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BMJ (Clinical Research Ed.) Dec 2003To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. (Review)
Review
OBJECTIVES
To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
DESIGN
Systematic review of randomised controlled trials.
DATA SOURCES
Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
STUDY SELECTION
Studies showing the effects of using a parachute during free fall.
MAIN OUTCOME MEASURE
Death or major trauma, defined as an injury severity score > 15.
RESULTS
We were unable to identify any randomised controlled trials of parachute intervention.
CONCLUSIONS
As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
Topics: Accidents, Aviation; Death, Sudden; Humans; Odds Ratio; Protective Devices; Publication Bias; Randomized Controlled Trials as Topic; Wit and Humor as Topic; Wounds and Injuries
PubMed: 14684649
DOI: 10.1136/bmj.327.7429.1459 -
BMJ (Clinical Research Ed.) Jul 2019To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.
REVIEW METHODS
Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I statistic, and publication bias was evaluated.
RESULTS
Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).
CONCLUSIONS
Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.
Topics: Cross-Sectional Studies; Evidence-Based Practice; Humans; Observational Studies as Topic; Patient Harm; Patient Safety; Prevalence; Quality Improvement; Retrospective Studies; Severity of Illness Index
PubMed: 31315828
DOI: 10.1136/bmj.l4185 -
Epidemiology (Cambridge, Mass.) Sep 2010Falls are the main cause of accidental death in persons aged 65 years or older. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Falls are the main cause of accidental death in persons aged 65 years or older.
METHODS
Using MEDLINE and previous reviews, we searched for prospective studies investigating risk factors for falls among community-dwelling older people. For risk factors investigated by at least 5 studies in a comparable way, we computed pooled odds ratios (ORs) using random-effects models, with a test for heterogeneity.
RESULTS
A total of 74 studies met the inclusion criteria and 31 risk factors were considered, including sociodemographic, mobility, sensory, psychologic, and medical factors and medication use. The strongest associations were found for history of falls (OR = 2.8 for all fallers; OR = 3.5 for recurrent fallers), gait problems (OR = 2.1; 2.2), walking aids use (OR = 2.2; 3.1), vertigo (OR = 1.8; 2.3), Parkinson disease (OR = 2.7; 2.8), and antiepileptic drug use (OR = 1.9; 2.7). For most other factors, the ORs were moderately above 1. ORs were generally higher for recurrent fallers than for all fallers. For some factors, there was substantial heterogeneity among studies. For some important factors (eg, balance and muscle weakness), we did not compute a summary estimate because the measures used in various studies were not comparable.
CONCLUSIONS
This meta-analysis provides comprehensive evidence-based assessment of risk factors for falls in older people, confirming their multifactorial etiology. Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling.
Topics: Accidental Falls; Age Factors; Aged; Aged, 80 and over; Female; Humans; Male; Multivariate Analysis; Odds Ratio; Recurrence; Risk Factors; Sex Factors
PubMed: 20585256
DOI: 10.1097/EDE.0b013e3181e89905 -
The American Journal of Emergency... Feb 2022Intrahospital transport of critically ill patients is often necessary for diagnostic procedures, therapeutic procedures, or admission to the intensive care unit. The aim... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Intrahospital transport of critically ill patients is often necessary for diagnostic procedures, therapeutic procedures, or admission to the intensive care unit. The aim of this study was to investigate and describe safety and adverse events during intrahospital transport of critically ill patients.
MATERIAL AND METHODS
A systematic search was performed of MEDLINE and the Cochrane Central Register of Controlled Trials for studies published up to June 3, 2020, and of the International Clinical Trials Platform Search Portal and ClinicalTrials.gov for ongoing trials. We selected prospective and retrospective cohort studies published in English on intrahospital transport of critically ill patients, and then performed a meta-analysis. The primary outcome was the incidence of all adverse events that occurred during intrahospital transport. The secondary outcomes were death due to intrahospital transport or life-threatening adverse events, minor events in vital signs, adverse events related to equipment, durations of ICU and hospital stay, and costs.
RESULTS
A total of 12,313 intrahospital transports and 1898 patients from 24 studies were included in the meta-analysis. Among 24 studies that evaluated the primary outcome, the pooled frequency of all adverse events was 26.2% (95% CI: 15.0-39.2) and the heterogeneity among these studies was high (I2 = 99.5%). The pooled frequency of death due to intrahospital transport and life-threatening adverse events was 0% and 1.47% each, but heterogeneity was also high.
CONCLUSIONS
Our findings suggest that adverse events can occur during intrahospital transport of critically ill patients, and that the frequency of critical adverse events is relatively low. The results of this meta-analysis could assist in risk-benefit analysis of diagnostic or therapeutic procedures requiring intrahospital transport of critically ill patients.
TRIAL REGISTRATION
UMIN000040963.
Topics: Adolescent; Adult; Aged; Critical Care; Critical Illness; Humans; Middle Aged; Patient Transfer; Risk Factors; Safety; Young Adult
PubMed: 34861515
DOI: 10.1016/j.ajem.2021.11.021 -
Annals of Physical and Rehabilitation... Nov 2020Falls play a pivotal role in the cause of injury or death and have become a public health problem, especially for older people. Tai Chi may be an effective approach to...
BACKGROUND
Falls play a pivotal role in the cause of injury or death and have become a public health problem, especially for older people. Tai Chi may be an effective approach to improving balance and reducing falls. However, the conclusions of systematic reviews (SRs) have been inconsistent and the quality needs to be appraised critically.
OBJECTIVE
To provide an overview of the methodological quality, risk of bias and reporting quality as well as quality of evidence of SRs of Tai Chi for improving balance and reducing falls.
METHODS
We conducted a systematic search of English- and Chinese-language SRs in 8 electronic databases, from inception to October 2019. The methodological quality, risk of bias, reporting quality and the quality of evidence were independently assessed by 2 reviewers who used the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grades of Recommendations, Assessment, Development and Evaluation (GRADE). Primary outcomes were fall rate and the Berg Balance Scale score in older people and people with Parkinson disease. Secondary outcomes included these outcomes in stroke, osteoarthritis and heart failure.
RESULTS
A total of 14 relevant SRs were included: 13 were rated critically low quality and 1 was rated low quality by AMSTAR 2. By the ROBIS, all SRs were rated low risk in Phase 1 (assessing relevance) and Domain 1 of Phase 2 (study eligibility criteria). With regard to Domain 2, assessing the identification and selection of studies, 3 (21.4%) SRs were rated low risk. Eleven (71.4%) were rated low risk in Domain 3 (data collection and study appraisal), 11 (71.4%) were rated low risk in Domain 4 (synthesis and findings), and 9 (64.3%) were rated low risk in Phase 3 (risk of bias in the review). According to PRISMA, the reporting was relatively complete, but there were still some reporting flaws in the topic of protocol and registration (2/14, 14.3%), search strategy (5/14, 35.7%), risk of bias (6/14, 42.9%), additional analyses (6/14, 42.9%) and funding (4/14, 28.6%). Among the 14 SRs, Tai Chi had benefits for improving balance and reducing falls in older people and people with Parkinson disease; however, no definitive conclusions could be drawn for its effectiveness in stroke, osteoarthritis and heart failure. The level of evidence for fall rate was "moderate" to "high" for older people and "low" for those with Parkinson disease. The level of evidence of the Berg Balance Scale was "low" to "moderate" for older people and "low" for those with Parkinson disease. Among the downgraded factors, imprecision was the most common, followed by inconsistency and publication bias.
CONCLUSIONS
Tai Chi may be beneficial for improving balance and reducing falls in older people and those with Parkinson disease. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs are needed to provide robust evidence for definitive conclusions.
Topics: Accidental Falls; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Postural Balance; Randomized Controlled Trials as Topic; Research Design; Systematic Reviews as Topic; Tai Ji
PubMed: 31981834
DOI: 10.1016/j.rehab.2019.12.008 -
Environmental Science and Pollution... May 2022Although a growing number of original epidemiological studies imply a link between ambient pollution exposure and mortality risk, the findings associated with carbon... (Meta-Analysis)
Meta-Analysis Review
Systematic review and meta-analysis of studies between short-term exposure to ambient carbon monoxide and non-accidental, cardiovascular, and respiratory mortality in China.
Although a growing number of original epidemiological studies imply a link between ambient pollution exposure and mortality risk, the findings associated with carbon monoxide (CO) exposure are inconsistent. Thus, we conducted a systematic review and meta-analysis of epidemiological studies to evaluate the correlations between ambient CO and non-accidental, cardiovascular, and respiratory mortality in China. Eight databases were searched from inception to 15 May 2021. A random-effect model was used to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs). Subgroup analyses as well as sensitivity analyses were performed. The I square value (I) was used to assess heterogeneity among different studies. The assessment of publication bias on included studies was examined by funnel plot and Egger's test. The influence of a potential publication bias on findings was explored by using the trim-and-fill procedure. Ultimately, a total of 19 studies were included in our analysis. The pooled relative risk for each 1 mg/m increase of ambient carbon monoxide was 1.0220 (95%CI: 1.0102-1.0339) for non-accidental mortality, 1.0304 (95%CI:1.0154-1.0457) for cardiovascular mortality, and 1.0318 (95%CI:1.0132-1.0506) for respiratory mortality. None of subgroup analyses could explain the source of heterogeneity. Exclusion of any single study did not materially alter the pooled effect estimates. Although it was suggestive of publication bias, findings were generally similar with principal findings when we explored the influence of a potential publication bias using the trim-and-fill method. Our meta-analysis demonstrated that exposure to ambient CO was positive with risk of deaths from all non-accidental causes, total cardiovascular, and respiratory diseases. Based on these findings, tougher intervention policies and initiatives to reduce the health effects of CO exposure should be established.
Topics: Air Pollutants; Air Pollution; Carbon Monoxide; Environmental Exposure; Humans; Particulate Matter; Respiratory Tract Diseases
PubMed: 35257337
DOI: 10.1007/s11356-022-19464-9 -
Reviews on Environmental Health Mar 2022Several studies on the health effects of heat exposure on workers have been reported; however, only few studies have summarized the overall and systematic health effects... (Review)
Review
OBJECTIVES
Several studies on the health effects of heat exposure on workers have been reported; however, only few studies have summarized the overall and systematic health effects of heat exposure on workers. This study aims to review the scientific reports on the health status of workers exposed to high temperatures in the workplace.
METHODS
We reviewed literature from databases such as PubMed and Google Scholar, using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to identify studies that address health effects of heat exposure among workers.
RESULTS
In total, 459 articles were identified, and finally, 47 articles were selected. Various health effects of heat exposure on workers have been reported, such as heat-related diseases, deaths, accidents or injuries, effects on the urinary system, reproductive system, and on the psychological system.
CONCLUSIONS
Our review suggests that many workers are vulnerable to heat exposure, and this has a health effect on workers.
Topics: Hot Temperature; Humans; Occupational Exposure; Occupational Health; Workplace
PubMed: 33752272
DOI: 10.1515/reveh-2020-0158 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Apr 2023To study of premature/early death of autistic patients from the perspective of life course can help families, medical institutions and policy makers better deal with the...
To study of premature/early death of autistic patients from the perspective of life course can help families, medical institutions and policy makers better deal with the adverse effects of autism. Several studies have shown that autistic patients have a high risk of death, however, the results are still inconsistent. To assess the risk of mortality among the autistic patients, we undertook a comprehensive search of MEDLINE, Web of Science and EMBASE databases. This paper reviewed the studies on the negative disease outcomes of autism spectrum disorders, including the risk of death, causes of death and several research hotspots in this field. Strict inclusion/exclusion criteria were used. Information was extracted from selected papers, tabulated and synthesized. In the study, 15 studies were included, with a total of 216 045 individuals. The main outcome was all-cause mortality in association with autism and the secondary outcome was cause-specific mortality. The results showed that all-cause mortality was higher for the autistic patients (=2.32, 95%: 1.98-2.72, =87.1%, < 0.001). Risk ratio showed a greater inequality for female than male (male: =2.00, 95%: 1.57-2.55, =93.2%, < 0.001; female: =4.66, 95%: 3.30-6.58, =92.0%, < 0.001). Compared with the unnatural death, the risk of natural death was higher (=3.44, 95%: 1.27-9.26, =80.2%, =0.025). As autism had many comorbidities, which would bring more health risks and natural deaths possibilities. There were some structural differences in unnatural death. Accidental injury death and suicide were two kinds of causes. Lacking social skills would weaken the ability to ask for help when encountering injuries. This paper put forward some suggestions for futures. First, to well study the comorbidity can reduce the risk of death from a medical point of view. Second, the scientists and policymakers should pay attention to the social environment and provide a safer environment for the autistic patients. Third, for women and for adolescents without cognitive impairment, due to their high risk of suicide, the society should provide them with more supportive social networks and improve their life satisfaction. Fourth, it is necessary to balance the rehabilitation resources in various regions in China and provide more high-quality lifelong rehabilitation monitoring and care services.
Topics: Adolescent; Humans; Male; Female; Autism Spectrum Disorder; Cause of Death; Comorbidity; Autistic Disorder; China
PubMed: 37042154
DOI: 10.19723/j.issn.1671-167X.2023.02.027 -
Journal of the American Medical... Nov 2023The primary objective of this study was to systematically review and meta-analyze the incidence and consequential morbidity and mortality from falls in skilled nursing... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The primary objective of this study was to systematically review and meta-analyze the incidence and consequential morbidity and mortality from falls in skilled nursing facilities. Our secondary objective is to synthesize current evidence on risk factors for injurious falls.
DESIGN
Systematic review and meta-analysis.
SETTING AND PARTICIPANTS
Older adults residing in skilled nursing facilities or similar settings.
METHODS
We completed study screening, data extraction, and quality assessment in duplicate. Random effects models were used for meta-analysis of fall incidence rates and proportions of outcomes per fall. Sensitivity analysis and meta-regression were completed to assess differences based on study design, quality, and population characteristics. The Newcastle Ottawa Scale and Cochrane Risk of Bias tools were used to assess quality of observational and intervention-based studies, respectively. The GRADE tool was used to evaluate strength of evidence for fall risk factors.
RESULTS
We identified 3103 unique references, of which 38 were included in systematic review and 37 in meta-analysis. Pooled incidence of falls was 121 per 100 person-years (95% CI 86-170). Outcomes of transfer to hospital, admission to hospital, overall injury, head injury, fracture, 30-day mortality, death in hospital, and disability were reported by included studies. Sensitivity analysis indicated no significant difference in fall rates between study designs. Meta-regression indicated no significant relationship between fall rate and age or sex; however, a weak positive correlation was identified with increasing prevalence of dementia. No fall risk factors were supported by high-quality evidence.
CONCLUSION/IMPLICATIONS
Our study confirms that falls in skilled nursing facilities are common and cause significant morbidity, mortality and health system use. As populations in high-income countries age, falls will become increasingly prevalent. Future research should be directed at preventing injurious falls and determining when hospital care will benefit a faller.
Topics: Humans; Aged; Accidental Falls; Incidence; Skilled Nursing Facilities; Fractures, Bone; Hospitals
PubMed: 37625452
DOI: 10.1016/j.jamda.2023.07.012 -
European Neuropsychopharmacology : the... Jun 2016Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma. However, the role of this substance in crash causation remains... (Meta-Analysis)
Meta-Analysis Review
Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma. However, the role of this substance in crash causation remains equivocal. We performed a systematic review to evaluate existing evidence regarding the association between amphetamine use and the risk of injury or death due to road traffic accidents. A bibliographical search of PubMed, SafetyLit, Scopus, and Science Direct literature databases from 01 January 1980 until May 2015 was performed. The quality of included studies was assessed using the Newcastle-Ottowa Scale (NOS) (cut-off of ≥7 indicated high quality). Inter-rater reliability between three independent reviewers for the NOS was calculated using Cohens kappa (κ) statistic, and best-evidence synthesis was performed. A total of 182 articles were found. Nine studies met eligibility criteria for inclusion for review, and seven studies were included for best-evidence synthesis. Best-evidence synthesis demonstrated a conflicting level of evidence for associations between the use of-amphetamine-type substances and the risk of sustaining an injury, and a moderate level of evidence between amphetamine use and the risk of death due to road trauma. This is the first review to synthesise evidence regarding the association between amphetamine-type substance use and the risk of injury or death due to a road traffic accident. More conclusive evidence of death due to road trauma among amphetamine users may reflect significant and global deficits in functioning associated with effective vehicular control under the influence of this substance. Additional high quality, sufficiently powered studies are required to elucidate the magnitude of these associations.
Topics: Accidents, Traffic; Amphetamines; Central Nervous System Stimulants; Humans; Observational Studies as Topic; Wounds and Injuries
PubMed: 27006144
DOI: 10.1016/j.euroneuro.2016.02.012