Abstract Purpose Stress urinary incontinence is a common problem experienced by many women that can have a significant negative impact on the quality of life of those who suffer from the condition ...and potentially those friends and family members whose lives and activities may also be limited. Materials and Methods A comprehensive search of the literature was performed by ECRI Institute. This search included articles published between January 2005 and December 2015 with an updated abstract search conducted through September 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. (Table 1) Results The American Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction have formulated an evidence-based guideline focused on the surgical treatment of female stress urinary incontinence in both index and non-index patients. This document is designed to be used in conjunction with the associated treatment algorithm. (Figure 1) Conclusions The surgical options for the treatment of stress urinary incontinence continue to evolve; as such, this guideline and the associated algorithm aim to outline the currently available treatment techniques as well as the data associated with each treatment. Indeed, the Panel recognizes that this guideline will require continued literature review and updating as further knowledge regarding current and future options continues to grow.
This guideline is structured to provide a clinical framework stratified by cancer severity to facilitate care decisions and guide the specifics of implementing the selected management options. The ...summary presented represents Part I of the two-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline discussing risk stratification and care options by cancer severity.
The systematic review utilized in the creation of this guideline was completed by the Agency for Healthcare Research and Quality and through additional supplementation by ECRI Institute. This review included articles published between January 2007 and March 2014 with an update search conducted through August 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. Additional information is provided as Clinical Principles and Expert Opinions (table 2 in supplementary unabridged guideline, http://jurology.com/).
The AUA (American Urological Association), ASTRO, and SUO (Society of Urologic Oncology) formulated an evidence-based guideline based on a risk stratified clinical framework for the management of localized prostate cancer.
This guideline attempts to improve a clinician’s ability to treat patients diagnosed with localized prostate cancer, but higher quality evidence in future trials will be essential to improve the level of care for these patients. In all cases, patient preferences should be considered when choosing a management strategy.
Background Surgical complications represent a significant cause of morbidity and mortality with the rate of major complications after inpatient surgery estimated at 3–17% in industrialised countries. ...The purpose of this review was to summarise experience with surgical checklist use and efficacy for improving patient safety. Methods A search of four databases (MEDLINE, CINAHL, EMBASE and the Cochrane Database of Controlled Trials) was conducted from 1 January 2000 to 26 October 2012. Articles describing actual use of the WHO checklist, the Surgical Patient Safety System (SURPASS) checklist, a wrong-site surgery checklist or an anaesthesia equipment checklist were eligible for inclusion (this manuscript summarises all but the anaesthesia equipment checklists, which are described in the Agency for Healthcare Research and Quality publication). Results We included a total of 33 studies. We report a variety of outcomes including avoidance of adverse events, facilitators and barriers to implementation. Checklists have been adopted in a wide variety of settings and represent a promising strategy for improving the culture of patient safety and perioperative care in a wide variety of settings. Surgical checklists were associated with increased detection of potential safety hazards, decreased surgical complications and improved communication among operating staff. Strategies for successful checklist implementation included enlisting institutional leaders as local champions, incorporating staff feedback for checklist adaptation and avoiding redundancies with existing systems for collecting information. Conclusions Surgical checklists represent a relatively simple and promising strategy for addressing surgical patient safety worldwide. Further studies are needed to evaluate to what degree checklists improve clinical outcomes and whether improvements may be more pronounced in particular settings.
The summary presented herein represents Part I of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part I outlines the appropriate evaluation of ...the male in an infertile couple. Recommendations proceed from obtaining an appropriate history and physical exam (Appendix I), as well as diagnostic testing, where indicated.
The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January, 2000 through May, 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. (Table 1) This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology.
This Guideline provides updated, evidence-based recommendations regarding evaluation of male infertility as well as the association of male infertility with other important health conditions. The detection of male infertility increases the risk of subsequent development of health problems for men. In addition, specific medical conditions are associated with some causes for male infertility. Evaluation and treatment recommendations are summarized in the associated algorithm. (Figure 1)
The presence of male infertility is crucial to the health of patients and its effects must be considered for the welfare of society. This document will undergo updating as the knowledge regarding current treatments and future treatment options continues to expand.
Diagnóstico y tratamiento de la infertilidad masculina: guía de la AUA/ ASRM parte 1.
El resumen representa la Parte I de una serie de dos partes dedicada al diagnóstico y tratamiento de la infertilidad masculina: Guía de la AUA/ASRM. La primera parte describe la evaluación apropiada del hombre en una pareja infértil. Las recomendaciones pasan por la realización de una historia y un examen físico apropiados (Apéndice I), así como pruebas de diagnóstico, cuando esté resulte indicado.
El equipo del Centro de Práctica Basada en la Evidencia del Instituto de Investigación de Cuidados de Emergencia buscó en PubMed, Embase y Medline desde enero de 2000 hasta mayo de 2019. Cuando existían pruebas suficientes, se asignaba al conjunto de pruebas una calificación de A (alta), B (moderada) o C (baja) para el apoyo de las recomendaciones fuertes, moderadas o condicionales. En ausencia de pruebas suficientes, se proporciona información adicional en forma de Principios Clínicos y Opiniones de Expertos. (Cuadro 1). Este resumen se publica simultáneamente en Fertility and Sterility y The Journal of Urology.
Esta guía proporciona recomendaciones actualizadas y basadas en la evidencia sobre la evaluación de la infertilidad masculina, así como la asociación de la infertilidad masculina con otras condiciones de salud importantes. La detección de la infertilidad masculina aumenta el riesgo de posterior desarrollo de los problemas de salud de los hombres. Además, determinadas afecciones médicas se asocian con algunas causas de la infertilidad masculina. La evaluación y las recomendaciones de tratamiento se resumen en el algoritmo asociado. (Figura 1)
La presencia de la infertilidad masculina es crucial para la salud de los pacientes y sus efectos deben ser considerados para el bienestar de sociedad. Este documento se actualizará a medida que continúe el conocimiento sobre los tratamientos actuales y las opciones de tratamiento futuras para expandirse.
This guideline is structured to provide a clinical framework stratified by cancer severity to facilitate care decisions and guide the specifics of implementing the selected management options. The ...summary presented herein represents Part II of the two-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline discussing risk stratification and care options by cancer severity. Please refer to Part I for discussion of specific care options and outcome expectations and management.
The systematic review utilized in the creation of this guideline was completed by the Agency for Healthcare Research and Quality and through additional supplementation by ECRI Institute. This review included articles published between January 2007 and March 2014 with an update search conducted through August 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. Additional information is provided as Clinical Principles and Expert Opinions (table 2 in supplementary unabridged guideline, http://jurology.com/).
The AUA (American Urological Association), ASTRO, and SUO (Society of Urologic Oncology) formulated an evidence-based guideline based on a risk stratified clinical framework for the management of localized prostate cancer.
This guideline attempts to improve a clinician’s ability to treat patients diagnosed with localized prostate cancer, but higher quality evidence in future trials will be essential to improve the level of care for these patients. In all cases, patient preferences should be considered when choosing a management strategy.
The summary presented herein represents Part II of the two-part series dedicated to the Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Part II outlines the appropriate management ...of the male in an infertile couple. Medical therapies, surgical techniques, as well as use of intrauterine insemination (IUI)/in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are covered to allow for optimal patient management. Please refer to Part I for discussion on evaluation of the infertile male and discussion of relevant health conditions that are associated with male infertility.
The Emergency Care Research Institute Evidence-based Practice Center team searched PubMed®, Embase®, and Medline from January 2000 through May 2019. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. (Table 1) This summary is being simultaneously published in Fertility and Sterility and The Journal of Urology.
This Guideline provides updated, evidence-based recommendations regarding management of male infertility. Such recommendations are summarized in the associated algorithm. (Figure 1)
Male contributions to infertility are prevalent, and specific treatment as well as assisted reproductive techniques are effective at managing male infertility. This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future treatment options continues to expand.
Diagnóstico y tratamiento de la infertilidad masculina: guía de AUA/ASRM parte II.
El resumen que se presenta en este documento representa la Parte II de la serie de dos partes dedicada al diagnóstico y tratamiento de la infertilidad en hombres: guía AUA / ASRM. La Parte II describe el manejo apropiado del hombre en una pareja infértil. Terapias médicas, técnicas quirúrgicas, así como el uso de inseminación intrauterina (IIU) / fertilización in vitro (FIV) / inyección intracitoplasmática espermática (ICSI) están incluidos para permitir un manejo óptimo del paciente. Consulte la Parte I para obtener información sobre la evaluación del varón infértil y la discusión sobre las condiciones de salud relevantes que están asociadas con la infertilidad masculina.
El equipo del Instituto de investigación de urgencias Centro de práctica Basado en la Evidencia buscó en PubMed®, Embase® y Medline desde enero de 2000 hasta mayo de 2019. Cuando existía evidencia suficiente, se asignaba al cuerpo de evidencia una calificación de fuerza de A (alto), B (moderado) o C (bajo) para el apoyo de recomendaciones fuertes, moderadas o condicionales. En ausencia de suficiente evidencia, se proporcionaba información adicional como Principios Clínicos y Opiniones de expertos (Tabla 1). Este resumen está siendo publicado simultáneamente en Fertility and Sterility y The Journal of Urology.
esta guía proporciona recomendaciones actualizadas y basadas en la evidencia sobre el manejo de la infertilidad masculina. Tales recomendaciones se resumen en el algoritmo asociado (Figura 1).
La contribución masculina a la infertilidad son prevalentes, y el tratamiento específico y las técnicas de reproducción asistida son eficaces en el manejo de la infertilidad masculina. Este documento se someterá a revisiones bibliográficas adicionales y se actualizará a medida que se conozcan los tratamientos actuales y las opciones de tratamiento futuras continúen expandiéndose.
Background
Opioid therapy for chronic noncancer pain (CNCP) is controversial due to concerns regarding long‐term effectiveness and safety, particularly the risk of tolerance, dependence, or abuse.
...Objectives
To assess safety, efficacy, and effectiveness of opioids taken long‐term for CNCP.
Search methods
We searched 10 bibliographic databases up to May 2009.
Selection criteria
We searched for studies that: collected efficacy data on participants after at least 6 months of treatment; were full‐text articles; did not include redundant data; were prospective; enrolled at least 10 participants; reported data of participants who had CNCP. Randomized controlled trials (RCTs) and pre‐post case‐series studies were included.
Data collection and analysis
Two review authors independently extracted safety and effectiveness data and settled discrepancies by consensus. We used random‐effects meta‐analysis' to summarize data where appropriate, used the I2 statistic to quantify heterogeneity, and, where appropriate, explored heterogeneity using meta‐regression. Several sensitivity analyses were performed to test the robustness of the results.
Main results
We reviewed 26 studies with 27 treatment groups that enrolled a total of 4893 participants. Twenty five of the studies were case series or uncontrolled long‐term trial continuations, the other was an RCT comparing two opioids. Opioids were administered orally (number of study treatments groups abbreviated as "k" = 12, n = 3040), transdermally (k = 5, n = 1628), or intrathecally (k = 10, n = 231). Many participants discontinued due to adverse effects (oral: 22.9% 95% confidence interval (CI): 15.3% to 32.8%; transdermal: 12.1% 95% CI: 4.9% to 27.0%; intrathecal: 8.9% 95% CI: 4.0% to 26.1%); or insufficient pain relief (oral: 10.3% 95% CI: 7.6% to 13.9%; intrathecal: 7.6% 95% CI: 3.7% to 14.8%; transdermal: 5.8% 95% CI: 4.2% to 7.9%). Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome. All three modes of administration were associated with clinically significant reductions in pain, but the amount of pain relief varied among studies. Findings regarding quality of life and functional status were inconclusive due to an insufficient quantity of evidence for oral administration studies and inconclusive statistical findings for transdermal and intrathecal administration studies.
Authors' conclusions
Many patients discontinue long‐term opioid therapy (especially oral opioids) due to adverse events or insufficient pain relief; however, weak evidence suggests that patients who are able to continue opioids long‐term experience clinically significant pain relief. Whether quality of life or functioning improves is inconclusive. Many minor adverse events (like nausea and headache) occurred, but serious adverse events, including iatrogenic opioid addiction, were rare.
Abstract Objective To establish guidance on grading strength of evidence for the Evidence-based Practice Center (EPC) program of the U.S. Agency for Healthcare Research and Quality. Study Design and ...Setting Authors reviewed authoritative systems for grading strength of evidence, identified domains and methods that should be considered when grading bodies of evidence in systematic reviews, considered public comments on an earlier draft, and discussed the approach with representatives of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. Results The EPC approach is conceptually similar to the GRADE system of evidence rating; it requires assessment of four domains: risk of bias, consistency, directness, and precision. Additional domains to be used when appropriate include dose–response association, presence of confounders that would diminish an observed effect, strength of association, and publication bias. Strength of evidence receives a single grade: high, moderate, low, or insufficient. We give definitions, examples, mechanisms for scoring domains, and an approach for assigning strength of evidence. Conclusion EPCs should grade strength of evidence separately for each major outcome and, for comparative effectiveness reviews, all major comparisons. We will collaborate with the GRADE group to address ongoing challenges in assessing the strength of evidence.
The prevalence of morbid obesity has risen sharply in recent years, even among pediatric patients. Bariatric surgery is used increasingly in an effort to induce weight loss, improve medical ...comorbidities, enhance quality of life, and extend survival. We performed a systematic review and meta-analysis of all published evidence pertaining specifically to bariatric surgery in pediatric patients.
We systematically searched MEDLINE, EMBASE, 13 other databases, and article bibliographies to identify relevant evidence. Included studies must have reported outcome data for > or =3 patients aged < or =21, representing > or =50% of pediatric patients enrolled at that center. We only included English language articles on currently performed procedures when data were separated by procedure, and there was a minimum 1-year follow-up for weight and body mass index (BMI).
Eight studies of laparoscopic adjustable gastric banding (LAGB) reported data on 352 patients (mean BMI 45.8); 6 studies of Roux-en-Y gastric bypass (RYGB) included 131 patients (mean BMI 51.8); 5 studies of other surgical procedures included 158 patients (mean BMI 48.8). Average patient age was 16.8 years (range, 9-21). Meta-analyses of BMI reductions at longest follow-up indicated sustained and clinically significant BMI reductions for both LAGB and RYGB. Comorbidity resolution was sparsely reported, but surgery did appear to resolve some medical conditions including diabetes and hypertension. For LAGB, band slippage and micronutrient deficiency were the most frequently reported complications, with sporadic cases of band erosion, port/tube dysfunction, hiatal hernia, wound infection, and pouch dilation. For RYGB, more severe complications have been documented, such as pulmonary embolism, shock, intestinal obstruction, postoperative bleeding, staple line leak, and severe malnutrition.
Bariatric surgery in pediatric patients results in sustained and clinically significant weight loss, but also has the potential for serious complications.
Improving the speed of systematic review (SR) development is key to supporting evidence-based medicine. Machine learning tools which semi-automate citation screening might improve efficiency. Few ...studies have assessed use of screening prioritization functionality or compared two tools head to head. In this project, we compared performance of two machine-learning tools for potential use in citation screening.
Using 9 evidence reports previously completed by the ECRI Institute Evidence-based Practice Center team, we compared performance of Abstrackr and EPPI-Reviewer, two off-the-shelf citations screening tools, for identifying relevant citations. Screening prioritization functionality was tested for 3 large reports and 6 small reports on a range of clinical topics. Large report topics were imaging for pancreatic cancer, indoor allergen reduction, and inguinal hernia repair. We trained Abstrackr and EPPI-Reviewer and screened all citations in 10% increments. In Task 1, we inputted whether an abstract was ordered for full-text screening; in Task 2, we inputted whether an abstract was included in the final report. For both tasks, screening continued until all studies ordered and included for the actual reports were identified. We assessed potential reductions in hypothetical screening burden (proportion of citations screened to identify all included studies) offered by each tool for all 9 reports.
For the 3 large reports, both EPPI-Reviewer and Abstrackr performed well with potential reductions in screening burden of 4 to 49% (Abstrackr) and 9 to 60% (EPPI-Reviewer). Both tools had markedly poorer performance for 1 large report (inguinal hernia), possibly due to its heterogeneous key questions. Based on McNemar's test for paired proportions in the 3 large reports, EPPI-Reviewer outperformed Abstrackr for identifying articles ordered for full-text review, but Abstrackr performed better in 2 of 3 reports for identifying articles included in the final report. For small reports, both tools provided benefits but EPPI-Reviewer generally outperformed Abstrackr in both tasks, although these results were often not statistically significant.
Abstrackr and EPPI-Reviewer performed well, but prioritization accuracy varied greatly across reports. Our work suggests screening prioritization functionality is a promising modality offering efficiency gains without giving up human involvement in the screening process.
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