distressing condition manifesting as an acute decline of attention and cognition—is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium. Design: A systematic review and meta-analysis. Methods: A systematic review of published delirium prevalence studies in inpatient settings was conducted and the implications of findings for delirium screening, assessment, prevention and management identified. The random-effects meta-analysis was conducted among studies measuring delirium point prevalence. The PRISMA statement was used to report systematic review and meta-analysis. Results: Nine studies were included in the review, with sample sizes ranging from 47–1867. Delirium point prevalence ranged from 9%–32%. Hypoactive delirium was the most common subtype, ranging from 23%–78%. Fifteen delirium screening tools or assessment or diagnostic methods were used. Comorbid dementia was present in up to 50% of inpatients. Conclusions: Gaining a consensus on effective delirium instruments, the time windows for assessment and measurement will be crucial in driving benchmarking and quality improvement studies

Illicit Substance Use Effects on Burn Related Reconstruction Patient Outcomes and Complications Following Hospital Admission: Systematic Review and Meta-analysis

Patients suffering from burn-related injuries admitted to the hospital concurrent illicit substance use are believed to be at an increased risk of poor outcomes and the development of complications following burn reconstruction, however data varies within the literature and remains controversial. This systematic review and meta-analysis compared outcomes and complications from studies during the years 1986 to 2017 between 15653 burn patients admitted to the hospital with substance use alcohol use reported by a positive toxicology screen (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, codeine/morphine, PCP, LSD, inhalants, solvents, aerosols, legal highs), or the patient on hospital admission to 299543 burn patients admitted who were not using substances. The PubMed, EMBASE, Cochrane Library, and Web of Science databases were systematically and independently searched. Clinical characteristics, illicit substance use, outcomes and complications were recorded. PRISMA and Cochrane guidelines where used throughout the review. Five of the 10 studies included in our study, were eligible for meta-analysis, with results from 8 of the possible 21 outcomes and complications queried. In conclusion, this systematic review and meta-analysis found that compared to patients suffering from burn-related injuries who did not use illicit substance, patients using illicit substances had a higher %TBSA of burns, longer hospital LOS, had a higher rate of intubation, had a higher rate of inhalation injury, longer ICU LOS, and increased wound/local skin infections

TRPV1 in Brain Is Involved in Acetaminophen-Induced Antinociception

Background: Acetaminophen, the major active metabolite of acetanilide in man, has become one of the most popular overthe- counter analgesic and antipyretic agents, consumed by millions of people daily. However, its mechanism of action is still a matter of debate. We have previously shown that acetaminophen is further metabolized to N-(4-hydroxyphenyl)-5Z,8Z,11Z,14Z-eicosatetraenamide (AM404) by fatty acid amide hydrolase (FAAH) in the rat and mouse brain and that this metabolite is a potent activator of transient receptor potential vanilloid 1 (TRPV1) in vitro. Pharmacological activation of TRPV1 in the midbrain periaqueductal gray elicits antinociception in rats. It is therefore possible that activation of TRPV1 in the brain contributes to the analgesic effect of acetaminophen. Methodology/Principal Findings: Here we show that the antinociceptive effect of acetaminophen at an oral dose lacking hypolocomotor activity is absent in FAAH and TRPV1 knockout mice in the formalin, tail immersion and von Frey tests. This dose of acetaminophen did not affect the global brain contents of prostaglandin E-2 (PGE(2)) and endocannabinoids. Intracerebroventricular injection of AM404 produced a TRPV1-mediated antinociceptive effect in the mouse formalin test. Pharmacological inhibition of TRPV1 in the brain by intracerebroventricular capsazepine injection abolished the antinociceptive effect of oral acetaminophen in the same test. Conclusions: This study shows that TRPV1 in brain is involved in the antinociceptive action of acetaminophen and provides a strategy for developing central nervous system active oral analgesics based on the coexpression of FAAH and TRPV1 in the brain

The Ethics of Penis Transplantation: A Systematic Review

Purpose: We conducted this systematic review to document ethical concerns regarding human penis allotransplantation and how these concerns have changed over time. Methods: We searched six databases (MEDLINE via PubMed, Embase, CINAHL, Scopus, Web of Science, and Google Scholar) from inception to November 9, 2018 to find articles addressing ethical concerns related to penis allotransplantation. Inclusion criteria were articles written in English on the topic of penis allotransplantation that discussed at least one bioethical principle. Data was extracted and categorized into the four bioethical pillars: autonomy, beneficence, nonmaleficence, and justice. We assessed theme frequency by publication year and temporal trends. A sub-analysis of the Bioethical pillars and themes specifically addressing the first penis transplantation case performed in 2006 were extracted and evaluated separately. Results:Search results yielded 142 citations. Thirty-nine articles were eligible and included in the final data extraction and analysis. Publication years were 2006 through 2018 with an average of 3 publications per year (range: 0 to 12). The most frequently addressed bioethical pillar was nonmaleficence with themes included in 37 of 39 articles (95%), followed by beneficence (36 of 39, 92%), justice (32 of 39, 82%), and autonomy (29 of 39, 74%). Top concerns pertaining to nonmaleficence included the risk-benefit ratio (n=30, 81%) and risks of long-term immunosuppression (n=29, 78%). Top concerns regarding beneficence included restoration of bodily function, integrity, or aesthetics (n=33, 92) and improved QOL (n=25, 69%). Top concerns pertaining to justice included patient selection (n=25, 78%), burden to donor family, and impact on deceased donor solid organ donation (n=13, 41%). Top concerns regarding autonomy included patient informed consent (n=18, 62%), and donor or donor family informed consent (n=16, 55%). Bioethical issues in reference to the 2006 case were mentioned in 29 of 39 articles (74%); nonmaleficence was most often addressed, mentioned in 27 of 29 articles (93%). Conclusions: Penis transplantation has been a topic of much ethical debate. During the 12-year study period, nonmaleficence was the most common recurring ethical pillar with the two most common themes being risks and benefits for undergoing the procedure and the need for life-long immunosuppression. The first attempt in 2006 that resulted in the graft being removed greatly influenced the field of penis transplantation

Embolization in Juvenile Nasopharyngeal Angiofibroma Surgery: A Systematic Review and Meta-Analysis

Objective: To compare outcomes of juvenile nasopharyngeal angiofibroma (JNA) resection between embolized and non-embolized cohorts, and between transarterial embolization (TAE) and direct puncture embolization (DPE). Data sources: Per PRISMA guidelines, PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched for publications prior to or in 2021. Materials and methods: Original English manuscripts investigating the resection of JNA with and without preoperative embolization were included. Embolization type, recurrence rate, complication rates, blood loss, and transfusions were extracted. Risk of bias was assessed by the Risk of Bias in Non-randomized Studies-of Interventions method. Results: There were 61 studies with 917 patients included. Preoperative embolization was performed in 79.3% of patients. Of those embolized, 75.8% (N = 551) underwent TAE and 15.8% (N = 115) underwent DPE. JNA recurrence in embolized patients was lower than in non-embolized patients (9.3% vs. 14.4%; odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.35, 1.06). DPE resulted in lower rates of disease recurrence (0% vs. 9.5%; OR: 0.066, 95% CI: 0.016, 0.272) and complications (1.8% vs. 21.9%; OR: 0.07, 95% CI: 0.02, 0.3) than TAE. A random effects Bayesian model was performed to analyze the difference in mean blood loss in 6 studies that included both embolized and non-embolized patients. This analysis showed a mean reduction in blood loss of 798 mL in the embolized group. Conclusions: We found embolization decreases blood loss in JNA resection. DPE led to improved recurrence and complication rates when compared to TAE, but future prospective studies are needed to further evaluate which embolization technique can optimize outcomes in JNA. Level of evidence: NA Laryngoscope, 2023.</p

Positive effect of neurolysis on diabetic patients with compressed nerves of the lower extremities: a systematic review and meta-analysis

PMCID: PMC4173835BACKGROUND: Despite proven benefits of upper extremity nerve decompression in diabetics, neurolysis for diabetic patients with lower extremity (LE) nerve compression remains controversial. METHODS: A search of ClinicalTrials.gov and Cochrane clinical trials registries, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, SCOPUS, and Google Scholar from 1962 to 2012, yielded 1956 citations. Any potential randomized or quasi-randomized controlled trials and observational cohort studies of diabetics with neurolysis of the common peroneal nerve, deep peroneal nerve, or tibial nerve were assessed. We included articles in any language that 1) provided information about diabetic patients who had neurolysis for symptomatic nerve compression diagnosed by (+) Tinel sign or electrodiagnostic study, and 2) quantified outcomes for pain, sensibility, or ulcerations/amputations. Case reports, review articles, animal or cadaver studies, and studies with 3 months. A meta-analysis of descriptive statistics was performed. RESULTS: Ten clinical series with a mean clinical relevance score of 70% and a mean methodologic quality score of 50% met inclusion criteria. We included 875 diabetic patients and 1053 LEs. Pain relief >3 points on visual analog scale occurred in 91% of patients; sensibility improved in 69%. Postoperative ulceration/amputation incidence was significantly reduced compared to preoperative incidence (odds ratio = 0.066, 95% confidence interval = 0.026-0.164, P < 0.0001). CONCLUSIONS: Observational data suggest that neurolysis significantly improves outcomes for diabetic patients with compressed nerves of the LE. No randomized controlled trials have been published.JH Libraries Open Access Fun

The Positive Effect of Neurolysis on Diabetic Patients with Compressed Nerves of the Lower Extremities: A Systematic Review and Meta-analysis

Background: Despite proven benefits of upper extremity nerve decompression in diabetics, neurolysis for diabetic patients with lower extremity (LE) nerve compression remains controversial. Methods: A search of ClinicalTrials.gov and Cochrane clinical trials registries, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, SCOPUS, and Google Scholar from 1962 to 2012, yielded 1956 citations. Any potential randomized or quasi-randomized controlled trials and observational cohort studies of diabetics with neurolysis of the common peroneal nerve, deep peroneal nerve, or tibial nerve were assessed. We included articles in any language that 1) provided information about diabetic patients who had neurolysis for symptomatic nerve compression diagnosed by (+) Tinel sign or electrodiagnostic study, and 2) quantified outcomes for pain, sensibility, or ulcerations/amputations. Case reports, review articles, animal or cadaver studies, and studies with <10 patients were excluded. We assessed pain relief, recovery of sensibility, and postoperative incidence of ulcerations/amputations at follow-up >3 months. A meta-analysis of descriptive statistics was performed. Results: Ten clinical series with a mean clinical relevance score of 70% and a mean methodologic quality score of 50% met inclusion criteria. We included 875 diabetic patients and 1053 LEs. Pain relief >3 points on visual analog scale occurred in 91% of patients; sensibility improved in 69%. Postoperative ulceration/amputation incidence was significantly reduced compared to preoperative incidence (odds ratio = 0.066, 95% confidence interval = 0.026–0.164, P < 0.0001). Conclusions: Observational data suggest that neurolysis significantly improves outcomes for diabetic patients with compressed nerves of the LE. No randomized controlled trials have been published