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BMC Pregnancy and Childbirth Jun 2021Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC).
METHODS
We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups.
RESULTS
Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60-1.80; I = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20-1.50; I = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00-6.51; I = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58-1.92; I = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33-1.53; I = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively).
CONCLUSIONS
Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Hypertension, Pregnancy-Induced; Odds Ratio; Oocyte Donation; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic
PubMed: 34182957
DOI: 10.1186/s12884-021-03938-8 -
Shoulder & Elbow Apr 2021is the most commonly detected pathogen during shoulder surgery. Lack of typical infection signs make infections difficult to diagnose. This systematic review aims to...
BACKGROUND
is the most commonly detected pathogen during shoulder surgery. Lack of typical infection signs make infections difficult to diagnose. This systematic review aims to determine which pre- and peroperative diagnostic tools are most reliable to identify infections after shoulder surgery.
METHODS
PubMed/Embase were searched for diagnostic studies. Methodological quality of included studies was assessed using QUADAS-2. Forest plots summarized results (sensitivity and specificity) for each pre- and peroperative diagnostic tool.
RESULTS
Twenty-two studies were included, of which 8 described preoperative, 10 peroperative, and 4 both pre- and peroperative diagnostic tools. Quality of the studies varied widely. For preoperative tools, synovial calprotectin, interleukin-6, and combined interleukin-6/interleukin-2/tumor necrosis factor-α had the best efficacy measures. Pre-revision biopsies and arthroscopic tissue cultures were the best peroperative tools.
CONCLUSION
Despite a lack of evidence and the use of different infection criteria and reference standards, the use of combined interleukin-6/interleukin-2/tumor necrosis factor-α as preoperative and arthroscopic tissue cultures as peroperative diagnostic tool is for now recommended based on results and validity. More research should be performed to provide valid evidence on these tools. In order to do so, an internationally accepted definition of infections is essential.
LEVEL OF EVIDENCE
Systematic review.
PubMed: 33897844
DOI: 10.1177/1758573220913243 -
Patient Preference and Adherence 2022Antipsychotics are a class of medications primarily used to treat individuals with psychotic disorders. They have also been indicated for patients with other psychiatric... (Review)
Review
BACKGROUND
Antipsychotics are a class of medications primarily used to treat individuals with psychotic disorders. They have also been indicated for patients with other psychiatric conditions, such as post-traumatic stress disorder and major depressive disorder. Non-adherence is prominent amongst individuals prescribed antipsychotics, with medication-related self-stigma and social stigma identified as major factors. No previous reviews have focused on stigma associated specifically with antipsychotic medication. This systematic literature review aimed to synthesise evidence on the prevalence of stigmatising attitudes and behaviours related to antipsychotic treatment and understand their impact on antipsychotic treatment initiation and continuation.
METHODS
Two independent reviewers screened studies from databases, congress proceedings, ClinicalTrials.gov, and PsychU.org; relevant studies reported quantitative or qualitative data on antipsychotic-related stigma in adults with psychotic disorders, mood disorders, borderline personality disorder or anxiety disorders, or healthcare providers or caregivers of these patients, and any impact on treatment. Framework synthesis facilitated extraction and synthesis of relevant information; quantitative and qualitative data were coded and indexed against a pre-specified thematic framework by two independent reviewers.
RESULTS
Forty-five articles reporting on 40 unique studies were included; 22 reported quantitative data, 16 reported qualitative data, and two reported quantitative and qualitative data relating to antipsychotic-related stigma. Framework synthesis identified four themes: 1) impact of antipsychotic treatment on a) social stigma or b) self-stigma; 2) impact of side effects of antipsychotic treatment on a) social stigma or b) self-stigma; 3) impact of route of administration of antipsychotic treatment on stigma; 4) impact of stigma on the use of antipsychotics.
CONCLUSION
This systematic literature review found that antipsychotic-related social and self-stigma is a factor in non-adherence to antipsychotics. Further research should examine stigma in a wider range of patients and the extent to which clinicians' treatment decisions are impacted by the potential stigma associated with antipsychotic medications.
PubMed: 35210756
DOI: 10.2147/PPA.S343211 -
BMC Medical Education Mar 2015Effective medication reconciliation is critical in reducing the risk of preventable adverse drug events. Medical trainees are often responsible for medication... (Comparative Study)
Comparative Study Review
BACKGROUND
Effective medication reconciliation is critical in reducing the risk of preventable adverse drug events. Medical trainees are often responsible for medication reconciliation on admission, transfer and discharge of the most vulnerable patients; therefore, it is important that trainees are educated on this aspect of quality care.
METHODS
We conducted a systematic review using MEDLINE and EMBASE databases to identify education initiatives targeted at improving trainee skill and knowledge in carrying out medication reconciliation. Studies published in English or French between July 1980 and July 2013, where the primary focus of the article was the role of medical trainees in conducting medication reconciliation, and where trainee-specific data was reported, were included. Included articles must have reported trainee-specific data. Given the anticipated heterogeneity and array of outcomes, we were unable to employ a specific tool in assessing the risk of bias across studies.
RESULTS
Seven studies met pre-specified eligibility criteria, indicating the lack of published education initiatives targeted towards improving trainee knowledge and experience. Four described an education intervention targeted towards students completing internal medicine clerkship, while the remaining 3 were implemented among residents. Although no two interventions were the same, 5 out of 7 included an experiential component.
CONCLUSIONS
Varying success was achieved with medication reconciliation education interventions. While some noted improved competence and/or confidence amongst trainees, namely undergraduate medical students, others noted little effect resulting from the intervention.
Topics: Clinical Clerkship; Clinical Competence; Curriculum; Drug-Related Side Effects and Adverse Reactions; Education, Medical, Graduate; Education, Medical, Undergraduate; Female; Humans; Internship and Residency; Male; Medication Reconciliation; Patient Discharge
PubMed: 25879196
DOI: 10.1186/s12909-015-0306-5 -
Schizophrenia (Heidelberg, Germany) Dec 2023Response to antipsychotic medications (AP) is subjected to a wide and unpredictable variability and efforts were directed to discover predictive biomarkers to... (Review)
Review
Response to antipsychotic medications (AP) is subjected to a wide and unpredictable variability and efforts were directed to discover predictive biomarkers to personalize treatment. Electroencephalography abnormalities in subjects with schizophrenia are well established, as well as a pattern of EEG changes induced by APs. The aim of this review is to provide a synthesis of the EEG features that are related to AP efficacy, including both pre-treatment signatures and changes induced by APs during treatment. A systematic review of English articles using PubMed, PsychINFO and the Cochrane database of systematic reviews was undertaken until july 2023. Additional studies were added by hand search. Studies having as an endpoint the relationship between AP-related clinical improvement and electroencephalographic features were included. Heterogeneity prevented a quantitative synthesis. Out of 1232 records screened, 22 studies were included in a final qualitative synthesis. Included studies evaluated resting-state and task-related power spectra, functional connectivity, microstates and epileptic abnormalities. At pre-treatment resting-state EEG, the most relevant predictors of a poor response were a change in theta power compared to healthy control, a high alpha power and connectivity, and diminished beta power. Considering EEG during treatment, an increased theta power, a reduced beta-band activity, an increased alpha activity, a decreased coherence in theta, alpha and beta-band were related to a favorable outcome. EEG is promising as a method to create a predictive biomarker for response to APs; further investigations are warranted to harmonize and generalize the contradictory results of reviewed studies.
PubMed: 38071394
DOI: 10.1038/s41537-023-00419-z -
Critical Care (London, England) Nov 2016Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the... (Review)
Review
BACKGROUND
Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice.
METHODS
Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings.
RESULTS
From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally.
CONCLUSION
Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.
Topics: Disease Management; Emergency Medical Services; France; Humans; Mass Casualty Incidents; Terrorism; Triage; Wounds, Gunshot
PubMed: 27825363
DOI: 10.1186/s13054-016-1543-7 -
PloS One 2015End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis.
METHODS
A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review.
RESULTS
Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence.
CONCLUSIONS
A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.
Topics: Adolescent; Adult; Aged; Female; Humans; Kidney Failure, Chronic; Male; Medication Adherence; Middle Aged; Polypharmacy; Renal Dialysis; Risk Factors; Young Adult
PubMed: 26636968
DOI: 10.1371/journal.pone.0144119 -
Pathogens and Global Health May 2019Schistosomiasis is a parasitic disease caused by helminths of the genus with two presentations; one intestinal and another urinary; which depend on the specie of . One... (Meta-Analysis)
Meta-Analysis
Schistosomiasis is a parasitic disease caused by helminths of the genus with two presentations; one intestinal and another urinary; which depend on the specie of . One of the species that can produce intestinal schistosomiasis is , and the specie that produces urinary schistosomiasis is . Infection can be aggravated by a deficient nutritional status, which negatively impacts the immune system and increases susceptibility to infection. The main objective of this meta-analysis is to determine if a relationship exists between multimicronutrient supplementation and the reduction of infestation with and in children and adolescents. A search was conducted through a scientific literature database, and articles that complied with the pre-established requirements were retrieved. The Review Manager (Rev Man) 5.3 computer program was used for data processing and analysis was carried out with the objective of testing whether the addition of micronutrient supplementation to treatment with broad-spectrum antiparasitic anthelmintic medication has an impact on schistosomiasis infection. Of the 257 initial articles retrieved, eight were included both quantitatively and qualitatively in the meta-analysis. Supplementation reduces infestation with 1.33 times more than placebo. In individuals infested with supplementation is 1.30 times more effective than placebo and for individuals infested with , supplementation is 1.62 times more effective than the placebo. The results show a clear relationship between supplementation and reduction of infestation. The supplementation with micronutrients decreases the presence of in children and adolescents.
Topics: Adolescent; Animals; Child; Child, Preschool; Female; Humans; Male; Micronutrients; Nutritional Status; Placebos; Schistosoma haematobium; Schistosoma mansoni; Schistosomiasis haematobia; Schistosomiasis mansoni
PubMed: 30983544
DOI: 10.1080/20477724.2019.1603902 -
Critical Care (London, England) Jul 2017Pre-hospital endotracheal intubation is frequently used for trauma patients in many emergency medical systems. Despite a wide range of publications in the field, it is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pre-hospital endotracheal intubation is frequently used for trauma patients in many emergency medical systems. Despite a wide range of publications in the field, it is debated whether the intervention is associated with a favourable outcome, when compared to more conservative airway measures.
METHODS
A systematic literature search was conducted to identify interventional and observational studies where the mortality rates of adult trauma patients undergoing pre-hospital endotracheal intubation were compared to those undergoing emergency department intubation.
RESULTS
Twenty-one studies examining 35,838 patients were included. The median mortality rate in patients undergoing pre-hospital intubation was 48% (range 8-94%), compared to 29% (range 6-67%) in patients undergoing intubation in the emergency department. Odds ratios were in favour of emergency department intubation both in crude and adjusted mortality, with 2.56 (95% CI: 2.06, 3.18) and 2.59 (95% CI: 1.97, 3.39), respectively. The overall quality of evidence is very low. Twelve of the twenty-one studies found a significantly higher mortality rate after pre-hospital intubation, seven found no significant differences, one found a positive effect, and for one study an analysis of the mortality rate was beyond the scope of the article.
CONCLUSIONS
The rationale for wide and unspecific indications for pre-hospital intubation seems to lack support in the literature, despite several publications involving a relatively large number of patients. Pre-hospital intubation is a complex intervention where guidelines and research findings should be approached cautiously. The association between pre-hospital intubation and a higher mortality rate does not necessarily contradict the importance of the intervention, but it does call for a thorough investigation by clinicians and researchers into possible causes for this finding.
Topics: Emergency Medical Services; Emergency Service, Hospital; Humans; Intubation, Intratracheal; Mortality; Quality of Health Care; Workforce
PubMed: 28756778
DOI: 10.1186/s13054-017-1787-x -
Dermatologic Therapy May 2022Numerous vaccines are under clinical development and implementation for the prevention of severe course and lethal outcomes of coronavirus disease 2019 (COVID-19). This... (Review)
Review
Numerous vaccines are under clinical development and implementation for the prevention of severe course and lethal outcomes of coronavirus disease 2019 (COVID-19). This systematic review aims to summarize and integrated the findings of studies regarding cutaneous side effects of COVID-19 vaccines. This systematic review conducted by searching the scientific databases of PubMed, Scopus, Science direct, and Web of knowledge from the beginning of the COVID-19 to May 10, 2021. Articles were reviewed and analyzed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Seventeen studies on cutaneous side effects of COVID-19 vaccines were included after the screening of search results based on to the eligibility criteria. The results showed that the most common injection site reactions and delayed large local reactions, arising from all vaccine types, were redness/erythema (39%), followed by: itchiness (28%), urticarial rash (17%) on the neck, upper limbs, and trunk, morbilliform eruptions (6.5%), Pityriasis rosea (3%), swelling, and burning, and so forth. Most cutaneous reactions occurred in women (84%), and middle-aged people, after the first dose of vaccine, with the onset ranged from 1 to 21 days after vaccination. In addition, cutaneous reactions were generally self-limiting, and needed little or no therapeutic intervention, that were not regarded as a barrier to injecting a second dose. In conclusion, severe cutaneous side effects are very rare and approved vaccines have satisfactory safety profiles. Therefore, mild or moderate cutaneous reactions should not discourage people from vaccination. In certain groups such as patients with allergies and a history of local injection reactions, pre-vaccination counseling and assurance, also use of appropriate medications may be helpful. However, more studies are needed to investigate the side effect profile of all COVID-19 vaccines.
Topics: COVID-19; COVID-19 Vaccines; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Middle Aged; Skin; Vaccination; Vaccines
PubMed: 35194894
DOI: 10.1111/dth.15391