The use of countercurrent heat exchangers diminishes accidental hypothermia during abdominal aortic aneurysm surgery Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials Warmed intravenous infusion for controlling intraoperative hypothermia. Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review Normothermia to Prevent Surgical Site Infections After Gastrointestinal Surgery: Holy Grail or False Idol? Acupuncture for the Treatment of Opiate Addiction Is Video-Based Education an Effective Method in Surgical Education? A Systematic Review. Systematic Reviews of Animal Studies; Missing Link in Translational Research? Assessing the complications of laparoscopic robot-assisted surgery: the case of radical prostatectomy Prevention of cervical cancer in HIV-seropositive women from developing countries: a systematic review protocol A systematic review of anxiety interventions in stroke and acquired brain injury: Efficacy and trial design Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review Randomized controlled trials of aprotinin in cardiac surgery: could clinical equipoise have stopped the bleeding? Warming with an underbody warming system reduces intraoperative hypothermia in patients undergoing laparoscopic gastrointestinal surgery: a randomized controlled study. Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Guidelines for randomized clinical trial protocol content: a systematic review How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review Towards systematic reviews that inform health care management and policy-making The Effectiveness of Psychosocial Interventions as Adjuncts to Orthopaedic Surgery: A Systematic Review Protocol Effects of physical activity on cancer survival: a systematic review. Perioperative warming, oxygen, and Ilomedin on oxygenation and healing in infrainguinal bypass surgery. How to Appraise the Effectiveness of Treatment
Background : Perioperative hypothermia is common and likely contributes to morbidity , but the efficacy of prophylactic fluid warming has hardly been analyzed systematic ally . We tested the hypothesis that the use of an infusion/blood warmer , based on the principle of countercurrent heat exchange , reduces incidence and degree of severe hypothermia following aortic surgery Objective : The objective of this article is to systematic ally analyse the r and omized , controlled trials that compare the use of antibacterial sutures ( ABS ) for skin closure in controlling surgical site infections . Methods : R and omized , controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections  were analysed systematic ally using RevMan ® and combined outcomes were expressed as odds ratios ( OR ) and st and ardized mean differences ( SMD ) . Results : Seven r and omized , controlled trials evaluating 1631 patients were retrieved from electronic data bases . There were 760 patients in the ABS group and 871 patients in the simple suture group . There was moderate heterogeneity among trials ( Tau2 = 0.12 ; chi2 = 8.40 , df = 6 [ P < 0.01 ] ; I2 = 29 % ) . Therefore in the r and om-effects model , the use of ABS for skin closure in surgical patients was associated with a reduced risk of developing surgical site infections ( OR , 0.16 ; 95 % CI , 0.37 , 0.99 ; z = 2.02 ; P < 0.04 ) and postoperative complications ( OR , 0.56 ; 95 % CI , 0.32 , 0.98 z = 2.04 ; P = 0.04 ) . The duration s of operation and lengths of hospital stay were similar following the use of ABS and SS for skin closure in patients undergoing various surgical procedures . Conclusion : Use of ABS for skin closure in surgical patients  is effective in reducing the risk of surgical site infection and postoperative complications  . ABS is comparable with SS in terms of length of hospital stay and duration of operation OBJECTIVE to verify the effectiveness of warmed intravenous infusion for hypothermia prevention in patients during the intraoperative period . METHOD experimental , comparative , field , prospect i ve and quantitative study undertaken at a federal public hospital . The sample was composed of 60 adults , included based on the criteria of axillary temperature between 36ºC and 37.1ºC and surgical abdominal access , divided into control and experimental groups , using the systematic probability sampling technique . RESULTS 22 patients ( 73.4 % ) from both groups left the operating room with hypothermia , that is , with temperatures below 36ºC ( p=1.0000 ) . The operating room temperature when patients arrived and patients ' temperature when they arrived at the operating room were statistically significant to affect the occurrence of hypothermia . CONCLUSION the planning and implementation of nursing interventions carried out by baccalaureate nurses are essential for preventing hypothermia and maintaining perioperative normothermia Aim Previous systematic review s have found hydrotherapy to be an effective management strategy for  fibromyalgia syndrome ( FMS ) .  The aim of this systematic review was to summarize the components of hydrotherapy programs used in r and omized controlled trials . Method A systematic review of r and omized controlled trials was conducted . Only trials that have reported significant FMS-related outcomes were included . Data relating to the components of hydrotherapy programs ( exercise type , duration , frequency and intensity , environmental factors , and service delivery ) were analyzed . Results Eleven r and omized controlled trials were included in this review . Overall , the quality of trials was good . Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component . Great variability was noted in both the environmental components of hydrotherapy programs and service delivery . Conclusions Aerobic exercise , warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes . Treatment duration of 60 minutes , frequency of three sessions per week and an intensity equivalent to 60%–80 % maximum heart rate were the most commonly reported exercise components . Exercise appears to be the most important component of an effective hydrotherapy program for FMS , particularly when considering mental health-related outcomes Objective : To analyze the association between perioperative normothermia ( temperature ≥36 ° C ) and  surgical site infections ( SSIs ) after gastrointestinal ( GI ) surgery . Summary of Background Data : Although active warming during colorectal surgery reduces SSIs , there is limited evidence that perioperative normothermia is associated with lower rates of SSI . Nonetheless , hospitals participating in the Surgical Care Improvement Project must report normothermia rates during major surgery . Methods : We conducted a nested , matched , case-control study ; cases consisted of GI surgery patients enrolled in our National Surgical Quality Improvement Program data base between March 2006 and March 2009 who developed SSIs . Patient/surgery risk factors for SSI were obtained from the National Surgical Quality Improvement Program data base . Perioperative temperature/antibiotic/glucose data were obtained from medical records . Cases/controls were compared using univariate/r and om effects/logistic regression models . Independent risk factors for SSIs were identified using multivariate/r and om effects/logistic regression models . Results : A total of 146 cases and 323 matched controls were identified ; 82 % of patients underwent noncolorectal surgery . Cases were more likely to have final intraoperative normothermia compared with controls ( 87.6 % vs. 77.8 % , P = 0.015 ) ; rates of immediate postoperative normothermia were similar ( 70.6 % vs. 65.3 % , respectively , P = 0.19 ) . Emergent surgery/higher wound class were associated with higher rates of intraoperative normothermia . Independent risk factors for SSI were diabetes , surgical complexity , small bowel surgery , and nonlaparoscopic surgery . There was no independent association between perioperative normothermia and SSI ( adjusted odds ratio , 1.05 ; 95 % confidence interval , 0.48–2.33 ; P = 0.90 ) . Conclusions : Pay-for-reporting measures focusing on perioperative normothermia may be of limited value in preventing SSI after GI surgery . Studies to define the benefit of active warming after noncolorectal GI surgery are warranted Acupuncture is an accepted treatment worldwide for various clinical conditions , and the effects of acupuncture on opiate addiction have been investigated in many clinical trials . The present review systematic ally analyzed data from r and omized clinical trials published in Chinese and English since 1970 . We found that the majority agreed on the efficacy of acupuncture as a strategy for the treatment of opiate addiction . However , some of the methods in several included trials have been criticized for their poor quality . This review summarizes the quality of the study design , the types of acupuncture applied , the commonly selected acupoints or sites of the body , the effectiveness of the treatment , and the possible mechanism underlying the effectiveness of acupuncture  in these trials OBJECTIVE Visual signs draw more attention during the learning process . Video is one of the most effective tool including a lot of visual cues . This systematic review set out to explore the influence of video in surgical education . We review ed the current evidence for the video-based surgical education methods , discuss the advantages and disadvantages on the teaching of technical and nontechnical surgical skills . METHODS This systematic review was conducted according to the guidelines defined in the preferred reporting items for systematic review s and meta-analyses statement . The electronic data bases : the Cochrane Library , Medline ( PubMED ) , and ProQuest were search ed from their inception to the 30 January 2016 . The Medical Subject Headings ( MeSH ) terms and keywords used were " video , " " education , " and " surgery . " We analyzed all full-texts , r and omised and nonr and omised clinical trials and observational studies including video-based education methods about any surgery . " Education " means a medical resident 's or student 's training and teaching process ; not patients ' education . We did not impose restrictions about language or publication date . RESULTS A total of nine articles which met inclusion criteria were included . These trials enrolled 507 participants and the total number of participants per trial ranged from 10 to 172 . Nearly all of the studies review ed report significant knowledge gain from video-based education techniques . The findings of this systematic review provide fair to good quality studies to demonstrate significant gains in knowledge compared with traditional teaching . Additional video to simulator exercise or 3D animations has beneficial effects on training time , learning duration , acquisition of surgical skills , and trainee 's satisfaction . CONCLUSION Video-based education has potential for use in surgical education as trainees face significant barriers in their practice . This method is effective according to the recent literature . Video should be used in addition to st and ard techniques in the surgical education Background The method ological quality of animal studies is an important factor hampering the translation of results from animal studies to a clinical setting . Systematic review s of animal studies may provide a suitable method to assess and thereby improve their method ological quality . Objectives The aims of this study were : 1 ) to evaluate the risk of bias assessment in animal-based systematic review s , and 2 ) to study the internal validity of the primary animal studies included in these systematic review s. Data Sources We systematic ally search ed Pubmed and Embase for SRs of pre clinical animal studies published between 2005 and 2012 . Results A total of 91 systematic review s met our inclusion criteria . The risk of bias was assessed in 48 ( 52.7 % ) of these 91 systematic review s. Thirty-three ( 36.3 % ) SRs provided sufficient information to evaluate the internal validity of the included studies . Of the evaluated primary studies , 24.6 % was r and omized , 14.6 % reported blinding of the investigator/caretaker , 23.9 % blinded the outcome assessment , and 23.1 % reported drop-outs . Conclusions To improve the translation of animal data to clinical practice , systematic review s of animal studies are worthwhile , but the internal validity of primary animal studies needs to be improved . Furthermore , risk of bias should be assessed by systematic review s of animal studies to provide insight into the reliability of the available evidence Background A robot-assisted laparoscopic approach for radical prostatectomy ( RALRP ) is being adopted increasingly worldwide for the treatment of localized prostate cancer ( CaP ) .  Complications assessment is essential to the objective evaluation of any new procedure . This study aim ed to assess the perioperative complications encountered during the implementation of a robot-assisted urologic surgery program . Methods A prospect i ve data collection for all men with a diagnosis of CaP who underwent RALRP between 2005 and 2009 in our department was achieved . Together with perioperative data , all the perioperative complications encountered were specifically recorded , including robot dysfunctions . The RALRP was performed with the three-arm Da Vinci system using a transperitoneal approach with six ports . To assess the perioperative complications , the vali date d Clavien – Dindo classification of surgical procedures was used . Two surgeons were involved in these procedures . A modified Clavien – Dindo classification also was used to account for intraoperative complications . Results According to the Clavien – Dindo classification , 16 complications ( 6.7 % complication rate ) were recorded during the first 240 procedures . Besides postoperative complications , five procedures ( 2.1 % ) were directly affected by robot malfunctions without notable consequences for the patients . Considering these five additional complications , an 8.8 % complication rate was recorded using a modified Clavien – Dindo classification . The main limitation of the study was its design restricted to RALRP procedures alone . The second limitation was that the authors ’ modified classification needs to be vali date d with a larger series and for different surgical procedures . Conclusions The findings show that RALRP is a safe alternative to classical surgery and that the robotic approach is reliable . The authors believe that the reliability of technological devices should be systematic ally discussed when outcome analysis of a new procedure is performed Background Over 85 % of cervical cancer cases and deaths occur in developing countries . HIV-seropositive women are more likely to develop precancerous lesions that lead to cervical cancer than HIV-negative women . However , the literature on cervical cancer prevention in seropositive women in developing countries has not been review ed . The aim of this study is to systematic ally review cervical cancer prevention modalities available for HIV-seropositive women in developing countries . Methods / design This protocol was developed by following the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) statement , and the systematic review will be reported in accordance with the PRISMA guidelines . Embase , MEDLINE , PubMed , CINAHL and Cochrane Library will be search ed from inception up to date of final search , and additional studies will be located through citation and reference list tracking . Eligible studies will be r and omised controlled trials , prospect i ve and retrospective cohort studies , case-control and cross-sectional studies carried out in developing countries . Studies will be included if they are published in English and examine cervical cancer prevention modalities in HIV-seropositive women . Results will be summarised in tables and , where appropriate , combined using meta- analysis . Discussion This review will address the gap in evidence by systematic ally review ing the published literature on the different prevention modalities being used to prevent  cervical cancer in HIV-seropositive women in developing countries . The findings may be used to inform evidence -based guidelines for prevention of cervical cancer in seropositive women as well as future research . Systematic review registration PROSPERO CRD42017054678 Objective There is little r and omized controlled trial ( RCT ) evidence to guide treatment for anxiety after stroke . We systematic ally review ed RCTs of anxiety interventions in acquired brain injury ( ABI ) conditions including stroke and traumatic brain injury ( TBI ) in order to summarize efficacy and key aspects of trial design to help guide future RCTs . Methods We search ed the Cochrane trial register , Medline , Embase , PsychInfo and CINAHL systematic ally up to August 2017 . Two independent review ers systematic ally selected studies and extracted data . We summarized the effect size , key study characteristics and sources of potential bias in trial design . Results 14 studies ( 12 stroke ; one stroke & TBI ; one TBI ) with 928 participants were included . Meta- analysis of five psychotherapy comparisons favoured intervention over control ( st and ardized mean difference ( SMD ) : − 0.41 [ − 0.79 , − 0.03 ] , I2 = 28 % ) ; Overall effect size of pharmacotherapy comparisons favoured intervention over control ( SMD : − 2.12 [ − 3.05 , − 1.18 ] , I2 = 89 % ) . One comparison of mixed pharmacotherapy and psychotherapy favoured intervention over usual care ( SMD : − 4.79 [ − 5.87 , − 3.71 ] ) . One comparison favoured  forest therapy versus urban control ( SMD : − 2.00 [ − 2.59 , − 1.41 ] ) . All positive studies carried high or unclear risk of bias . Sample sizes were small in all included studies . Conclusions There is low quality evidence to suggest that psychotherapy and pharmacotherapy may be effective interventions in the treatment of anxiety after stroke based on underpowered studies that carried high risk of bias . Large-scale well- design ed definitive trials are needed to establish whether pharmacological or psychotherapy works . Our review highlighted key considerations for investigators wishing to design high quality trials to evaluate treatments for anxiety after stroke Background Stress urinary incontinence ( SUI ) is a prevalent and costly condition which may be treated surgically or by physical therapy . The aim of this review was to systematic ally assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training ( PFMT ) performed alone and together with adjunctive therapies ( eg biofeedback , electrical stimulation , vaginal cones ) for the treatment of female SUI . Methods All major electronic sources of relevant information were systematic ally search ed to identify peer- review ed English language abstract s or papers published between 1995 and 2005 . R and omised controlled trials ( RCTs ) and other study design s eg non-r and omised trials , cohort studies , case series , were considered for this review in order to source all the available evidence relevant to clinical practice . Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion . Excluded were studies of women who were pregnant , immediately post-partum or with a diagnosis of mixed or urge incontinence . Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered . Two independent review ers assessed the eligibility of each study , its level of evidence and the method ological quality . Due to the heterogeneity of study design s , the results are presented in narrative format . Results Twenty four studies , including 17 RCTs and seven non- RCTs , met the inclusion criteria . The method ological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence . This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for  women  with  SUI  with rates of ' cure ' and ' cure/improvement ' up to 73 % and 97 % respectively . The contribution of adjunctive therapies is unclear and there is limited evidence about treatment outcomes in primary care setting s. Conclusion There is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further high quality studies are needed to evaluate the optimal treatment programs and training protocol s in subgroups of women and their effectiveness in clinical practice Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Background Aprotinin is a serine protease inhibitor used to limit perioperative bleeding and reduce the need for donated blood transfusions during cardiac surgery . R and omized controlled trials of aprotinin evaluating its effect on the outcome of perioperative transfusion have been published since 1987 , and systematic review s were conducted in 1992 and 1997 . Methods A systematic search was conducted for all RCTs of aprotinin  that used placebo controls or were open-label with no active control treatment . Data collected included the primary outcome , objective of each study , whether a systematic review was cited or conducted as part of the background and /or rationale for the study and the number of previously published RCTs cited . Cumulative meta-analyses were performed . Results Sixty-four r and omized , controlled trials of aprotinin were found , conducted between 1987 and 2002 , reporting an endpoint of perioperative transfusion .  Median trial size was 64 subjects , with a range of 20 to 1784 . A cumulative meta- analysis indicated that aprotinin greatly decreased the need for perioperative transfusion , stabilizing at an odds ratio of 0.25 ( p , 10 2 6 ) by the 12th study , published in June of 1992 . The upper limit of the confidence interval never exceeded 0.65 and results were similar in all subgroups . Citation of previous RCTs was extremely low , with a median of 20 % of prior trials cited . Only 7 of 44 ( 15 % ) of subsequent reports referenced the largest trial ( N 1/4 1784 ) , which was 28 times larger than the median trial size . Conclusions This study demonstrates that investigators evaluating aprotinin were not adequately citing previous research , result ing in a large number of RCTs being conducted to address efficacy questions that prior trials had already definitively answered . Institutional review boards and journals could reduce the number of redundant trials by requiring investigators to conduct adequate search es for prior evidence and conducting systematic review BACKGROUND Intraoperative hypothermia is a common event during laparoscopic abdominal surgery . On one h and , intraoperative hypothermia can delay the metabolism and prevent tissue damage . One the other h and , long-term and severe intraoperative hypothermia may also lead to perioperative complications , such as increasing of peripheral resistance , coagulation dysfunction , intraoperative hemorrhage and postoperative shivering . Maintenance of normothermia during surgical procedures may improve the quality of patient care . OBJECTIVES This study investigated the feasibility and efficacy of intraoperative cutaneous warming with an underbody warming system during laparoscopic gastrointestinal surgery . METHODS 110 patients undergoing laparoscopic surgery for gastrointestinal cancer between January and December 2011 were r and omized into the laparoscopic control ( Control ) group and laparoscopic intervention ( Intervention ) group . Nasopharyngeal temperature , prothrombin time , activated partial thromboplastin time , and thrombin time were measured before and during surgery , intraoperative and postoperative complications , as well as shivering after anesthesia and visual analog scale score for pain evaluation after surgery were also recorded . Clinical risk factors that may cause intraoperative hypothermia during laparoscopic surgery were also analyzed by correlation analysis . RESULTS The two groups were comparable at the baseline . Intraoperative hypothermia was observed in 29 patients ( 52.7 % ) in Control group and 3 ( 5.5 % ) in Intervention group . Nasopharyngeal temperature in Control group was significantly decreased since 30min after the start of operation until the end of surgery comparing to that at the start of anesthesia , but there was no difference in the Intervention group . In Intervention group , the nasopharyngeal temperature was remaining at ∼36.5 ° C , indicating the feasibility and efficiency of the underbody warming system in preventing intraoperative hypothermia during laparoscopic gastrointestinal surgery . Moreover , with anesthesia and operation time increased , there was no significant change of coagulation function , hemoglobin level as well as less intraoperative hemorrhage , less postoperative shivering and lower visual analog scale score in Intervention group comparing to Control group . Multivariate logistic regression analysis revealed that anesthesia time and volume of CO2 were independent risk factors for perioperative hypothermia . CONCLUSIONS Cutaneous warming with an underbody warming system is a feasible and effective method to prevent intraoperative hypothermia during laparoscopic gastrointestinal surgery OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity Background All r and omized clinical trials ( RCTs ) require a protocol ; however , numerous studies have highlighted protocol deficiencies . Reporting guidelines may improve the content of research reports and , if developed using robust methods , may increase the utility of reports to stakeholders . The objective of this study was to systematic ally identify and review RCT protocol guidelines , to assess their characteristics and methods of development , and to compare recommendations . Methods We conducted a systematic review of indexed literature ( MEDLINE , EMBASE and the Cochrane Methodology Register from inception to September 2010 ; reference lists ; related article features ; forward citation search ing ) and a targeted search of supplementary sources , including a survey of major trial funding agencies in six countries . Records were eligible if they described a content guideline in English or French relevant to RCT protocol s. Guidelines were excluded if they specified content for protocol s for trials of specific procedures or conditions or were intended to assess trial quality . We extracted guideline characteristics and methods . Content was mapped for a subset of guidelines that described development methods or had institutional endorsement . Results Forty guidelines published in journals , books and institutional reports were included in the review ; seven were specific to RCT protocol s. Only eight ( 20 % ) described development methods which included informal consensus methods , pilot testing and formal validation ; no guideline described all of these methods . No guideline described formal consensus methods or a systematic retrieval of empirical evidence to inform its development . The guidelines included a median of 23 concepts per guideline ( interquartile range ( IQR ) = 14 to 34 ; range = 7 to 109 ) . Among the subset of guidelines ( n = 23 ) for which content was mapped , approximately 380 concepts were explicitly addressed ( median concepts per guideline IQR = 31 ( 24,80 ) ; range = 16 to 150 ) ; most concepts were addressed in a minority of guidelines . Conclusions Existing guidelines for RCT protocol content varied substantially in their recommendations . Few reports described the methods of guideline development , limiting comparisons of guideline validity . Given the importance of protocol s to diverse stakeholders , we believe a systematic ally developed , evidence -informed guideline for clinical trial protocol s is needed We conducted a review of systematic review s ( SRs ) and r and omized-controlled trials ( RCTs ) to analyze efficacy and safety of cannabis-based medication in patients with mental disorders . Five data bases were systematic ally search ed ( 2006—August 2018 ) ; 4 SRs ( of 11 RCTs ) and 14 RCTs ( 1629 participants ) were included . Diagnoses were : dementia , cannabis and opioid dependence , psychoses/schizophrenia , general social anxiety , posttraumatic stress disorder , anorexia nervosa , attention-deficit hyperactivity disorder , and Tourette`s disorder . Outcome variables were too heterogeneous to conduct a meta- analysis . A narrative synthesis method was applied . The study quality was assessed using the risk-of-bias tool and SIGN-checklists . THC- and CBD-based medicines , given as adjunct to pharmaco- and psychotherapy , were associated with improvements of several symptoms of mental disorders , but not with remission . Side effects occurred , but severe adverse effects were mentioned in single cases only . In order to provide reliable treatment recommendations , more and larger RCTs with follow-up assessment s , consistent outcome measures and active comparisons are needed Objectives To identify ways to improve the usefulness of systematic review s for health care managers and policy-makers that could then be evaluated prospect ively . Methods We systematic ally review ed studies of decision-making by health care managers and policy-makers , conducted interviews with a purposive sample of them in Canada and the United Kingdom ( n=29 ) , and review ed the websites of research funders , producers/purveyors of research , and journals that include them among their target audiences ( n=45 ) . Results Our systematic review identified that factors such as interactions between research ers and health care policy-makers and timing/timeliness appear to increase the prospect s for research use among policy-makers . Our interviews with health care managers and policy-makers suggest that they would benefit from having information that is relevant for decisions highlighted for them ( e.g. context ual factors that affect a review 's local applicability and information about the benefits , harms/risks and costs of interventions ) and having review s presented in a way that allows for rapid scanning for relevance and then grade d entry ( such as one page of take-home messages , a three-page executive summary and a 25-page report ) . Managers and policy-makers have mixed views about the helpfulness of recommendations . Our analysis of websites found that context ual factors were rarely highlighted , recommendations were often provided and grade d entry formats were rarely used . Conclusions Research ers could help to ensure that the future flow of systematic review s will better inform health care management and policy-making by involving health care managers and policy-makers in their production and better highlighting information that is relevant for decisions . Research funders could help to ensure that the global stock of systematic review s will better inform health care management and policy-making by supporting and evaluating local adaptation processes such as developing and making available online more user-friendly ‘ front ends ’ for potentially relevant systematic review AIMS Pain and anxiety are commonly reported among those undergoing orthopaedic surgery . Improvement in anxiety and pain control might be achieved by supplementing st and ard care with psychological interventions . However , the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic review s in orthopaedic surgeries . The present study aim ed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery , to identify the most effective intervention types and to evaluate potential moderators . METHODS We will perform a systematic review and meta- analysis to address the study aims . PubMed , PsycINFO , CINAHL and ProQuest Dissertations & Theses will be search ed between 1980 and 2015 . Prospect i ve controlled clinical trials completed in adults , contrasting st and ard care and st and ard care supplemented with psychosocial methods  , will be eligible for inclusion . Effectiveness will be assessed through the outcomes of postoperative pain intensity , analgesic requirement , perioperative anxiety , quality of life and postoperative recovery . The results of a r and om-effect meta- analysis will be reported . To aid implementation of best practice , moderating effects of the type and timing of psychosocial intervention , type of surgical intervention and type of anaesthesia will be evaluated through meta-regression . Sensitivity analyses and subgroup contrasts will follow as necessary . DISCUSSION Recommendations will be made to improve medical care in orthopaedic procedures . The quality of evidence will be rated using GRADE criteria . Copyright © 2016 John Wiley & Sons , PURPOSE Physical activity ( PA ) has been suggested to help increase the survival of individuals with cancer . The objective of this review was to systematic ally evaluate and summarize the available evidence investigating the effect of PA on the survival of individuals with cancer . METHODS Electronic data bases ( CINAHL , EMBASE , and MEDLINE ) were systematic ally search ed for r and omized controlled trials and cohort studies . Selected studies were assessed by two independent investigators for method ological quality , using the PEDro scale . RESULTS Ten prospect i ve cohort studies met the inclusion criteria . Quality - assessment scores averaged 5/10 on the PEDro scale , with two articles obtaining a score of 6/10 . The majority of studies found that individuals participating in higher levels of physical activity had a reduced risk of cancer-related mortality . This trend was observed specifically for breast , colon , and colorectal cancers . On average , it appears that engaging in higher levels of metabolic equivalent hours per week may help to improve survival rates among individuals diagnosed with cancer . CONCLUSION Patients diagnosed with cancer demonstrated a trend toward increased survival with greater levels of PA . However , because only prospect i ve cohort studies were included in the study , the conclusions drawn should be regarded with caution BACKGROUND Perioperative adjuncts are utilized across surgical specialities with the goal of improving patient outcomes . High-dose oxygen and extended warming are shown to increase wound collagen deposition during abdominal surgery . Prostacyclin is shown to improve limb salvage and patency rate in infrainguinal bypass ( IIB ) surgery . This study evaluated the impact of these adjuncts on healing and perfusion post IIB surgery . METHODS This r and omized controlled study allocated patients undergoing IIB surgery into three treatment arms ( perioperative high-dose oxygen , extended warming , and a synthetic prostacyclin ) or a control group . The primary outcome was accumulation of hydroxyproline ( OHP , collagen surrogate marker ) as collected in polytetrafluoroethylene implants on day 5 . Secondary outcomes included levels of growth factors and cytokines , and tissue oxygenation of the wound and foot as measured by hyperspectral technology and ankle-brachial pressure index . Clinical outcomes were observed to day 30 , with long-term follow-up of 12 mo . RESULTS Seventy-one patients completed the study . Comparing treatment groups with the control at day 5 , there were no differences in OHP , growth factors or cytokines levels , or improvement in tissue oxygenation at the surgical incision . However , there was more flow to the foot ( HT-SUM ( % ) change ) in the Ilomedin group compared to control ( 0 % versus -14.6 % , P = 0.045 ) . HT-deoxy was higher at the peripheries in the oxygen and temperature groups , suggesting decreased tissue oxygenation . CONCLUSIONS The perioperative treatments did not dramatically improve oxygenation or healing of the surgical wound in IIB surgery ; however , Ilomedin may result in greater flow to the peripheries Before implementing a new therapy , we should ascertain the benefits and risks of the therapy and assure ourselves that the re sources consumed during the intervention will not be exorbitant . In the hierarchy of research design s , the results of r and omized controlled trials , especially if systematic ally review ed , are considered the highest level of evidence . We suggest a three-step approach to using an article from the medical literature to guide your patient care . We recommend that readers ask whether the study can provide valid results , review the results , and consider how the results can be applied to patient care . Given the time constraints of busy surgical practice s and surgical training programs , applying this analysis to every relevant article will be challenging . However , the basis of this process is essentially what we all do many times each week when making decisions about whether and how to treat patients . Making this process explicit with guidelines to assess the strength of the available evidence can serve to improve patient care . It also allow us to defend therapeutic interventions based on available evidence and not anecdote
In the fixed effect model , the warming group had significantly less pain and lower incidence of wound infection , compared with the no-warming group .
In the r and om effect model , the warming group was also associated with lower risk of post-anesthetic shivering .
Both in the r and om and the fixed effect models , the warming group was associated with significantly less blood loss .
Perioperative warming of surgical patients is effective in reducing postoperative wound pain , wound infection and shivering .
Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy .
OBJECTIVE The objective of this review was to systematic ally analyze the trials on the effectiveness of perioperative warming in surgical patients .