Determinants of weight loss maintenance: a systematic review. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Summary: 2017 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Simulation-Based Skill Training for Trainees in Cardiac Surgery: A Systematic Review. Age of red blood cells and transfusion in critically ill patients Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Obesity in children. Part 2: Prevention and management Efficiency and Contribution of Strategies for Finding Randomized Controlled Trials: A Case Study from a Systematic Review on Therapeutic Interventions of Chronic Depression
BACKGROUND Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity . We have therefore systematic ally synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity . METHODS With the use of the Preferred Reporting Items for Systematic Review s and Meta-Analyses statement , prospect i ve studies were identified from search es in PubMed and PsycINFO from 2006 to 2016 . We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication .  Included articles were scored on their method ological quality , and a best- evidence synthesis was applied to summarize the results . RESULTS Our search result ed in 8,222 articles of which 67 articles were selected . In total , 124 determinants were identified of which 5 were demographic , 59 were behavioural , 51 were psychological/cognitive and 9 were social and physical environmental determinants . We found consistent evidence that demographic determinants were not predictive of weight loss maintenance . Behavioural and cognitive determinants that promote a reduction in energy intake , an increase in energy expenditure and monitoring of this balance are predictive determinants . CONCLUSION This review identifies key determinants in weight loss maintenance . However , more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance BACKGROUND Early mobilization is considered an important element of postoperative care ; however , how best to implement this intervention in clinical practice is unknown . This systematic review summarizes the evidence regarding the impact of specific early mobilization protocol s on postoperative outcomes after abdominal and thoracic surgery . METHOD The review was performed according to PRISMA guidelines . We search ed 8 electronic data bases to identify studies comparing patients receiving a specific protocol of early mobilization to a control group .  Method ologic quality was assessed using the Downs and Black tool . RESULTS Four studies in abdominal surgery ( 3 r and omized controlled trials [ RCTs ] and 1 observational prospect i ve study ) and 4 studies in thoracic surgery ( 3 RCTs and 1 observational retrospective study ) were identified . None of the 5 studies evaluating postoperative complications reported differences between groups . One of 4 studies evaluating duration of stay reported a significant decrease in the intervention group . One of 3 studies evaluating gastrointestinal function reported differences in favor of the intervention group . One of 4 studies evaluating performance-based outcomes reported differences in favor of the intervention group . One of 5 studies evaluating patient-reported outcomes reported differences in favor of the intervention group . Overall method ologic quality was poor . CONCLUSION Few comparative studies have evaluated the impact of early mobilization protocol s on outcomes after abdominal and thoracic surgery . The quality of these studies was poor and results were conflicting . Although bed rest is harmful , there is little available evidence to guide clinicians in effective early mobilization protocol s that increase mobilization and improve outcomes Objective The aim of this article is to summarize the relevant findings that inform the 2017 International Consultation on Incontinence pathway for surgical treatment of pelvic organ prolapse ( POP ) . Methods We conducted an evidence -based review of the English- language peer- review ed literature relating to POP surgery published prior to December 2016 . Level 1 evidence ( r and omized controlled trials [ RCTs ] or systematic review s of RCTs ) was preferred ; however , level 2 ( poor- quality RCT , prospect i ve cohort studies ) or 3 evidence ( case series or retrospective studies ) has been included if level 1 data were lacking . The committee evaluated the literature and made recommendations based on the Oxford grading system summarized as follows : grade A recommendation usually depends on consistent level 1 evidence ; grade B recommendation usually depends on consistent level 2 and /or 3 studies , or “ majority evidence ” from RCTs ; grade C recommendation usually depends on level 3 studies or “ majority evidence ” from level 2/3 studies or Delphi-processed expert opinion ; grade D , “ no recommendation possible , ” would be used where the evidence is inadequate or conflicting . Results The recommendations from each chapter of the review are presented and serve to inform an evidence -based pathway for the surgical treatment of prolapse . A Web-based interactive application of the pathway is presented . Conclusions The 2017 International Consultation on Incontinence pathway on surgery for POP is design ed as an adjunct to transparent consultation and consent relating to POP surgery . The final decision regarding surgical intervention can be made only after a shared decision-making process between the patient and the clinician that will evaluate a variety of individual factors that can not be assessed in the pathway Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes BACKGROUND Simulation-based training has been an important part of the solution to address the shortfalls in cardiac surgery training . This review was conducted to identify and systematic ally summarize existing evidence on outcomes and method ological quality of  simulation-based skills training  for cardiac surgery trainees . METHODS MEDLINE , Embase , and ERIC ( Education Re sources Information Center ) data bases were search ed . Studies included peer- review ed publications with simulation-based skill training in cardiac surgery programs with outcome measures of performance . Data extraction covered the type of skills training , simulator type and fidelity , the level of trainees , assessment tools , assessors , study design and its components , strengths and limitations , and elements required for the Medical Education Research Study Quality Instrument score . The review followed the Preferred Reporting Items for Systematic Review s and Meta-Analyses guidelines . RESULTS Of 16 studies that met the criteria , only four ( 25 % ) r and omized controlled trials were identified , and the remaining were observational studies . Seven observational studies ( 43.7 % ) were single-group pre-post tests . The  mean number of trainees was 20.4 ( SD , 14.1 ) .  Low-fidelity simulators were used in 13 studies ( 81.2 % ) . Most of the studies ( 81.3 % ) were high quality based on a Medical Education Research Study Quality Instrument score of 12 or more . Evidence of assessment tool validation was absent among all studies . No study outcome measures were directed to skills transfer to the operating room or patient outcomes . Overall learning outcomes ' effect sizes were consistently high ( 2.2 ; SD , 1.6 ) , with junior residents benefitting most ( effect size , 2.8 ; SD , 2.2 ) CONCLUSIONS : Simulation-based skill training is associated with improved learning outcomes for cardiac surgery trainees with large effect sizes , but more behavior-level outcomes are required to fully assess its value Red blood cells ( RBC ) storage facilitates the supply of RBC to meet the clinical dem and for transfusion and to avoid wastage . However , RBC storage is associated with adverse changes in erythrocytes and their preservation medium . These changes are responsible for functional alterations and for the accumulation of potentially injurious bioreactive substances . They also may have clinical ly harmful effects especially in critically ill patients . The clinical consequences of storage lesions , however , remain a matter of persistent controversy . Multiple retrospective , observational , and single-center studies have reported heterogeneous and conflicting findings about the effect of blood storage duration on morbidity and /or mortality in trauma , cardiac surgery , and intensive care unit patients . Describing the details of this controversy , this review not only summarizes the current literature but also highlights the equipoise that currently exists with regard to the use of short versus current st and ard ( extended ) storage duration red cells in critically ill patients and supports the need for large , r and omized , controlled trials evaluating the clinical impact of transfusing fresh ( short duration of storage ) versus older ( extended duration of storage ) red cells in critically ill patients At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as # # # # Summary points In the first part of this article we described how obesity in children is measured , its prevalence , whether children should be screened , and the risk factors for and consequences of obesity.1 In this part we review the current evidence on the prevention and management of childhood obesity . # # # # Sources and selection criteria This review draws on the Foresight report , guidance from the National Institute for Health and Clinical Excellence and the Australian National Health Medical Research Council , and Cochrane review . In April 2008 we search ed the Cochrane Library data base of review s and the Centre for Review s and Dissemination data bases using the search term “ obesity ” . We also conducted a Medline search ( ( Child$ or paediatric or pediatric or adolescent ) and ( Obes$ or overweight ) ) limited to 1 January 2005 to 6 May 2008 and “ review articles ” ; this identified 1105 articles . We read the abstract s of these articles and retrieved relevant papers . We also used articles from our own bibliographies collected over the past 10 years . The evidence to support the measurement , prevention , and management of obesity in children is still relatively weak , with few r and omised controlled trials or systematic review s. The strength of evidence is developing and the up date d Cochrane review that will be published in 2009 Background Identifying all existing evidence is a crucial aspect in conducting systematic review s. Since the retrieval of electronic data base search es alone is limited , guidelines recommend the use of additional search strategies . The aim of this investigation was to assess the efficiency and contribution of additional search strategies for identifying r and omized controlled trials in conducting a systematic review on interventions after performing a sensitive electronic data base search . Design and Methods Seven electronic data bases , 3 journals and 11 systematic review s were search ed . All first authors of the included studies were contacted ; citation tracking and a search in clinical trial registers were performed . A priori defined evaluation criteria were calculated for each search strategy . Results A total of 358 full-text articles were identified ; 50 studies were included in the systematic review , wherefrom 84.0 % ( 42 ) were acquired by the sensitive electronic data base search and 16.0 % ( 8) through additional search strategies . Screening reference lists of related systematic review s was the most beneficial additional search strategy , with an efficiency of 31.3 % ( 5 ) and a contribution of 10.0 % ( 5/50 ) , whereas h and - search ing and author contacts contributed two and one additional studies , respectively . Citation tracking and search ing clinical trial registers did not lead to any further inclusion of primary studies . Conclusions Based on our findings , h and - search ing contents of relevant journals and screening reference lists of related systematic review s may be helpful additional strategies to identify an extensive body of evidence . In case of limited re sources , a sensitive electronic data base search may constitute an appropriate alternative for identifying relevant trials . Significance for public health Systematic review s provide the strongest form of evidence synthesis for therapeutic interventions and are of high relevance for decision makers in public health . Preparing high quality systematic review s can be very time-consuming since all existing evidence should be identified , but the retrieval of electronic data base search es is limited and therefore additional search strategies are recommended . However , the time needed for conducting full systematic review s does often not address the need for urgent evidence . Thus , priorities of summarizing all available evidence and providing fast evidence -based recommendations may conflict . So far , no consensus exists regarding which additional search strategies are beneficial and sparsely time-consuming for conducting systematic review s. We examined the efficiency and contribution of additional search strategies performed after a sensitive electronic data base search . Our results provide highly relevant information for research ers conducting systematic review s in various fields of public health research and for establishing guidelines for conducting rapid review
Results Insulin resistance indicators were significantly improved after bariatric surgery .
Leptin was also significantly decreased while adiponectin was significantly increased .
Although the level of metabolic hormones changed after bariatric surgery , they were not statistically significant .
Inflammation indicators were significantly decreased .
Significant reduction was also detected in PAI-1 and sICAM-1 .
Conclusions Bariatric surgery is beneficial in morbidly obese patients .
Although treating obesity in a surgical way may cause some complications , the weight loss is generally safe and effective
Background Considering conflicting results on the consequences of all types of obesity surgery , we were to summarize them via a systematic review .