Quality of life among adults following bariatric and body contouring surgery: a systematic review.

BACKGROUND: Weight loss following bariatric surgery is associated with significant improvements in obesity-related comorbidities, body satisfaction and psychosocial outcomes, at least in the short term. However, in the context of extreme weight loss, body image and appearance may worsen again because the "excess" or "loose" skin can lead to both functional and profound dissatisfaction with appearance. These concerns have led to an increasing uptake of post-bariatric surgery, "body-contouring" procedures but the implications for quality of life (QoL) have not been thoroughly considered. OBJECTIVE/PURPOSE: The objective was to identify the best available evidence regarding the QoL outcomes for adults following bariatric and body contouring surgery. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The review considered studies involving people aged 18 years and beyond who underwent bariatric surgery and body contouring surgery. TYPES OF INTERVENTIONS: The review considered studies that evaluated bariatric surgery as well as body contouring surgery. TYPES OF STUDIES: The review considered both experimental and epidemiological study designs. OUTCOMES: The primary outcomes were QoL as measured by validated tools at less than two years, two to five years and more than five years following body contouring surgery. The secondary outcomes were adverse events, unsatisfactory aesthetic appearance and weight gain. SEARCH STRATEGY: Six databases were searched, including Cochrane Central, MEDLINE, Embase, Web of Science, PsycINFO and CINAHL. Studies published from 1954 to 2014 were considered. Additional searches for unpublished studies were undertaken in BIOSIS citation index, Register of Current Controlled Trials and Global Health Observatory. METHODOLOGICAL QUALITY: The methodological quality of eligible studies was assessed independently by two reviewers using the Joanna Briggs Institute quality assessment tool. DATA EXTRACTION: Data extraction from the included studies was undertaken and summarized independently by two reviewers using the standardized Joanna Briggs Institute data extraction tool. DATA SYNTHESIS: Studies were too heterogeneous and could not be pooled in statistical meta-analysis. Therefore, the data results are presented as a narrative summary in relation to the outcomes of interest. RESULTS: Nine quantitative studies (four comparable cohort studies, including two group design and two four-group designs and five descriptive or case-series studies) were included in the review. The included studies reported significant clinical improvements in appearance, wellbeing and QoL. These included primary outcomes pointing to body image satisfaction, improved self-esteem and confidence, improved physical function/pain and improved social function. The secondary outcomes were related to adverse events in the early postoperative period and reported wound healing problems, including seromas, partial necrosis, dehiscence, hematoma and anemia because of blood loss. Also, some data sets shed light on appearance-related distress and body dysphoria post surgery associated with visible scars and contour deformities. CONCLUSION: Body contouring surgery has been shown to have positive benefits, especially in relation to improved wellbeing, function and QoL. However, adjustment to changing body image following body contouring is both challenging and empowering and seems to be a transitional process.

Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies.

OBJECTIVES: To assess the effects of treatments for non-metastatic invasive squamous cell carcinoma (SCC) of the skin using evidence from observational studies, given the paucity of evidence from randomised controlled trials. DESIGN: Systematic review of observational studies. DATA SOURCES: Medline, Embase, to December 2012. REVIEW METHODS: Observational studies of interventions for primary, non-metastatic, invasive, SCC of the skin that reported recurrence during follow-up, quality of life, initial response to treatment, adverse events, cosmetic appearance, or death from disease. Studies were excluded if data for primary cutaneous SCC was not separable from other data. Data were extracted independently by two reviewers. Meta-analysis was performed where appropriate using a random effects model to estimate the pooled proportion of an event with 95% confidence intervals. RESULTS: 118 publications were included, covering seven treatment modalities. Pooled estimates of recurrence of SCCs were lowest after cryotherapy (0.8% (95% confidence interval 0.1% to 2%)) and curettage and electrodesiccation (1.7% (0.5% to 3.4%)), but most treated SCCs were small, low risk lesions. After Mohs micrographic surgery, the pooled estimate of local recurrence during variable follow-up periods from 10 studies was 3.0% (2.2% to 3.9%), which was non-significantly lower than the pooled average local recurrence of 5.4% (2.5% to 9.1%) after standard surgical excision (12 studies), and 6.4% (3.0% to 11.0%) after external radiotherapy (7 studies). After an apparently successful initial response of SCCs to photodynamic therapy, pooled average recurrence of 26.4% (12.3% to 43.7%; 8 studies) was significantly higher than other treatments. Evidence was limited for laser treatment (1 study) and for topical and systemic treatments (mostly single case reports or small non-comparative series with limited follow-up). CONCLUSIONS: Many observational studies have looked at different treatment modalities for SCC, but the evidence base for the effectiveness of these interventions is poor. Comparison of outcomes after different treatments should be interpreted cautiously owing to biases inherent in the types of study included, and lack of direct comparisons to enable the estimation of relative treatment effect. Further evidence is needed to develop a prognostic model and stratify individuals at high risk of developing SCC, to improve the evidence base for this common cancer and to optimise clinical management. PROTOCOL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42011001450.

How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis.

Attention-deficit hyperactivity disorder (ADHD) has a significant impact on children's classroom behaviour, daily functioning and experience of school life. However, the effects of drug treatment for ADHD on learning and academic achievement are not fully understood. This review was undertaken to describe the effects of methylphenidate, dexamfetamine, mixed amfetamine salts and atomoxetine on children's on-task behaviour and their academic performance, and to perform a meta-analysis to quantify these effects. Nine electronic databases were systematically searched for randomized controlled trials comparing drug treatment for ADHD against (i) no drug treatment, (ii) baseline (in crossover trials), or (iii) placebo; reporting outcomes encompassing measures of educational achievement within the classroom environment. Forty-three studies involving a pooled total of 2,110 participants were identified for inclusion. Drug treatment benefited children in the amount of school work that they completed, by up to 15%, and less consistently improved children's accuracy in specific types of academic assignments, such as arithmetic. Similar improvements were seen in classroom behaviour, with up to 14% more of children's time spent "on task". Methylphenidate, dexamfetamine and mixed amfetamine formulations all showed beneficial effects on children's on-task behaviour and academic work completion. Atomoxetine was examined in two studies, and was found to have no significant effect. These review findings suggest that medication for ADHD has the potential to improve children's learning and academic achievement.

Public attitudes to death and dying in the UK: a review of published literature.

BACKGROUND: Public attitudes are important in shaping public policy and the political will that determines future service provision. They also help to identify priorities for public education. This paper presents a review and synthesis of published literature on public attitudes to death and dying in the UK from 1990. METHOD: The approach to the review was systematic and involved searching for published research in five databases combined with reviewing references proposed by experts in the field and following up relevant citations from identified sources. The selected sources were assessed by the review team and analysed using a thematic approach. RESULTS: The review identified 22 sources reporting 19 studies which met our criteria for inclusion in the descriptive analysis. Three descriptive themes were identified: preferences relating to death and dying, attitudes to euthanasia and attitudes to life-sustaining treatments and interventions. CONCLUSION: The review outcomes challenge widespread assumptions about public attitudes to death and dying and identify the need for more rigorous work to better understand public views on dying and death. Such work is needed if public health services are to meet the expectations and reflect the wishes of individuals in this area in future.

The needs and experiences of people with a diagnosis of skin cancer: a systematic review.

EXECUTIVE SUMMARY: Background Skin cancer is the most common cancer in Caucasians and the incidence is increasing worldwide. There has been no qualitative systematic review looking at the needs and experiences of patients through the skin cancer journey.Objectives The main objective of this systematic review was to identify, appraise and synthesise the literature relating to the needs and experiences of people with a diagnosis of skin cancer. INCLUSION CRITERIA: Adults with a diagnosis of skin cancer.The needs and experiences of people with skin cancer.All qualitative studies that described or analysed the needs and experiences with people who had been diagnosed with skin cancer.Search strategy The search strategy sought to identify both published and unpublished research studies. A three step search strategy was used, limited to English language papers.Methodological quality Each paper was independently assessed by two independent reviewers for methodological quality, using the critical appraisal instrument from Joanna Briggs Institute Qualitative Assessment of Review Instrument (QARI), prior to inclusion in the review.Data collection The standardised data extraction tool from JBI-QARI was used to extract data from the papers.Data synthesis The qualitative research findings were pooled using JBI-QARI approach. This involved the aggregation of findings.Results Only two studies were included. The 12 findings were grouped according to their similarities of meaning to form 4 categories. These four categories resulted in two synthesised findings. The diagnosis of skin cancer produces a range of emotional responses in individuals. Individuals also delay seeking medical help however once treated are satisfied with care.Conclusions There is very little good research on patient's experiences and needs of skin cancer. People require support in coming to terms with the diagnosis and there is a need for an educational intervention of some form to prevent delay in seeking medical help.Implications for practice There is a real need to increase knowledge of skin cancer so that people do not delay in seeking medical help as early diagnosis can dramatically improve both prognosis and the patient experience since early lesions are treated more simply compared with larger or neglected lesions. Health professionals caring for these patients need to understand the psychosocial concerns of this patient group in order to design services appropriately and to provide patients with the support they need and information that they can easily understand.Implications for research Results from this review have identified that the needs and experiences of individuals with skin cancer remains under-researched and this has implications for those caring for and delivering services to this group of patients. There are very few studies considering this aspect of patients' experiences and therefore a real need to conduct further research into the needs and experience of skin cancer patients.

What evidence supports the use of computerized alerts and prompts to improve clinicians' prescribing behavior?

Alerts and prompts represent promising types of decision support in electronic prescribing to tackle inadequacies in prescribing. A systematic review was conducted to evaluate the efficacy of computerized drug alerts and prompts searching EMBASE, CINHAL, MEDLINE, and PsychINFO up to May 2007. Studies assessing the impact of electronic alerts and prompts on clinicians' prescribing behavior were selected and categorized by decision support type. Most alerts and prompts (23 out of 27) demonstrated benefit in improving prescribing behavior and/or reducing error rates. The impact appeared to vary based on the type of decision support. Some of these alerts (n = 5) reported a positive impact on clinical and health service management outcomes. For many categories of reminders, the number of studies was very small and few data were available from the outpatient setting. None of the studies evaluated features that might make alerts and prompts more effective. Details of an updated search run in Jan 2009 are included in the supplement section of this review.