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Background: Botulinum toxin type A (BoNTA) injection into the masticatory muscles has been widely used to treat a number of painful and nonpainful conditions; however, no systematic reviews have been performed on the long‐term effect to the mandibular bone. Objective: Our systematic review aimed to evaluate the impact of botulinum toxin injection into the masticatory muscles on mandibular bone based. Methods: PubMed, Embase, Ovid, CINAHL and Web of Science were searched for human studies assessing mandibular bone after injection of BoNTA using computed tomography (CT) and cone beam CT (CBCT). Results: Seven studies were eligible for review; five reported significant bony changes to one or more areas of the mandible. Most frequently affected were the condylar head, coronoid process and ramus. The most frequent changes were decreased bone volume, cortical thickness and cortical and trabecular density. Conclusions: This is the first systematic review to examine an association between BoNTA injection into the masticatory muscles and mandibular bone quality. Data were analysed from a limited number of studies with a small sample size, and the quality of the included studies was very low. While the majority of available evidence suggests BoNTA injection results in bony change, further study is required to confirm a dose‐dependence effect and the impact of gender and age. High‐quality trials should utilise a combination of software analysis and radiologist review, with longer‐term follow‐up to monitor for persistence of bony effect and clinical significance. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of steroid and hyperbaric oxygen therapy (HBOT) in the setting of acute noise-induced hearing loss.Methods: Systematic review and meta-analysis of noise-induced hearing loss treatment studies that reported on patients who (1) reported individual frequencies up to 8,000 Hz with mean and SDs; (2) were treated only with steroids ± HBOT; and (3) sustained acute acoustic trauma. The Newcastle-Ottawa Scale was used to assess risk of bias across cohorts. Data sources were Embase, Web of Science, Cochrane Databases (via Ovid EBM Reviews), and PubMed.Results: Four studies were of retrospective cohorts and one of a prospective cohort. Only one study examined blast acoustic trauma, and the remaining four examined gunfire acoustic trauma. This meta-analysis used a random-effects model for pure tone average (PTA) (0.5, 1, and 2 kHz) and "high-frequency" PTA (HPTA) (4, 6, and 8 kHz) for the five studies included. Steroid therapy demonstrated a 6.55-dB (95% CI, 0.08-13.17 dB) PTA (n = 55) improvement and a 9.02-dB (95% CI, 1.45-16.59 dB) HPTA (n = 71) improvement. Steroid with HBOT demonstrated a 7.00-dB (95% CI, 0.84-13.17 dB) PTA (n = 133) improvement and a 12.41-dB (95% CI, 3.97-20.86 dB) HPTA (n = 150) improvement. According to our statistical analysis of the pooled studies' heterogeneity, there was moderate inconsistency in the cross-study results of both treatment groups.Conclusion: Steroids with or without HBOT appear to improve both low and high hearing thresholds following acoustic trauma. Future studies will require inclusion of control groups, precise definition of acoustic trauma intensity and duration, and genetic polymorphisms. [ABSTRACT FROM AUTHOR]

Objective: To systematically review studies assessing the effects of health information technology (health IT) on patient safety outcomes.Materials and Methods: The authors employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement methods. MEDLINE, Cumulative Index to Nursing Allied Health (CINAHL), EMBASE, and Cochrane Library databases, from 2001 to June 2012, were searched. Descriptive and comparative studies were included that involved use of health IT in a clinical setting and measured effects on patient safety outcomes.Results: Data on setting, subjects, information technology implemented, and type of patient safety outcomes were all abstracted. The quality of the studies was evaluated by 2 independent reviewers (scored from 0 to 10). A total of 69 studies met inclusion criteria. Quality scores ranged from 1 to 9. There were 25 (36%) studies that found benefit of health IT on direct patient safety outcomes for the primary outcome measured, 43 (62%) studies that either had non-significant or mixed findings, and 1 (1%) study for which health IT had a detrimental effect. Neither the quality of the studies nor the rate of randomized control trials performed changed over time. Most studies that demonstrated a positive benefit of health IT on direct patient safety outcomes were inpatient, single-center, and either cohort or observational trials studying clinical decision support or computerized provider order entry.Discussion and Conclusion: Many areas of health IT application remain understudied and the majority of studies have non-significant or mixed findings. Our study suggests that larger, higher quality studies need to be conducted, particularly in the long-term care and ambulatory care settings. [ABSTRACT FROM AUTHOR]