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The Lancet. Respiratory Medicine Dec 2022The association of respiratory mechanics, particularly respiratory system static compliance (C), with severity of hypoxaemia in patients with COVID-19-related acute... (Meta-Analysis)
Meta-Analysis Review
Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis.
The association of respiratory mechanics, particularly respiratory system static compliance (C), with severity of hypoxaemia in patients with COVID-19-related acute respiratory distress syndrome (ARDS) has been widely debated, with some studies reporting distinct ARDS phenotypes based on C. Ascertaining whether such phenotypes exist is important, because they might indicate the need for ventilation strategies that differ from those used in patients with ARDS due to other causes. In a systematic review and meta-analysis of studies published between Dec 1, 2019, and March 14, 2022, we evaluated respiratory system mechanics, ventilator parameters, gas exchange parameters, and clinical outcomes in patients with COVID-19-related ARDS. Among 11 356 patients in 37 studies, mean reported C, measured close to the time of endotracheal intubation, was 35·8 mL/cm HO (95% CI 33·9-37·8; I=96·9%, τ=32·6). Pooled mean C was normally distributed. Increasing ARDS severity (assessed by PaO/FiO ratio as mild, moderate, or severe) was associated with decreasing C. We found no evidence for distinct C-based clinical phenotypes in patients with COVID-19-related ARDS, and we therefore conclude that no change in conventional lung-protective ventilation strategies is warranted. Future studies should explore the personalisation of mechanical ventilation strategies according to factors including respiratory system mechanics and haemodynamic status in patients with ARDS.
Topics: Humans; Respiration, Artificial; COVID-19; Respiratory Distress Syndrome; Respiratory Mechanics; Lung
PubMed: 36335956
DOI: 10.1016/S2213-2600(22)00393-9 -
International Journal of Infectious... Nov 2022We aimed to investigate published data on treatment outcomes of multidrug-resistant (MDR)/rifampicin-resistant tuberculosis (TB) in Central and West Africa because... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
We aimed to investigate published data on treatment outcomes of multidrug-resistant (MDR)/rifampicin-resistant tuberculosis (TB) in Central and West Africa because these, to the best of our knowledge, are sparsely available.
METHODS
Systematic review and meta-analysis.
RESULTS
A total of 14 studies were included, representing 4268 individuals in 14 of the 26 countries. Using a random-effects model meta-analysis, we observed a pooled success rate of 80.8% (95% confidence interval [CI] 56.0-93.3) for the Central African subgroup and 69.2% (95% CI 56.3-79.7) for the West African subgroup (P = 0.0522). The overall treatment success for all studies was 74.6% (95% CI 65.0-82.2). We found high heterogeneity among included studies (I = 96.1%). The estimated proportion of successfully treated individuals with MDR/rifampicin-resistant TB was considerably higher than the global estimate provided by the World Health Organization (59%), reaching the 2015 World Health Organization target of at least 75% treatment success for MDR-TB.
CONCLUSION
The use of shorter treatment regimens and the standardized treatment conditions, including directly observed therapy in these studies, could have contributed to a high treatment success. Yet, the available literature was not fully representative of the regions, possibly highlighting the sparse resources in many of these countries. The review was registered at PROSPERO (https://www.crd.york.ac.uk/prospero/) (CRD42022353163).
Topics: Humans; Antitubercular Agents; Tuberculosis, Multidrug-Resistant; Rifampin; Directly Observed Therapy; Treatment Outcome; Mycobacterium tuberculosis
PubMed: 36007688
DOI: 10.1016/j.ijid.2022.08.015 -
Journal of Multidisciplinary Healthcare 2022COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and... (Review)
Review
Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review.
BACKGROUND
COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and international guidelines, the COPD burden to frontline healthcare services has increased in the last decade. Suboptimal guidelines concordance can be disruptive to health-related quality of life (HRQoL), hastening pulmonary function decline and surging overall morbidity and mortality. A lack of concordance with guidelines has created an escalating economic burden on health-care systems. Identifying interdisciplinary interventions to facilitate improved adherence to guidelines may significantly reduce re-admissions, enhance HRQoL amongst patients and their families, and facilitate economic efficiency.
MATERIALS AND METHODS
This review adhered to the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews and the PRISMA ScR reporting guidelines. Two independent reviewers screened abstracts and full text articles in consonance with inclusion criteria. The convergent integrative JBI method collated quantitative, qualitative and mixed methods studies from nine databases. JBI critical appraisal tools were utilised to assess the quality of research papers. The theoretical domains framework (TDF) along with a specifically developed COPD data extraction tool were adopted as a priori to collect and collate data. Identified barriers and corresponding clinical behavioural change solutions were categorised using TDF domains and behavior change wheel (BCW) to provide future research and implementation recommendations.
RESULTS
Searches returned 1068 studies from which 37 studies were included (see Figure 1). COPD recommendations identified to be discordant with clinical practice included initiating non-invasive ventilation, over- or under-prescription of corticosteroids and antibiotics, and a lack of discharging patients with a smoking cessation plan or pulmonary rehabilitation. TDF domains with highest frequency scores were knowledge, environmental resources, and clinical behaviour regulation. Electronic order sets/digital proforma with guideline resources at point of care and easily accessible digital community referrals to target both pharmacological and non-pharmacological management appear to be a solution to improve concordance.
CONCLUSION
Implementation of consistent quality improvement intervention within hospitals for patients with COPD may exclude any implementation gap and prevent readmissions. Electronic proformas with digital referrals will assist with future evaluation audits to prioritise and target interventions to improve guidelines concordance.
ETHICS AND DISSEMINATION
Ethical approval is not required, and results dissemination will occur through peer-reviewed publication.
PROSPERO REGISTRATION NUMBER
CRD42020156267.
PubMed: 35046662
DOI: 10.2147/JMDH.S343277 -
Respiratory Medicine Jan 2022Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients.
METHODS
Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates.
RESULTS
47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03-1.10); I = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28-1.47); I = 14; p = 0.33]; obesity [RR = 1.30 (1.12-1.50); I = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17-1.40); I = 0; p = 0.62]; higher income [RR = 1.63 (1.05-2.56); I = 0; p = 0.52]; being employed [RR = 0.87 (0.83-0.90); I = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79-0.84); I = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate.
CONCLUSIONS
Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.
Topics: Asthma; Cross-Sectional Studies; Humans; Nebulizers and Vaporizers; Patient Compliance; Pulmonary Disease, Chronic Obstructive
PubMed: 34954637
DOI: 10.1016/j.rmed.2021.106724 -
Frontiers in Surgery 2022Hypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of... (Review)
Review
BACKGROUND
Hypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPC) in thoracic surgery is higher than that in other surgeries. Previous studies have demonstrated that driving pressure-oriented ventilation can reduce both mortality in patients with acute respiratory distress syndrome (ARDS) and the incidence of PPC in patients undergoing general anesthesia. Our aim was to determine whether driving pressure-oriented ventilation improves intraoperative physiology and outcomes in patients undergoing thoracic surgery.
METHODS
We searched MEDLINE via PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov and performed a meta-analysis to compare the effects of driving pressure-oriented ventilation with other ventilation strategies on patients undergoing OLV. The primary outcome was the PaO/FiO ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPC during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV.
RESULTS
This review included seven studies, with a total of 640 patients. The PaO/FiO ratio was higher during OLV in the driving pressure-oriented ventilation group (mean difference [MD]: 44.96; 95% confidence interval [CI], 24.22-65.70.32; : 58%; < 0.0001). The incidence of PPC was lower (OR: 0.58; 95% CI, 0.34-0.99; : 0%; = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97-8.32; : 57%; < 0.00001) in the driving pressure-oriented group during OLV. We did not find a significant difference in the mean arterial pressure between the two groups.
CONCLUSION
Driving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPC, and improved compliance of the respiratory system.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier: CRD42021297063.
PubMed: 35722525
DOI: 10.3389/fsurg.2022.914984 -
Korean Journal of Anesthesiology Dec 2023Mechanical ventilation, particularly one-lung ventilation (OLV), can cause pulmonary dysfunction. This meta-analysis assessed the effects of dexmedetomidine on the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mechanical ventilation, particularly one-lung ventilation (OLV), can cause pulmonary dysfunction. This meta-analysis assessed the effects of dexmedetomidine on the pulmonary function of patients receiving OLV.
METHODS
The Embase, PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, and Chinese Clinical Trial Registry databases were systematically searched. The primary outcome was oxygenation index (OI). Other outcomes including the incidence of postoperative complications were assessed.
RESULTS
Fourteen randomized controlled trials involving 845 patients were included in this meta-analysis. Dexmedetomidine improved the OI at 30 (mean difference [MD]: 40.49, 95% CI [10.21, 70.78]), 60 (MD: 60.86, 95% CI [35.81, 85.92]), and 90 min (MD: 55, 95% CI [34.89, 75.11]) after OLV and after surgery (MD: 28.98, 95% CI [17.94, 40.0]) and improved lung compliance 90 min after OLV (MD: 3.62, 95% CI [1.7, 5.53]). Additionally, dexmedetomidine reduced the incidence of postoperative pulmonary complications (odds ratio: 0.44, 95% CI [0.24, 0.82]) and length of hospital stay (MD: -0.99, 95% CI [-1.25, -0.73]); decreased tumor necrosis factor-α, interleukin (IL)-6, IL-8, and malondialdehyde levels; and increased superoxide dismutase levels. However, only the results for the OI and IL-6 levels were confirmed by the sensitivity and trial sequential analyses.
CONCLUSIONS
Dexmedetomidine improves oxygenation in patients receiving OLV and may additionally decrease the incidence of postoperative pulmonary complications and shorten the length of hospital stay, which may be related to associated improvements in lung compliance, anti-inflammatory effects, and regulation of oxidative stress reactions. However, robust evidence is required to confirm these conclusions.
Topics: Humans; One-Lung Ventilation; Dexmedetomidine; Lung; Blood Gas Analysis; Randomized Controlled Trials as Topic
PubMed: 36924790
DOI: 10.4097/kja.22787 -
BMJ Open Respiratory Research Dec 2020Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that may be punctuated by episodes of worsening symptoms, called exacerbations. Acute... (Review)
Review
Interventions to standardise hospital care at presentation, admission or discharge or to reduce unnecessary admissions or readmissions for patients with acute exacerbation of chronic obstructive pulmonary disease: a scoping review.
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that may be punctuated by episodes of worsening symptoms, called exacerbations. Acute exacerbations of COPD (AECOPD) are detrimental to clinical outcomes, reduce patient quality of life and often result in hospitalisation and cost for the health system. Improved diagnosis and management of COPD may reduce the incidence of hospitalisation and death among this population. This scoping review aims to identify improvement interventions designed to standardise the hospital care of patients with AECOPD at presentation, admission and discharge, and/or aim to reduce unnecessary admissions/readmissions.
METHODS
The review followed a published protocol based on methodology set out by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic database searches for peer-reviewed primary evidence were conducted in Web of Science, EMBASE (Elsevier) and PubMed. Abstract, full-text screening and data extraction were completed independently by a panel of expert reviewers. Data on type of intervention, implementation supports and clinical outcomes were extracted. Findings were grouped by theme and are presented descriptively.
RESULTS
21 articles met the inclusion criteria. Eight implemented a clinical intervention bundle at admission and/or discharge; six used a multidisciplinary care pathway; five used coordinated case management and two ran a health coaching intervention with patients.
CONCLUSION
The findings indicate that when executed reliably, improvement initiatives are associated with positive outcomes, such as reduction in length of stay, readmissions or use of health resources. Most of the studies reported an improvement in staff compliance with the initiatives and in the patient's understanding of their disease. Implementation supports varied and included quality improvement methodology, multidisciplinary team engagement, staff education and development of written or in-person delivery of patient information. Consideration of the implementation strategy and methods of support will be necessary to enhance the likelihood of success in any future intervention.
Topics: Hospitalization; Hospitals; Humans; Patient Discharge; Patient Readmission; Pulmonary Disease, Chronic Obstructive; Quality of Life
PubMed: 33262103
DOI: 10.1136/bmjresp-2020-000733 -
BMJ Open Jul 2023The objectives of this systematic review are to identify studies that assess the effectiveness of patient-directed financial incentive interventions to improve asthma...
OBJECTIVES
The objectives of this systematic review are to identify studies that assess the effectiveness of patient-directed financial incentive interventions to improve asthma management behaviours, determine overall effectiveness of financial incentives, identify design characteristics of effective interventions and assess the impact on longer-term outcomes in the context of asthma.
DESIGN
Systematic review with narrative synthesis.
DATA SOURCES
Electronic databases (MEDLINE, Embase, Global Health, PsycINFO, CINAHL, PubMed and Web of Science) and grey literature sources (NHS Digital, CORE, ProQuest, Clinical Trials Register and EU Clinical Trials Register) were searched in November 2021 and updated March 2023.
ELIGIBLITY CRITERIA
Eligible articles assessed financial incentives to improve asthma management behaviours (attendance at appointments, medication adherence, tobacco smoke/allergen exposure, inhaler technique and asthma education) for patients with asthma or parents/guardians of children with asthma. Eligible study design included randomised controlled, controlled or quasi-randomised trials and retrospective/prospective cohort, case-controlled or pilot/feasibility studies.
SYNTHESIS
A narrative synthesis was conducted; eligible studies were grouped by asthma management behaviours and financial incentive framework domains.
RESULTS
We identified 4268 articles; 8 met the inclusion criteria. The studies were from the USA (n=7) and the UK (n=1). Asthma management behaviours included attendance at appointments (n=4), reduction in smoke exposure (n=1) and medication adherence (n=3). Five studies demonstrated positive behaviour change, four of which were significant (attendance at appointments (n=3) showed significant differences between intervention and control: 73% and 49% in one study, 46.3% and 28.9% in another, and 35.7% and 18.9%, respectively; medication adherence (n=1) showed significant change from 80% during intervention to 33% post intervention). These four significant studies used 'positive gain', 'certain', 'fixed' financial incentives of smaller magnitude, given for 'all' instances of behaviour.
CONCLUSION
There is some evidence that patient-directed financial incentives improve asthma management behaviours. However, in view of the wide heterogeneity in study design and measured outcomes, determining overall effectiveness was challenging.
PROSPERO REGISTRATION NUMBER
CRD42021266679.
Topics: Child; Humans; Motivation; Prospective Studies; Retrospective Studies; Asthma; Medication Adherence
PubMed: 37518086
DOI: 10.1136/bmjopen-2022-070761 -
BioMed Research International 2020This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) for pneumoconiosis. We systematically searched PubMed, Embase, The Cochrane Library, Web of... (Meta-Analysis)
Meta-Analysis
This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) for pneumoconiosis. We systematically searched PubMed, Embase, The Cochrane Library, Web of Science, SinoMed, CNKI, VIP databases and Wanfang Data from their inception to June 1, 2019. A systematic review and meta-analysis of randomized controlled trials (RCTs) of PR for pneumoconiosis was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently screened literature, extracted data, and assessed bias risk. All statistical analyses were performed using the RevMan software. Sixteen RCTs with 1307 subjects were ultimately included for analysis. Compared with routine treatment, PR was able to improve the 6-minute walking distance (mean difference (MD) 69.10, 95% confidence interval (CI) 61.95-76.25); the 36-Item Short Form Health Survey total score (MD 17.60, 95% CI 13.59-21.61); physical function score (MD 15.45, 95% CI 3.20-27.69); role physical score (MD 17.87, 95% CI 12.06-23.69); body pain score (MD 14.34, 95% CI 10.33-18.36); general health score (MD 20.86, 95% CI 16.87-24.84); vitality score (MD 11.66, 95% CI 0.18-23.13); social function score (MD 9.67, 95% CI 1.27-18.08); mental health score (MD 20.60, 95% CI 13.61-27.59); forced vital capacity (FVC) (MD 0.20, 95% CI 0.12-0.29); forced expiratory volume in 1 s (FEV1) (MD 0.23, 95% CI 0.09-0.38); FEV1% (MD 5.19, 95% CI 1.48-8.90); maximal voluntary ventilation (MD 4.47, 95% CI 1.14-7.81); reduction in the St. George's Respiratory Questionnaire score (MD -9.60, 95% CI -16.40 to -2.80); and the modified Medical Research Council Scale score. Furthermore, PR did not increase the FEV1/FVC (MD 3.61, 95% CI -3.43 to 10.65), nor the emotional score (MD 6.18, 95% CI -23.01 to 35.38) compared with the control. We found no reports of adverse events associated with PR. Thus, to some extent, PR can improve functional capacity and quality of life in patients with pneumoconiosis. However, these results should be interpreted with caution because of high heterogeneity. This trial is registered with registration number CRD42018095266.
Topics: Exercise Tolerance; Humans; Lung; Pneumoconiosis; Quality of Life; Respiratory Function Tests
PubMed: 32802860
DOI: 10.1155/2020/6174936 -
BMJ Open Aug 2019In England, the NHS111 service provides assessment and triage by telephone for urgent health problems. A digital version of this service has recently been introduced. We...
OBJECTIVES
In England, the NHS111 service provides assessment and triage by telephone for urgent health problems. A digital version of this service has recently been introduced. We aimed to systematically review the evidence on digital and online symptom checkers and similar services.
DESIGN
Systematic review.
DATA SOURCES
We searched Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium, Web of Science and ACM Digital Library up to April 2018, supplemented by phrase searches for known symptom checkers and citation searching of key studies.
ELIGIBILITY CRITERIA
Studies of any design that evaluated a digital or online symptom checker or health assessment service for people seeking advice about an urgent health problem.
DATA EXTRACTION AND SYNTHESIS
Data extraction and quality assessment (using the Cochrane Collaboration version of QUADAS for diagnostic accuracy studies and the National Heart, Lung and Blood Institute tool for observational studies) were done by one reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies structured around pre-defined research questions and key outcomes.
RESULTS
We included 29 publications (27 studies). Evidence on patient safety was weak. Diagnostic accuracy varied between different systems but was generally low. Algorithm-based triage tended to be more risk averse than that of health professionals. There was very limited evidence on patients' compliance with online triage advice. Study participants generally expressed high levels of satisfaction, although in mainly uncontrolled studies. Younger and more highly educated people were more likely to use these services.
CONCLUSIONS
The English 'digital 111' service has been implemented against a background of uncertainty around the likely impact on important outcomes. The health system may need to respond to short-term changes and/or shifts in demand. The popularity of online and digital services with younger and more educated people has implications for health equity.
PROSPERO REGISTRATION NUMBER
CRD42018093564.
Topics: England; Health Services Accessibility; Health Services Research; Hotlines; Humans; Information Seeking Behavior; Quality of Health Care; Telemedicine; Triage
PubMed: 31375610
DOI: 10.1136/bmjopen-2018-027743