Umbilical cord blood acid-base analysis at birth and long-term neurodevelopmental outcomes in children: a systematic review and meta-analysis.

BACKGROUND: Umbilical cord blood acid-base sampling is routinely performed at many hospitals. Recent studies have questioned this practice and the association of acidosis with cerebral palsy. OBJECTIVE: To investigate the associations between the results of umbilical cord blood acid-base analysis at birth and long-term neurodevelopmental outcomes and mortality in children. SEARCH STRATEGY: We searched six databases using the search strategy: umbilical cord AND outcomes. SELECTION CRITERIA: Randomised controlled trials, cohorts and case-control studies from high-income countries that investigated the association between umbilical cord blood analysis and neurodevelopmental outcomes and mortality from 1 year after birth in children born at term. DATA COLLECTION AND ANALYSIS: We critically assessed the included studies, extracted data and conducted meta-analyses comparing adverse outcomes between children with and without acidosis, and the mean proportions of adverse outcomes. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. MAIN RESULTS: We have very low confidence in the following findings: acidosis was associated with higher cognitive development scores compared with non-acidosis (mean difference 5.18, 95% CI 0.84-9.52; n = two studies). Children with acidosis also showed a tendency towards higher risk of death (relative risk [RR] 5.72, 95% CI 0.90-36.27; n = four studies) and CP (RR 3.40, 95% CI 0.86-13.39; n = four studies), although this was not statistically significant. The proportion of children with CP was 2.39/1000 across the studies, assessed as high certainty evidence. CONCLUSION: Due to low certainty of evidence, the associations between umbilical cord blood gas analysis at delivery and long-term neurodevelopmental outcomes in children remains unclear.

Digital learning designs in physiotherapy education: a systematic review and meta-analysis.

BACKGROUND: Digital learning designs have the potential to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education. METHODS: The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses. RESULTS: Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62), for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43) and for students self-produced videos on a practical skill in a cervical spine scenario (SMD: 0.49; 95% CI: 0.06, 0.93). Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching. CONCLUSIONS: The current findings from physiotherapy education indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching. The meta-analyses revealed significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students' learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments.

The effects of multidisciplinary psychosocial interventions on adult cancer patients: a systematic review and meta-analysis.

Purpose: To summarize evidence on the effects of multidisciplinary psychosocial rehabilitation interventions for adult cancer patients on fatigue, quality of life, participation, coping, and self-efficacy.Materials and methods: We searched MEDLINE, Embase, PyscINFO, PEDro, OT Seeker, Sociological Abstracts, CINAHL, and Cochrane CENTRAL for randomized controlled trials. Two reviewers selected articles independently.Results: Thirty-one articles were included and four meta-analyses were conducted. The results of one meta-analysis was statistically significant when comparing multidisciplinary psychosocial interventions to standard care on fatigue among breast cancer patients (standardized mean differences [SMD] 0.30 (95% confidence interval [CI] 0.04, 0.56)) at 2-6 months follow-up. However, no significant results were revealed on health-related quality of life among breast cancer (SMD 0.38 (95% CI -0.40, 1.16)), prostate cancer (SMD 0.06 (95% CI -0.18, 0.29)), and patients with different cancer diagnoses (SMD 0.06 (95% CI -0.14, 0.25)) at follow-up. One study reported on effects of interventions on participation, and four studied the outcomes of coping and self-efficacy.Conclusions: Multidisciplinary psychosocial interventions may decrease fatigue among breast cancer patients. There is an urgent need for rigorous designed trials in cancer rehabilitation, preferably on fatigue, participation, and coping or self-efficacy. The interventions need to be thoroughly described.Implications for rehabilitationMultidisciplinary psychosocial interventions may reduce fatigue among breast cancer patients.The effects of multidisciplinary psychosocial interventions among cancer patients on health-related quality of life, participation, and coping are unclear.Urgent need for a systemic approach to the development and conduction of multidisciplinary psychosocial interventions, ideally based on guidelines for complex interventions.Need of larger and more rigorously conducted randomized controlled trials investigating the effects of these rehabilitation interventions on fatigue, participation and coping.

Effects of preventive use of compression stockings for elderly with chronic venous insufficiency and swollen legs: a systematic review and meta-analysis.

BACKGROUND: Many home-dwelling elderly use medical compression stockings to prevent venous insufficiency, deep venous thrombosis, painful legs and leg ulcers. Assisting users with applying and removing compression stockings demands resources from the home based health services, but the effects are uncertain. This systematic review aims to summarize the effects of preventive use of medical compression stockings for patients with chronic venous insufficiency and swollen legs. METHODS: We conducted a search in six databases (Epistemonikos, Cochrane Database of Systematic Reviews, MEDLINE, Embase, CENTRAL and CINAHL) in March 2018. Randomized controlled trials evaluating the preventive effects of European standard compression stockings class 3 or 2 for elderly with chronic venous insufficiency and swollen legs were included. Primary outcomes were thrombosis, leg ulcers and mobility. Secondary outcomes were other health related outcomes, e.g. pain, compliance. We assessed risk of bias in the included studies and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool for evaluating the overall quality of evidence. RESULTS: Five randomized controlled trials met the inclusion criteria. Comparing compression stockings class 2 to class 1, meta-analysis showed a reduction in leg ulcer recurrence at 12 months (RR 0.52; 95% CI 0.30 to 0.88). The quality of evidence was assessed as moderate by GRADE. One study (100 participants) did not detect a difference between compression stockings class 3 versus class 2 on ulcer recurrence after six months (RR 0.64; 95% CI 0.20 to 2.03). In another study, patients wearing class 3 compression stockings had lower recurrence risk compared with patients without stockings (RR 0.46; 95% CI 0.27 to 0.76) at six months and (RR 0.43; 95% CI 0.27 to 0.69) at 12 months. We found no difference between class 2 and class 1 stockings on subjective symptoms of chronic venous insufficiency or outcomes of vein thrombosis or mobility. CONCLUSION: Compression stockings class 2 probably reduce the risk of leg ulcer recurrence compared to compression stockings class 1. It is uncertain whether the use of stockings with higher compression grades is associated with a further risk reduction. More randomized controlled trials on vein thrombosis and mobility are needed.

Survival and Impairment of Extremely Premature Infants: A Meta-analysis.

CONTEXT: Survival of infants born at the limit of viability varies between high-income countries. OBJECTIVE: To summarize the prognosis of survival and risk of impairment for infants born at 22 + 0/7 weeks' to 27 + 6/7 weeks' gestational age (GA) in high-income countries. DATA SOURCES: We searched 9 databases for cohort studies published between 2000 and 2017 in which researchers reported on survival or neurodevelopmental outcomes. STUDY SELECTION: GA was based on ultrasound results, the last menstrual period, or a combination of both, and neurodevelopmental outcomes were measured by using the Bayley Scales of Infant Development II or III at 18 to 36 months of age. DATA EXTRACTION: Two reviewers independently extracted data and assessed the risk of bias and quality of evidence. RESULTS: Sixty-five studies were included. Mean survival rates increased from near 0% of all births, 7.3% of live births, and 24.1% of infants admitted to intensive care at 22 weeks' GA to 82.1%, 90.1%, and 90.2% at 27 weeks' GA, respectively. For the survivors, the rates of severe impairment decreased from 36.3% to 19.1% for 22 to 24 weeks' GA and from 14.0% to 4.2% for 25 to 27 weeks' GA. The mean chance of survival without impairment for infants born alive increased from 1.2% to 9.3% for 22 to 24 weeks' GA and from 40.6% to 64.2% for 25 to 27 weeks' GA. LIMITATIONS: The confidence in these estimates ranged from high to very low. CONCLUSIONS: Survival without impairment was substantially lower for children born at <25 weeks' GA than for those born later.

The long-term effects of conductive education courses in young children with cerebral palsy: a randomized controlled trial.

PURPOSE: To assess the additional long-term effects of multiple conductive education (CE) courses followed by conventional practice on functional skills and quality of life in children with cerebral palsy (CP) compared to a 4-month CE-course delay including conventional practice. METHODS: Twenty-one children with CP, 3-6 years and varied functional levels, were randomized to 3-week CE course(s) followed by conventional practice or 4 months on a waiting list, including conventional practice and followed by CE-courses. Outcomes were measured 8 and 12 months after baseline. A web-based log collected data on conventional practice. RESULTS: We found no interaction between group assignment and time on functional skills and quality of life in children with CP at 8 and 12 months. Two thirds of the children in both groups performed a large amount of conventional practice. CONCLUSIONS: No added long-term effects of CE courses were found. Larger controlled CE studies are needed.

Effects of a conductive education course in young children with cerebral palsy:A randomized controlled trial.

PURPOSE: To evaluate the effects of a conductive education (CE) course followed by conventional practice, on gross motor function, other functional skills, quality of life, and parents' experiences of family-centered services in young children with cerebral palsy (CP). METHODS: Twenty-one children with CP, 3-6 years old, were randomized to one 3-week CE course followed by conventional practice or conventional practice on a waiting list. Outcomes were measured 4 months after baseline. A web-based log collected data on the conventional practice. RESULTS: No additional improvements in the children's outcome were found. However, parents in the CE group reported that they received more information than parents in the waiting list group (p = 0.01). Children in both groups performed high amount of conventional practice at home. CONCLUSIONS: A 3-week CE course did not add any improvements in the children's functioning, possibly explained by the large amount of conventional practice reported of both groups.

Family-centred practices in the provision of interventions and services in primary health care: A survey of parents of preschool children with cerebral palsy.

The aims of this study were to explore how parents of preschoolers with cerebral palsy (CP) experienced the level of family-centred services using the Measure of Processes of Care (MPOC-20) within primary health care in Norway and to examine the relationships between these experiences and the provided everyday skills interventions and services. A survey was sent to 360 parents of preschool children with CP. The response rate was 34%. Of the MPOC scales respectful and supportive care and coordinated and comprehensive care received the highest ratings, and providing general information received the lowest. Our findings indicate lower levels of family centredness in primary health-care contexts than that reported in specialist health care. Significant positive associations were found between all the five MPOC-20 scales and the parents' satisfaction with the amount of service coordination (p = .000-.004). The high scores for respectful and supportive care and the low scores for general information indicate that the families experienced relational help giving practices to a larger extent and participatory practices to a lesser extent. To increase the participatory aspects of family-centred practice, further research needs to address facilitators and barriers of information sharing and ways of giving this information both in specialist and primary health care.

Motor training and physical activity among preschoolers with cerebral palsy: a survey of parents' experiences.

OBJECTIVE: To describe motor training and physical activity among preschoolers with cerebral palsy (CP) in Norway, and assess associations between child, parent, and motor intervention characteristics, and parent-reported child benefits from interventions. METHOD: Survey of 360 parents and data from the Norwegian CP follow-up program. The response rate was 34%. RESULTS: During the six months preceding the time of the survey, 75% of the children performed gross-motor training, 73% fine-motor training, 80% manual stretching, and 67% participated regularly in physical activities. The training was highly goal-directed, intensive, frequently incorporated in daily routines, and often with a high level of parental involvement. The use of goals was associated with higher parent-reported child benefits for all types of interventions. Moreover, the positive relationship, which was indicated between frequency of training, parent education, and parent-reported child benefits of gross-motor training, was not seen for fine-motor training. CONCLUSION: Parent-reported child benefits support goal-directed motor interventions, and the use of everyday activities to increase practice of motor skills.