Are wearable devices effective for preventing and detecting falls: an umbrella review (a review of systematic reviews).

BACKGROUND: Falls are a common and serious health issue facing the global population, causing an estimated 646,000 deaths per year globally. Wearable devices typically combine accelerometers, gyroscopes and even barometers; using the data collected and inputting this into an algorithm that decides whether a fall has occurred. The purpose of this umbrella review was to provide a comprehensive overview of the systematic reviews on the effectiveness of wearable electronic devices for falls detection in adults. METHODS: MEDLINE, Embase, Cochrane Database of Systematic Reviews (CDSR), and CINAHL, were searched from their inceptions until April 2019 for systematic reviews that assessed the accuracy of wearable technology in the detection of falls. RESULTS: Seven systematic reviews were included in this review. Due to heterogeneity between the included systematic reviews in their methods and their reporting of results, a meta-analysis could not be performed. Most devices tested used accelerometers, often in combination with gyroscopes. Three systematic reviews reported an average sensitivity of 93.1% or greater and an average specificity of 86.4% or greater for the detection of falls. Placing sensors on the trunk, foot or leg appears to provide the highest accuracy for falls detection, with multiple sensors increasing the accuracy, specificity, and sensitivity of these devices. CONCLUSIONS: This review demonstrated that wearable device technology offers a low-cost and accurate way to effectively detect falls and summon for help. There are significant differences in the effectiveness of these devices depending on the type of device and its placement. Further high-quality research is needed to confirm the accuracy of these devices in frail older people in real-world settings.

The efficacy of cognitive behavioral therapy for the treatment of antenatal depression: A systematic review.

BACKGROUND: Antenatal depression affects 7-20% of pregnant women globally yet less than a fifth of such women receive adequate treatment. Cognitive behavioral therapy (CBT) is known to be effective in the treatment of depression. However, the research is more limited with regard to the antenatal period suggesting a need for clearer evidence within this field. OBJECTIVE: To determine if CBT is effective in the treatment of antenatal depression. METHODS: Medline, Embase, PsychINFO, CINAHL and CENTRAL were searched for studies that quantified the effectiveness of CBT in women with a confirmed diagnosis of antenatal depression. Randomised controlled trials that measured the effectiveness of CBT delivered during the antenatal period, compared to another intervention or usual care, measured using a validated depression score pre and post intervention were included. RESULTS: Five RCTs were eligible for inclusion, all of which found a significant decrease in depression scores following CBT interventions, greater than that observed in control groups. Improvements in depressive scores were maintained long-term for participants who received CBT. Participant satisfaction with the interventions received was high. LIMITATIONS: Studies included displayed major performance biases, and language bias is present due to exclusion of an Iranian paper. CONCLUSION: CBT, tailored to pregnant women, is effective in the treatment of antenatal depression, with little difference in efficacy between CBT sub-types. Further large-scale RCTs are needed to confirm these hypotheses and determine the most cost-effective way of delivering CBT to pregnant women. There is also need for a specific, validated tool for assessing antenatal depression.

Endovascular Intervention Versus Surgery in Ruptured Intracranial Aneurysms in Equipoise: A Systematic Review.

Background and Purpose- The benefits of endovascular intervention over surgery in the treatment of ruptured aneurysms of anterior circulation remains uncertain. Recently, published studies did not find superiority of endovascular intervention, challenging earlier evidence from a clinical trial. The earlier evidence also had a higher than average proportion of patients in good clinical status, leading to uncertainty about external validity of earlier trials. Methods- We performed a systematic review of studies after 2005 under a protocol published in the International Prospective Register of Systematic Reviews. Primary outcomes were posttreatment rebleeding and adverse events (procedural complications). Secondary outcomes were dependency at 3 to 6 and 12 months, delayed cerebral ischemia, and seizures. Results- Rebleeding was more frequent after endovascular intervention (Peto OR, 2.18 [95% CI, 1.29-3.70]; 3104 participants; 15 studies; I2=0%, Grading of Recommendations, Assessment, Development and Evaluation: very low certainty of evidence). Fewer adverse events were reported with the endovascular intervention (RR, 0.71 [95% CI, 0.53-0.95]; 1661 participants; 11 studies; I2=14%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence). Three to six months dependency (RR, 0.82 [95% CI, 0.73-0.93]; 4081 participants; 18 studies; I2=15%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) and 12-month dependency (RR, 0.76 [95% CI, 0.66-0.86]; 1981 participants; 10 studies; I2=0%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) were lower after endovascular intervention. Conclusions- This study found consistent results between recent studies and the earlier evidence, in that endovascular intervention results in lower chance of dependency compared with surgery for repair of ruptured anterior circulation aneurysms. A lower proportion of patients in good clinical status in this review supports the application of the earlier evidence. Registration- URL: https://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42018090396.

Fibrin tissue adhesive versus nasal packing in endoscopic nasal surgery: a systematic review and meta-analysis.

BACKGROUND: It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery. METHODOLOGY: MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model. RESULTS: 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions. CONCLUSION: Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.

The effectiveness of omega-3 supplementation in reducing ADHD associated symptoms in children as measured by the Conners' rating scales: A systematic review of randomized controlled trials.

Omega-3 supplements are considered to have anti-inflammatory effects which may be beneficial as inflammation has been linked to ADHD. The aim of this review is to examine the effectiveness of omega-3 supplementation at reducing ADHD symptoms in children and adolescents. Medline, Cinahl+, PsycINFO, Cochrane and Embase were searched for trials investigating the effects of omega-3 supplementation in children and adolescents with ADHD. The primary outcome measure was a mean difference in Conners' rating scale (CRS) between the intervention and placebo group. Search terms used include ADHD, omega-3, fish oils, eicosapentaenoic acid, docosahexaenoic acids, alpha-linolenic acid and Conners' rating scale. Randomized controlled trials examining the efficacy of omega-3 supplementation in children and adolescents as measured by CRS were included. Studies using a combination of polyunsaturated fatty acids or any other rating scale were excluded. Seven trials were included in this review, totalling 926 participants. We found no evidence of publication bias or heterogeneity between trials. Overall, there was a slightly greater reduction in CRS score in favour of the experiment group. One study found a greater reduction in score in favour of the placebo group. Neither findings were statistically significant. There is little supportive evidence to validate the claim of omega-3 supplementation to reduce the degree of ADHD symptoms experienced by children and adolescents. Both experiment and control groups saw similar reductions in Conners rating scale score.

Total cosine R-to-T for predicting ventricular arrhythmic and mortality outcomes: A systematic review and meta-analysis.

BACKGROUND: The total cosine R-to-T (TCRT), a vectorcardiographic marker reflecting the spatial difference between the depolarization and repolarization wavefronts, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD) in different clinical settings. However, its prognostic value has been controversial. OBJECTIVE: This systematic review and meta-analysis evaluated the significance of TRCT in predicting arrhythmic and/or mortality endpoints. METHODS: PubMed and Embase databases were searched through December 31, 2016. RESULTS: Of the 890 studies identified initially, 13 observational studies were included in our meta-analysis. A total of 11,528 patients, mean age 47 years old, 72% male, were followed for 43 ± 6 months. Data from five studies demonstrated lower TCRT values in myocardial infarction patients with adverse events (syncope, ventricular arrhythmias, or sudden cardiac death) compared to those without these events (mean difference = -0.36 ± 0.05, p < .001; I2  = 48%). By contrast, only two studies analyzed outcomes in heart failure, and pooled meta-analysis did not demonstrate significant difference in TCRT between event-positive and event-negative patients (mean difference = -0.01 ± 0.10, p > .05; I2  = 80%). CONCLUSION: TCRT is lower in MI patients at high risk of adverse events when compared to those free from such events. It can provide additional risk stratification beyond the use of clinical parameters and traditional electrocardiogram markers. Its value in other diseases such as heart failure requires further studies.

Shisha waterpipe use and awareness of health risks among young adults in a semi-rural underprivileged community in North West England.

INTRODUCTION: Waterpipe smoking has become increasingly popular among young adults across the globe. Evidence suggests waterpipes have overtaken cigarettes in popularity among university students in the UK. This survey aimed to measure the prevalence of use, awareness of the tobacco content and associated health risks of waterpipes among young adults in a non-university semi-rural underprivileged community in England. METHODS: A self-completed questionnaire was distributed by six schools and colleges to young adults aged 16-25 in Tameside, North West England. RESULTS: A total of 210 young adults completed the survey, of these 12% smoked cigarettes and 16% smoked waterpipes. Of those that smoked waterpipes, 45% smoked at home and 88% smoked in shisha bars. Of the respondents, 62% did not know that shisha waterpipes contained tobacco and 18% believed that waterpipes were less harmful than smoking cigarettes. There was no difference in knowledge of tobacco content, or of the associated health risks, between those who smoked waterpipes and those that did not. The majority of respondents (81%) stated that if they wanted to know more about how shisha tobacco could affect their health they would access information via the internet. Social networking websites was by far the most popular route for communication for messages about the health risks associated with smoking shisha waterpipes. CONCLUSIONS: These results suggest that waterpipes may have overtaken cigarettes as the method of choice for smoking tobacco among the young adult population in the UK.

Prognostic factors in patients with metastatic spinal cord compression secondary to melanoma: a systematic review.

Melanoma is one of the most common primary tumours associated with metastatic spinal cord compression (MSCC). The aim of this review is to identify prognostic factors specifically for MSCC secondary to melanoma. A systematic search of literature was performed in MEDLINE, Embase and the Cochrane Library to identify studies reporting prognostic factors for patients with MSCC secondary to melanoma. Two studies, involving a total of 39 patients, fulfilled the inclusion criteria. The variables associated with increased survival were receiving postoperative radiotherapy, receiving chemotherapy, perioperative lactate dehydrogenase level less than or equal to 8.0 µkat/l, preoperative haemoglobin level more than 11.5 mg/dl, an interval of 4 or more years between melanoma diagnosis and skeletal metastasis, absence of further skeletal metastases, absence of visceral metastases, Eastern Cooperative Oncology Group Performance Status of 2 or less, two or fewer involved vertebrae, being ambulatory preradiotherapy and an interval of more than 7 days between developing motor deficits and radiotherapy. The variables associated with good functional outcome were slow development of motor dysfunction, good performance status and being ambulatory before radiotherapy. The most important prognostic factors for survival are Eastern Cooperative Oncology Group Performance Status of 2 or less and absence of visceral metastases. There is a lack of studies looking specifically at prognostic factors for patients with MSCC secondary to melanoma, and the number of patients involved in the existing studies is small.

Impact of peer support on student mental wellbeing: a systematic review.

This article was migrated. The article was marked as recommended. Objectives: Many universities use peer support programmes to support students. However, there are currently no guidelines on the most effective way of facilitating emotional wellbeing in students. The aim of this paper is to review the evidence for the effectiveness of peer support to improve mental health wellbeing in university students. Methods: Six electronic databases (Medline, Embase, British Education Index (BEI), Australian Education Index (AEI), PsychINFO and Applied Social Sciences Index and Abstracts (ASSIA)) were searched in December 2017. Search terms included "peer support", "university students" and "mental wellbeing". Studies that did not include peer support or assess the impact of students' mental health were excluded. Data about design and delivery of the peer support intervention and changes in student mental wellbeing outcomes were extracted. Results: 489 records were identified. Three studies met the inclusion criteria; two cross-sectional surveys and one non-randomised intervention study. One study found social support to be the most important protective factor for mental wellbeing. Two studies showed no statistically significant improvement in wellbeing outcomes with peer support. One study found that majority of mentors and mentees found peer support useful. Conclusions: There is currently no evidence that peer support improves mental wellbeing among university students.

The Tpeak - Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis.

BACKGROUND: The Tpeak - Tend interval (the interval from the peak to the end of the T wave), an electrocardiographic marker reflecting transmural dispersion of repolarization, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death in different clinical settings. OBJECTIVE: This systematic review and meta-analysis evaluated the significance of the Tpeak - Tend interval in predicting arrhythmic and/or mortality end points. METHODS: PubMed, Embase, Cochrane Library, and CINAHL Plus databases were searched through November 30, 2016. RESULTS: Of the 854 studies identified initially, 33 observational studies involving 155,856 patients were included in our meta-analysis. Tpeak - Tend interval prolongation (mean cutoff value 103.3 ± 17.4 ms) was a significant predictor of the arrhythmic or mortality outcomes (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.11-1.17; P < .001). When different end points were analyzed, the ORs were as follows: VT/VF, 1.10 (95% CI 1.06-1.13; P < .0001); sudden cardiac death, 1.27 (95% CI 1.17-1.39; P < .0001); cardiovascular death, 1.40 (95% CI 1.19-1.64; P < .0001); and all-cause mortality, 4.56 (95% CI 0.62-33.68; P < .0001). Subgroup analysis for each disease revealed that the risk of VT/VF or death was highest for Brugada syndrome (OR 5.68; 95% CI 1.57-20.53; P < .01), followed by hypertension (OR 1.52; 95% CI 1.26-1.85; P < .0001), heart failure (OR 1.07; 95% CI 1.04-1.11; P < .0001), and ischemic heart disease (OR 1.06; 95% CI 1.02-1.10; P = 0.001). CONCLUSION: The Tpeak - Tend interval is a useful risk stratification tool in different diseases and in the general population.

Can consultant geriatrician led comprehensive geriatric assessment in the emergency department reduce hospital admission rates? A systematic review.

Objective: economic and demographic pressures are driving a need to reassess the way in which we care for older patients presenting to emergency departments (EDs). This systematic review seeks to assess the extent to which performing comprehensive geriatric assessment (CGA) in the ED can reduce admission rates. Design: systematic search of both published and unpublished literature to identify studies reporting admission rates following the introduction of consultant geriatrician led teams performing CGA in the ED. Changes in inpatient length of stay and subsequent readmission rates were identified as secondary outcome measures. Results: five studies with a total of 28,434 participants were included. All of the studies reported statistically significant reductions in admission rates (ranging between 2.6 and 19.7%). However, variation in the degree of changes leads to uncertainty as to the financial viability of the intervention. No studies have yet examined the clinical effects of performing CGA within the ED. The results were far more varied with regards to inpatient length of stay and readmission rates, indicating that complex local factors, such as the design of community support services, may play an important role. Conclusion: consultant geriatrician led teams performing CGA within the ED can reduce admissions rates among older patients. It is unclear as to what impact such interventions have upon readmission rates or inpatient length of stay. Future research is needed to assess the clinical outcomes and financial viability of such admissions avoidance teams. PROSPERO registration number: CRD42016038840.

Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review.

INTRODUCTION: Childhood obesity is now a global epidemic and the incidence continues to increase. Dietary interventions and nutritional education are possible options to manage childhood obesity. However, restrictive diets can result in negative outcomes, and therefore it may be more apt to encourage children to consume more fruit and vegetables and thereby develop a healthier positive attitude towards food. METHOD: A systematic review of literature of interventions to increase fruit and/or vegetable consumption in overweight or obese children and adolescents was conducted, applying a free-text strategy with a set of search terms. RESULTS: A total of five studies describing seven interventions published in international peer-reviewed journals and meeting the review's eligibility criteria were identified. All five studies examined family-focused interventions to increase daily fruit and vegetable consumption measured either by child self-report or parent report. Only one intervention reported a lasting statistically significant increased consumption of fruit and vegetables. CONCLUSIONS: This review highlights that in order to tackle obesity narrow interventions focusing on single aspects of behaviour are unlikely to achieve long-term change. Successful public health interventions tackling childhood obesity will need to take a holistic approach and target behaviour change in multiple aspects of children's lifestyles and their surroundings, including nutritional education, parental support and physical activity.

An evaluation of pulsed shortwave on knee osteoarthritis using radioleucoscintigraphy: a randomised, double blind, controlled trial.

OBJECTIVE: To evaluate the effects of pulsed shortwave on osteoarthritis of the knee. METHODS: A double blinded, randomised, controlled trial. Thirteen female and 14 male patients with radiographic evidence of knee osteoarthritis were randomly allocated to either low dose (10 W), or high dose (20 W) or placebo high frequency pulsed shortwave. Knee radioleucoscintigraphy was performed pre and post treatment as well as objective functional and subjective evaluations. RESULTS: There were no significant differences between the groups in the pre and post treatment percentage change for radioleucoscintigraphy (P > 0.05). Functional and subjective measures also revealed no pre and post treatment differences between the groups (P > 0.05), except for improved knee range of motion in the placebo group (P < 0.05). CONCLUSION: Joint inflammation in knee osteoarthritis, measured using radioleucoscintigraphy, was not altered significantly by pulsed shortwave, therefore this therapeutic modality has little or no anti-inflammatory effect on conditions such as osteoarthritis of the knee.