Therapy Services
http://hdl.handle.net/20.500.12904/34
2024-03-29T11:41:05ZTHE IMPACT OF USING INTRAOPERATIVE ULTRASOUND ON SURGICAL RESECTION OF HIGH-GRADE GLIOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS
http://hdl.handle.net/20.500.12904/15811
THE IMPACT OF USING INTRAOPERATIVE ULTRASOUND ON SURGICAL RESECTION OF HIGH-GRADE GLIOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Christou, A
BACKGROUND: Despite operative and adjuvant therapies, high-grade glioma (HGG) remains incurable, with the extent of surgical resection being one of the modalities that can improve patient survival. Enabling maximal safe and minimising post-operative neurological morbidity is a key aim of surgical resection. Numerous intraoperative surgical adjuncts are used at surgery and intraoperative ultrasound (IoUS), is one such adjunct. IoUS is a cost-effective, easy to use, repeatable surgical adjunct, safe for the patient and potentially available in all centres. Although it's commonly used, no up to date systematic review exists collating and quantifying the level of evidence, delineating its impact on the extent of surgical resection. MATERIAL AND METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The study was registered with the PROSPERO data- base (CRD42022300034). Keywords across Medline/PubMed and Embase between 1996 and November 2021 were used. We included articles with adult supratentorial, histopathologically confirmed HGG patients aimed for resection, evaluating the correlation of IoUS use and gross-total resection (GTR). Meta-analyses were conducted according to the statistical heterogeneity between the studies using the Open Meta Analyst software. RESULT(S): 2942 articles were identified of which 16 were qualitative assessed and 10 used for quantitative meta-analysis. In qualitative assessment, a mean 4.63/8 Newcastle-Ottawa-Scale score was found for studies with no cohorts (no use of IoUS) and a mean score of 6/9, for studies including exposed versus non-exposed cohorts. The RCT was of moderate quality according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. A pooled analysis across 10 studies of HGG aimed for resection with the use of IoUS, led to GTR achieved in 168/365 cases, resulting in an overall GTR rate of 51.1% (95% CI, 33.9%-68.3%, p<0.001), with great heterogeneity across studies (93.02% p<0.001). In a subgroup meta-analysis of 3 studies of HGG aimed for complete resection only, GTR was achieved in 43/62 cases, yielding a 72.7% GTR rate (95% CI 41.6%-100%, p<0.001) with significant heterogeneity across studies (I2 92.1%, p<0.001). In 4 case-controlled studies, a total of 43.6% (48/110) GTR rate was achieved when IoUS was used versus 24.7% (65/263) when IoUS was not used, resulting in an odds ratio = 2.009 (95% CI 1.157-3.490, p <0.001) for achieving GTR. CONCLUSION(S): The meta-analysis showed a high GTR rate (72.7%) when HGG were aimed for complete resection and a two-fold probability of achieving GTR when IoUS is used than not used.
2022-09-01T00:00:00ZTherapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients
http://hdl.handle.net/20.500.12904/15760
Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients
Lisseman-Stones, Yvonne
Background: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. Objectives: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. Design: A randomised controlled trial with two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. Setting: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. Participants: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. Methods: Patients were randomised to one of two treatment arms, 5-10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3m, 6m, 12m and 24m. Results: 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n=66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n=87) and graduate workers (n=66) (P<0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. Conclusion: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings.
2015-03-01T00:00:00ZPatients' experiences of occupational therapy within a multidisciplinary pain management programme: A qualitative study
http://hdl.handle.net/20.500.12904/15043
Patients' experiences of occupational therapy within a multidisciplinary pain management programme: A qualitative study
Goodall, Jacqueline
Background Occupational problems are common for adults experiencing chronic pain, but occupational therapists are not always accessed as part of the multidisciplinary team. Despite evidence of benefit for work-focused interventions, there is limited evidence for broader benefit from occupational therapy interventions within the context of multidisciplinary pain management. The aim of this study was to explore the experiences of programme attendees who received structured intervention from an occupational therapist as part of a multidisciplinary pain management programme, and gain an understanding as to how they felt it influenced changes they made to occupational participation. Method A qualitative approach was undertaken with 9 individual patients recruited from a group pain management programme for adults with chronic low back pain. Semi-structured interviews were carried out, recorded and transcribed. Thematic analysis was used to identify themes in the data. Results Three key themes were identified: 1) the helpfulness of activity pacing techniques 2) the value of participating in a therapeutic activity-based session and 3) an increased understanding of the importance of leisure and creative activities in the context of their lives. Conclusion Participants perceived the specific occupational therapy content of the programme to be helpful in a number of different ways. The findings suggest that occupational therapy can be important in facilitating patients to apply theoretical techniques in the real world, thereby increasing the likelihood of long term benefit.
Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: A systematic review and meta-analysis
http://hdl.handle.net/20.500.12904/1585
Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: A systematic review and meta-analysis
West, Morgan
Background: Rotator cuff related shoulder pain (RCSP) is common with a range of conservative treatments currently offered. Evidence supporting superiority of one approach over another is lacking. Scapula focused approaches (SFA) are frequently prescribed and warrant investigation. Objective: To evaluate the effectiveness of SFA in RCSP. Design: Systematic review of randomised controlled trials. Methods: An electronic search including MEDLINE, PEDro, ENFISPO to January 2016 was supplemented by hand searching. Randomised controlled trials were included; appraised using the PEDro scale and synthesised via meta-analysis or narratively, where appropriate. Results: Four studies (n = 190) reported on pain and three studies (n = 122) reported on disability. Regarding pain, there was statistical but not clinically significant benefit of SFA versus generalised approaches (mean difference (VAS) 0.714; 95% CI 0.402-1.026) in the short term (< 6 weeks); regarding disability, there was significant benefit of SFA versus generalised approaches (mean difference 14.0; 95% CI 11.2-16.8) in the short term (< 6 weeks). One study (n = 22) reported disability at 3 months, which was not statistically significant. Evidence is conflicting from four studies relating to the effect of SFA on scapula position/movement. Conclusion: SFA for RCSP confers benefit over generalised approaches up to six weeks but this benefit is not apparent by 3 months. Early changes in pain are not clinically significant. With regards to scapula position/movement, the evidence is conflicting. These preliminary conclusions should be treated with significant caution due to limitations of the evidence base. (C) 2016 Elsevier Ltd. All rights reserved.
2016-09-01T00:00:00Z