Laura Banfield

A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults

Objective We performed a systematic review, meta-analysis and meta-regression to determine if dietary protein supplementation augments resistance exercise training (RET)-induced gains in muscle mass and strength. Data sources A systematic search of Medline, Embase, CINAHL and SportDiscus. Eligibility criteria Only randomised controlled trials with RET ≥6 weeks in duration and dietary protein supplementation. Design Random-effects meta-analyses and meta-regressions with four a priori determined covariates. Two-phase break point analysis was used to determine the relationship between total protein intake and changes in fat-free mass (FFM). Results Data from 49 studies with 1863 participants showed that dietary protein supplementation significantly (all p<0.05) increased changes (means (95% CI)) in: strength—one-repetition-maximum (2.49 kg (0.64, 4.33)), FFM (0.30 kg (0.09, 0.52)) and muscle size—muscle fibre cross-sectional area (CSA; 310 µm2 (51, 570)) and mid-femur CSA (7.2 mm2 (0.20, 14.30)) during periods of prolonged RET. The impact of protein supplementation on gains in FFM was reduced with increasing age (−0.01 kg (−0.02,–0.00), p=0.002) and was more effective in resistance-trained individuals (0.75 kg (0.09, 1.40), p=0.03). Protein supplementation beyond total protein intakes of 1.62 g/kg/day resulted in no further RET-induced gains in FFM. Summary/conclusion Dietary protein supplementation significantly enhanced changes in muscle strength and size during prolonged RET in healthy adults. Increasing age reduces and training experience increases the efficacy of protein supplementation during RET. With protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute RET-induced gains in FFM.

Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis.

Objective To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery. Data Sources Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions. Study Selection We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion. Data Extraction One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes. Data Synthesis To identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable. Results Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2–8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1–24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4–7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8–13.5, p = 0.002) were associated with a good postoperative seizure outcome. Conclusions Small retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best available evidence suggests four preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Large long-term prospective multicenter observational studies are required to further evaluate the risk factors identified in this review.

Information literacy during entry to practice: Information-seeking behaviors in student nurses and recent nurse graduates

BACKGROUND The ability to locate information pertinent to guide clinical practice is important for quality nursing care and patient safety. To date, little is known about the transfer of information literacy skills as student nurses transition to clinical practice as new graduates. This study begins to address this gap from the perspective of student nurses, recent nurse graduates (RNs), nurse leaders and library staff. OBJECTIVES To describe the information-seeking behaviors of student nurses and RNs within their clinical settings. DESIGN AND PARTICIPANTS This is a descriptive study that included both cross-sectional surveys and key informant interviews. Participants were senior-level undergraduate students and recently graduated RNs (graduated since 2008), and nurse leaders and library staff employed in one of the clinical sites accepting undergraduate students from the McMaster Mohawk and Conestoga BScN program. The study was completed in two large hospital corporations in Hamilton, Ontario, Canada. METHODS Student nurses and RNs were invited to complete online surveys to assess their access to and use of information sources and resources within clinical practice. Students completed a survey comprised of five open-ended questions, while RNs completed a survey comprised of 13 fixed choice and open-ended questions. Nurse leaders and library staff participated in qualitative interviews to verify the extent and availability of information resources. RESULTS Eighteen RNs and 62 students completed their respective surveys. Three categories of information sources and resources were identified: electronic, print and interpersonal. Electronic sources of information were the most used resource by both students and RNs. More RNs reported using interpersonal sources, while students reported using more print sources of information. CONCLUSIONS Recent RN graduates meet the Canadian Association of Schools of Nursing performance indicators related to information access for the entry to practice Nursing Informatics competencies.

Adductor Canal Block Versus Femoral Canal Block for Total Knee Arthroplasty: A Meta-Analysis: What Does the Evidence Suggest?

Due to the invasiveness of total knee arthroplasty (TKA), the procedure is often associated with extreme postoperative pain. In fact, 23% of patients cite at home pain as “severe/ extreme” after surgery, whereas 54% of the patients indicate “severe pain at least some of the time.”Moreover, it has been suggested that postoperative pain can also interfere with the recovery process, which can put patients at an increased risk for postoperative complications including infections, loosening of the joint, and reflex sympathetic dystrophy. Different techniques can be used preoperatively to complement the effects of general anesthesia, including femoral nerve block (FNB) and adductor canal block (ACB)/saphenous nerve block. Femoral nerve block has traditionally been an efficient method to reduce postoperative pain after TKA. For instance, Chan et al found that FNB decreased pain scores at 24 hours as comparedwith a sham procedure. Moreover, Jadon et al observed that FNB is a more efficient method of analgesia as compared with IV fentanyl. However, FNB has been found to have postsurgical complications, including severe quadriceps muscle weakness. Certainly, surgical causes such as tourniquet-related weakness or surgical quadriceps dysfunction must also be considered, but femoral nerve blockade– related weakness can be explained by the anatomy of the nerve targeted in the FNB. The femoral nerve not only comprises sensory branches, but also contains motor branches that innervate muscles of the upper and lower leg. The motor nerve involvement of the FNB is what leads to muscle weakness, which can alter the ability of the patient to ambulate properly and can increase the risk of postoperative falls. As such, ACB is a method of analgesia that has recently sparked tremendous interest in the scientific community due to its potential benefits over FNB; however, this approach itself does not come without controversy. Adductor canal block is thought to be as effective as FNB in reducing postoperative pain. In addition to having similar pain scores reported by patients, ACB has been thought to be

A Systematic Review of Surgical Randomized Controlled Trials: Part I. Risk of Bias and Outcomes: Common Pitfalls Plastic Surgeons Can Overcome

Background: The authors investigated the methodological validity of plastic surgery randomized controlled trials that compared surgical interventions. Methods: An electronic search identified randomized controlled trials published between 2000 and 2013. Reviewers, independently and in duplicate, assessed manuscripts and performed data extraction. Methodological safeguards (randomization, allocation concealment, blinding, and incomplete outcome data) were examined using the Cochrane risk of bias tool. Regression analysis was used to identify trial characteristics associated with risk of bias. Results: Of 1664 potentially eligible studies, 173 randomized controlled trials were included. Proper randomization and allocation concealment methods were described in 61 of 173 (35 percent) and 21 of 173 (12 percent), respectively. Outcome assessors were blinded in 58 of 173 (34 percent) trials, and patients were blinded in 45 of 173 (26 percent). Follow-up rates were high, with 99 of 173 (57 percent) randomized controlled trials appearing to have complete follow-up. An intention-to-treat analysis was used in 19 of 173 (11 percent) trials. One-third (58 of 173, 34 percent) did not state their primary outcomes. The most common type of primary outcome used was a symptom/quality of life, class III, outcome (73 of 173, 42 percent). Multinomial regression demonstrated trials reporting an a priori sample size as more likely to have a low risk of bias (p = 0.001). Conclusions: This article highlights methodological safeguards that plastic surgeons should consider when interpreting results of a surgical randomized controlled trial. Allocation concealment, outcome assessor blinding, and patient blinding were identified as areas of concern. Valid and reliable outcome measures are being used in plastic surgery. This analysis provides strong rationale for continued focus on the performance and reporting of clinical trials within our specialty.

A scoping review of the psychological responses to interval exercise: is interval exercise a viable alternative to traditional exercise?

ABSTRACT While considerable evidence suggests that interval exercise confers numerous physiological adaptations linked to improved health, its psychological consequences and behavioural implications are less clear and the subject of intense debate. The purpose of this scoping review was to catalogue studies investigating the psychological responses to interval exercise in order to identify what psychological outcomes have been assessed, the research methods used, and the results. A secondary objective was to identify research issues and gaps. Forty-two published articles met the review inclusion/exclusion criteria. These studies involved 1258 participants drawn from various active/inactive and healthy/unhealthy populations, and 55 interval exercise protocols (69% high-intensity interval training [HIIT], 27% sprint interval training [SIT], and 4% body-weight interval training [BWIT]). Affect and enjoyment were the most frequently studied psychological outcomes. Post-exercise assessments indicate that overall, enjoyment of, and preferences for interval exercise are equal or greater than for continuous exercise, and participants can hold relatively positive social cognitions regarding interval exercise. Although several methodological issues (e.g., inconsistent use of terminology, measures and protocols) and gaps (e.g., data on adherence and real-world protocols) require attention, from a psychological perspective, the emerging data support the viability of interval exercise as an alternative to continuous exercise.

A Systematic Review of Surgical Randomized Controlled Trials: Part 2. Funding Source, Conflict of Interest, and Sample Size in Plastic Surgery.

Background: The authors examined industry support, conflict of interest, and sample size in plastic surgery randomized controlled trials that compared surgical interventions. They hypothesized that industry-funded trials demonstrate statistically significant outcomes more often, and randomized controlled trials with small sample sizes report statistically significant results more frequently. Methods: An electronic search identified randomized controlled trials published between 2000 and 2013. Independent reviewers assessed manuscripts and performed data extraction. Funding source, conflict of interest, primary outcome direction, and sample size were examined. Chi-squared and independent-samples t tests were used in the analysis. Results: The search identified 173 randomized controlled trials, of which 100 (58 percent) did not acknowledge funding status. A relationship between funding source and trial outcome direction was not observed. Both funding status and conflict of interest reporting improved over time. Only 24 percent (six of 25) of industry-funded randomized controlled trials reported authors to have independent control of data and manuscript contents. The mean number of patients randomized was 73 per trial (median, 43, minimum, 3, maximum, 936). Small trials were not found to be positive more often than large trials (p = 0.87). Conclusions: Randomized controlled trials with small sample size were common; however, this provides great opportunity for the field to engage in further collaboration and produce larger, more definitive trials. Reporting of trial funding and conflict of interest is historically poor, but it greatly improved over the study period. Underreporting at author and journal levels remains a limitation when assessing the relationship between funding source and trial outcomes. Improved reporting and manuscript control should be goals that both authors and journals can actively achieve.

Association between BDNF levels and suicidal behaviour: a systematic review and meta-analysis

BackgroundSuicidal behaviour is a complex phenomenon with a multitude of risk factors. Brain-derived neurotrophic factor (BDNF), a protein crucial to nervous system function, may be involved in suicide risk. The objective of this systematic review is to evaluate and summarize the literature examining the relationship between BDNF levels and suicidal behaviour.MethodsA predefined search strategy was used to search MEDLINE, EMBASE, PsychINFO, and CINAHL from inception to December 2015. Studies were included if they investigated the association between BDNF levels and suicidal behaviours (including completed suicide, attempted suicide, or suicidal ideation) by comparing BDNF levels in groups with and without suicidal behaviour. Only the following observational studies were included: case-control and cohort studies. Both clinical- and community-based samples were included. Screening, data extraction, and risk of bias assessment were conducted in duplicate.ResultsSix-hundred thirty-one articles were screened, and 14 were included in the review. Three studies that assessed serum BDNF levels in individuals with suicide attempts and controls were combined in a meta-analysis that showed no significant association between serum BDNF and suicide attempts. The remaining 11 studies were not eligible for the meta-analysis and provided inconsistent findings regarding associations between BDNF and suicidal behaviour.ConclusionsThe findings of the meta-analysis indicate that there is no significant association between serum BDNF and attempted suicide. The qualitative review of the literature did not provide consistent support for an association between BDNF levels and suicidal behaviour. The evidence has significant methodological limitations.Systematic review registrationPROSPERO CRD42015015871

Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

BACKGROUND Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. METHODS In this systematic review and meta-analysis, we independently searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomised controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication. Randomised trials comparing atraumatic and conventional needles in which no dural puncture was done (epidural injections) or without a conventional needle control group were excluded. We screened studies and extracted data from published reports independently. The primary outcome of postdural-puncture headache incidence and additional safety and efficacy outcomes were assessed by random-effects and fixed-effects meta-analysis. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42016047546. FINDINGS We identified 20 241 reports; after exclusions, 110 trials done between 1989 and 2017 from 29 countries, including a total of 31 412 participants, were eligible for analysis. The incidence of postdural-puncture headache was significantly reduced from 11·0% (95% CI 9·1-13·3) in the conventional needle group to 4·2% (3·3-5·2) in the atraumatic group (relative risk 0·40, 95% CI 0·34-0·47, p<0·0001; I2=45·4%). Atraumatic needles were also associated with significant reductions in the need for intravenous fluid or controlled analgesia (0·44, 95% CI 0·29-0·64; p<0·0001), need for epidural blood patch (0·50, 0·33-0·75; p=0·001), any headache (0·50, 0·43-0·57; p<0·0001), mild headache (0·52, 0·38-0·70; p<0·0001), severe headache (0·41, 0·28-0·59; p<0·0001), nerve root irritation (0·71, 0·54-0·92; p=0·011), and hearing disturbance (0·25, 0·11-0·60; p=0·002). Success of lumbar puncture on first attempt, failure rate, mean number of attempts, and the incidence of traumatic tap and backache did not differ significantly between the two needle groups. Prespecified subgroup analyses of postdural-puncture headache revealed no interactions between needle type and patient age, sex, use of prophylactic intravenous fluid, needle gauge, patient position, indication for lumbar puncture, bed rest after puncture, or clinician specialty. These results were rated high-quality evidence as examined using the grading of recommendations assessment, development, and evaluation. INTERPRETATION Among patients who had lumbar puncture, atraumatic needles were associated with a decrease in the incidence of postdural-puncture headache and in the need for patients to return to hospital for additional therapy, and had similar efficacy to conventional needles. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of atraumatic needles as a superior option for patients who require lumbar puncture. FUNDING None.

Intramedullary Nailing Versus Plate Fixation for the Treatment Displaced Midshaft Clavicular Fractures: A Systematic Review and Meta-Analysis.

The two commonly performed surgical techniques used to repair displaced midshaft clavicle fractures are plate fixation or intramedullary nailing; however, despite recent evidence, the optimal method to treat such fractures remains a continued topic of debate. A meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate long term function, complications, and operative duration in adult patients receiving intramedullary nailing in comparison to plating. Seven RCTs and three quasi-randomized trials were included. No significant difference was found in long-term function between the two groups (MD: −0.66, 95% CI: −2.03 to 0.71, I2 = 62%, p = 0.34). Patients who received plating had a 2.19 times increased risk of treatment failure, but this failed to reach significance (95% CI: 0.93 to 5.15, I2 = 0%, p = 0.07). The risk of non-operative complications was 2.11 times higher in patients who received plating and this reached statistical significance (95% CI: 1.38 to 3.23, I2 = 53%, p = 0.0006). Finally, plating significantly prolonged operative duration by 20.16 minutes (95% CI: 16.87 to 23.44, I2 = 56%, p < 0.00001). Our results suggest that intramedullary nailing and plating provide equivalent long-term functional outcomes; however, plating may lead to a higher risk of treatment failure and non-operative complications.