Analysis of Graft Types Augmented With an Internal Brace for ACL Reconstruction: A Systematic Review.

BACKGROUND: New techniques are being developed to decrease the failure rate of anterior cruciate ligament (ACL) grafts and prevent revision surgery. One such technique involves high-strength suture tape (ST), also referred to as internal bracing. Recent literature has highlighted the use of ST for ACL reconstruction, but no study has compared ST augmentation between graft types. PURPOSE: To compare the use of ST augmentation for ACL reconstruction based on the type of graft used (ie, bone-patellar tendon-bone [BPTB], quadriceps, hamstring). STUDY DESIGN: Systematic review; Level of evidence, 5. METHODS: An online search of multiple databases was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was completed April 2022 to identify studies related to ST augmentation of ACL grafts. RESULTS: Of 926 studies identified, 10 met inclusion criteria. Five studies (50%) used hamstring tendon (HT), 3 (30%) used quadriceps tendon (QT), 1 (10%) used BPTB, and 1 (10%) used both HT and QT grafts. HT autografts augmented with ST had decreased dynamic and peak elongation (15%-56%), increased load to failure, and increased initial and final dynamic stiffness compared with controls. There was no significant difference in postoperative physical examination findings (range of motion, Lachman, pivot shift), except that ST-augmented grafts had significantly less laxity after surgery compared with HT alone (0.8 vs 1.9 mm; P < .05). QT allografts with ST augmentation showed increased graft strength. Human QT autograft studies showed higher Knee injury and Osteoarthritis Outcome Score scores compared with controls. BPTB allografts with ST augmentation had decreased cyclic displacement by 31% (P = .015) and increased load (758 ± 128 N; P < .001) and stiffness (156 ± 23 N/mm; P = .003) compared with nonaugmented groups. The complication rate was low or showed no increase in the ST augmentation groups compared with control groups. CONCLUSION: HT, QT, and BPTB grafts augmented with ST demonstrate an effective method for ACL reconstruction. All graft types with ST augmentation showed no evidence of clinical disadvantage, with some studies indicating significant biomechanical or clinical advantages compared with conventional ACL reconstruction.

Evidence mapping and quality assessment of systematic reviews in dental traumatology.

BACKGROUND/AIMS: Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research. METHODS: Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed. RESULTS: The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods. CONCLUSION: The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.

Assessing dental student perceptions after engaging in a longitudinal interprofessional education curriculum: A preliminary study.

PURPOSE/OBJECTIVES: Baseline IPE perceptions for dental students were gathered prior to the implementation of a 2-year formalised IPE curriculum at a US institution. The goal was to establish a baseline of student perceptions and, in the future, continue to track student IPE perception data with IPE engagement as one measure of outcomes. The purpose of this paper is to analyse two dental student cohort perceptions of IPE after engaging in a 2-year longitudinal curriculum. METHODS: First- and second-year students were required to participate in a 2-year IPE curriculum. As a requirement of the curriculum, students were asked to complete a validated IPE assessment, the Student Perceptions of Interprofessional Clinical Education-Revised instrument, version 2 (SPICE-R2). Students completed the SPICE-R2 survey, using a retrospective pretest/post-test design, after engaging in the 2-year curriculum. RESULTS: Sixty-four students in cohort 2017 and 70 students in cohort 2018 completed the entire SPICE-R2. Statistically significant positive changes (p < .05) were found in both dental student cohorts after engagement in the 2-year longitudinal IPE curriculum. CONCLUSION(S): A longitudinal IPE curriculum has the potential to impact student IPE perceptions. Additional longitudinal multi-institutional research is needed to determine best practices in delivery and learning.

Effect of intrathecal morphine plus patient-controlled analgesia with morphine versus patient-controlled analgesia with morphine alone on total morphine dose 24 hours post-surgery: a systematic review.

OBJECTIVE: The objective of this review was to evaluate the effects of preoperative intrathecal morphine (ITM) in addition to patient-controlled analgesia with morphine (PCAM) versus PCAM without preoperative ITM on total morphine dose in the first 24 hours postoperatively in adult patients undergoing abdominal or thoracic surgery. INTRODUCTION: Postoperative pain is a significant problem for patients undergoing major abdominal and thoracic surgery. Intrathecal morphine can reduce postoperative pain and reduce intravenous (IV) morphine requirements during the first 24 hours after surgery; however, the amount of IV morphine dose reduction achieved has not been well established. This knowledge could help anesthesia providers determine if ITM is an appropriate analgesic option for patients. INCLUSION CRITERIA: This review included studies with participants 18 years of age or older receiving general anesthesia for abdominal or thoracic surgery. Studies were included that used the intervention of preoperative ITM in addition to PCAM versus PCAM without preoperative ITM. Total morphine dose in milligrams during the first 24 hours after surgery was the outcome of interest. METHODS: A search of PubMed and CINAHL was conducted for studies published between January 1984 and October 2018 using the key terms intrathecal, morphine, postoperative, pain, patient-controlled analgesia and general anesthesia. Index terms and keywords from identified articles were used to search CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, Ovid MEDLINE, ProQuest Dissertations and Theses/Nursing and Allied Health Databases, and Scopus. The reference lists of articles that underwent critical appraisal were searched for additional studies. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. Two independent reviewers assessed each selected article. Study results were pooled in statistical meta-analysis using the JBI System for the Unified Management, Assessment and Review of Information, and two studies were described in narrative form. Differences in IV morphine dose between the ITM plus PCAM and PCAM alone groups were calculated to produce the weighted mean difference (WMD) utilizing a 95% confidence interval (CI). Heterogeneity was assessed using χ and I values. Subgroup analysis was conducted on two studies that included IV non-opioid analgesia in addition to ITM and PCAM for postoperative analgesia. RESULTS: Seven RCTs with a total sample size of 352 patients were included in this review. Five studies that evaluated postoperative total morphine dose in milligrams with and without preoperative ITM were included for statistical meta-analysis, with 277 participants from four countries. Total morphine dose was significantly reduced in patients who received ITM (WMD = -24.44 mg, 95% CI -28.70 to -20.18 mg) compared to PCAM without ITM. Subgroup analysis of two studies involving 112 participants using IV acetaminophen in addition to ITM and PCAM indicated no additional benefit after ITM was already administered (WMD = -25.93, 95% CI -32.05 to -19.80 mg). Two studies with 75 participants were described narratively because total morphine dose was reported as median rather than mean values. CONCLUSIONS: In this review, ITM provided a significant decrease in overall total morphine dose during the first 24 hours after surgery in abdominal surgery patients. The addition of IV non-opioids to the postoperative analgesia protocol showed no additional reduction in postoperative IV morphine dose between groups. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018100613.

Osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures: A systematic review.

PURPOSE: The evidence pertaining to the contribution of the sinus membrane to new bone formation following maxillary sinus augmentation procedures is equivocal. The purpose of this study was to analyse the evidence currently available on the osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures, and the effect of local delivery of recombinant human bone morphogenic proteins (rhBMPs) on the bone-forming potential of the sinus membrane. MATERIALS AND METHODS: An electronic search was conducted using six different databases to identify controlled trials, prospective and retrospective cohort studies, case series and case reports, as well as preclinical (animal) studies reporting on new bone formation in close proximity with the sinus membrane after maxillary sinus augmentation procedures, assessed through histological and/or histomorphometrical evaluation, on the basis of pre-established eligibility criteria. RESULTS: No clinical studies were identified. Twenty-six preclinical studies were included in the review. Nine of them supported the osteogenic potential of the sinus membrane, while eight reported no evidence of osteogenicity from the sinus membrane. The nine remaining studies reported on the local effect of rhBMPs. The majority of these nine studies reported enhanced new bone formation in the sinus membrane region. CONCLUSIONS: The sinus membrane contains pluripotent mesenchymal cells with the capacity to differentiate and participate in the process of new bone formation. However, the findings from the studies selected in this systematic review do not consistently support that the sinus membrane significantly contributes to new bone formation following maxillary sinus augmentation procedures.

Cosmetic gynecology-a systematic review and call for standardized outcome measures.

OBJECTIVE: Cosmetic gynecology, a field which has garnered substantial attention over recent years, lacks a universally accepted nomenclature. The aim of this systematic review is to evaluate techniques, outcome measures reported, and adverse events in patients undergoing cosmetic gynecology procedures and offer recommendations to improve reporting metrics. METHODS: A systematic literature search was performed using electronic databases from inception to April 2019. The search was based on 51 unique cosmetic gynecology keywords such as: "labiaplasty," "vaginal rejuvenation," and "liposuction mons pubis." All English full-text prospective and retrospective observational and interventional studies with at least five subjects that describe a cosmetic gynecology procedure were included. Only full-text articles were included. This protocol has been registered with PROSPERO (CRD 42019131860). RESULTS: A total of 1837 articles were identified from the search strategy with 42 included in the quantitative synthesis. Procedures described included: labia minora reduction with or without clitoral hood reduction, labia majora augmentation, surgical vaginal caliber reduction, mons pubis reduction/suspension, and energy-based therapy for vaginal laxity or vulvar laxity. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. Complication rates varied by procedure but were generally low and ranged between Clavien-Dindo grades I-III. CONCLUSIONS: Although there is a breadth of literature on cosmetic gynecology surgical techniques and short-term complication rates, the terminology and outcome measures utilized are heterogeneous. To address this, standardized terminology along with uniform cosmetic and functional endpoints must be developed.

PROSPERO: An International Register of Systematic Review Protocols.

PROSPERO is an international database of systematic review protocols produced by the University of York's Center for Research and Dissemination and funded by the National Institute for Health Research. It contains protocols of systematic reviews on health and social care, welfare, public health, education, crime, justice, and health-related international development. PROSPERO compiles a comprehensive listing of systematic review protocols in an attempt to avoid duplication of effort, reduce reporting bias, and promote transparency.

The usefulness of YouTube™ videos as a source of information on burning mouth syndrome.

OBJECTIVES: The aim of this review was to investigate quality assessment and quantitative information on burning mouth syndrome (BMS) on YouTube™ videos. METHODS: An electronic search of YouTube™ videos on BMS was performed using subject headings, keywords and synonyms of BMS. For each video, quality information, via the quality assessment score (QAS) and quantitative information, such as the total number of results per term searched, date of upload, clip length, view count, source category (professional, personal, educational, mixed), number of likes and dislikes and YouTube™ category were evaluated. RESULTS: The search identified 3768 videos of which only 114 were included in our analysis: the quality of videos was very poor (mean ± standard deviation = 1.76 ± 1.64). The most representative categories were "educational" with 53 (46.5%) videos scoring between 0 and 4 and "mixed" with 24 (21.1%) videos scoring between 0 and 2. Significant differences were found among all four categories in relation to length in seconds (P < 0.001), number of views (P = 0.006) and interaction index (P = 0.001), as well as between "professional" and the other categories and between "educational" and "personal" in relation to length in seconds (P < 0.001), between "educational" and "personal" (P < 0.001) and "personal" and "mixed" category in relation to interaction index (P = 0.003) and between "professional" and "personal" in relation to views per day (P = 0.015). CONCLUSIONS: A large number of videos regarding BMS have published on YouTube™, with a wide range of distribution regarding their length and views. Unfortunately, they presented unreliable information which is most often scientifically inaccurate. Health care institutions and professionals should be more actively involved in improving high-quality e-information about BMS on YouTube™.

Plasma rich in growth factors (PRGF) in intraoral bone grafting procedures: A systematic review.

PURPOSE: This systematic review aimed at assessing the effects of PRGF in new bone formation, soft tissue healing and post-operative pain and swelling in sites that underwent ridge preservation, ridge augmentation and maxillary sinus augmentation procedures. MATERIALS AND METHODS: A comprehensive literature search employing seven databases was conducted by two independent reviewers. Only randomized and non-randomized controlled clinical trials using PRGF alone or in combination with bone grafting materials were selected. RESULTS: Overall, 919 studies were identified, of which a total of 8 articles were included in the qualitative analysis. Two of the selected studies reported on ridge preservation, one on ridge augmentation and five on maxillary sinus augmentation. Positive results were recorded for soft tissue healing and post-operative pain and swelling following these procedures. However, outcomes of PRGF on new bone formation post extraction and on maxillary sinus augmentation when combined with other biomaterials were conflicting. Meta-analysis could not be conducted for any variables due to the heterogeneity of selected studies. CONCLUSION: Limited evidence exists on the effects of PRGF in different intraoral bone grafting procedures, with some benefit reported on soft tissue healing and post-operative symptomatology. As this platelet concentrate is commonly used in clinical practice, further research is needed to fully assess its clinical indications and effectiveness.

Effectiveness of sugammadex versus neostigmine on restoration of neuromuscular function in surgical patients with myasthenia gravis undergoing rocuronium-induced neuromuscular blockade: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify the effectiveness of sugammadex versus neostigmine on the reversal of rocuronium-induced neuromuscular blockade in surgical patients with myasthenia gravis undergoing general anesthesia.

Developing Interprofessional Education at One U.S. Dental School: Establishing a Baseline and Moving Forward.

Dental schools across the U.S. are in the process of incorporating interprofessional education (IPE) into their curricula. At Louisiana State University Health Sciences Center-New Orleans (LSUHSC), the process of educating competent students fully prepared to maximize patient outcomes through interprofessional care is under way. The aim of this study was to establish baseline data on three years of LSU dental students' perceptions of IPE prior to and as a new two-year IPE curriculum was being introduced. A survey was conducted of dental students in all four years from 2015 to 2017 using the Student Perceptions of Interprofessional Clinical Education-Revised instrument, version 2 (SPICE-R2). In 2015, 120 students participated in the survey for a response rate of 46%, followed by 160 students in 2016 (62%) and 170 in 2017 (67%). The results showed that the first-year students in 2017 had a higher total SPICE-R2 mean score than the first-year students in 2015 and 2016; the difference was statistically significant. Even though the 2017 first-year students had only received an orientation to the curriculum at the time they completed the survey, this change in attitude suggests the new focus on IPE was already having an effect on students. There were no statistically significant differences between mean scores for the three cohorts of second-, third-, and fourth-year students, none of whom had experienced the new IPE curriculum. Data from this study will serve as a baseline from which to evaluate the impact of the new IPE curriculum that is now required of all first- and second-year dental students. Through continued IPE exposure in the curriculum and ongoing faculty development, further improvements in students' attitudes toward IPE can be anticipated.

Effects of preoperative intrathecal morphine on postoperative intravenous morphine dosage: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The purpose of this systematic review is to describe the effect of preoperative intrathecal morphine (ITM) on postoperative intravenous (IV) morphine dosage during the first postoperative day. This systematic review will compare the postoperative IV morphine dosage of patients receiving ITM plus morphine morphine-based patient-controlled analgesia (PCA), to patients receiving PCA morphine without ITM. This will establish the magnitude of the postoperative morphine sparing effect of ITM.This review aims to answer the following specific question: In adult abdominal and thoracic surgery patients undergoing general anesthesia (GA), what is the effect of ITM plus PCA morphine, compared to PCA morphine alone, on total IV morphine dosage (in milligrams) during the first 24 hours after surgery?

Drug-induced oral lichenoid reactions: a real clinical entity? A systematic review.

PURPOSE: Drug-induced oral lichenoid reactions (DIOLRs) have been extensively reported in the literature, but the validity of the causality relationship between any drug and the oral lichenoid lesions (OLLs) still remains questionable. We sought to determine whether this causality relationship really exists, whether a resolution of the oral lesions upon withdrawal occurs, and what the most common alleged offending medications are. METHODS: Nine electronic databases from January 1966 to December 2016 were systematically searched to identify all relevant studies selected with specific inclusion criteria (a clinical and histopathological diagnosis of DIOLRs, and clearly statement on the systemic offending medication). Searched terms included but not limited to oral lichen planus/oral lichenoid lesions/oral lichenoid reactions, the adverse effects of medication, and drug-induced. Statistical analyses conducted. RESULTS: The search retrieved a total of 817 articles, of which only 46 were included into a qualitative synthesis: 40 case reports/series and 6 studies. The causality assessment was done only in 14.8% of cases with the C-D-R protocol. The Naranjo algorithm was not reported in the majority of cases (98.2%). Culprit medication was withdrawn in 68.5% of the cases, obtaining a partial or complete resolution without treatment in 16.7% of cases and with treatment in 27.7% of cases. The median number of culprit medication(s) described was 1 with the most frequent ones being Methyldopa (20.37%), Interferon (IFN)-alpha (11.11%), and Imatinib and Infliximab (9.26%). CONCLUSION: This systematic review demonstrated that there is no strong scientific evidence to support the causal relationship between any drug and oral lichenoid lesions; therefore, in all reviewed cases, we must question whether the DIOLRs represent a real and separate clinical entity. Further and more thorough investigations using one of the available algorithms for adverse drug reaction are warranted.

Biliary Dyskinesia in Children: A Systematic Review.

Cholecystectomy rates for biliary dyskinesia in children are rising in the United States, but not in other countries. Biliary dyskinesia is a validated functional gallbladder disorder in adults, requiring biliary colic in the diagnosis. In contrast, most studies in children require upper abdominal pain, absent gallstones on ultrasound, and an abnormal gallbladder ejection fraction (GBEF) on cholecystokinin-stimulated cholescintigraphy for diagnosis. We aimed to systematically review existing literature in biliary dyskinesia in children, determine the validity and reliability of diagnostic criteria, GBEF, and to assess outcomes following cholecystectomy. We performed a systematic review following the PRISMA checklist and searched 7 databases including PubMed, Scopus, Embase, Ovid, MEDLINE, ProQuest, Web of Science, and the Cochrane library. Bibliographies of articles were screened for additional studies. Our search terms yielded 916 articles of which 28 were included. Three articles were manually added from searched references. We reviewed 31 peer-reviewed publications, all retrospective chart reviews. There was heterogeneity in diagnostic criteria and GBEF values. Outcomes after laparoscopic cholecystectomy varied from 34% to 100% success, and there was no consensus concerning factors influencing outcomes. The observational, retrospective study designs that comprised our review limited interpretation of safety and efficacy of the investigations and treatment in biliary dyskinesia in children. Symptoms of biliary dyskinesia overlapped with functional dyspepsia. There is a need for consensus on symptoms defining biliary dyskinesia, validation of testing required for diagnosis of biliary dyskinesia, and randomized controlled trials comparing medical versus surgical management in children with upper abdominal pain.

Oral health literacy in the dental office: the unrecognized patient risk factor.

According to the report Healthy People 2010, oral health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions. Studies have linked a patient's health literacy to a variety of significant health behaviors, statuses and outcomes. This article provides an overview of the literature concerning the levels of health literacy among adults in the U.S., the effects of literacy levels on treatment and patient outcomes, literacy assessment in the practice setting and the effects of a patient's literacy on communication with a dental health provider. The implications of inadequate patient oral health literacy on the practice of dental hygienists and communication recommendations are discussed, as is the need for future research specifically on oral health literacy.