The association between guideline adherence, age and overall survival among women with non-metastatic breast cancer: A systematic review.

INTRODUCTION: Conformity with treatment guidelines should benefit patients. Studies have reported variation in adherence to breast cancer (BC) guidelines, particularly among older women. This study investigated (i) whether adherence to treatment guideline recommendations for women with non-metastatic BC improves overall survival (OS), (ii) whether that relationship varies by age. METHODOLOGY: MEDLINE and EMBASE were systematically searched for studies on guideline adherence and OS in women with non-metastatic BC, published after January 2000, which examined recommendations on breast surgery, chemotherapy, radiotherapy or endocrine therapy. Study results were summarised using narrative synthesis. RESULTS: Sixteen studies met the inclusion criteria. The recommendations for each treatment covered were similar, but studies differed in their definitions of adherence. 5-year OS rates among patients having compliant treatment ranged from 91.3% to 93.2%, while rates among patients having non-compliant treatment ranged from 75.9% to 83.4%. Six studies reported an adjusted hazard ratio (aHR) for non-compliant treatment compared with compliant treatment; all concluded OS was worse among patients whose overall treatment was non-compliant (aHR range: 1.52 [1.30-1.82] to 2.57 [1.96-3.37]), but adjustment for potential confounders was limited. Worse adherence among older women was reported in 12/16 studies, but they did not provide consistent evidence on whether OS was associated with treatment adherence and age. CONCLUSIONS: Individual studies reported that better adherence to guidelines improved OS among women with non-metastatic BC, but the evidence base has weaknesses including inconsistent definitions of adherence. More precise and consistent research designs, including the evaluation of barriers to adherence across the spectrum of healthcare practice, are required to fully understand guideline compliance, as well as the relationship between compliance and OS following a BC diagnosis.

Methods for assessment of patient adherence to removable orthoses used after surgery or trauma to the appendicular skeleton: a systematic review.

BACKGROUND: Patient adherence to treatment is a key determinant of outcome for healthcare interventions. Whilst non-adherence has been well evidenced in settings such as drug therapy, information regarding patient adherence to orthoses, particularly in the acute setting, is lacking. The aim of this systematic review was to identify, summarise, and critically appraise reported methods for assessing adherence to removable orthoses in adults following acute injury or surgery. METHODS: Comprehensive searches of the Ovid versions of MEDLINE, Embase, AMED, CINAHL, Central, the Cochrane Database of Systematic Reviews, and SPORTDiscus identified complete papers published in English between 1990 and September 2018 reporting measurement of adherence to orthoses in adults following surgery or trauma to the appendicular skeleton. Only primary studies with reference to adherence in the title/abstract were included to maintain the focus of the review. Data extraction included study design, sample size, study population, orthosis studied, and instructions for use. Details of methods for assessing adherence were extracted, including instrument/method used, frequency of completion, number of items (if applicable), and score (if any) used to evaluate adherence overall. Validity and reliability of identified methods were assessed together with any conclusions drawn between adherence and outcomes in the study. RESULTS: Seventeen papers (5 randomised trials, 10 cohort studies, and 2 case series) were included covering upper (n = 13) and lower (n = 4) limb conditions. A variety of methods for assessing adherence were identified, including questionnaires (n = 10) with single (n = 3) or multiple items (n = 7), home diaries (n = 4), and discussions with the patient (n = 3). There was no consistency in the target behaviour assessed or in the timing or frequency of assessment or the scoring systems used. None of the measures was validated for use in the target population. CONCLUSIONS: Measurement and reporting of adherence to orthosis use is currently inconsistent. Further research is required to develop a measurement tool that provides a rigorous and reproducible assessment of adherence in this acute population. TRIAL REGISTRATION: PROSPERO: CRD42016048462. Registered on 17/10/2016.

Current practice of anticoagulant in the treatment of splanchnic vein thrombosis secondary to acute pancreatitis.

BACKGROUND: Severe acute pancreatitis is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality. A consequence of severe acute pancreatitis is thrombus in the splanchnic veins. These thrombi can potentially lead to bowel ischemia or hepatic failure. However, another complication of severe acute pancreatitis is retroperitoneal bleeding. At this time, it is unclear if treating patients for splanchnic vein thrombosis in the context of severe acute pancreatitis is associated with any outcome benefit. A systematic review might clarify this question. DATA SOURCES: A two-fold search strategy (one broad and one precise) looked at all published literature. The review was registered on PROSPERO (ID: CRD42018102705). MEDLINE, EMBASE, PubMed, Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed independently by two researchers. Any disagreement was reviewed by a third independent researcher. Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications. RESULTS: Of 1462 papers assessed, a total of 16 papers were eligible for inclusion. There were no randomized controlled trials, 2 were case series, 5 retrospective single-center studies and 9 case reports. There were a total of 198 patients in these studies of whom 92 (46.5%) received anticoagulation therapy. The rates of recanalization of veins in the treated and non-treated groups was 14% and 11% and bleeding complications were 16% and 5%, respectively. However, the included studies were too heterogeneous to undertake a meta-analysis. CONCLUSIONS: The systematic review highlights the lack evidence addressing this clinical question. Therefore a randomized controlled trial would be appropriate to undertake.

Research Into Childhood Obstructive Sleep-Disordered Breathing: A Systematic Review.

BACKGROUND: Despite recent clinical guideline development, the best pathway of care for children with symptoms of obstructive sleep-disordered breathing (oSDB) is still debated. This systematic review aims to map the research in childhood oSDB that has been conducted so far to support further guideline development, identify evidence gaps, and guide future research. METHODS: A systematic search was performed in PubMed, EMBASE, and the Cochrane Library from inception to November 26, 2015. All publications on childhood oSDB were included, irrespective of type and language. The annual number of publications in the field of oSDB was counted over all years; for those published since January 1, 2011 (ie, the date of the latest literature search of the American Academy of Pediatrics guideline), total and annual numbers of publications across main research themes and methodologies were calculated. RESULTS: Of the 7,637 unique records retrieved, 5,871 publications were eligible for inclusion. There was an increase in annual publications since 2000, with 46% published since 2011. Most publications (61%) focused on individual treatment modalities, incidence, or prognosis. Few publications (2.7%) focused on health service delivery, outcomes, and health economics. Observational studies composed 78.5% of publications, 2.4% were randomized controlled trials, and 0.4% used a qualitative approach as their main methodology. CONCLUSIONS: A recent surge in research activity into childhood oSDB has improved the knowledge base for this condition; however, the lack of health services, health economics, and outcomes research impacts the applicability of evidence informing current guidance and leaves important questions for future research. REGISTRATION: PROSPERO: registration number CRD42015029291.

A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery.

BACKGROUND: Oral antiseptics reduce nosocomial infections and ventilator-associated pneumonia in critically ill medical and surgical patients intubated for prolonged periods. However, the role of oral antiseptics given before and after planned surgery is not clear. The aim of this systematic review and meta-analysis is to determine the effect of oral antiseptics (chlorhexidine or povidone-iodine) when administered before and after major elective surgery. METHODS: Searches were conducted of the MEDLINE, EMBASE and Cochrane databases. The analysis was performed using the random-effects method and the risk ratio (RR) with 95 % confidence interval (CI). RESULTS: Of 1114 unique identified articles, perioperative chlorhexidine was administered to patients undergoing elective surgery in four studies. This identified 2265 patients undergoing elective cardiac surgery, of whom 1093 (48.3 %) received perioperative chlorhexidine. Postoperative pneumonia and nosocomial infections were observed in 5.3 and 20.2 % who received chlorhexidine compared to 10.4 and 31.3 % who received a control preparation, respectively. Oral perioperative chlorhexidine significantly reduced the risk of postoperative pneumonia (RR = 0.52; 95 % CI 0.39-0.71; p < 0.01) and overall nosocomial infections (RR = 0.65; 95 % CI 0.52-0.81; p < 0.01), with no effect on in-hospital mortality (RR = 1.01; 95 % CI 0.49-2.09; p = 0.98). CONCLUSIONS: Perioperative oral chlorhexidine significantly decreases the incidence of nosocomial infection and postoperative pneumonia in patients undergoing elective cardiac surgery. There are no randomised controlled studies of this simple and cheap intervention in patients undergoing elective non-cardiac surgery. TRIAL REGISTRATION: This systematic review was registered with the International prospective register of systematic reviews (PROSPERO). The registration number is CRD42015016063.

Food groups and fatty acids associated with self-reported depression: an analysis from the Australian National Nutrition and Health Surveys.

OBJECTIVE: The aim of this study was to explore the associations between incidence of depression and dietary intakes of foods and fatty acids in adult Australians. METHODS: Data from the 1995 Australian National Nutrition Survey (NNS), the 1995 Australian National Health Survey (NHS) and an updated fatty acid database were merged and the 24-h fatty acid intakes were calculated for the 10 986 adult participants ages 18 to 79 y in the 1995 NNS. The merged data set was used to run a logistic regression with depression as the response variable and the food groups and calculated fatty acid values, age, and sex as predictors. RESULTS: The regression model indicated that increased intakes per kilojoule of meat, poultry, and game; vegetables; and eicosapentaenoic acid (EPA) are associated with lower odds of having depression, whereas increased intakes of non-alcoholic beverages, milk products and dishes, and docosapentaenoic acid (DPA) are associated with an increase in the odds of having depression. The results confirm a collective effect of diet on mood. Although other studies have shown that fish consumption is associated with lower odds of depression, this study showed lower odds of depression with high meat consumption, possibly reflecting the fact that Australians consume six times more meat than fish. CONCLUSION: Significant associations between food and mood identified in this study warrant further research to determine causality.

The impact of PFOS on health in the general population: a review.

Perfluorooctane sulphonate (PFOS) is a persistent organic pollutant that is toxic, bioaccumulative and undergoes wide transportation across all environmental media. It has been widely detected in environmental samples but there is limited information about the health effects on humans from environmental exposure. This paper presents the findings of a review of the literature on the impact of PFOS on the health of the general population. Fifteen relevant epidemiological studies were identified that looked at the association between human PFOS exposure and a range of health related outcomes. Small but statistically significant associations have been reported with PFOS and total cholesterol, glucose metabolism, body mass index (BMI), thyroid function, infertility, breast feeding, uric acid and attention deficit/hyperactivity disorder (ADHD). The true significance of these findings is uncertain due to the inconsistencies in some of the study results and the limitations of the literature. The majority of studies were cross-sectional and considered surrogate markers of health (e.g. cholesterol levels). The available literature is also limited in ascertaining the link between PFOS concentrations in the environment, exposure pathways and health effects. We conclude that the current evidence is inconclusive and further large-scale prospective cohort studies would be useful to assess the association between environmental exposure to PFOS, appropriate biomarkers (e.g. serum levels of PFOS) and health outcomes.

The longitudinal relationship between depressive symptoms and disability for older adults: a population-based study.

BACKGROUND: Although depressive symptoms in older adults are common, their relationship with disability and the influence of disability on the development of depressive symptoms over time is not well understood. This longitudinal study investigates the change trajectories of both depressive symptoms and disability, as well as their associations over time. METHODS: Participants included 442 community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Depression was scored with the Short Psychiatric Evaluation Schedule and disability with the instrumental and physical activities of daily living measure during each consecutive data collection wave. The autoregressive latent trajectory model and parallel latent growth curve modeling were adopted for analysis of the data. RESULTS: The autoregressive latent trajectory model highlights that previous depressive symptoms (and disability) significantly contributed to the advancement of more severe depressive symptoms (and disability). This model also indicates that disability significantly contributed to the onset of depressive symptoms and vice versa. The parallel latent growth curve modeling highlights that the disability intercept had significant effects on the depressive symptoms intercept, as did the depressive symptoms on disability. Furthermore, the disability slope had significant effects on the slope of the depressive symptoms. CONCLUSIONS: These findings demonstrate that disability is a stronger predictor of depressive symptoms than depressive symptoms are of disability. In addition, the prior existence of a health condition will lead to further deterioration of health conditions and that they often coexist.

Epidemiology of unintentional carbon monoxide fatalities in the UK.

This study aims to describe the epidemiology of unintentional non-fire related CO fatalities in the UK and to relate this information to sources of CO. Data from the CO-Gas Safety Society (COGSS) database was analysed and compared with data from the English House Condition Survey (EHCS). There were 462 deaths from the COGSS database, from 1 January 1996 to 31 December 2007 inclusive. The relative risk for death due to non-gas vs gas fuels was 10.52 (95% CI 7.71-14.34). The main weakness of the study is the likely underascertainment of CO deaths in the database. However, this study has identified specific risk factors for CO-related deaths in the UK; the use of non-gas fuels has not previously been highlighted as a significant cause of CO poisoning, and the relative risk (although not the absolute risk) of CO-related fatalities from these fuels is substantial.

Trajectories of depression and their relationship with health status and social service use.

This longitudinal study was conducted between 1994 and 2004 in a cohort of Southern Taiwan community-living elderly residents. The study aims to explore the trajectories of depression and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and health/social service use predicted the different trajectories of depression. Eight hundred and ten participants had completed all six waves of the survey or were followed-up at each wave until death in the prospective study in Kaohsiung City. Depressive symptoms were evaluated by the Short Psychiatric Evaluation Schedule (SPES). Changes in levels of depression during the ageing process were identified. Different trajectories clearly reflected heterogeneity within depression and the association with mortality. The study highlighted that diabetes, gastrointestinal problems, heart disease and disability, whether at baseline or as new occurrences, were predictors of health decline. High uses of health/social services were also predictive of increased depression. These findings identified depression as a highly dynamic process, characterized by different trajectories of depression between states of no, mild and severe depression. Greater awareness of these various trajectories should potentially improve the prevention and/or management strategies of depression.

Air pollution effects on peak expiratory flow rate in children.

Airway mucus hypersecretion Health effects caused by air pollutants may range from subtle biochemical or physiological signs, such as mildly reduced lung function, to difficult breathing, wheezing, coughing and exacerbation of existing respiratory conditions such as asthma. The aim of this study was measuring the adverse health effects of air pollution on lung function of primary school students. The lung function of students was measured daily for seven weeks in two elementary schools in District 12 of Tehran, after obtaining permission from the two principals and signed parents' consent forms. Twenty four hourly air pollution levels were used as potential predictors of lung function. The principal analysis conducted was a logistic regression on a subset of the data using a case-crossover design. The outcomes data consisted of the results of lung function tests for 356 female and 206 male students over the six-week period. Using the difference between mean (87) and maximum (125) concentration of moving average of NO in this period to judge the size of the effect, such an increase in NO is predicted to lead to an increase in the probability of poor lung function (OR=20) based on population-based predicted value. This study has shown strong and consistent associations between children's poor lung function and outdoor air pollutants in District 12 of Tehran for some pollutants. The strong association found in this study was an increase in seven-day moving average of NO using both definitions.

Self-reported neurological symptoms in relation to CO emissions due to problem gas appliance installations in London: a cross-sectional survey.

BACKGROUND: Previous research by the authors found evidence that up to 10% of particular household categories may be exposed to elevated carbon monoxide (CO) concentrations from poor quality gas appliance installations. The literature suggests certain neurological symptoms are linked to exposure to low levels of CO. This paper addresses the hypothesis that certain self-reported neurological symptoms experienced by a householder are linked to an estimate of their CO exposure. METHODS: Between 27 April and 27 June 2006, 597 homes with a mains supply of natural gas were surveyed, mainly in old, urban areas of London. Qualified gas engineers tested all gas appliances (cooker, boiler, gas fire, and water heater) and reported, according to the Gas Industry Unsafe Situations Procedure, appliances considered At Risk (AR), Immediately Dangerous (ID) or Not to Current Standards (NCS). Five exposure risk categories were defined based on measurement of CO emitted by the appliance, its features and its use, with "high or very high" exposure category where occupants were considered likely to be exposed to levels greater than 26 ppm for one hour. The prevalence of symptoms at each level of exposure was compared with that at lowest level of exposure. RESULTS: Of the households, 6% were assessed as having a "high or very high" risk of exposure to CO. Of the individuals, 9% reported at least one neurological symptom. There was a statistically significant association between "high or very high" exposure risk to CO and self-reported symptoms compared to "no exposure" likelihood, for households not in receipt of benefit, controlling for "number of residents" and presence of pensioners, OR = 3.23 (95%CI: 1.28, 8.15). Risk ratios across all categories of exposure likelihood indicate a dose-response pattern. Those households in receipt of benefit showed no dose-response pattern. CONCLUSION: This study found an association between risk of CO exposure at low concentration, and prevalence of self-reported neurological symptoms in the community for those households not in receipt of benefit. As health status was self-reported, this association requires further investigation.

Respiratory symptoms and lung function of coke oven workers: a lung function surveillance system from 1990-2000.

This study investigated the association of exposure to coke oven emissions with respiratory symptoms and with lung function. Data for respiratory symptoms and lung function were repeatedly collected from 764 male coke oven workers between 1990 and 2000. The data were analyzed cross-sectionally and longitudinally. Working in "Operation" increased the risk for cough (odds ratio [OR] = 2.37), phlegm (OR = 2.55), and shortness of breath (OR = 1.52). Cross-sectionally, each year of working in Operation was associated with a reduction in FEV1 of approximately 10 mL (P = 0.006) and in FVC of around 21 mL (P = 0.0001). From longitudinal analysis, each year of working in Operation was associated with an extra annual decline in FEV1 of 1.5 mL (P = 0.0012) and in FVC of around 1.8 mL (P = 0.0017). Exposure to coke oven emissions increased the risk for respiratory symptoms and adversely affected lung function.

Surgery dot.com: the quality of information disseminated by Web-based waiting time information services.

OBJECTIVES: To assess Web-based waiting time information services to identify how they aimed to meet the information needs of patients and general practitioners, and to evaluate how well waiting time information was presented. DESIGN: A cross-sectional survey of six government websites in English-speaking countries with publicly funded hospitals. Sites were evaluated on the clarity of instructions about how their information should be used, and the accuracy of the statistics they contained was assessed indirectly using methodological criteria. RESULTS: The services were judged to encourage GPs and patients to use the statistics to avoid surgical units with long waiting times, but overall advice was poor. Services did not state whether the statistics predicted expected waiting times, and just one stated that the statistics were only intended as a guide. Statistics were based on different types of data, and derived at different levels of aggregation, raising questions of accuracy. Most sites explained waiting list terms, but provided inadequate advice on the uncertainty associated with making statistical inferences. CONCLUSIONS: GPs and patients should use Web-based waiting time information services cautiously because of a lack of guidance on how to appropriately interpret the presented information.