ObjectiveThis update of a 2004 guideline codeveloped by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.PurposeThe purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical pra...

https://journals.sagepub.com/doi/pdf/10.1177/0194599815623467

Clinical Practice Guideline Otitis Media with Effusion (Update)

Aim
The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP).

Method
This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health.

Results
Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red).

Interpretation
Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.

/pdf/a-systematic-review-of-interventions-for-children-with-52c90cna9r.pdf

A systematic review of interventions for children with cerebral palsy: state of the evidence.

Ambulatory Surgery - 대장, 항문

Recognition of the fact that bacterial biofilm may play a role in the pathogenesis of disease has led to an increased focus on identifying diseases that may be biofilm-related. Biofilm infections are typically chronic in nature, as biofilm-residing bacteria can be resilient to both the immune system, antibiotics, and other treatments. This is a comprehensive review describing biofilm diseases in the auditory, the cardiovascular, the digestive, the integumentary, the reproductive, the respiratory, and the urinary system. In most cases reviewed, the biofilms were identified through various imaging technics, in addition to other study approaches. The current knowledge on how biofilm may contribute to the pathogenesis of disease indicates a number of different mechanisms. This spans from biofilm being a mere reservoir of pathogenic bacteria, to playing a more active role, e.g., by contributing to inflammation. Observations also indicate that biofilm does not exclusively occur extracellularly, but may also be formed inside living cells. Furthermore, the presence of biofilm may contribute to development of cancer. In conclusion, this review shows that biofilm is part of many, probably most chronic infections. This is important knowledge for development of effective treatment strategies for such infections.

https://www.mdpi.com/2079-6382/9/2/59/pdf

Bacterial Biofilm and its Role in the Pathogenesis of Disease.

Most individuals engage in multiple unhealthy lifestyle behaviors with the potential for negative health consequences. Yet most health promotion research has addressed risk factors as categorically separate entities, and little is known about how to effectively promote multiple health behavior change (MHBC). This review summarizes the recent literature (January 2004 to December 2009) on randomized clinical trials evaluating MHBC interventions for primary prevention. Combining all the studies across all the reviews, fewer than 150 studies were identified. This is a fraction of the number of trials conducted on changing individual behavioral risks. Three primary behavioral clusters dominated: (1) the energy balance behaviors of physical activity and diet; (2) addictive behaviors like smoking and other drugs; and (3) disease-related behaviors, specifically cardiovascular disease (CVD) and cancer related. Findings were largely disappointing for studies of diet and physical activity, particularly with youth. T...

/pdf/a-review-of-multiple-health-behavior-change-interventions-33zlp669ju.pdf

A Review of Multiple Health Behavior Change Interventions for Primary Prevention

ObjectiveInsertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ea...

https://journals.sagepub.com/doi/pdf/10.1177/0194599813487302

Clinical Practice Guideline Tympanostomy Tubes in Children

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Tympanostomy Tubes in Children. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 12 recommendations developed address patient selection, surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes.

/pdf/clinical-practice-guideline-tympanostomy-tubes-in-children-3qp18097or.pdf

Wendy L. Mackey

Papers

Clinical Practice Guideline Tympanostomy Tubes in Children

Clinical practice guideline: Tympanostomy tubes in children-executive summary