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Zhu H, Xu X, Zhang K, Ye Q. The effect of intravenous vitamin C on clinical outcomes in patients with sepsis or septic shock: A meta-analysis of randomized controlled trials. Front Nutr 2022; 9:964484. [PMID: 35967816 PMCID: PMC9366349 DOI: 10.3389/fnut.2022.964484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/06/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives Vitamin C deficiency is common among patients with sepsis and has been associated with poor clinical outcomes. Nevertheless, the effect of intravenous (IV) vitamin C for the treatment of sepsis remains controversial. The purpose of this meta-analysis was to evaluate the effect of IV vitamin C in patients with sepsis or septic shock. Methods Electronic databases (PubMed, Embase, Scopus, and Cochrane Library) were searched from inception through May 25, 2022 for randomized controlled trials evaluating the effect of IV vitamin C treatment in patients with sepsis. The primary outcome was short-term mortality, and secondary outcomes including the duration of vasopressor, length of intensive care unit (ICU) stay, and Sequential Organ Failure Assessment (SOFA) score after vitamin C treatment. Subgroup analyses were performed based on the type of disease, dose and duration of IV vitamin C. Results A total of 10 studies were included, with a total sample of 755 septic patients. The IV vitamin C was associated with a significant reduction in the short-term mortality (OR 0.51, 95% CI 0.37–0.69, I2 = 0%) and duration of vasopressor (MD −27.88, 95% CI −49.84 to −5.92, I2 = 95%). The length of ICU stay (MD −0.68, 95% CI −2.13 to 0.78, I2 = 74%) and SOFA score (MD −0.05, 95% CI −1.69 to 1.58, I2 = 86%) were not significantly different between two groups. Conclusion In patients with sepsis or septic shock, the IV vitamin C reduced the short-term mortality rate and duration of vasopressor, with no effect on the length of ICU stay and SOFA score. Further trials are required to explore the optimal dosage and duration of IV vitamin C. Systematic Review Registration https://inplasy.com/inplasy-2022-6-0013/, identifier INPLASY202260013.
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Affiliation(s)
- Huiyan Zhu
- Department of General Surgery, Lishui People's Hospital, Lishui, China
| | - Xiaoya Xu
- Department of General Surgery, Lishui People's Hospital, Lishui, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiaoping Ye
- Department of General Surgery, Lishui People's Hospital, Lishui, China
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Lu L, Phua QS, Bacchi S, Goh R, Gupta AK, Kovoor JG, Ovenden CD, To MS. Small Study Effects in Diagnostic Imaging Accuracy: A Meta-Analysis. JAMA Netw Open 2022; 5:e2228776. [PMID: 36006641 PMCID: PMC9412222 DOI: 10.1001/jamanetworkopen.2022.28776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Small study effects are the phenomena that studies with smaller sample sizes tend to report larger and more favorable effect estimates than studies with larger sample sizes. OBJECTIVE To evaluate the presence and extent of small study effects in diagnostic imaging accuracy meta-analyses. DATA SOURCES A search was conducted in the PubMed database for diagnostic imaging accuracy meta-analyses published between 2010 and 2019. STUDY SELECTION Meta-analyses with 10 or more studies of medical imaging diagnostic accuracy, assessing a single imaging modality, and providing 2 × 2 contingency data were included. Studies that did not assess diagnostic accuracy of medical imaging techniques, compared 2 or more imaging modalities or different methods of 1 imaging modality, were cost analyses, used predictive or prognostic tests, did not provide individual patient data, or were network meta-analyses were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in accordance with the PRISMA guidelines. MAIN OUTCOMES AND MEASURES The diagnostic odds ratio (DOR) was calculated for each primary study using 2 × 2 contingency data. Regression analysis was used to examine the association between effect size estimate and precision across meta-analyses. RESULTS A total of 31 meta-analyses involving 668 primary studies and 80 206 patients were included. Fixed effects analysis produced a regression coefficient for the natural log of DOR against the SE of the natural log of DOR of 2.19 (95% CI, 1.49-2.90; P < .001), with computed tomography as the reference modality. Interaction test for modality and SE of the natural log of DOR did not depend on modality (Wald statistic P = .50). Taken together, this analysis found an inverse association between effect size estimate and precision that was independent of imaging modality. Of 26 meta-analyses that formally assessed for publication bias using funnel plots and statistical tests for funnel plot asymmetry, 21 found no evidence for such bias. CONCLUSIONS AND RELEVANCE This meta-analysis found evidence of widespread prevalence of small study effects in the diagnostic imaging accuracy literature. One likely contributor to the observed effects is publication bias, which can undermine the results of many meta-analyses. Conventional methods for detecting funnel plot asymmetry conducted by included studies appeared to underestimate the presence of small study effects. Further studies are required to elucidate the various factors that contribute to small study effects.
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Affiliation(s)
- Lucy Lu
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Qi Sheng Phua
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Stephen Bacchi
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rudy Goh
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
- Department of Neurology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Aashray K. Gupta
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Southport, Australia
| | - Joshua G. Kovoor
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Department of Surgery, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Christopher D. Ovenden
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, Australia
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To MS, Lu L, Tran M, Chong C. Preferential reporting of significant p-values in radiology journal abstracts. Clin Radiol 2022; 77:743-748. [PMID: 35810024 DOI: 10.1016/j.crad.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022]
Abstract
AIM To assess the prevalence of publication bias in the radiology literature, data-mining techniques were used to extract p-values in abstracts published in key radiology journals over the past 20 years. MATERIALS AND METHODS A total of 34,699 abstracts published in Radiology, Investigative Radiology, European Radiology, American Journal of Roentgenology, and American Journal of Neuroradiology published between January 2000 and December 2019 were included in the analysis. Automated text mining using regular expressions was used to mine abstracts for p-values. RESULTS The text mining algorithm detected 43,489 p-values, the majority (82.4%) of which were reported as "significant", i.e., p<0.05. There has also been an increased propensity to report more p-values over time. The distribution of p-values showed a step change at the conventional significance threshold of 0.05. The odds ratio of a "significant" p-value being reported in the abstract compared to the full text was calculated to be 2.52 (95% confidence interval 1.78-3.58; p<0.001). Taken together, these results provide strong evidence for selective reporting of significant p-values in abstracts. CONCLUSION Statistically significant p-values are preferentially reported in radiology journal abstracts.
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Affiliation(s)
- M-S To
- Flinders Health and Medical Research Institute, Bedford Park, SA, Australia; Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia.
| | - L Lu
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - M Tran
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - C Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
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Mijnster T, Boersma GJ, Meijer E, Lancel M. Effectivity of (Personalized) Cognitive Behavioral Therapy for Insomnia in Mental Health Populations and the Elderly: An Overview. J Pers Med 2022; 12:1070. [PMID: 35887566 PMCID: PMC9319701 DOI: 10.3390/jpm12071070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Insomnia is very prevalent in psychiatry and is considered a transdiagnostic symptom of mental disorders. Yet, it is not only a consequence of a mental condition but may also exert detrimental effects on psychiatric symptom severity and therapeutic response; thus, adequate insomnia treatment is particularly important in psychiatric populations. The first choice of intervention is cognitive behavioral therapy for insomnia (CBT-I) as it is rather effective, also in the long run without side effects. It is offered in various forms, ranging from in-person therapy to internet-delivered applications. CBT-I protocols are typically developed for individuals with insomnia disorder without co-occurring conditions. For an optimal therapeutic outcome of CBT-I in individuals with comorbid mental disorders, adaptations of the protocol to tailor the treatment might be beneficial. Based on a literature search using major search engines (Embase; Medline; APA Psych Info; and Cochrane Reviews), this paper provides an overview of the effectiveness of the different CBT-I applications in individuals with diverse comorbid mental conditions and older adults and describes the functionality of CBT-I protocols that have been personalized to specific psychiatric populations, such as depression, substance abuse, and schizophrenia spectrum disorder. Finally, we discuss urgent needs for insomnia therapy targeted to improve both sleep and psychopathologies.
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Affiliation(s)
- Teus Mijnster
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
| | - Gretha J. Boersma
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
- Forensic Psychiatric Hospital, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands
| | - Esther Meijer
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
| | - Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
- Forensic Psychiatric Hospital, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 TS Groningen, The Netherlands
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Brown S, Girling C, Thapa Magar H, Chaudry A, Bhatti B, Sayers A, Hind D. Guidelines, guidelines and more guidelines for haemorrhoid treatment: A review to sort the wheat from the chaff. Colorectal Dis 2022; 24:764-772. [PMID: 35119707 PMCID: PMC9310584 DOI: 10.1111/codi.16078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 01/15/2023]
Abstract
AIM Guidelines benefit patients and clinicians by distilling evidence into easy-to-read recommendations. The literature around the management of haemorrhoids is immense and guidelines are invaluable to improve treatment integrity and patient outcomes. We identified current haemorrhoid guidelines and assessed them for quality and consistency. METHODS A systematic search of the literature from January 2011 to October 2021 was carried out. Guidelines identified were assessed for quality using the AGREE II instrument and for consistency in terms of tabulated treatment recommendations. RESULTS During this period nine guidelines were identified worldwide. The general quality was poor with only one guideline considered of high enough quality for use. In general, expert selection criteria for guideline development groups were vaguely defined. There were inconsistencies in the interpretation of the published evidence leading to variation in treatment recommendations. DISCUSSION Fewer, higher quality guidelines, with more consistent results, are needed. Particular attention should be given to defining the selection of experts involved.
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Affiliation(s)
- Steven Brown
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Carla Girling
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Adeeb Chaudry
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Brian Bhatti
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Adele Sayers
- NHS Foundation TrustSheffield Teaching HospitalSheffieldUK
| | - Daniel Hind
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Schnell D, Bourmaud A, Reynaud M, Rouleau S, Merdji H, Boivin A, Benyamina M, Vincent F, Lautrette A, Leroy C, Cohen Y, Legrand M, Morel J, Terreaux J, Darmon M. Performance of renal Doppler to predict the occurrence of acute kidney injury in patients without acute kidney injury at admission. J Crit Care 2022; 69:153983. [DOI: 10.1016/j.jcrc.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
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Agarwal A, Oczkowski S, Sevransky J. Phase 2 Vitamin C Sepsis Trials: Another Brick in the (Evidence) Wall? Crit Care Med 2022; 50:897-899. [PMID: 35485591 PMCID: PMC9118696 DOI: 10.1097/ccm.0000000000005432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ankita Agarwal
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Emory Center for Critical Care, Emory University, Atlanta, GA
| | - Simon Oczkowski
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jonathan Sevransky
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Emory Center for Critical Care, Emory University, Atlanta, GA
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Liu Q, Yan W, Liu R, Bo E, Liu J, Liu M. The Association Between Diabetes Mellitus and the Risk of Latent Tuberculosis Infection: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:899821. [PMID: 35547228 PMCID: PMC9082645 DOI: 10.3389/fmed.2022.899821] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background The estimated global latent tuberculosis infection (LTBI) burden indicates a large reservoir of population at risk of developing active tuberculosis (TB). Previous studies suggested diabetes mellitus (DM) might associate with LTBI, though still controversial. We aimed to systematically assess the association between DM and LTBI. Methods We searched PubMed, Embase, Cochrane Library and Web of Science. Observational studies reporting the number of LTBI and non-LTBI individuals with and without DM were included. Random-effects or fixed-effects models were used to estimate the pooled effect by risk ratios (RRs) and odds ratios (ORs) and its 95% confidence interval (CI), using the original number of participants involved. Results 20 studies involving 4,055,082 participants were included. The pooled effect showed a significant association between DM and LTBI (for cohort studies, RR = 1.62, 95% CI: 1.02-2.56; for cross-sectional studies, OR = 1.55, 95% CI: 1.30-1.84). The pooled OR was high in studies with healthcare workers (5.27, 95% CI: 1.52-8.20), refugees (2.88, 95% CI: 1.93-4.29), sample size of 1,000-5,000 (1.99, 95% CI: 1.49-2.66), and male participants accounted for less than 40% (2.28, 95% CI: 1.28-4.06). Prediabetes also associated with LTBI (OR = 1.36, 95% CI: 1.01-1.84). Conclusion The risk of LTBI was found to be a 60% increase in DM patients, compared with non-DM patients. LTBI screening among DM patients could be of vital importance. More studies are needed to explore appropriate strategies for targeted LTBI screening among DM patients.
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Affiliation(s)
- Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Runqing Liu
- School of Health Humanities, Peking University, Beijing, China
| | - Ershu Bo
- School of Basic Medicine, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Jiang J, Ye G, Wang J, Xu X, Zhang K, Wang S. The Comparison of Short- and Long-Term Outcomes for Laparoscopic Versus Open Gastrectomy for Patients With Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials. Front Oncol 2022; 12:844803. [PMID: 35449576 PMCID: PMC9016843 DOI: 10.3389/fonc.2022.844803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The effect of laparoscopic gastrectomy (LG) for the treatment of advanced gastric cancer (AGC) is still controversial. The aim of this meta-analysis was to contrast the short- and long-term outcomes of laparoscopic versus conventional open gastrectomy (OG) for patients with AGC. Methods Databases including PubMed, Embase, Scopus, and Cochrane Library were systematically searched until December 2021 for randomized controlled trial-enrolled patients undergoing LG or OG for the treatment of AGC. Short-term outcomes were overall postoperative complications, anastomotic leakage, number of retrieved lymph node, surgical time, blood loss, length of hospital stay, and short-term mortality. Long-term outcomes were survival rates at 1, 3, and 5 years. Results A total of 12 trials involving 4,101 patients (2,059 in LG group, 2,042 in OG group) were included. No effect on overall postoperative complications (OR 0.84, 95% CI 0.67 to 1.05, p = 0.12, I2 = 34%) and anastomotic leakage (OR 1.26, 95% CI 0.82 to 1.95, p = 0.30, I2 = 0%) was found. Compared with the open approach, patients receiving LG had fewer blood loss (MD -54.38, 95% CI -78.09 to -30.67, p < 0.00001, I2 = 90%) and shorter length of hospital stay (MD -1.25, 95% CI -2.08 to -0.42, p = 0.003, I2 = 86%). However, the LG was associated with a lower number of retrieved lymph nodes (MD -1.02, 95% CI -1.77 to -0.27, p = 0.008, I2 = 0%) and longer surgical time (MD 40.87, 95% CI 20.37 to 54.44, p < 0.00001, I2 = 94%). Furthermore, there were no differences between LG and OG groups in short-term mortality and survival rate at 1, 3, and 5 years. Conclusions LG offers improved short-term outcomes including shorter hospital stays and fewer blood loss, with comparable postoperative complications, short-term mortality, and survival rate at 1, 3, and 5 years when compared to the open approach. Our results support the implementation of LG in patients with AGC. Systematic Review Registration PROSPERO (CRD 42021297141).
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Affiliation(s)
- Jinyan Jiang
- Department of Nursing, Lishui People's Hospital, Lishui, China
| | - Guanxiong Ye
- Department of General Surgery, Lishui People's Hospital, Lishui, China
| | - Jun Wang
- Department of General Surgery, Lishui People's Hospital, Lishui, China
| | - Xiaoya Xu
- Department of General Surgery, Lishui People's Hospital, Lishui, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shi Wang
- Department of General Surgery, Lishui People's Hospital, Lishui, China
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Guerra BA, Pereira TG, Eckert IC, Bernardes S, Silva FM. Markers of respiratory function response to high-carbohydrate and high-fat intake in patients with lung diseases: a systematic review with meta-analysis of randomized clinical trials. JPEN J Parenter Enteral Nutr 2022; 46:1522-1534. [PMID: 35437762 DOI: 10.1002/jpen.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Macronutrients can differently affect respiratory function markers such as VO2 , VCO2 , PaO2 , PaCO2 and respiratory quotients (RQ), but systematic appraisal of the evidence on randomized clinical trials (RCTs) is lacking. OBJECTIVE To compare the response of respiratory function markers to high-carbohydrate and high-fat intake in patients with lung diseases. METHODS Systematic review conducted according to Cochrane Collaboration recommendations, reported following PRISMA 2020. PubMed, EMBASE, Scopus, and Cochrane CENTRAL were searched up to July/2021. Two reviewers selected the RCTs and extracted the data. Risk of bias and the certainty of evidence were assessed by RoB 2 and GRADE, respectively. Statistical and graphical data guided the publication bias investigation. Meta-analyses were conducted. RESULTS We included 14 RCTs (362 participants), four of which were parallel. Most studies included patients with COPD. High-fat intake decreased VCO2 [MD = -35.89(95%CI -45.24; -26.21) ml/min; I²=0%], VO2 [MD= -29.30(95% CI -40.94, -17.66) ml/min; I² = 0%], PaCO2 [MD = -4.62(95%CI -7.67; -1.58) mmHg; I²=84%], and RQ [MD = -0.08(95%CI -0.09; -0.06); I² = 0%] in the subset of parallel RCTs. In crossover RCTs, there was generally no evidence of effect except for a greater decrease in RQ [MD = -0.09(95%CI -0.12; -0.02); I² = 96%] in favor of high fat intake. CONCLUSION High-fat intake resulted in greater reductions of VCO2 , VO2 , PaCO2 , and RQ in adult patients with lung diseases. The certainty of the evidence is very low/ low, and it precludes a specific recommendation on macronutrients contribution to energy intake of these patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bruno A Guerra
- Registered Dietitian, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Thainá G Pereira
- Registered Dietitian, Msc, Nutrition Science Graduate Program of Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Igor C Eckert
- Registered Dietitian, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Simone Bernardes
- Registered Dietitian, Msc, PhD student, Graduate Program of Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Registered Dietitian, Professor, Researcher, PhD, Nutrition Department and Nutrition Science Graduate Program of Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Cheema HA, Shahid A, Ayyan M, Mustafa B, Zahid A, Fatima M, Ehsan M, Athar F, Duric N, Szakmany T. Probiotics for the Prevention of Ventilator-Associated Pneumonia: An Updated Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2022; 14:1600. [PMID: 35458162 PMCID: PMC9031795 DOI: 10.3390/nu14081600] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Presently, there is conflicting evidence regarding the efficacy of probiotics in the prevention of ventilator-associated pneumonia (VAP). This meta-analysis was conducted to update current clinical evidence and evaluate the efficacy and safety of probiotics for the prevention of VAP. METHODS We searched three databases and two trial registers to retrieve randomised controlled trials (RCTs) comparing probiotics or synbiotics with placebo or standard treatment for the prevention of VAP in adult patients receiving mechanical ventilation in the intensive care unit (ICU). RESULTS Our meta-analysis included 18 RCTs involving 4893 patients. Our results showed that probiotics may reduce the incidence of VAP (RR 0.68, 95% CI: 0.55-0.84; low certainty). However, in our subgroup and sensitivity analyses, the effect was not significant in double-blind studies, and in studies with a low risk of bias in the randomisation process. Probiotics reduced the length of ICU stay (MD -2.22 days, 95% CI: -4.17 to -0.28; moderate certainty) and the duration of antibiotic use (MD -1.25 days, 95% CI -1.86 to -0.64; moderate certainty). CONCLUSIONS Probiotics may reduce the incidence of VAP but due to the low quality of pooled evidence, the use of probiotics warrants caution. Further, large-scale, high-quality RCTs need to be conducted to provide conclusive evidence.
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Affiliation(s)
- Huzaifa Ahmad Cheema
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Abia Shahid
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Muhammad Ayyan
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Biah Mustafa
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Afra Zahid
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Maurish Fatima
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Muhammad Ehsan
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Farwa Athar
- Department of Medicine, King Edward Medical University, Lahore 54000, Pakistan; (A.S.); (M.A.); (B.M.); (A.Z.); (M.F.); (M.E.); (F.A.)
| | - Natalie Duric
- Critical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK;
| | - Tamas Szakmany
- Critical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK;
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
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Liao J, Zhan Y, Wu H, Yao Z, Peng X, Lai J. Effect of aggressive versus conservative hydration for early phase of acute pancreatitis in adult patients: A meta-analysis of 3,127 cases. Pancreatology 2022; 22:226-234. [PMID: 35031209 DOI: 10.1016/j.pan.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The advantages of aggressive hydration compared to conservative hydration within 24 h for acute pancreatitis (AP) remain controversial in adult patients. A meta-analysis was undertaken to investigate whether aggressive strategies are more beneficial. METHODS We searched (on February 1, 2021) PubMed, Embase, and the Cochrane Library for eligible trials that assessed the two therapies and performed a meta-analysis. The primary endpoint was in-hospital mortality. Secondary outcomes were adverse events (e.g., renal failure and pancreatic necrosis) within 24 h of treatment. RESULTS Five randomized controlled trials and 8 observational trials involving 3127 patients were identified. Patients with severe pancreatitis showed significant difference of in-hospital mortality (OR 1.75; 95% CI 1.32-2.33) in aggressive hydration group, which were less susceptible to study type and age. Patients with severe pancreatitis were likely to develop respiratory failure (OR 5.08; 95% CI 2.31-11.15), persistent SIRS (OR 2.83; 95% CI 1.58-5.04), renal failure (OR 2.58; 95% CI 1.90-3.50) with significant difference. A longer hospital stay was observed in patients with severe pancreatitis (WMD 7.61; 95% CI 5.51-9.71; P < 0.05) in the aggressive hydration group. Higher incidence of pancreatic necrosis (OR 2.34; 95% CI 1.60-3.42; P < 0.05) was major susceptible to observational studies, old patients and mild pancreatitis. CONCLUSIONS Compared to conservative hydration, aggressive hydration increases in-hospital mortality and the incidence of renal failure, pancreatic necrosis with relatively strong evidence. Further investigation should be designed with a definitive follow-up period and therapeutic goals to address reverse causation bias.
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Affiliation(s)
- Jiyang Liao
- Department of Intensive Care Unit, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 Shajing Street, Baoan District, Shenzhen, 518000, Guangdong Province, China
| | - Yang Zhan
- The Acupuncture Rehabilitation Clinical College of Guangzhou University of Chinese Medicine, No. 12 Airport Road, Baiyun District, Guangzhou, 510000, Guangdong Province, China
| | - Huachu Wu
- Department of Intensive Care Unit, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 Shajing Street, Baoan District, Shenzhen, 518000, Guangdong Province, China
| | - Zhijun Yao
- Department of Intensive Care Unit, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 Shajing Street, Baoan District, Shenzhen, 518000, Guangdong Province, China
| | - Xian Peng
- Department of Intensive Care Unit, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 Shajing Street, Baoan District, Shenzhen, 518000, Guangdong Province, China
| | - Jianbo Lai
- Department of Intensive Care Unit, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 Shajing Street, Baoan District, Shenzhen, 518000, Guangdong Province, China.
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Lau Y, Yen KY, Wong SH, Cheng JY, Cheng LJ. Effect of digital cognitive behavioral therapy on psychological symptoms among perinatal women in high income-countries: A systematic review and meta-regression. J Psychiatr Res 2022; 146:234-248. [PMID: 34774299 DOI: 10.1016/j.jpsychires.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/11/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Several reviews focused on the use of digital cognitive behavioral therapy (CBT) across different populations. This review synthesized randomized controlled trials (RCTs) that evaluated the effectiveness of digital CBT on psychological symptoms (depression, anxiety, and stress symptoms). An extensive search was conducted in 10 databases from inception until August 29, 2021. A meta-analysis using a random-effects model was performed using Hedges' g. The potential sources of heterogeneity were explored through subgroup analyses and meta-regression analysis. A total of 18 RCTs in 2514 perinatal women were identified from over 23 countries. The sample size ranged from 25 to 910. Meta-analyses showed that digital CBT significantly reduced depression (g = -0.56, 95% CI: -0.85, -0.27, I2 = 84.81%, p < 0.001), anxiety (g = -0.30, 95% CI: -0.44, -0.17, I2 = 0%, p < 0.001), and stress (g = -0.75, 95% CI: -0.95, -0.56, I2 = 0%, p < 0.001) symptoms at post-intervention and stress symptoms at follow-up (g = -0.52, 95% CI: -0.93, -0.11, I2 = 0%, p = 0.01) compared with those in the control group. Subgroup analyses highlighted that the intervention was effective when CBT was combined with other therapeutic components which delivered via a mobile application. Preferable features of intervention should be more than eight sessions and conducted for than 6 weeks among postnatal women. Multivariable meta-regression showed that age was a significant covariate on depression symptoms. The sample size in the selected RCTs was small, and the overall quality of the evidence was very low. Digital CBT is a potential intervention for alleviating psychological outcomes in perinatal women. This review suggests the essential features to optimize the intervention effect. Further well-designed RCTs with large sample sizes are necessary.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Kai Yoong Yen
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sai Ho Wong
- Alexandra Hospital, National University Health System, Singapore.
| | - Jing Ying Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Song H, Hu W, Zhou X, Tao J, Zhang S, Su X, Wu W. Clinical Benefits From Administering Probiotics to Mechanical Ventilated Patients in Intensive Care Unit: A PRISMA-Guided Meta-Analysis. Front Nutr 2022; 8:798827. [PMID: 35155520 PMCID: PMC8829544 DOI: 10.3389/fnut.2021.798827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background The use of probiotics has been considered as a new intervention for ventilator-associated pneumonia (VAP) prevention in the intensive care unit (ICU). The aim of this meta-analysis was to evaluate the effect of probiotics on mechanical-ventilated patients in ICU. Methods PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) from their respective inception through October 10, 2021. All studies meeting the inclusion criteria were selected to evaluate the effect of probiotics on patients receiving mechanical ventilation in ICU. Results A total of 15 studies involving 4,693 participants met our inclusion criterion and were included in this meta-analysis. The incidence of VAP in the probiotic group was significantly lower (odds ratio [OR] 0.58, 95% CI 0.41 to 0.81; p = 0.002; I2 = 71%). However, a publication bias may be present as the test of asymmetry was significant (p = 0.007). The probiotic administration was associated with a significant reduction in the duration of mechanical ventilation (mean difference [MD] −1.57, 95% CI −3.12 to −0.03; p = 0.05; inconsistency [I]2 = 80%), length of ICU stay (MD −1.87, 95% CI −3.45 to −0.28; p = 0.02; I2 = 76%), and incidence of bacterial colonization (OR 0.59, 95% CI 0.45 to 0.78; p = 0.0001; I2 = 34%). Moreover, no statistically significant differences were observed regarding the incidence of diarrhea (OR 0.90, 95% CI 0.65 to 1.25; p = 0.54; I2 = 12%) and mortality (OR 0.91, 95% CI 0.80 to 1.05; p = 0.19; I2 = 0%) between probiotics group and control group. Conclusion Our meta-analysis shows that probiotics are associated with a reduction in VAP, as well as the duration of mechanical ventilation, ICU length of stay, and bacterial colonization, but no significant effects on ICU mortality and occurrence of diarrhea. However, in consideration of the significant heterogeneity and publication bias, our findings need to be further validated. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42020150770.
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Affiliation(s)
- Hongzhuan Song
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Wenqing Hu
- Department of Emergency, Haining People's Hospital, Haining, China
| | - Xiujie Zhou
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Jiaping Tao
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Siyi Zhang
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Xuhong Su
- Department of Hematology, Haining People's Hospital, Haining, China
| | - Wenjun Wu
- Department of Hematology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Wenjun Wu
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Adachi T, Yamada K, Fujino H, Enomoto K, Shibata M. Associations between anger and chronic primary pain: a systematic review and meta-analysis. Scand J Pain 2022; 22:1-13. [PMID: 34908255 DOI: 10.1515/sjpain-2021-0154] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Anger is a negative emotion characterized by antagonism toward someone or something, is rooted in an appraisal or attribution of wrongdoing, and is accompanied by an action tendency to undo the wrongdoing. Anger is prevalent in individuals with chronic pain, especially those with chronic primary pain. The associations between anger and pain-related outcomes (e.g., pain intensity, disability) have been examined in previous studies. However, to our knowledge, no systematic review or meta-analysis has summarized the findings of anger-pain associations through a focus on chronic primary pain. Hence, we sought to summarize the findings on the associations of anger-related variables with pain and disability in individuals with chronic primary pain. METHODS All studies reporting at least one association between anger-related variables and the two pain-related outcomes in individuals with chronic primary pain were eligible. We searched electronic databases using keywords relevant to anger and chronic primary pain. Multiple reviewers independently screened for study eligibility, data extraction, and methodological quality assessment. RESULTS Thirty-eight studies were included in this systematic review, of which 20 provided data for meta-analyses (2,682 participants with chronic primary pain). Of the included studies, 68.4% had a medium methodological quality. Evidence showed mixed results in the qualitative synthesis. Most anger-related variables had significant positive pooled correlations with small to moderate effect sizes for pain and disability. CONCLUSIONS Through a comprehensive search, we identified several key anger-related variables associated with pain-related outcomes. In particular, associations with perceived injustice were substantial.
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Affiliation(s)
- Tomonori Adachi
- Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Keiko Yamada
- Department of Psychology, McGill University, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Haruo Fujino
- United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Kiyoka Enomoto
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
- Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Masahiko Shibata
- Department of Health Science, Naragakuen University, Nara, Nara, Japan
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Nielsen OH, Gubatan JM, Juhl CB, Streett SE, Maxwell C. Biologics for Inflammatory Bowel Disease and Their Safety in Pregnancy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2022; 20:74-87.e3. [PMID: 32931960 DOI: 10.1016/j.cgh.2020.09.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Biologics are used routinely in pregnant women with inflammatory bowel disease (IBD), but large-scale data reporting adverse pregnancy outcomes among biologic users are lacking. We sought to estimate the prevalence of adverse pregnancy outcomes in women with IBD on biologic therapies. METHODS We searched major databases from inception to June 2020 for studies estimating the prevalence of adverse pregnancy outcomes in IBD when using biologics (anti-tumor necrosis factor [TNF], anti-integrins, and anticytokines). Prevalence and relative risk (RR) were pooled using a random-effects model. RESULTS Forty-eight studies were included in the meta-analysis comprising 6963 patients. Biologic therapy in IBD pregnancies was associated with a pooled prevalence of 8% (95% CI, 6%-10%; I2 = 87.4%) for early pregnancy loss, 9% (95% CI, 7%-11%; I2 = 89.9%) for preterm birth, 0% (95% CI, 0%-0%; I2 = 0%) for stillbirth, 8% (95% CI, 5%-10%; I2 = 87.0%) for low birth weight, and 1% (95% CI, 1%-2%; I2 = 78.3%) for congenital malformations. These rates are comparable with those published in the general population. In subgroup analyses of a small number of studies, the prevalence of early pregnancy loss and preterm birth were higher in vedolizumab vs anti-TNF users. Meta-regression did not show an association of disease activity or concomitant thiopurine on adverse outcomes. Continued TNF inhibitor use during the third trimester was not associated with risk of preterm birth (RR, 1.41; 95% CI, 0.77-2.60; I2 = 0%), low birth weight (RR, 1.32; 95% CI, 0.80-2.18; I2 = 0%), or congenital malformations (RR, 1.28; 95% CI, 0.47-3.49; I2 = 0%). CONCLUSIONS Adverse pregnancy outcomes among pregnant IBD women using biologics are comparable with that of the general population. PROSPERO protocol #CRD42019135721.
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Affiliation(s)
- Ole Haagen Nielsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - John Mark Gubatan
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carsten Bogh Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Elizabeth Streett
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Cynthia Maxwell
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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Tu J, Mo X, Zhang X, Xun J, Chen X, Liu Y, Jing W, Xie T. Effects of different corticosteroid therapy on severe COVID-19 patients: a meta-analysis of randomized controlled trials. Expert Rev Respir Med 2022; 16:79-89. [PMID: 34541972 PMCID: PMC8500308 DOI: 10.1080/17476348.2021.1983429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND To assess the efficacy and safety of corticosteroids in COVID-19 patients compared with standard care or placebo. METHODS Electronic databases were searched to identify relevant studies. The mortality, adverse events, and other data from studies were pooled for statistical analysis. RESULTS Ten randomized clinical trials were eligible for inclusion. Corticosteroid treatment in COVID-19 patients did not significantly reduce the risk of death (RR: 0.93; CI: 0.82, 1.05) and the need for mechanical ventilation (RR: 0.82; CI: 0.62, 1.08). No mortality reduction was also observed in the subgroup of patients requiring mechanical ventilation (RR: 0.90; CI: 0.79-1.03). The use of corticosteroids increased mortality in the subgroup of patients not requiring oxygen support (RR: 1.24; CI: 1.00-1.55). The survival benefit was observed in a low dosage of corticosteroids (RR: 0.90; CI: 0.84-0.97) and dexamethasone (RR: 0.90; 95% CI: 0.79-1.04). There was no difference in the rates of adverse events (RR: 1.13; CI: 0.58, 2.20) and secondary infections (RR: 0.87; CI: 0.66, 1.15). CONCLUSION Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. Low-dose dexamethasone could be considered as a drug for the treatment of COVID-19 patients. More high-quality trials are needed to further verify this conclusion.Expert Opinion: The effect of corticosteroids on patient survival highly depended on the selection of the right dosage and type and in a specific subgroup of patients. This meta-analysis, which included more RCTs, evaluated the safety and efficacy in severe COVID-19 patients and analyzed the effects of different types of corticosteroid treatments. Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. But the low dose dexamethasone appear to have a role in the management of severe COVID-19 patients.
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Affiliation(s)
- Jiayuan Tu
- School of Chemistry and Life Science, Nanjing University Jinling College, Nanjing, China
| | - Xiaoqiao Mo
- Department of Operating Room, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangda Zhang
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jing Xun
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xueshun Chen
- School of Chemistry and Life Science, Nanjing University Jinling College, Nanjing, China
| | - Yun Liu
- Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenhua Jing
- School of Chemistry and Life Science, Nanjing University Jinling College, Nanjing, China
| | - Tian Xie
- Department of Hepatobiliary and Pancreatic Surgery, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
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Wang C, Chen Q, Wang P, Jin W, Zhong C, Ge Z, Xu K. The Effect of Dexmedetomidine as a Sedative Agent for Mechanically Ventilated Patients With Sepsis: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:776882. [PMID: 34966760 PMCID: PMC8711777 DOI: 10.3389/fmed.2021.776882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose: Dexmedetomidine has been shown to improve clinical outcomes in critically ill patients. However, its effect on septic patients remains controversial. Therefore, the purpose of this meta-analysis was to assess the effect of dexmedetomidine as a sedative agent for mechanically ventilated patients with sepsis. Methods: We searched PubMed, Embase, Scopus, and Cochrane Library from inception through May 2021 for randomized controlled trials that enrolled mechanically ventilated, adult septic patients comparing dexmedetomidine with other sedatives or placebo. Results: A total of nine studies involving 1,134 patients were included in our meta-analysis. The overall mortality (RR 0.97, 95%CI 0.82 to 1.13, P = 0.67, I2 = 25%), length of intensive care unit stay (MD -1.12, 95%CI -2.89 to 0.64, P = 0.21, I2 = 71%), incidence of delirium (RR 0.95, 95%CI 0.72 to 1.25, P = 0.70, I2 = 0%), and delirium free days (MD 1.76, 95%CI -0.94 to 4.47, P = 0.20, I2 = 80%) were not significantly different between dexmedetomidine and other sedative agents. Alternatively, the use of dexmedetomidine was associated with a significant reduction in the duration of mechanical ventilation (MD -0.53, 95%CI -0.85 to -0.21, P = 0.001, I2 = 0%) and inflammatory response (TNF-α: MD -5.27, 95%CI -7.99 to -2.54, P<0.001, I2 = 0%; IL-1β: MD -1.25, 95%CI -1.91 to -0.59, P<0.001, I2 = 0%). Conclusions: For patients with sepsis, the use of dexmedetomidine as compared with other sedative agents does not affect all-cause mortality, length of intensive care unit stay, the incidence of delirium, and delirium-free days. But the dexmedetomidine was associated with the reduced duration of mechanical ventilation and inflammatory response.
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Affiliation(s)
- Caimu Wang
- General Intensive Care Unit, Ninghai First Hospital, Ningbo, China
| | - Qijiang Chen
- General Intensive Care Unit, Ninghai First Hospital, Ningbo, China
| | - Ping Wang
- General Intensive Care Unit, Ninghai First Hospital, Ningbo, China
| | - Weisheng Jin
- General Intensive Care Unit, Ninghai First Hospital, Ningbo, China
| | - Chao Zhong
- General Intensive Care Unit, Ninghai First Hospital, Ningbo, China
| | - Zisheng Ge
- General Intensive Care Unit, Ninghai First Hospital, Ningbo, China
| | - Kangmin Xu
- General Intensive Care Unit, Ninghai First Hospital, Ningbo, China
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Deng J, Zhou F, Hou W, Heybati K, Ali S, Chang O, Silver Z, Dhivagaran T, Ramaraju HB, Wong CY, Zuo QK, Lapshina E, Mellett M. Efficacy of lopinavir-ritonavir combination therapy for the treatment of hospitalized COVID-19 patients: a meta-analysis. Future Virol 2021; 17:10.2217/fvl-2021-0066. [PMID: 35145560 PMCID: PMC8815807 DOI: 10.2217/fvl-2021-0066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 12/08/2021] [Indexed: 12/15/2022]
Abstract
Aim: To evaluate the efficacy and safety of lopinavir-ritonavir (LPV/r) therapy in treating hospitalized COVID-19 patients. Materials & methods: Data from randomized and observational studies were included in meta-analyses. Primary outcomes were length of stay, time for SARS-CoV-2 test conversion, mortality, incidence of mechanical ventilation, time to body temperature normalization and incidence of adverse events. Results: Twenty-four studies (n = 10,718) were included. LPV/r demonstrated no significant benefit over the control groups in all efficacy outcomes. The use of LPV/r was associated with a significant increase in the odds of adverse events. Conclusion: Given the lack of efficacy and increased incidence of adverse events, the clinical use of LPV/r in hospitalized COVID-19 patients is not recommended.
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Affiliation(s)
- Jiawen Deng
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Wenteng Hou
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Kiyan Heybati
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Saif Ali
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Oswin Chang
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Zachary Silver
- Faculty of Science, Carleton University, 1125 Colonel By Dr, Ottawa, ON, K1S 5B6, Canada
| | - Thanansayan Dhivagaran
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
- Integrated Biomedical Engineering & Health Sciences Program, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | | | - Chi Yi Wong
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Qi Kang Zuo
- Department of Anesthesiology, Rutgers, New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Elizabeth Lapshina
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Madeline Mellett
- Faculty of Science, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
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Comment on "Perioperative Probiotics or Synbiotics in Adults Undergoing Elective Abdominal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials". Ann Surg 2021; 274:e675-e676. [PMID: 31895710 DOI: 10.1097/sla.0000000000003762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Pelayo J, Lo KB, Peterson E, DeFaria C, Nehvi A, Torres R, Maqsood MH, Farooq M, Mathew RO, Rangaswami J. Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers and outcomes in patients with acute decompensated heart failure: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:1037-1043. [PMID: 34751630 DOI: 10.1080/14779072.2021.2004121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin-receptor blocker (ARB) are cornerstones in the treatment of heart failure with reduced ejection (HFrEF). However, there are limited data on their risk-benefit profile in patients with acute heart failure requiring hospitalizations. METHODS We did a meta-analysis pooling data from all studies examining the use of ACEi/ARB in patients hospitalized for heart failure compared to patients without ACEi/ARB use. We calculated pooled hazard ratios (HR) and their 95% confidence intervals (CI) using a random-effects model. RESULTS Twenty-five studies were included in the meta-analysis. Continued use of ACEi/ARBs in hospitalized patients with HFrEF was associated with lower 1-year mortality risk (pooled HR 0.68 [0.60-0.77] p < 0.001) and with lower 1-6-year mortality risk in those with heart failure preserved ejection fraction (HFpEF) (pooled HR 0.86 [0.78-0.94] p = 0.002). There were significant reductions in 1-year HF readmissions among hospitalized HFrEF patients (pooled HR 0.83 [0.73-0.95] p = 0.005). CONCLUSION Maintaining or initiating patients with HFrEF hospitalized for acute decompensated heart failure (ADHF) on ACEi/ARB is associated with a reduce risk of mortality and 1-year admissions, but the effect size is lower among those with HFpEF with more heterogeneous outcomes.
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Affiliation(s)
- Jerald Pelayo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Eric Peterson
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Carly DeFaria
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Atif Nehvi
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Ricardo Torres
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Minaam Farooq
- Department of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Roy O Mathew
- Division of Nephrology, Columbia Va Health Care System, Columbia, SC, USA
| | - Janani Rangaswami
- Department of Nephrology, George Washington University, Washington, DC, USA
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Honarmand K, Penn J, Agarwal A, Siemieniuk R, Brignardello-Petersen R, Bartoszko JJ, Zeraatkar D, Agoritsas T, Burns K, Fernando SM, Foroutan F, Ge L, Lamontagne F, Jimenez-Mora MA, Murthy S, Yepes-Nuñez JJ, Vandvik PO, Ye Z, Rochwerg B. Clinical trials in COVID-19 management & prevention: A meta-epidemiological study examining methodological quality. J Clin Epidemiol 2021; 139:68-79. [PMID: 34274489 PMCID: PMC8280397 DOI: 10.1016/j.jclinepi.2021.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the characteristics of Covid-19 randomized clinical trials (RCTs) and examine the association between trial characteristics and the likelihood of finding a significant effect. STUDY DESIGN We conducted a systematic review to identify RCTs (up to October 21, 2020) evaluating drugs or blood products to treat or prevent Covid-19. We extracted trial characteristics (number of centers, funding sources, and sample size) and assessed risk of bias (RoB) using the Cochrane RoB 2.0 tool. We performed logistic regressions to evaluate the association between RoB due to randomization, single vs. multicentre, funding source, and sample size, and finding a statistically significant effect. RESULTS We included 91 RCTs (n = 46,802); 40 (44%) were single-center, 23 (25.3%) enrolled <50 patients, 28 (30.8%) received industry funding, and 75 (82.4%) had high or probably high RoB. Thirty-eight trials (41.8%) reported a statistically significant effect. RoB due to randomization and being a single-center trial were associated with increased odds of finding a statistically significant effect. CONCLUSIONS There is high variability in RoB among Covid-19 trials. Researchers, funders, and knowledge-users should be cognizant of the impact of RoB due to randomization and single-center trial status in designing, evaluating, and interpreting the results of RCTs. REGISTRATION CRD42020192095.
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Affiliation(s)
- Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western University, 1151 Richmond Street London, Ontario, N6A 3K7, Canada.
| | - Jeremy Penn
- Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada; Department of Biomedical Informatics, Harvard Medical School, Boston, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada; Division General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4 1205, Geneva, Switzerland
| | - Karen Burns
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada; Unity Health Toronto, St. Michael's Hospital, Li Ka Shing Knowledge Institute, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario, K1N 6N5, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, 222 Tianshui S Rd, Chengguan District, Lanzhou, Gansu, China
| | - Francois Lamontagne
- Department of Medicine and Centre de recherche du CHU de Sherbrooke, 12e Avenue N Porte 6, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Mario A Jimenez-Mora
- School of Medicine, Universidad de los Andes, Cra. 1 #18a-12, Bogotá D.C, Colombia
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Juan Jose Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Cra. 1 #18a-12, Bogotá D.C, Colombia; Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Cra. 7b (#)12390, Bogotá D.C, Colombia
| | - Per O Vandvik
- Department of Health and Society, Faculty of Medicine, University of Oslo, Problemveien 7, 0315, Oslo, Norway
| | - Zhikang Ye
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
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Baumeister H, Paganini S, Sander LB, Lin J, Schlicker S, Terhorst Y, Moshagen M, Bengel J, Lehr D, Ebert DD. Effectiveness of a Guided Internet- and Mobile-Based Intervention for Patients with Chronic Back Pain and Depression (WARD-BP): A Multicenter, Pragmatic Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:255-268. [PMID: 33321501 DOI: 10.1159/000511881] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is neither strong evidence on effective treatments for patients with chronic back pain (CBP) and depressive disorder nor sufficiently available mental health care offers. OBJECTIVE The aim is to assess the effectiveness of internet- and mobile-based interventions (IMI) as a scalable approach for treating depression in a routine care setting. METHODS This is an observer-masked, multicenter, pragmatic randomized controlled trial with a randomization ratio of 1:1.Patients with CBP and diagnosed depressive disorder (mild to moderate severity) were recruited from 82 orthopedic rehabilitation clinics across Germany. The intervention group (IG) received a guided depression IMI tailored to CBP next to treatment-as-usual (TAU; including medication), while the control group (CG) received TAU. The primary outcome was observer-masked clinician-rated Hamilton depression severity (9-week follow-up). The secondary outcomes were: further depression outcomes, pain-related outcomes, health-related quality of life, and work capacity. Biostatistician blinded analyses using regression models were conducted by intention-to-treat and per protocol analysis. RESULTS Between October 2015 and July 2017, we randomly assigned 210 participants (IG, n = 105; CG, n = 105), mostly with only a mild pain intensity but substantial pain disability. No statistically significant difference in depression severity between IG and CG was observed at the 9-week follow-up (β = -0.19, 95% CI -0.43 to 0.05). Explorative secondary depression (4/9) and pain-related (4/6) outcomes were in part significant (p < 0.05). Health-related quality of life was significantly higher in the IG. No differences were found in work capacity. CONCLUSION The results indicate that an IMI for patients with CBP and depression in a routine care setting has limited impact on depression. Benefits in pain and health-related outcomes suggest that an IMI might still be a useful measure to improve routine care.
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Affiliation(s)
- Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany,
| | - Sarah Paganini
- Department of Sport Psychology, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Jiaxi Lin
- Department of Psychiatry and Psychotherapy Medical Center, Freiburg, Germany
| | - Sandra Schlicker
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Morten Moshagen
- Department of Psychological Research Methods, Ulm University, Ulm, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, University of Lüneburg, Lüneburg, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Medical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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To MS, Di Ubaldo LJ, Wells AJ, Jukes A. Absence of small study effects in neurosurgical meta-analyses: A meta-epidemiological study. J Clin Neurosci 2021; 93:137-140. [PMID: 34656237 DOI: 10.1016/j.jocn.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 07/24/2021] [Accepted: 09/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Small studies are prone to lower methodological quality and publication bias, and are more likely to report greater beneficial effects. A meta-epidemiological study was undertaken to investigate and quantify the impact of small study effects on meta-analyses in the neurosurgical literature. METHODS A PubMed search was used to procure meta-analyses from Journal of Neurosurgery, Neurosurgery, Spine, Acta Neurochirurgica and Journal of Neurotrauma. Outcome data were extracted from meta-analyses the effect of study size was estimated by calculating the ratio of odds ratios (RORs) between small and large studies. RESULTS 16 meta-analyses of 229 primary studies and 90,629 patients were included. All but two included pooled outcomes were significantly different from 1. On average small studies did not demonstrate greater beneficial effects, with an estimated pooled ROR of 1.32 (95% CI, 0.89 to 1.75). Stratification by meta-analysis effect size and heterogeneity yielded similar findings. CONCLUSIONS The absence of small study effects in meta-analyses of neurosurgical studies may reflect widespread poor quality of the neurosurgical literature affecting both large and small studies, rather than an absence of publication bias.
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Affiliation(s)
- Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia.
| | - Lucas J Di Ubaldo
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Adam J Wells
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; DDepartment of Neurosurgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Alistair Jukes
- Department of Neurosurgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Nikniaz Z, Beheshti S, Abbasalizad Farhangi M, Nikniaz L. A systematic review and meta-analysis of the prevalence and odds of eating disorders in patients with celiac disease and vice-versa. Int J Eat Disord 2021; 54:1563-1574. [PMID: 34042201 DOI: 10.1002/eat.23561] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In the present systematic review and meta-analysis study, we aimed to review studies that assessed the prevalence and risk of eating disorders (EDs) in patients with celiac disease (CD) and vice-versa. METHOD We conducted a systematic search in PubMed, Embase, Scopus, and Web of Science for studies that assessed the prevalence and risk of AN in patients with CD and vice-versa. Joanna Briggs Institute tools were used for critical appraisal. The STATA software was used for the meta-analysis of the random-effect model. RESULTS In this study, 23 observational studies were included. The results of the meta-analysis indicated that the pooled prevalence of EDs and bulimia nervosa in patients with CD was 8.88% [95% CI: 6.4, 11.7] and 7.26% [95% CI: 0.23, 21.57], respectively. Moreover, the risk of anorexia nervosa in patients with CD was significantly higher than in the healthy population (relative risk [RR]: 1.48 [95% CI: 1.32, 1.64]). The rates of CD in patients with AN and EDs were 0.96% [95% CI: 0.15, 2.31] and 0.90% [95% CI: 0.56, 1.31], respectively. Moreover, the overall risk of CD in patients with AN was significantly higher compared with healthy adults (RR: 2.35 [95% CI: 1.27-3.44]). DISCUSSION The result of the present meta-analysis showed the high prevalence of EDs in patients with CD. Moreover, there was a significant bidirectional association between CD and EDs.
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Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samineh Beheshti
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Leila Nikniaz
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Duan Z, Cai G, Li J, Chen F, Chen X. Meta-Analysis of Renal Replacement Therapy for Burn Patients: Incidence Rate, Mortality, and Renal Outcome. Front Med (Lausanne) 2021; 8:708533. [PMID: 34434946 PMCID: PMC8381047 DOI: 10.3389/fmed.2021.708533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Renal replacement therapy (RRT) was often needed by some severe burn patients with acute kidney injury (AKI). The primary aim of this study was to review incidence rate and mortality of RRT in severe burn patients. Second aims were to review RRT complications and renal outcome. Methods: We searched multiple databases for studies published between 1 January 1960 and 31 December 2019. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 57 studies, including 27,437 patients were enrolled in our analysis. The prevalence rates of RRT were 8.34% (95% CI 7.18–9.5%) in all burn patients and 37.05% (95% CI 29.85–44.24%) in AKI patients. The mortality of all burn patients with RRT was 65.52% (95% CI 58.41–72.64%). The prevalence rates of RRT in sample size≥100 group were 6.86% (95% CI 5.70–8.03%), which was lower than that of <100 group (17.61%, 95% CI 13.39–21.82%). With the increase of TBSA, the prevalence of RRT may have the increasing trend. The prevalence rates of RRT in Asian group was 12.75% (95% CI 9.50–16.00%), which was higher than that of European (10.45%, 95% CI 7.30–13.61%) and North America group (5.61%, 95% CI 4.27–6.95%). The prevalence rates of RRT in 2010–2019 group was 12.22% (95% CI 10.09–14.35%), which was higher than that of 2009–2000 group (5.17%, 95% CI 2.88–7.46%). The prevalence rates of RRT in 1989 and before group was the lowest, which was 1.56% (95% CI 0–3.68%). However, there was no significant correlation between the year of publication and the mortality of burn patients with RRT. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain haemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence rate of RRT is about 6–8%; approximately, one-third of burn patients with AKI need RRT. The prevalence rate of RRT increased over time, but the mortality did not change. The prevalence rates of RRT in Asian group was higher than that of European and North America group.
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Affiliation(s)
- ZhiYu Duan
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Nephrology, The Fourth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - GuangYan Cai
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - JiJun Li
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Nephrology, The Fourth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - FengKun Chen
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Nephrology, The Fourth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - XiangMei Chen
- State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center for Kidney Diseases, Chinese People's Liberation Army Institute of Nephrology, Chinese People's Liberation Army General Hospital, Beijing, China
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Lu Z, Zhu X, Hua T, Zhang J, Xiao W, Jia D, Yang M. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis. BMJ Open 2021; 11:e045031. [PMID: 34373293 PMCID: PMC8354272 DOI: 10.1136/bmjopen-2020-045031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional 'step-up' strategy based on percutaneous catheter drainage (PCD). DESIGN Systematic review and meta-analysis. METHODS PubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional 'step-up' strategy based on PCD were included. OUTCOMES The primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay. RESULTS Five cohort studies and three RCTs were included in the analysis. Compared with the conventional 'step-up' method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) -0.31, 95% CI -0.53 to -0.10 and p=0.005; RCTs: SMD -0.45, 95% CI -0.64 to -0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD -2.49, 95% CI -4.46 to -0.51 and p<0.001; RCTs: SMD -0.67, 95% CI -0.89 to -0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04). CONCLUSIONS The findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the 'step-up' strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials. PROSPERO REGISTRATION NUMBER CRD42020168537.
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Affiliation(s)
- Zongqing Lu
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingxing Zhu
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jin Zhang
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Di Jia
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Eckert I, Koehler IC, Bauer J, Busnello FM, Silva FM. Effects of different sources of dietary protein on markers of kidney function in individuals with diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2021; 80:812-825. [PMID: 34338778 DOI: 10.1093/nutrit/nuab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT The type of dietary protein may modulate markers of diabetic kidney disease; however, no attempt to summarize the evidence from randomized controlled trials (RCTs) has been performed to date. OBJECTIVE To assess the effects of different types of dietary protein on urinary albumin excretion and glomerular filtration rate in individuals with diabetes. DATA SOURCES MEDLINE, EMBASE, and Scopus were searched for all published RCTs, with no language restriction, up to July 2020. DATA EXTRACTION Study selection and data extraction were performed independently by 3 authors. Risk of bias was assessed independently by 2 authors, and the GRADE approach was used to assess the quality of the evidence. RESULTS Twelve RCTs were included, of which 11 (involving 228 participants) were compiled in meta-analyses of random-effects models. Interventions consisted of diets emphasizing plant or white meat protein, with reduced intake of animal or red meat protein. Pooled data from crossover trials (n = 8) favored intervention diets for urinary albumin excretion (ratio of means, 0.86; 95% confidence interval 0.80 to 0.94; I2 = 4%) and glomerular filtration rate (ratio of means, 0.90; 95% confidence interval 0.87 to 0.94; I2 = 45%), compared with control diets. Results from parallel-design studies (n = 3), however, were not statistically significant for any outcome. The quality of the evidence ranged from very low to moderate, and most studies were judged with at least some concerns in terms of risk of bias. CONCLUSION This meta-analysis found weak evidence for small to moderate improvements in markers of kidney function in favor of interventions with lower animal protein (or red meat protein) compared with usual diets in short-term crossover trials. These findings require confirmation in well-designed randomized controlled trials.
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Affiliation(s)
- Igor Eckert
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Igor C Koehler
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Julia Bauer
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Fernanda M Busnello
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Flávia M Silva
- I. Eckert is with the Undergraduate Nutrition Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. I.C. Koehler is with the Undergraduate Medical Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. J. Bauer is with the Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil. F.M. Busnello and F.M. Silva are with the Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
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Vita A, Barlati S, Ceraso A, Nibbio G, Ariu C, Deste G, Wykes T. Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Psychiatry 2021; 78:848-858. [PMID: 33877289 PMCID: PMC8058696 DOI: 10.1001/jamapsychiatry.2021.0620] [Citation(s) in RCA: 222] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/17/2021] [Indexed: 12/30/2022]
Abstract
Importance Cognitive impairment is a core feature of schizophrenia, with negative consequences on functional outcomes. Although cognitive remediation (CR) is effective and mentioned in treatment guidance for schizophrenia, its active ingredients and ideal candidates are still debated. Objective To provide a comprehensive update on CR effectiveness for cognition and functioning in schizophrenia and analyze the core ingredients of efficacy and role of patient characteristics. Data Sources The reference list of the last comprehensive meta-analysis in 2011 was screened against eligibility criteria. Then, electronic databases (PubMed, Scopus, and PsycInfo) were systematically searched for articles published from January 2011 to February 2020. Reference lists of included articles and relevant reviews were hand searched, and Google Scholar was manually inspected. Study Selection Eligible studies were randomized clinical trials comparing CR with any other control condition in patients diagnosed with schizophrenia spectrum disorders (with an unrestricted clinical status). Screening was performed by at least 2 independent reviewers. Data Extraction and Synthesis The PRISMA guidelines were followed. Study data were independently extracted and pooled using random-effect models. Cohen d was used to measure outcomes. Trial methodological quality was evaluated with the Clinical Trials Assessment Measure. Main Outcomes and Measures Primary outcomes were changes in global cognition and overall functioning from baseline to after treatment, subsequently investigated through metaregressions, subgroup, and sensitivity analyses based on prespecified hypotheses, to identify potential moderators of response associated with treatment modality and patient characteristics. Results Of 1815 identified reports, 358 full texts were assessed and 194 reports on 130 studies were included. Based on 130 studies with 8851 participants, CR was effective on cognition (d, 0.29 [95% CI, 0.24-0.34]) and functioning (d, 0.22 [95% CI, 0.16-0.29]). An active and trained therapist (cognition: χ21, 4.14; P = .04; functioning: χ21, 4.26; P = .04), structured development of cognitive strategies (cognition: χ21, 9.34; P = .002; functioning: χ21, 8.12; P = .004), and integration with psychosocial rehabilitation (cognition: χ21, 5.66; functioning: χ21, 12.08) were crucial ingredients of efficacy. Patients with fewer years of education (global cognition: coefficient, -0.055 [95% CI, -0.103 to -0.006]; P = .03; global functioning: coefficient, -0.061 [95% CI, -0.112 to -0.011]; P = .02), lower premorbid IQ (global functioning: coefficient, -0.013 [-0.025 to -0.001]; P = .04), and higher baseline symptom severity (global cognition: coefficient, 0.006 [95% CI, 0.002 to 0.010]; P = .005) emerged as optimal candidates. Conclusions and Relevance These findings show that CR is an evidence-based intervention that should be included consistently into clinical guidelines for the treatment of individuals with schizophrenia and implemented more widely in clinical practice.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Anna Ceraso
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cassandra Ariu
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom
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Zhou X, Pan W, Chen B, Xu Z, Pan J. Predictive performance of dynamic arterial elastance for arterial pressure response to fluid expansion in mechanically ventilated hypotensive adults: a systematic review and meta-analysis of observational studies. Ann Intensive Care 2021; 11:119. [PMID: 34331607 PMCID: PMC8325731 DOI: 10.1186/s13613-021-00909-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dynamic arterial elastance (Eadyn) has been extensively considered as a functional parameter of arterial load. However, conflicting evidence has been obtained on the ability of Eadyn to predict mean arterial pressure (MAP) changes after fluid expansion. This meta-analysis sought to assess the predictive performance of Eadyn for the MAP response to fluid expansion in mechanically ventilated hypotensive patients. METHODS We systematically searched electronic databases through November 28, 2020, to retrieve studies that evaluated the association between Eadyn and fluid expansion-induced MAP increases in mechanically ventilated hypotensive adults. Given the diverse threshold value of Eadyn among the studies, we only reported the area under the hierarchical summary receiver operating characteristic curve (AUHSROC) as the primary measure of diagnostic accuracy. RESULTS Eight observational studies that included 323 patients with 361 fluid expansions met the eligibility criteria. The results showed that Eadyn was a good predictor of MAP increases in response to fluid expansion, with an AUHSROC of 0.92 [95% confidence interval (CI) 0.89 to 0.94]. Six studies reported the cut-off value of Eadyn, which ranged from 0.65 to 0.89. The cut-off value of Eadyn was nearly conically symmetrical, most data were centred between 0.7 and 0.8, and the mean and median values were 0.77 and 0.75, respectively. The subgroup analyses indicated that the AUHSROC was slightly higher in the intensive care unit (ICU) patients (0.96; 95% CI 0.94 to 0.98) but lower in the surgical patients in the operating room (0.72; 95% CI 0.67 to 0.75). The results indicated that the fluid type and measurement technique might not affect the diagnostic accuracy of Eadyn. Moreover, the AUHSROC for the sensitivity analysis of prospective studies was comparable to that in the primary analysis. CONCLUSIONS Eadyn exhibits good performance for predicting MAP increases in response to fluid expansion in mechanically ventilated hypotensive adults, especially in the ICU setting.
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Affiliation(s)
- Xiaoyang Zhou
- Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China
| | - Weihao Pan
- Department of Emergency, Ningbo Yinzhou No.2 Hospital, Ningbo, 315000, Zhejiang, China
| | - Bixin Chen
- Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China
| | - Zhaojun Xu
- Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China
| | - Jianneng Pan
- Department of Intensive Care Medicine, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China. .,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China.
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81
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Obotiba AD, Swain S, Kaur J, Yaseen K, Doherty M, Zhang W, Abhishek A. Synovitis and bone marrow lesions associate with symptoms and radiographic progression in hand osteoarthritis: a systematic review and meta-analysis of observational studies. Osteoarthritis Cartilage 2021; 29:946-955. [PMID: 33895290 DOI: 10.1016/j.joca.2021.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
AIMS To systematically review observational studies for the association between features detected on ultrasound (US) and magnetic resonance imaging (MRI) and, symptoms, signs and radiographic progression of hand osteoarthritis (OA). METHODS Medline, Web of Science, EMBASE, CINAHL and AMED were searched from inception to 14th January 2020 to identify relevant studies. Quality of studies was assessed using the Newcastle-Ottawa scales and data were extracted. Odds ratios (OR) and linear regression coefficients and 95% confidence intervals (CI) were pooled using the random-effects model (METAN package, Stata v16.1). Heterogeneity and publication bias were assessed. RESULTS Thirty-two studies using US and MRI comprising 1,350 and 638 participants respectively were included. While only grey-scale synovitis (GSS) associated with AUSCAN-pain (pooled Regression coefficient (95% CI): 0.46 (0.13-0.79); 0-20 scale for AUSCAN-pain), US-detected osteophytes, GSS and power Doppler (PD) [pooled ORs (95% CI): 2.68(2.16-3.33), 2.38(1.74-3.26) and 2.04 (1.45-2.88)] as well as MRI-detected bone marrow lesions (BMLs), synovitis, osteophytes, and central bone erosions (CBEs) associated with joint tenderness [pooled ORs (95% CI): 2.59(2.12-3.18), 2.17(1.85-2.54), 2.15(1.55-2.99), and 2.41 (1.45-4.02)] respectively. US-detected GSS and PD associated with radiographic progression of CBEs [pooled ORs 5.37, 5.08], osteophytes [pooled ORs 5.17, 6.45], and joint space narrowing (pooled ORs 4.28, 4.36) whilst MRI-detected synovitis and BMLs associated with increasing KL grades with pooled ORs 2.92, 2.54 respectively. CONCLUSIONS US and MRI-detected structural and inflammatory changes associate with tenderness, whilst articular inflammation and subchondral bone damage associate with radiographic hand OA progression. There was inconsistent relationship between these changes and pain.
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Affiliation(s)
- A D Obotiba
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom; Department of Medical Imaging, College of Medicine and Health, University of Exeter, United Kingdom.
| | - S Swain
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - J Kaur
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - K Yaseen
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom; School of Health Sciences, University of Nottingham, United Kingdom.
| | - M Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - W Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - A Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom; Nottingham NIHR-BRC, Nottingham, United Kingdom.
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82
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Marshall IJ, L'Esperance V, Marshall R, Thomas J, Noel-Storr A, Soboczenski F, Nye B, Nenkova A, Wallace BC. State of the evidence: a survey of global disparities in clinical trials. BMJ Glob Health 2021; 6:bmjgh-2020-004145. [PMID: 33402333 PMCID: PMC7786802 DOI: 10.1136/bmjgh-2020-004145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Ideally, health conditions causing the greatest global disease burden should attract increased research attention. We conducted a comprehensive global study investigating the number of randomised controlled trials (RCTs) published on different health conditions, and how this compares with the global disease burden that they impose. Methods We use machine learning to monitor PubMed daily, and find and analyse RCT reports. We assessed RCTs investigating the leading causes of morbidity and mortality from the Global Burden of Disease study. Using regression models, we compared numbers of actual RCTs in different health conditions to numbers predicted from their global disease burden (disability-adjusted life years (DALYs)). We investigated whether RCT numbers differed for conditions disproportionately affecting countries with lower socioeconomic development. Results We estimate 463 000 articles describing RCTs (95% prediction interval 439 000 to 485 000) were published from 1990 to July 2020. RCTs recruited a median of 72 participants (IQR 32–195). 82% of RCTs were conducted by researchers in the top fifth of countries by socio-economic development. As DALYs increased for a particular health condition by 10%, the number of RCTs in the same year increased by 5% (3.2%–6.9%), but the association was weak (adjusted R2=0.13). Conditions disproportionately affecting countries with lower socioeconomic development, including respiratory infections and tuberculosis (7000 RCTs below predicted) and enteric infections (9700 RCTs below predicted), appear relatively under-researched for their disease burden. Each 10% shift in DALYs towards countries with low and middle socioeconomic development was associated with a 4% reduction in RCTs (3.7%–4.9%). These disparities have not changed substantially over time. Conclusion Research priorities are not well optimised to reduce the global burden of disease. Most RCTs are produced by highly developed countries, and the health needs of these countries have been, on average, favoured.
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Affiliation(s)
- Iain James Marshall
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Veline L'Esperance
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | | | - James Thomas
- EPPI-Centre, Department of Social Science, UCL, London, UK
| | | | - Frank Soboczenski
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Benjamin Nye
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Ani Nenkova
- Computer and Information Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Byron C Wallace
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts, USA
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83
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Park SK, Lim T, Cho H, Yoon HK, Lee HJ, Lee JH, Yoo S, Kim JT, Kim WH. Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis. Sci Rep 2021; 11:11922. [PMID: 34099790 PMCID: PMC8184858 DOI: 10.1038/s41598-021-91314-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/24/2021] [Indexed: 12/30/2022] Open
Abstract
Many pharmacologic agents were investigated for the effect to prevent delirium. We aimed to comprehensively compare the effect of the pharmacological interventions to prevent postoperative delirium. A Bayesian network meta-analysis of randomized trials was performed using random effects model. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched on 20 January 2021. Randomized trials comparing the effect of a drug to prevent postoperative delirium with another drug or placebo in adult patients undergoing any kind of surgery were included. Primary outcome was the postoperative incidence of delirium. Eighty-six trials with 26,992 participants were included. Dexmedetomidine, haloperidol, and atypical antipsychotics significantly decreased the incidence of delirium than placebo [dexmedetomidine: odds ratio 0.51, 95% credible interval (CrI) 0.40-0.66, moderate quality of evidence (QOE); haloperidol: odds ratio 0.59, 95% CrI 0.37-0.95, moderate QOE; atypical antipsychotics: odds ratio 0.27, 95% CrI 0.14-0.51, moderate QOE]. Dexmedetomidine and atypical antipsychotics had the highest-ranking probabilities to be the best. However, significant heterogeneity regarding diagnostic time window as well as small study effects precludes firm conclusion.
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Affiliation(s)
- Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Taeyoon Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyeyeon Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Shao J, Zhang H, Wu Z. Non-operative versus operative management of open fractures in the paediatric population: We need more evidence. Injury 2021; 52:1648-1649. [PMID: 33066987 DOI: 10.1016/j.injury.2020.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Jiashen Shao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Graduate School of Peking Union Medical College, Beijing 100005, China
| | - Huixin Zhang
- Department of Liver Disease, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Zhihong Wu
- Department of Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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Observational Research for Therapies Titrated to Effect and Associated With Severity of Illness: Misleading Results From Commonly Used Statistical Methods. Crit Care Med 2021; 48:1720-1728. [PMID: 33009100 DOI: 10.1097/ccm.0000000000004612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES In critically ill patients, treatment dose or intensity is often related to severity of illness and mortality risk, whereas overtreatment or undertreatment (relative to the individual need) may further increase the odds of death. We aimed to investigate how these relationships affect the results of common statistical methods used in observational studies. DESIGN Using Monte Carlo simulation, we generated data for 5,000 patients with a treatment dose related to the pretreatment mortality risk but with randomly distributed overtreatment or undertreatment. Significant overtreatment or undertreatment (relative to the optimal dose) further increased the mortality risk. A prognostic score that reflects the mortality risk and an outcome of death or survival was then generated. The study was analyzed: 1) using logistic regression to estimate the effect of treatment dose on outcome while controlling for prognostic score and 2) using propensity score matching and inverse probability weighting of the effect of high treatment dose on outcome. The data generation and analyses were repeated 1,500 times over sample sizes between 200 and 30,000 patients, with an increasing accuracy of the prognostic score and with different underlying assumptions. SETTING Computer-simulated studies. MEASUREMENTS AND MAIN RESULTS In the simulated 5,000-patient observational study, higher treatment dose was found to be associated with increased odds of death (p = 0.00001) while controlling for the prognostic score with logistic regression. Propensity-matched analysis led to similar results. Larger sample sizes led to equally biased estimates with narrower CIs. A perfect risk predictor negated the bias only under artificially perfect assumptions. CONCLUSIONS When a treatment dose is associated with severity of illness and should be dosed "enough," logistic regression, propensity score matching, and inverse probability weighting to adjust for confounding by severity of illness lead to biased results. Larger sample sizes lead to more precisely wrong estimates.
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86
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Eckert I, Kumbier MCC, Silva FM, Franzosi OS, de Almeida JC. Association of specialized enteral nutrition with glycemic control and clinical outcomes in critically ill patients: A meta-analysis of randomized controlled trials. Clin Nutr 2021; 40:3940-3949. [PMID: 34139467 DOI: 10.1016/j.clnu.2021.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the association of glycemic-control formulae (GCF) with measurements of glycemic control and clinical outcomes compared to standard enteral formulae (SF) in critically ill patients. DATA SOURCES MEDLINE, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials were searched from inception up to January, 2021. STUDY SELECTION RCTs that assessed the effects of GCF relative to SF in adult critically ill patients. DATA EXTRACTION Measurements of glycemic control were the primary outcomes. Secondary outcomes included insulin requirements, mechanical ventilation (MV), length of intensive care unit (ICU) stay and mortality. Two authors independently extracted data and assessed risk of bias using the Cochrane's RoB 2 tool and the GRADE approach was used to assess the quality of evidence. DATA SYNTHESIS Ten studies (12 reports, 685 patients) were included. The use of GCFs was associated with lower blood glucose (WMD, -16.06 mg/dL; 95% CI -23.48 to -8.63; I2 = 47%) and lower daily administered insulin (WMD, -7.20 IU; 95% CI -13.92 to -0.48; I2 = 53%). Glycemic variability, measured by the coefficient of variation, was also associated with the use of GCFs (WMD, -6.84%; 95% CI, -13.57 to -0.11; I2 = 95%). In contrast, analyses for length of ICU stay (WMD, -0.12, 95% CI -1.77 to 1.52; I2 = 0%), duration of MV (WMD, -0.34 days; 95% CI, -1.72 to 1.04; I2 = 0%) and mortality (RR, 1.13; 95% CI 0.82 to 1.56; I2 = 0%) were not statistically significant. Quality of evidence ranged from low to very low, and only one study was judged as at low risk of bias. CONCLUSIONS In this meta-analysis, GCFs were significantly associated with lower insulin requirements and improved glycemic control. Although results for clinical outcomes were not statistically significant, there is insufficient evidence to confirm or exclude important differences due to serious imprecision in the effect estimates and overall low quality of evidence. The effects of GCFs on clinical outcomes require confirmation in larger randomized trials.
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Affiliation(s)
- Igor Eckert
- Nutrition Undergraduate Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil
| | - Magali C C Kumbier
- Graduate Program on Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul (UFRGS), Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Department of Nutrition and Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil.
| | - Oellen S Franzosi
- Nutrition and Dietetic Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jussara C de Almeida
- Graduate Program on Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul (UFRGS), Rio Grande do Sul, Brazil; Division of Nutrition and Dietetics, Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil; Department of Nutrition, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Rio Grande do Sul (UFRGS), Brazil
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87
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Shen H, Mei Y, Zhang K, Xu X. The Effect of Vitamin D Supplementation on Clinical Outcomes for Critically Ill Patients: A Systemic Review and Meta-Analysis of Randomized Clinical Trials. Front Nutr 2021; 8:664940. [PMID: 34017850 PMCID: PMC8129506 DOI: 10.3389/fnut.2021.664940] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose: Vitamin D deficiency is a common scenario in critically ill patients and has been proven to be associated with poor outcomes. However, the effect of vitamin D supplementation for critically ill patients remains controversial. Thus, we conducted a meta-analysis to evaluate the effect of vitamin D supplementation among critically ill patients. Methods: Electronic databases PubMed, Embase, Scopus, and the Cochrane Library were searched for eligible randomized controlled trials between 2000 and January 2021. The primary outcome was overall mortality, and the secondary ones were the length of intensive care unit stay, the length of hospital stay, as well as the duration of mechanical ventilation. Subgroup analyses were performed to explore the treatment effect by type of admission, route of administration, dose of supplemented vitamin D, and the degree of vitamin D deficiency. Results: A total of 14 studies involving 2,324 patients were finally included. No effect on overall mortality was found between vitamin D supplementation and control group [odds ratio (OR), 0.73; 95% CI, 0.52-1.03; I 2 = 28%]. The vitamin D supplementation reduced the length of intensive care unit stay [mean difference (MD), -2.25; 95% CI, -4.07 to -0.44, I 2 = 71%] and duration of mechanical ventilation (MD, -3.47; 95% CI, -6.37 to -0.57, I 2 = 88%). In the subgroup analyses, the vitamin D supplementation for surgical patients (OR, 0.67; 95% CI, 0.47-0.94; I 2 = 0%) or through parenteral way (OR, 0.42; 95% CI, 0.22-0.82, I 2 = 0%) was associated with reduced mortality. Conclusion: In critically ill patients, the supplementation of vitamin D has no effect on overall mortality compared to placebo but may decrease the length of intensive care unit stay and mechanical ventilation. Further trials are necessary to confirm our findings.
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Affiliation(s)
- Hejuan Shen
- Department of General Surgery, Lishui People's Hospital, Lishui, China.,Department of General Surgery, Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yijun Mei
- Department of General Surgery, Lishui People's Hospital, Lishui, China.,Department of General Surgery, Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoya Xu
- Department of General Surgery, Lishui People's Hospital, Lishui, China.,Department of General Surgery, Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
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88
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Akbar MR, Wibowo A, Pranata R, Setiabudiawan B. Low Serum 25-hydroxyvitamin D (Vitamin D) Level Is Associated With Susceptibility to COVID-19, Severity, and Mortality: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:660420. [PMID: 33855042 PMCID: PMC8039288 DOI: 10.3389/fnut.2021.660420] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background: This systematic review and meta-analysis aimed to assess whether low serum 25-hydroxyvitamin D (25-OHD) level is associated with susceptibility to COVID-19, severity, and mortality related to COVID-19. Methods: Systematic literature searches of PubMed, Scopus, and Embase database up until 9 December 2020. We include published observational prospective and retrospective studies with information on 25-OHD that reported main/secondary outcome. Low serum 25-OHD refers to participants with serum 25-OHD level below a cut-off point ranging from 20 to 30 ng/mL. Other cut-off values were excluded to reduce heterogeneity. The main outcome was mortality defined as non-survivor/death. The secondary outcome was susceptibility and severe COVID-19. Results: There were 14 studies comprising of 999,179 participants. Low serum 25-OHD was associated with higher rate of COVID-19 infection compared to the control group (OR = 2.71 [1.72, 4.29], p < 0.001; I 2: 92.6%). Higher rate of severe COVID-19 was observed in patients with low serum 25-OHD (OR = 1.90 [1.24, 2.93], p = 0.003; I 2: 55.3%), with a sensitivity of 83%, specificity of 39%, PLR of 1.4, NLR of 0.43, and DOR of 3. Low serum 25-OHD was associated with higher mortality (OR = 3.08 [1.35, 7.00], p = 0.011; I 2: 80.3%), with a sensitivity of 85%, specificity of 35%, PLR of 1.3, NLR of 0.44, and DOR of 3. Meta-regression analysis showed that the association between low serum 25-OHD and mortality was affected by male gender (OR = 1.22 [1.08, 1.39], p = 0.002), diabetes (OR = 0.88 [0.79, 0.98], p = 0.019). Conclusion: Low serum 25-OHD level was associated with COVID-19 infection, severe presentation, and mortality.
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Affiliation(s)
- Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Yang W, Wen J, Wu F, Zeng H, Guo B, Ge L. Pharmacotherapy weight-loss interventions to prevent type 2 diabetes in overweight or obese adults and older adults: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e24812. [PMID: 33725948 PMCID: PMC7982236 DOI: 10.1097/md.0000000000024812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Obesity is a worldwide problem and is associated with multiple negative health effects. Obesity also has a direct relationship with risk of diabetes. Several pharmacotherapy weight-reducing interventions have been employed to prevent type 2 diabetes (T2D) in overweight or obese adults and older adults. However, data with respect to comparative effectiveness are limited. To address this gap, in this study, evidence on benefits of anti-obesity agents for preventing diabetes will be systematically reviewed using a network meta-analysis. METHODS We will perform an online systematic search for randomized controlled trials (RCTs) investigating 5 FDA-approved anti-obesity agents for preventing T2D in obese or overweight adults and older adults through electronic databases of PubMed, Embase, and the Cochrane Library from inception until December 31, 2020. Two independent reviewers will screen titles, abstracts, and full-texts of all potentially eligible trials. Two authors working independently will abstract data on trial-, participant- and intervention-related characteristics. The primary outcome will be incidence of T2D. Secondary outcomes will be achievement of normoglycaemia in patients with prediabetes, percentage of individuals achieving at least 5% or 10% weight loss of their baseline weight. We will conduct pairwise meta-analyses for all outcomes included in this study. To determine comparative efficacy of multiple interventions, network meta-analysis with a frequentist random-effects model will be performed. Moreover, subgroup analyses and sensitivity analyses will be performed to assess the robustness of our findings. To evaluate publication bias, the comparison-adjusted funnel plot will be utilized. Stata version 14.0 and RevMan version 5.3.3 will be used to perform all statistical analyses. RESULTS This study will evaluate the effectiveness of weight-loss medications on T2D prevention in overweight or obese people. CONCLUSIONS This study will generate meaningful findings for overweight or obese adults and older adults, clinicians, and policy-makers concerning the optimal anti-obesity pharmacotherapy to decrease risk of T2D. STUDY REGISTRATION NUMBER INPLASY202110104.
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Affiliation(s)
- Wenxiao Yang
- Department of Science and Technology, Shanghai University of Medicine and Health Sciences, Shanghai
| | - Junru Wen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Fangfang Wu
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai
| | - Hai Zeng
- College of Traditional Chinese Medicine, Jinan University, Guangzhou
| | - Bing Guo
- Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Li Ge
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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90
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Shao L, Wu XD, Huang W. Cardiovascular Safety of Denosumab Across Multiple Indications. J Bone Miner Res 2021; 36:617-618. [PMID: 33095450 DOI: 10.1002/jbmr.4189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/12/2020] [Accepted: 10/03/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Long Shao
- Department of Orthopaedic Surgery, Ningbo No.6 Hospital, Ningbo, China
| | - Xiang-Dong Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies. Int J Infect Dis 2021; 105:567-578. [PMID: 33647509 DOI: 10.1016/j.ijid.2021.02.095] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcomes are risk factors for neonatal mortality and morbidity. While some studies have demonstrated notable associations between influenza and adverse pregnancy outcomes, the findings have contrasted with other studies. This meta-analysis was conducted to assess the effect of influenza infection on pregnancy outcomes. METHODS We searched PubMed, Embase, Cochrane Library and Web of Science from inception to 4 November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects or fixed-effects models. RESULTS A total of 17 studies involving 2,351,204 participants were included. Influenza infection increased the risk of stillbirth (RR = 3.62, 95% CI: 1.60-8.20), with no significant effect on preterm birth (RR = 1.17, 95%CI: 0.95-1.45), fetal death (RR = 0.93, 95%CI: 0.73-1.18), small for gestational age (SGA) (RR = 1.10, 95%CI: 0.98-1.24) and low birth weight (LBW) (RR = 1.88, 95%CI: 0.46-7.66). In a subgroup analysis of LBW, the association was evident in studies conducted during the 2009 H1N1 pandemic (RR = 2.28, 95%CI: 1.81-2.87), with no evidence of an association in pre-pandemic or post-pandemic studies. CONCLUSIONS Influenza virus infection was associated with an increased risk of stillbirth, but its effect on preterm birth, fetal death, SGA and LBW is still uncertain.
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Nugroho CW, Suryantoro SD, Yuliasih Y, Rosyid AN, Asmarawati TP, Andrianto L, Setiawan HW, Mahdi BA, Windradi C, Agustin ED, Fajar JK. Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis. F1000Res 2021; 10:73. [PMID: 33763201 PMCID: PMC7953915 DOI: 10.12688/f1000research.45046.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria.
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Affiliation(s)
- Cahyo Wibisono Nugroho
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Yuliasih Yuliasih
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Alfian Nur Rosyid
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Tri Pudy Asmarawati
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Lucky Andrianto
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Herley Windo Setiawan
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Bagus Aulia Mahdi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Choirina Windradi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | | | - Jonny Karunia Fajar
- Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, East Java, 65145, Indonesia
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Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular Function of the Knee Joint Following Knee Injuries: Does It Ever Get Back to Normal? A Systematic Review with Meta-Analyses. Sports Med 2021; 51:321-338. [PMID: 33247378 PMCID: PMC7846527 DOI: 10.1007/s40279-020-01386-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. OBJECTIVE To identify how peri-articular neuromuscular function changes over time after knee injury and surgery. DESIGN Systematic review with meta-analyses. DATA SOURCES PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes. RESULTS A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries. CONCLUSIONS Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA. TRIAL REGISTRATION NUMBER PROSPERO CRD42019141850.
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Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.
| | | | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, E1 4DG, UK
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Cardona S, Downing J, Alfalasi R, Bzhilyanskaya V, Milzman D, Rehan M, Schwartz B, Yardi I, Yazdanpanah F, Tran QK. Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis. Am J Emerg Med 2021; 43:88-96. [PMID: 33550104 PMCID: PMC7839795 DOI: 10.1016/j.ajem.2021.01.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Awake prone positioning (PP), or proning, is used to avoid intubations in hypoxic patients with COVID-19, but because of the disease's novelty and constant evolution of treatment strategies, the efficacy of awake PP is unclear. We conducted a meta-analysis of the literature to assess the intubation rate among patients with COVID-19 requiring oxygen or noninvasive ventilatory support who underwent awake PP. METHODS We searched PubMed, Embase, and Scopus databases through August 15, 2020 to identify relevant randomized control trials, observational studies, and case series. We performed random-effects meta-analyses for the primary outcome of intubation rate. We used moderator analysis and meta-regressions to assess sources of heterogeneity. We used the standard and modified Newcastle-Ottawa Scales (NOS) to assess studies' quality. RESULTS Our search identified 1043 articles. We included 16 studies from the original search and 2 in-press as of October 2020 in our analysis. All were observational studies. Our analysis included 364 patients; mean age was 56.8 (SD 7.12) years, and 68% were men. The intubation rate was 28% (95% CI 20%-38%, I2 = 63%). The mortality rate among patients who underwent awake PP was 14% (95% CI 7.4%-24.4%). Potential sources of heterogeneity were study design and setting (practice and geographic). CONCLUSIONS Our study demonstrated an intubation rate of 28% among hypoxic patients with COVID-19 who underwent awake PP. Awake PP in COVID-19 is feasible and practical, and more rigorous research is needed to confirm this promising intervention.
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Affiliation(s)
- Stephanie Cardona
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jessica Downing
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Reem Alfalasi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vera Bzhilyanskaya
- Research Associate Program in Emergency Medicine and Critical Care, The Critical Care Resuscitation Unit, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David Milzman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mehboob Rehan
- Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, ID, USA
| | - Bradford Schwartz
- Department of Emergency Medicine, Prince George's Hospital Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Isha Yardi
- Research Associate Program in Emergency Medicine and Critical Care, The Critical Care Resuscitation Unit, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fariba Yazdanpanah
- Department of Medicine, University of Maryland Capital Region Health, Prince George's Hospital Center, Cheverly, MD, USA
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Research Associate Program in Emergency Medicine and Critical Care, The Critical Care Resuscitation Unit, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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Publication Trends of Pediatric and Adult Randomized Controlled Trials in General Medical Journals, 2005-2018: A Citation Analysis. CHILDREN-BASEL 2020; 7:children7120293. [PMID: 33333770 PMCID: PMC7765242 DOI: 10.3390/children7120293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/30/2022]
Abstract
Policy has been developed to promote the conduct of high-quality pediatric randomized controlled trials (RCTs). Whether these strategies have influenced publication trends in high-impact journals is unknown. We aim to evaluate characteristics, citation patterns, and publication trends of pediatric RCTs published in general medical journals (GMJs) compared with adult RCTs over a 13-year period. Studies were identified using Medline, and impact metrics were collected from Web of Science and Scopus. All RCTs published from 2005–2018 in 7 GMJs with the highest impact factors were identified for analysis. A random sample of matched pediatric and adult RCTs were assessed for publication characteristics, academic and non-academic citation. Citations were counted from publication until June 2019. Among 4146 RCTs, 2794 (67.3%) enrolled adults, 591 (14.2%) enrolled children, and 761 RCTs (18.3%) enrolled adult and pediatric patients. Adult RCTs published in GMJs grew by 5.1 publications per year (95% CI: 3.3–6.9), while the number of pediatric RCTs did not show significant change (−0.4 RCTs/year, 95% CI: −1.4–0.6). Adult RCTs were cited more than pediatric RCTs (median(IQR): 29.9 (68.5–462.8) citations/year vs. 13.2 (6.8–24.9) citations/year; p < 0.001); however, social media attention was similar (median(IQR) Altmetric Attention Score: 37 (13.75–133.8) vs. 26 (6.2–107.5); p = 0.25). Despite policies which may facilitate conduct of pediatric RCTs, the publishing gap in high-impact GMJs is widening.
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Quadri MFA, Fageeh HI, Ibraheem W, Jessani A. A Case-Control Study of Type 2 Diabetes Mellitus and Periodontitis in Saudi Arabian Adults. J Multidiscip Healthc 2020; 13:1741-1748. [PMID: 33273822 PMCID: PMC7708264 DOI: 10.2147/jmdh.s288681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The relationship between type 2 diabetes mellitus (T2DM) and periodontitis is bidirectional and has been investigated. However, the evidence from the middle-eastern region is sparse. The current report assessed the association between uncontrolled T2DM and periodontal status from a sample of the Saudi Arabian adult population. Methods A case–control study was carried out. Cases were adults diagnosed with periodontitis (clinical attachment loss ≥1 mm) and controls were patients from the same dental setting with no gum conditions matched with age, sex, and location. Diabetes was recorded using HbA1c readings. The other health conditions including hypertension, epilepsy, bronchitis, thyroid disorders, and arthritis were obtained from medical records. Data on the use of tobacco and related products (smoking, khat/qat, sheesha, shammah) were gathered using a self-perceived questionnaire. Frequencies, percentages, p-values, crude and adjusted odds ratios (OR) with 95% confidence intervals were computed. Results Overall sample comprises 166 cases and 332 controls with a mean age of 37.5 years. Multivariable analysis indicated uncontrolled T2DM as an important predictor for periodontitis among Saudi Arabian adults, and they had nearly three times greater odds (OR: 2.779; 95% CI: 1.425–5.419; p=0.003) of being diagnosed with periodontitis in contrast to non-diabetics. Secondary findings revealed that cigarette ever-users were two times more likely to be suffering from periodontitis than never-users, and those brushing once per day or less had five times greater odds of developing periodontitis as compared to those brushing twice daily. Conclusion To conclude, the current evidence from Saudi Arabia is supportive of earlier studies and an awareness of this association is warranted among all healthcare providers and patients in the region for early detection of periodontitis.
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Affiliation(s)
- Mir Faeq Ali Quadri
- Department of Preventive Dental Sciences, Division of Dental Public Health, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Hammam I Fageeh
- Department of Preventive Dental Sciences, Division of Periodontology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Wael Ibraheem
- Department of Preventive Dental Sciences, Division of Periodontology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Abbas Jessani
- College of Dentistry, Schulich School of Medicine & Dentistry, Toronto, Canada
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Ding H, Chen SH, Edwards I, Jayasena R, Doecke J, Layland J, Yang IA, Maiorana A. Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis. J Med Internet Res 2020; 22:e20032. [PMID: 33185554 PMCID: PMC7695537 DOI: 10.2196/20032] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/08/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes. OBJECTIVE The aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure. METHODS We reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2). RESULTS We included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95% CI 0.64-0.96 vs IRR=1.00, 95% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95% CI 0.53-0.85 vs RR=0.95, 95% CI 0.84-1.07). CONCLUSIONS Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure.
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Affiliation(s)
- Hang Ding
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- The Australian e-Health Research Centre, Commonwealth Scientific & Industrial Research Organisation, Brisbane, Australia
- Prince Charles Hospital - Northside Clinic Unit School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sheau Huey Chen
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Iain Edwards
- Department of Community Health, Peninsula Health, Melbourne, Australia
| | - Rajiv Jayasena
- The Australian e-Health Research Centre, Commonwealth Scientific & Industrial Research Organisation, Melbourne, Australia
| | - James Doecke
- The Australian e-Health Research Centre, Commonwealth Scientific & Industrial Research Organisation, Melbourne, Australia
| | - Jamie Layland
- Department of Cardiology, Peninsula Health, Melbourne, Australia
- Peninsula Clinical School, Monash University, Melbourne, Australia
| | - Ian A Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, The University of Queensland, Brisbane, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia
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Schnaubelt S, Monsieurs KG, Semeraro F, Schlieber J, Cheng A, Bigham BL, Garg R, Finn JC, Greif R. Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings - A scoping review. Resuscitation 2020; 156:137-145. [PMID: 32920113 DOI: 10.1016/j.resuscitation.2020.08.126] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
AIM OF THE SCOPING REVIEW Scientific recommendations on resuscitation are typically formulated from the perspective of an ideal resource environment, with little consideration of applicability in lower-income countries. We aimed to determine clinical outcomes from out-of-hospital cardiac arrest (OHCA) in low-resource countries, to identify shortcomings related to resuscitation in these areas and possible solutions, and to suggest future research priorities. DATA SOURCES This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We identified low-resource countries as countries with a low- or middle gross national income per capita (World Bank data). We performed a literature search on outcomes after OHCA in these countries, and we extracted data on the outcome. We applied descriptive statistics and conducted a post-hoc correlation analysis of cohort size and ROSC rates. RESULTS We defined 24 eligible studies originating from middle-income countries, but none from low-income regions, suggesting a reporting bias. The number of reported patients in these studies ranged from 54 to 3214. Utstein-style reporting was rarely used. Return of spontaneous circulation varied from 0% to 62%. Fifteen studies reported on survival to hospital discharge (between 1.0 and 16.7%) or favourable neurological outcome (between 1.0 and 9.3%). An inverse correlation was found for study cohort size and the rate of return of spontaneous circulation (ρ = -0.48, p = 0.034). CONCLUSION Studies of OHCA outcomes in low-resource countries are heterogeneous and may be compromised by reporting bias. Minimum cardiopulmonary resuscitation standards for low-resource settings should be developed collaboratively involving local experts, respecting culture and context while balancing competing health priorities.
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Affiliation(s)
- S Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| | - K G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital Bologna, Italy
| | - J Schlieber
- Department of Anaesthesia and Intensive Care, Allgemeine Unfallversicherungsanstalt, Trauma Centre Salzburg, Salzburg, Austria
| | - A Cheng
- Departments of Paediatrics and Emergency Medicine, University of Calgary, Calgary, Canada
| | - B L Bigham
- Department of Medicine, Stanford University, CA, USA
| | - R Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr Braich, All India Institute of Medical Sciences, New Delhi, India
| | - J C Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - R Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Shamszadeh S, Asgary S, Shirvani A, Eghbal MJ. Effects of antibiotic administration on post-operative endodontic symptoms in patients with pulpal necrosis: A systematic review and meta-analysis. J Oral Rehabil 2020; 48:332-342. [PMID: 32681652 DOI: 10.1111/joor.13057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The current systematic review and meta-analysis aimed to assess the efficacy of prophylactic oral antibiotics in the management of post-operative endodontic symptoms in adults with necrotic pulp. MATERIALS AND METHODS A systematic search up to April 2020 was performed to find all randomised controlled trials (RTCs) comparing oral antibiotics with placebo to manage post-endodontic symptoms. The outcome measures were post-operative pain, swelling and/or the combined pain and swelling at different follow-ups. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were estimated using random-effect inverse-variance method. Additional analysis was performed if heterogeneity existed (P < .05). RESULTS For post-endodontic pain, 8 RCTs (n = 690) were included. Antibiotic prescription had no significant effect on endodontic pain at 6 (SMD = -0.008, 95% CI -0.279 - 0.264, P = .95), 12 (SMD = -0.080, 95% CI -1.39 - 1.23, P = .90), 24 (SMD = -0.044, 95% CI -0.29 - 0.20, P = .72), 48 (SMD = 0.18, 95% CI -0.26 - 0.62, P = .42) and 72 h (SMD= -0.050, 95% CI -0.33 - 0.23, P = .723) post-operatively. For post-endodontic swelling, 4 RCTs (n = 149) were included. Antibiotic prescription had no significant effect on endodontic swelling at 24 (SMD = 0.29, 95% CI -0.72 - 1.32, P = .56), 48 (SMD = -0.23, 95% CI -0.98 - 0.51, P = .54) and 72 hours (SMD= -0.03, 95% CI -1.25 - 1.33, P = .96), post-operatively. For combined pain and swelling, no meta-analysis was performed. CONCLUSION The administration of prophylactic antibiotics to prevent post-operative endodontic symptoms is not supported by the current evidence.
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Affiliation(s)
- Sayna Shamszadeh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohammad Jafar Eghbal
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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Brouwer J, van den Berg F, Knooihuizen R, Loerts H, Keijzer M. Exploring Language Learning as a Potential Tool against Cognitive Impairment in Late-Life Depression: Two Meta-Analyses and Suggestions for Future Research. Behav Sci (Basel) 2020; 10:E132. [PMID: 32878051 PMCID: PMC7551097 DOI: 10.3390/bs10090132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
Late-life depression (LLD) affects about an eighth of community-dwelling seniors. LLD impacts well-being, with loneliness and small social networks being typical. It has also been linked to cognitive dysfunction and an increased risk of developing dementia. Safety and efficacy of pharmacological treatments for LLD have been debated, and cognitive dysfunction often persists even after remission. Various cognitive interventions have been proposed for LLD. Among these, one has received special attention: foreign language learning could serve as a social intervention that simultaneously targets brain structures affected in LLD. Lifelong bilingualism may significantly delay the onset of cognitive impairment symptoms by boosting cognitive reserve. Even late-life foreign language learning without lifelong bilingualism can train cognitive flexibility. It is then counterintuitive that the effects of language learning on LLD have never been examined. In order to create a theoretical basis for further interdisciplinary research, this paper presents a status quo of current work through two meta-analyses investigating cognitive functioning in LLD on the one hand and in senior bilinguals or seniors following a language course on the other hand. While LLD was consistently associated with cognitive dysfunction, inconsistent results were found for bilingualism and language learners. Possible reasons for this and suggestions for future research are subsequently discussed.
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Affiliation(s)
- Jelle Brouwer
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Floor van den Berg
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Remco Knooihuizen
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
| | - Hanneke Loerts
- Department of Minorities and Multilingualism, University of Groningen, 9712 EK Groningen, The Netherlands;
| | - Merel Keijzer
- Department of Linguistics & English as a Second Language, University of Groningen, 9712 EK Groningen, The Netherlands; (F.v.d.B.); (R.K.); (M.K.)
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