Is there any advantage between using continuous passive motion and conventional physical therapy in patients with primary adhesive capsulitis?: A systematic review and meta-analysis.

BACKGROUND: We are unsure if continuous passive motion (CPM) has any role in the nonoperative management of the Primary Stiff Shoulder (frozen shoulder). We hypothesized that there is no difference in pain improvement, range of motion, and function with or without CPM in patients with a primary stiff shoulder. METHOD: We searched the databases for clinical trials comparing CPM versus no-CPM physiotherapy. In the final step, we reviewed five randomized clinical trials. We collected the data of Constant Shoulder Score (CSS), the visual analog scale of pain, shoulder pain and disability index (SPADI), and range of motion (flexion, abduction, external and internal rotation). We used a random-effects model to analyze the data. RESULTS: Five studies with a total of 224 patients were included. There were 113 patients in the CPM arm and 111 in the control arm. Both the CPM and control groups showed significant improvements in all measured parameters compared to the first visit after 8-24 weeks. Meta-analysis of pooled data showed significant differences in pain improvement, forward flexion, and CSS favoring the CPM. Still, there was no significant difference in abduction, external and internal rotation, and SPADI. DISCUSSION: The CPM seems to be slightly effective in improving pain and motion in the short term, but its long-term efficacy is still under question. The extra cost and time must be considered when offering the CPM.

Curriculum frameworks and educational programs in artificial intelligence for medical students, residents, and practicing physicians: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to synthesize knowledge from the literature on curriculum frameworks and current educational programs that focus on the teaching and learning of artificial intelligence (AI) for medical students, residents, and practicing physicians. INTRODUCTION: To advance the implementation of AI in clinical practice, physicians need to have a better understanding of AI and how to use it within clinical practice. Consequently, medical education must introduce AI topics and concepts into the curriculum. Curriculum frameworks are educational road maps to teaching and learning. Therefore, any existing AI curriculum frameworks must be reviewed and, if none exist, such a framework must be developed. INCLUSION CRITERIA: This review will include articles that describe curriculum frameworks for teaching and learning AI in medicine, irrespective of country. All types of articles and study designs will be included, except conference abstracts and protocols. METHODS: This review will follow the JBI methodology for scoping reviews. Keywords will first be identified from relevant articles. Another search will then be conducted using the identified keywords and index terms. The following databases will be searched: MEDLINE (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCOhost), and Scopus. Gray literature will also be searched. Articles will be limited to the English and French languages, commencing from the year 2000. The reference lists of all included articles will be screened for additional articles. Data will then be extracted from included articles and the results will be presented in a table.

Total Ankle Replacement Outcome in Patients With Inflammatory Versus Noninflammatory Arthritis: A Systematic Review and Meta-analysis.

BACKGROUND: The decision regarding total ankle replacement (TAR) is challenging in patients with inflammatory arthritis (IA) regarding more inferior bone quality, large bone cysts, and increased risk of infections. This systematic review and meta-analysis aimed to compare the functional outcome, revision rate, complication rate, and survival rate of TAR between IA (including rheumatoid arthritis [RA]) and noninflammatory arthritis (NIA) (primary and posttraumatic). METHODS: After reviewing the full texts, 30 articles fulfilled all inclusion criteria from 1985 until 2021, comparing TAR results. The eligible studies included 5508 patients, of whom 1565 patients had IA and 3943 patients had NIA. At the time of surgery, the average age was 58 years in the IA group and 63 in the NIA group. The average follow-up was 67.2 months in the IA group and 67 months in the NIA group. The outcome measures were the American Orthopaedic Foot and Ankle Society (AOFAS) score and the rate of complications, revisions, and survival. RESULTS: The mean final AOFAS score was 82 (95% confidence interval [CI]: 78-86) in the IA group and 83 (95% CI: 78-88) in the NIA group, with no significant difference. There was no significant difference in the mean preoperative to postoperative AOFAS score change between the IA and the NIA. The complication rate was 16% (95% CI: 9%-27%) in the IA group and 15% (95% CI: 8%-27%) in the NIA group with no significant difference. The revision rate was 12% (95% CI: 10%-15%) in the IA group and 13% (95% CI: 10%-18%) in the NIA group, which was significant (P = .04). There was no significant difference in the survival rate between IA and NIA. CONCLUSION: Total ankle replacement is a safe procedure in inflammatory ankle arthritis, specifically in RA patients with relatively minor and major complications close to other reasons for ankle replacement. LEVELS OF EVIDENCE: Level IV: prognostic.

Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review.

PURPOSE: To compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer. METHODS: A comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow-up and Level I-IV evidence. Articles were separated into six groups: debridement, arthroscopic and open repair, allograft bridging/augmentation, SCR, subacromial balloon spacer, and tendon transfer. Data points included range of motion (external rotation, abduction, forward flexion, and internal rotation), visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, rate of revision surgery, and rate of conversion to arthroplasty. RESULTS: A total of 83 studies and 3363 patients were included. All treatment options had statistically significant improvements in postoperative range of motion and patient-reported outcomes. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. The SCR subgroup had the greatest improvement in ASES scores postoperatively. The overall revision rate was 7.2% among all surgical options, with the allograft bridging/augmentation group having the lowest rate of revision at 0-8.3%. The overall rate of conversion to arthroplasty was 7.2%, with debridement having the greatest rate of conversion at 15.4%. CONCLUSION: All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. However, these conclusions should be interpreted with caution due to the heterogeneous nature of the data, lack of prospective randomized control trials, and short-term follow-up. The findings of this study highlight the complexity of irreparable, massive rotator cuff tears, and the need for an individualized approach when treating these patients. LEVEL OF EVIDENCE: Level IV.

The Impact of Lateral Decubitus vs. Beach Chair Positioning on the Clinical Outcome of the Patients with Isolated SLAP Type II Repair: A Systematic Review and Meta-analysis.

Background: A superior labrum from anterior to posterior (SLAP) repairs can be performed in either beach chair (BC) or lateral decubitus (LD). The purpose of this study was to perform a systematic review and meta-analysis to compare the outcomes of surgical repair of type II SLAP injuries between the BC vs. LD positions. We hypothesized no statistically significant differences in the functional, pain, and motion outcomes between the BC vs. LD positions after type II SLAP repair. Methods: A comprehensive literature search was performed using MEDLINE, Scopus, Web of Science, Embase, and Cochrane to identify studies reporting outcomes after type II SLAP repair. Outcome measures consisted of pain using the visual analog score (VAS), range of motion (ROM), and functional scores, including the University of California at Los Angeles Shoulder (UCLA) score, American Shoulder and Elbow Surgeons (ASES), and Constant score. The outcomes were pooled and analyzed for eligibility and stratified into two subgroups for a random-effects model meta-analysis. Results: Of the 8,016 identified studies through a database search, 13 papers (378 patients) were eligible for statistical analysis in the BC and 10 articles (473 patients) were included in the LD group. The mean follow-up for BC and LD was 35 and 44 months, respectively. The SLAP repair in both positions demonstrated improvements in postoperative clinical outcomes and ROM. Comparing the two positions, the LD group demonstrated significantly greater improvements in VAS which contributed to better functional outcomes, while the BC group showed a significantly greater improvement in abduction. No other differences were identified including ASES, UCLA, and Constant score as well as remaining ROM. Conclusion: Based on the findings of this systematic review and meta-analysis, both the BC and LD positions provide patients better outcomes following operative repair of type II SLAPs. While LD represented a better improvement in functional outcome measures, the BC position demonstrated better abduction with no other significant differences between both positions. An individualized approach to position selection concerning the patient's complaint (pain vs. motion) as well as the surgeon's discretion is recommended.

Central nervous system infections in patients with systemic lupus erythematosus: a systematic review and meta-analysis.

We aimed to conduct a systematic review and meta-analysis of studies on central nervous system (CNS) infections in patients with SLE, in order to describe their clinical and microbiological characteristics, and outcomes. A systematic search of PubMed/Medline and Embase electronic databases was performed (March 2021) to identify all published studies on CNS infections and their characteristics in patients with SLE. A random-effects model was adopted and findings were reported with 95% CI. Overall, 6 studies involving 17 751 patients with SLE and 209 SLE cases with CNS infection were included in our meta-analysis. The frequency rate of CNS infections in patients with SLE was 0.012 (95% CI: 0.008 to 0.018). Meningitis was the most common clinical syndrome (93.5%, n=109/114, 95% CI: 82.6% to 97.8%) and Cryptococcus neoformans (35.9%, n=55, 95% CI: 27.2% to 45.7%) and Mycobacterium tuberculosis (27.1%, n=43, 95% CI: 14.6% to 44.8%) were the most common causative pathogens. Our patient-pool showed a mean SLE Disease Activity Index (SLEDAI) score of 7.9 (95% CI: 6.1 to 9.6), while 92.4% (n=72/76, 95% CI: 83.0% to 96.8%) of cases were on oral systemic corticosteroids, with a prednisone equivalent mean daily dose of 30.9 mg/day (95% CI: 18.0 to 43.7). Our meta-analysis revealed a mortality rate of 29.0% (95% CI: 15.0% to 48.6%). Clinicians should maintain a high index of suspicion for cryptococcal and tuberculosis (TB) meningitis in patients with SLE with suspected CNS infection, particularly in those with higher SLEDAI and on higher doses of systemic corticosteroids. In conclusion, initiation of empiric antituberculous treatment for patients with SLE who are highly suspected to have CNS TB is warranted while awaiting the results of diagnostic tests. Antifungals might also be potentially useful empirically in patients with SLE who are suspected to have fungal CNS infections. However, with respect to side effects such as toxicity and high cost of antifungals, decision regarding early antifungal therapy should be guided by early and less time-consuming fungal diagnostic tests.

Clinical outcomes of reverse total shoulder arthroplasty for elective indications versus acute 3- and 4-part proximal humeral fractures: a systematic review and meta-analysis.

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) has continued to increase in clinical utility and popularity as an effective treatment for cuff tear arthropathy (CTA), irreparable rotator cuff tears (RCTs), osteoarthritis, and acute 3- and 4-part proximal humeral fractures. Performing RTSA for acute proximal humeral fractures presents the unique challenges of tuberosity management, bone loss, and instability compared with elective indications such as CTA or irreparable RCTs. The purpose of this study was to compare the clinical outcomes, active range of motion (ROM), radiographic outcomes, and complications between patients undergoing elective RTSA (RTSA-E) and those undergoing RTSA for fracture (RTSA-F). METHODS: A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We queried 3 electronic databases (Embase, Cochrane, and PubMed) using the search term "reverse" AND "shoulder" AND "arthroplasty." Studies investigating the clinical outcomes of RTSA for traumatic and/or elective indications were included. Studies were excluded if they included RTSA performed for fracture sequelae, inflammatory arthritis, post-traumatic osteoarthritis, or avascular necrosis. Data collected included patient demographic characteristics, subjective outcome measurements, ROM, and complications. The pooled means and proportions along with their 95% confidence intervals were generated by a random-effects model that incorporated the between-study variations in weighting. RESULTS: A total of 134 studies (11,651 shoulders) investigating the clinical outcomes of RTSA-E patients and 66 studies (3117 shoulders) investigating RTSA-F patients were included in this systematic review. Analysis of patient-reported outcomes demonstrated that RTSA-F patients experienced significantly lower Constant scores than RTSA-E patients; however, relative Constant scores, Simple Shoulder Test scores, Disabilities of the Arm, Shoulder and Hand scores, American Shoulder and Elbow Surgeons scores, and visual analog scale pain scores were similar. RTSA-F patients also had significantly lower forward elevation, abduction, and external rotation. RTSA-F patients experienced tuberosity complications at a significantly higher rate than RTSA-E patients (25.9% vs. 4.1%). There was no significant difference between the 2 groups in terms of other complications such as heterotopic ossification, radiographic loosening, revision, nerve injury, postoperative stiffness, infection, dislocation, and component loosening. DISCUSSION: RTSA performed for acute 3- and 4-part proximal humeral fractures yields overall worse clinical outcomes and active ROM compared with RTSA performed for elective indications including CTA, massive irreparable RCTs, and osteoarthritis with deformity. Tuberosity healing may be a major contributing factor to the difference in clinical outcomes. In the setting of RTSA-F, patient and surgeon expectations may need to be tempered and appropriate measures undertaken to optimize tuberosity healing.

Prevalence of Comorbidities in COVID-19 Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: In this study, we aimed to assess the prevalence of comorbidities in the confirmed COVID-19 patients. This might help showing which comorbidity might pose the patients at risk of more severe symptoms. METHODS: We searched all relevant databases on April 7th, 2020 using the keywords ("novel coronavirus" OR COVID-19 OR SARS-CoV-2 OR Coronavirus) AND (comorbidities OR clinical characteristics OR epidemiologic*). We reviewed 33 papers' full text out of 1053 papers. There were 32 papers from China and 1 from Taiwan. There was no language or study level limit. Prevalence of comorbidities including hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, chronic kidney disease, malignancies, cerebrovascular diseases, chronic liver disease and smoking were extracted to measure the pooled estimates. We used OpenMeta and used random-effect model to do a single arm meta-analysis. RESULTS: The mean age of the diagnosed patients was 51 years. The male to female ratio was 55 to 45. The most prevalent finding in the confirmed COVID-19 patients was hypertension, which was found in 1/5 of the patients (21%). Other most prevalent finding was diabetes mellitus (DM) in 11%, cerebrovascular disease in 2.4%, cardiovascular disease in 5.8%, chronic kidney disease in 3.6%, chronic liver disease in 2.9%, chronic pulmonary disease in 2.0%, malignancy in 2.7%, and smoking in 8.7% of the patients. CONCLUSION: COVID-19 infection seems to be affecting every race, sex, age, irrespective of health status. The risk of symptomatic and severe disease might be higher due to the higher age which is usually accompanied with comorbidities. However, comorbidities do not seem to be the prerequisite for symptomatic and severe COVID-19 infection, except hypertension.

COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis.

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

Comparison of Custom-made Versus Prefabricated Thumb Splinting for Carpometacarpal Arthrosis: A Systematic Review and Meta-analysis.

BACKGROUND: The goal of this study was to compare the two types of orthoses, prefabricated soft splints versus short thermoplastic custom-made splints, that are the most commonly used for the management of first carpometacarpal (CMC) osteoarthritis (OA). METHODS: We conducted a meta-analysis and systematic review in the literature based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted the outcomes of disability scores, pain scores, grip and pinch strength and gathered the unified data accordingly. RESULTS: We included five randomized clinical trials with 230 patients with the mean age of 61 years and the mean follow-up of 8.1 weeks. The results of the pooled data demonstrated only a statistically significant difference in disability scores among splints in favor of the prefabricated splints. The rest of the outcome measures consisting of pain, grip strength, and pinch strength were not statistically different. CONCLUSION: According to our systematic review and meta-analysis, both thumb-based splints improved pain and function in the first CMC OA in a short-term follow-up, nevertheless the efficacy of prefabricated splints in abatement of disability scores was significantly higher than custom-made splints. In contrast, the other outcome measures including pain, grip and pinch strength were improved identically after wearing either of the splints. LEVEL OF EVIDENCE: II.