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Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review [Internet]

Traumatic brain injury (TBI) is a common condition, especially among military members. Twelve to 23 percent of service members returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) experienced a TBI while deployed. Although various criteria are used to define TBI severity, the majority of documented TBI events among OEF/OIF/OND service members may be classified as mild in severity, or mTBI, according to the definition used by the Veterans Health Administration and Department of Defense (VA/DoD).

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: January 2013

Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring (E-Entropy, Bispectral Index and Narcotrend): a systematic review and economic evaluation

The report found that there is some evidence that Bispectral Index, E-Entropy and Narcotrend technologies can be effective for monitoring the depth of general anaesthesia in surgical patients.

Health Technology Assessment - NIHR Journals Library.

Version: August 2013
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Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care

This guideline has been developed to advise on the treatment and management of post-traumatic stress disorder (PTSD). The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, PTSD sufferers and guideline methodologists after careful consideration of the best available evidence. (The term ‘PTSD sufferer’ was chosen for use in the guideline on the basis of a survey conducted by sufferer members of the Guideline Development Group. People with the disorder were presented with a range of options such as ‘people with PTSD’, ‘patients with PTSD’ and ‘PTSD sufferer’ and asked to indicate which term they preferred; ‘PTSD sufferer’ was the term favoured by the majority.) It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for those with PTSD while also emphasising the importance of the experience of care for patients and their families.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2005

Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: November 2008
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Direct Lateral Interbody Fusion in Patients Requiring Surgery for Spinal Instability: A Review of the Comparative Clinical and Cost-Effectiveness, and Guidelines [Internet]

The purpose of this report is to retrieve and review the existing evidence of clinical effectiveness, and safety of direct lateral interbody fusion (DLIF) in patients requiring surgery for spinal instability. In addition this report aims to examine the available evidence for comparative clinical effectiveness, and cost-effectiveness of DLIF as compared to other surgical lumbar fusion techniques in single and multiple transpsoas fusions for the treatment of spinal instability. Finally this report aims to retrieve and review available guidelines on performing DLIF in patients requiring surgery for spinal instability.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: June 25, 2015

The Management of Hip Fracture in Adults [Internet]

Although hip fracture is predominantly a phenomenon of later life, it may occur at any age in people with osteoporosis or osteopenia, and this guidance is applicable to adults across the age spectrum. Skills in its management have, however been accrued, researched and reported especially by collaborative teams specialising in the care of older people (using the general designation ‘orthogeriatrics’). These skills are applicable in hip fracture irrespective of age, and the guidance includes recommendations that cover the needs of younger patients by drawing on such skills in an organised manner.

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

Version: 2011

Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010
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Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Children, Young People and Adults

For the purposes of this guideline, head injury is defined as any trauma to the head other than superficial injuries to the face. Head injury is the commonest cause of death and disability in people aged 1–40 years in the UK. Data for head injury are recorded in the Hospital Episode Statistics (http://www.hscic.gov.uk/hes). Each year, 1.4 million people attend emergency departments in England and Wales with a recent head injury. Between 33% and 50% of these are children aged under 15 years. Annually, about 200,000 people are admitted to hospital with head injury. Of these, one-fifth have features suggesting skull fracture or have evidence of brain damage. Most patients recover without specific or specialist intervention, but others experience long-term disability or even die from the effects of complications that could potentially be minimised or avoided with early detection and appropriate treatment.

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

Version: January 2014
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Neck pain following cervical laminoplasty: does preservation of the C2 muscle attachments and/or C7 matter?

Study Design Systematic review. Objective In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results We identified 11 articles meeting our inclusion criteria. Only the randomized controlled trial (RCT) showed no significant difference in late axial pain (at 12 months) when C7 spinous muscle preservation was compared with no preservation. However, seven other retrospective cohort studies showed significant pain relief in the preserved group compared with the nonpreserved group. The preservation group included those with preservation of the C7 spinous process and/or attached muscles, the deep extensor muscles, or C2 muscle attachment and/or C3 laminectomy (as opposed to laminoplasty). One study that included preservation of either the C2 or C7 posterior paraspinal muscles found that only preservation of the muscles attached to C2 resulted in reduced postoperative pain. Another study that included preservation of either the C7 spinous process or the deep extensor muscles found that only preservation of C7 resulted in reduced postoperative pain. Conclusion Although there is conflicting data regarding the importance of preserving C7 and/or the semispinalis cervicis muscle attachments to C2, there is enough evidence to suggest that surgeons should make every attempt to preserve these structures whenever possible since there appears to be little downside to doing so, unless it compromises the neurologic decompression.

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

Version: 2013

Biological substitutes/extenders for spinal arthrodesis: which agents are cost-effective?

STUDY DESIGN: Systematic review.

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

Version: 2014

Management of faecal incontinence and constipation in adults with central nervous system diseases

Individuals with central nervous system disease or injury have a much higher risk of loss of bowel control and severe constipation than other people. This is called neurogenic bowel dysfunction (NBD). It can be very difficult to treat constipation without causing bowel leakage, or to prevent bowel leakage without causing constipation. The time spent on emptying the bowel is nearly always much greater for these individuals. Bowel problems like this cause a lot of anxiety and distress and can reduce the quality of life of those who suffer them. This review of research about NBD could be of interest to individuals with any damage to the central nervous system caused by disease or injury, or present at birth, which has a long term effect on how their bowel works.

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

Version: 2014

Multidisciplinary Pain Programs for Chronic Noncancer Pain [Internet]

Chronic noncancer pain affects millions of Americans, seriously impacting their quality of life and costing billions of dollars every year in health care expenditures and lost productivity. There are currently no definitive cures for the most prevalent chronic pain syndromes. Multidisciplinary Pain Programs (MPPs) follow a model of care that emphasizes, when pain cannot be successfully eliminated, managing the pain to the extent that the patient's independence is restored and overall quality of life improved.

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

Version: September 2011
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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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Drug Class Review: Neuropathic Pain: Final Update 1 Report [Internet]

We compared the effectiveness and harms of anticonvulsants, tricyclic antidepressants, serotonin–norepinephrine reuptake inhibitors (SNRIs), and the lidocaine patchin adults with neuropathic pain.

Drug Class Reviews - Oregon Health & Science University.

Version: June 2011
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Delirium: Screening, Prevention, and Diagnosis – A Systematic Review of the Evidence [Internet]

Delirium is a common syndrome in hospitalized or institutionalized adults. It is characterized by the acute onset of altered mental status, hallmarked by difficulty sustaining attention and a fluctuating course. Delirium frequently causes patients, families, and health care providers considerable distress. The incidence varies widely based on patient population, setting, and intensity of diagnostic ascertainment with reported values of 10% to over 80%. Delirium is associated with multiple serious outcomes including increased morbidity, length of hospital stay, healthcare costs, institutionalization, and mortality. In surgical settings, older adults and those with multiple medical conditions are at increased risk for postoperative delirium. Delirium may be under-recognized by healthcare providers and it can be difficult to resolve. Several brief “bedside” questionnaires and checklists exist that can help detect delirium earlier and among those with milder symptoms. Additionally, efforts to prevent the development of delirium in those at risk have been advocated. Medications (including sedatives, narcotics, and anticholinergic drugs), diseases and intercurrent illnesses (e.g., stroke, infection, shock, anemia), surgical procedures (especially orthopedic and cardiac surgery), and environmental factors (e.g., use of a bladder catheter, pain, and emotional stress) are all associated with delirium. Therefore, identifying and implementing effective strategies to prevent and detect delirium could improve clinical outcomes and resource utilization. Suggested strategies to prevent delirium include avoidance of psychoactive medications, pharmacologic interventions to decrease risk, and single- or multi-component non-pharmacologic interventions (including use of music, mobilization, fluid and nutrition management, and orientation and cognitive stimulation).

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: September 2011
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Vertebral artery anomaly and injury in spinal surgery

STUDY DESIGN: Systematic review.

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

Version: 2014

Acupuncture for spinal cord injury survivors in Chinese literature: a systematic review

The authors concluded that there was suggestive evidence for the effectiveness of acupuncture as adjuvant therapy in spinal cord injury, but that the total number and quality of included trials was too low to draw firm conclusions. The review had some methodological problems, but the authors’ conclusions are suitably cautious and appear appropriate.

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

Version: 2009

Carbohydrate and lipid disorders and relevant considerations in persons with spinal cord injury

This review evaluated exercise, pharmacologic and dietary interventions in adults with chronic spinal cord injury. The authors concluded that evidence for carbohydrate, lipid and cardiovascular outcomes was inconclusive. Given the poor quality and variability of the included studies, the authors conclusion is justified. Methodological concerns within the review process suggests the extent to which this conclusion is reliable is unclear.

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

Version: 2008

Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease

The guideline covers adults and children (from birth) with lower urinary tract dysfunction resulting from neurological disease or injury.

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

Version: August 2012

Pain Management Interventions for Hip Fracture [Internet]

To review and synthesize the evidence on pain management interventions in nonpathological hip fracture patients following low-energy trauma. Outcomes include pain management (short and long term), mortality, functional status, pain medication use, mental status, health-related quality of life, quality of sleep, ability to participate in rehabilitation, return to pre-fracture living arrangements, health services utilization, and adverse effects.

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

Version: May 2011
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