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A weakening, shrinking, and loss of muscle caused by disease or lack of use.

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Drug treatment for spinal muscular atrophy type I

Spinal muscular atrophy (SMA) is a severe neuromuscular disease with onset in childhood and adolescence that results in progressive muscle weakness. There are three main types of SMA. Drug treatment for SMA types II and III is discussed in a separate Cochrane review. The age of onset of SMA type I, also known as Werdnig‐Hoffmann disease, is before six months. Children with SMA type I will never be able to sit without support and usually die by the age of two years. It is one of the most important causes of death due to a genetic disease in childhood. There was only one small randomised trial in the original review, which assessed the efficacy of riluzole for 10 children with SMA type I. In this trial all three children in the placebo group died, but three of the seven children treated with riluzole were still alive at the ages of 30, 48 and 64 months. However, none of the children in the riluzole or placebo group developed the ability to roll, sit or stand. For several reasons the overall quality of the study was low, mainly because the study was too small to detect an effect and there were baseline differences that resulted in risk of bias. Evidence is insufficient to recommend riluzole for SMA type I. No further trials were identified for this 2011 update. No drug treatment has been shown to have significant efficacy for SMA type I.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drug treatment for spinal muscular atrophy types II and III

Spinal muscular atrophy (SMA) is a neuromuscular disorder that results in progressive muscle weakness with onset in childhood and adolescence. There are three main types of SMA. Drug treatment for SMA type I is discussed in a separate Cochrane review. This review is of drug treatment for SMA types II and III. Both of these reviews were first published in 2009 and are now updated. The age of onset of SMA type II is between six and 18 months. Children with SMA type II will never be able to walk without support; they survive beyond two years and may live into adolescence or longer. The age of onset of SMA III, also known as Kugelberg‐Welander disease, is after 18 months. Children with SMA type III develop the ability to walk at some time and their life expectancy is normal. From six randomised controlled trials, there is no evidence for a significant effect on the disease course when patients with SMA types II and III are treated with creatine (55 participants), phenylbutyrate (107 participants), gabapentin (84 participants), thyrotropin releasing hormone (9 participants), hydroxyurea (57 participants) or combination therapy with valproate and acetyl‐L‐carnitine (61 participants). The risk of bias of the included trials was systematically analysed and none of the studies were completely free of bias. Thus, there is still no known efficacious drug treatment for SMA types II and III.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet]

To systematically review and synthesize evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, along with potential long-term benefits and harms of those treatments.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2015
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Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review

BACKGROUND: Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Strength training or comprehensive aerobic exercise training for muscle disease

Strength training, which is performed to improve muscle strength and muscle endurance, or aerobic exercise programmes, which are designed to improve cardiorespiratory endurance, might optimise physical fitness and prevent additional muscle wasting in people with muscle disease. However, people with muscle disease and some clinicians are still afraid of overuse and have a cautious approach to training. This updated review (most recent date of search 2 July 2012) included two eligible trials of strength training in people with facioscapulohumeral muscular dystrophy (FSHD) and myotonic dystrophy (101 participants), two trials of strength training combined with aerobic exercise in people with mitochondrial myopathy (18 participants) and myotonic dystrophy type I (35 participants) and one trial of aerobic exercise in people with polymyositis and dermatomyositis (14 participants). These trials showed that moderate‐intensity strength training in people with myotonic dystrophy or with FSHD, and aerobic exercise training in people with dermatomyositis or polymyositis appear not to harm muscles. Strength training combined with aerobic exercise appears to be safe in myotonic dystrophy type I and may be effective in increasing endurance in people with mitochondrial myopathy. Evidence suggests that strength training is not harmful in people in FSHD, myotonic dystrophy, mitochondrial disorders and dermatomyositis and polymyositis, but further research is needed to determine potential benefit.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Neuromuscular electrical stimulation in critically ill patients in the intensive care unit: a systematic review

OBJECTIVE: To analyze the outcomes enabled by the neuromuscular electric stimulation in critically ill patients in intensive care unit assisted.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

The effect of supported standing in adults with upper motor neurone disorders: a systematic review

OBJECTIVES: To evaluate whether supported standing can affect lower limb muscle length, spasticity, bone mineral density or the function of adults with upper motor neurone disorders.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Interventions to Prevent Falls in Older Adults: An Updated Systematic Review [Internet]

Falls represent an important source of preventable morbidity and mortality in older adults, the fastest growing segment of the U.S. population. We undertook a systematic review of falls interventions applicable to primary care populations to inform the U.S. Preventive Services Task Force’s (USPSTF’s) updated recommendation on preventing falls in older adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2010
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Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears [Internet]

The objective of this review is to provide a comprehensive synthesis of the evidence examining the effectiveness of nonoperative and operative interventions for the treatment of rotator cuff tears. The report is intended for a broad audience, including professional societies developing clinical practice guidelines, patients and their care providers, as well as researchers conducting studies on treatments of this condition. Outcomes of interest include health-related quality of life, shoulder function, time to return to work, cuff integrity, pain, range of motion and strength of the shoulder.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: July 2010
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Outcomes in adult scoliosis patients who undergo spinal fusion stopping at L5 compared with extension to the sacrum

Study Design Systematic review. Study Rationale Adult scoliosis is a common disorder that is associated with significantly higher pain, functional impairment, and effect on quality of life than those without scoliosis. Surgical spinal fusion has led to quantifiable improvement in patient's quality of life. However, for patients undergoing long lumbar fusion, the decision to stop the fusion at L5 or to extend to S1, particularly if the L5-S1 disc is healthy, remains controversial. Objective The aim of the study is to evaluate if fusion stopping at L5 increases the comparative rates of revision, correction loss, and/or poor functional outcomes compared with extension to the sacrum in adult scoliosis patients who require spinal fusion surgery. Materials and Methods A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database and bibliographies of key articles that evaluated adult scoliosis patients who required spinal fusion surgery and compared outcomes for fusions to the sacrum versus stopping at L5. Articles were included on the basis of predetermined criteria and were appraised using a predefined quality-rating scheme. Results From 111 citations, 26 articles underwent full-text review, and 3 retrospective cohort studies met all inclusion and exclusion criteria. Revision rates in subjects who underwent spinal fusion to L5 (20.8-23.5%) were lower in two studies compared with those with fusion extending to the sacrum (19.0-58.3%). Studies that assessed deformity correction used different measures, making comparison across studies difficult. No significant differences were found in patient-reported functional outcomes across two studies that used different measures. Conclusion The limited data available suggest that differences in revision rates did not consistently reach statistical significance across studies that compared spinal fusion to L5 versus extension to sacrum in adult scoliosis patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Motor Neurone Disease: Assessment and Management

Motor neurone disease (MND) is a neurodegenerative condition that affects the brain and spinal cord. MND is characterised by the degeneration of primarily motor neurones, leading to muscle weakness.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016
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Botulinum toxin type A for masseter hypertrophy

Masseter muscle hypertrophy occurs as a soft enlargement of the jaw muscles near the angle of the lower jaw and seldom presents a major health problem. However, in some individuals the swelling can be associated with pain or may be so large that it causes facial disfigurement. Although the cause of the condition is unclear it does appear to be more common in certain ethnic groups.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

The influence of strength training on muscle activation in elderly persons: a systematic review and meta-analysis

Age-related muscle weakness is only partially related to muscle atrophy, due to neuromuscular changes including reduced voluntary muscle activation and antagonist muscle co-activation. The respective contribution of these mechanisms in exercise-induced strength gains at higher age is unclear. Here the literature was systematically reviewed for studies reporting exercise-induced effects on voluntary muscle activation and antagonist muscle co-activation in elderly persons. Seventeen relevant studies were identified, 4 investigated voluntary muscle activation, 8 antagonist muscle co-activation and 5 studies investigated both. Meta-analysis showed an exercise-induced improvement in voluntary activation in plantar flexors (weighted mean difference (WMD) +8.8%, p<0.001), and knee extensors (WMD +1.8%, p<0.001), with greater gains in activation capacity obtained in subjects with lower voluntary activation level prior to the onset of training. We found no significant overall effect of strength training on antagonist co-activation during ankle plantar flexion (WMD +0.6%, p=0.686) or knee extension (WMD -1.1%, p=0.699 for the RCT's and -1.8%, p=0.516 for the non-controlled trials). Based on our results we can conclude that there is evidence for exercise-induced increase in voluntary activation related to strength gains in the lower extremities in elderly persons. The results for exercise-induced effects on antagonist co-activation are inconsistent and more research is necessary to determine its contribution to strength gains following resistance training in elderly persons.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review

BACKGROUND: The aging process results in a number of functional (e.g., deficits in balance and strength/power performance), neural (e.g., loss of sensory/motor neurons), muscular (e.g., atrophy of type-II muscle fibers in particular), and bone-related (e.g., osteoporosis) deteriorations. Traditionally, balance and/or lower extremity resistance training were used to mitigate these age-related deficits. However, the effects of resistance training are limited and poorly translate into improvements in balance, functional tasks, activities of daily living, and fall rates. Thus, it is necessary to develop and design new intervention programs that are specifically tailored to counteract age-related weaknesses. Recent studies indicate that measures of trunk muscle strength (TMS) are associated with variables of static/dynamic balance, functional performance, and falls (i.e., occurrence, fear, rate, and/or risk of falls). Further, there is preliminary evidence in the literature that core strength training (CST) and Pilates exercise training (PET) have a positive influence on measures of strength, balance, functional performance, and falls in older adults.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Impact of supplementation with amino acids or their metabolites on muscle wasting in patients with critical illness or other muscle wasting illness: a systematic review

Muscle wasting during critical illness impairs recovery. Dietary strategies to minimise wasting include nutritional supplements, particularly essential amino acids. We reviewed the evidence on enteral supplementation with amino acids or their metabolites in the critically ill and in muscle wasting illness with similarities to critical illness, aiming to assess whether this intervention could limit muscle wasting in vulnerable patient groups. Citation databases, including MEDLINE, Web of Knowledge, EMBASE, the meta-register of controlled trials and the Cochrane Collaboration library, were searched for articles from 1950 to 2013. Search terms included 'critical illness', 'muscle wasting', 'amino acid supplementation', 'chronic obstructive pulmonary disease', 'chronic heart failure', 'sarcopenia' and 'disuse atrophy'. Reviews, observational studies, sport nutrition, intravenous supplementation and studies in children were excluded. One hundred and eighty studies were assessed for eligibility and 158 were excluded. Twenty-two studies were graded according to standardised criteria using the GRADE methodology: four in critical care populations, and 18 from other clinically relevant areas. Methodologies, interventions and outcome measures used were highly heterogeneous and meta-analysis was not appropriate. Methodology and quality of studies were too varied to draw any firm conclusion. Dietary manipulation with leucine enriched essential amino acids (EAA), β-hydroxy-β-methylbutyrate and creatine warrant further investigation in critical care; EAA has demonstrated improvements in body composition and nutritional status in other groups with muscle wasting illness. High-quality research is required in critical care before treatment recommendations can be made.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Menopause: Full Guideline

In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 12, 2015
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Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2007
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Diabetes (Type 1 and Type 2) in Children and Young People: Diagnosis and Management

Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed here and in this guideline. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2015
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Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet]

Alcohol is the most widely used psychotropic drug in the industrialised world; it has been used for thousands of years as a social lubricant and anxiolytic. In the UK, it is estimated that 24% of adult men and 13% of adult women drink in a hazardous or harmful way. Levels of hazardous and harmful drinking are lowest in the central and eastern regions of England (21–24% of men and 10–14% of women). They are highest in the north (26–28% of men, 16–18% of women). Hazardous and harmful drinking are commonly encountered amongst hospital attendees; 12% of emergency department attendances are directly related to alcohol whilst 20% of patients admitted to hospital for illnesses unrelated to alcohol are drinking at potentially hazardous levels. Continued hazardous and harmful drinking can result in dependence and tolerance with the consequence that an abrupt reduction in intake might result in development of a withdrawal syndrome. In addition, persistent drinking at hazardous and harmful levels can also result in damage to almost every organ or system of the body. Alcohol-attributable conditions include liver damage, pancreatitis and the Wernicke’s encephalopathy. Key areas in the investigation and management of these conditions are covered in this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: 2010
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Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care

Without early diagnosis and treatment, an acute episode of constipation can lead to anal fissure and become chronic. By the time the child or young person is seen they may be in a vicious cycle. Children and young people and their families are often given conflicting advice and practice is inconsistent, making treatment potentially less effective and frustrating for all concerned. Early identification of constipation and effective treatment can improve outcomes for children and young people. This guideline provides strategies based on the best available evidence to support early identification, positive diagnosis and timely, effective management. Implementation of this guideline will provide a consistent, coordinated approach and will improve outcomes for children and young people.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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