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Critical Care Medicine Feb 2023Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies.
DATA SOURCES
Systematic search of five databases up to November 24, 2021.
STUDY SELECTION
Studies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility.
DATA EXTRACTION
Study demographics, ultrasound methodologies, and clinimetric data.
DATA SYNTHESIS
Sixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter- and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98; 95% CI, 0.94-0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79; 95% CI, 0.73-0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84; 95% CI, 0.78-0.91).
CONCLUSIONS
Diaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.
Topics: Adult; Humans; Ventilator Weaning; Reproducibility of Results; Ultrasonography; Diaphragm; Critical Care
PubMed: 36661463
DOI: 10.1097/CCM.0000000000005739 -
Fertility and Sterility Jul 2022To assess the awareness, knowledge, and misconceptions of young people regarding long-acting reversible contraceptives (LARCs). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the awareness, knowledge, and misconceptions of young people regarding long-acting reversible contraceptives (LARCs).
DESIGN
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of MEDLINE-Ovid, Embase, and Cumulative Index to Nursing and Allied Health Literature. A random-effects meta-analysis was performed with formal tests for heterogeneity and publication bias. Additional outcomes were summarized using thematic analysis.
SETTING
Not applicable.
PATIENT(S)
Adolescents and young adults (aged 12-25 years) with a uterus.
INTERVENTION(S)
Not applicable.
MAIN OUTCOME MEASURE(S)
Patient-reported outcomes related to awareness, knowledge, and misconceptions of LARCs (including intrauterine devices, subdermal implants, and injections) were analyzed.
RESULT(S)
Of the 4,077 database citations, we included 40 studies encompassing 10,470 adolescents and young people. Twenty studies were eligible for meta-analysis. The pooled prevalence described that only 65.0% (95% confidence interval [CI], 51-78) of participants were aware of at least 1 type of LARC (I = 100). The meta-regression noted that the region, risk of bias, gravidity, sexual history, previous LARC experience, and postsecondary education were not associated with awareness. There were numerous misconceptions regarding eligibility, safety, and usage. Notably, 62% (95% CI, 20-91) did not understand that LARCs could be used in nulliparous individuals, and 37% (95% CI, 21-56) believed that LARCs could cause infertility.
CONCLUSION(S)
There are notable knowledge gaps among adolescents and young people regarding LARCs, such as eligibility criteria, the reversibility of long-acting options, and misconceptions regarding infertility. Clinicians should specifically counsel regarding the suitability for LARCs in nulliparous populations and that LARCs do not cause infertility.
Topics: Adolescent; Contraceptive Agents, Female; Female; Humans; Infertility; Intrauterine Devices; Young Adult
PubMed: 35637026
DOI: 10.1016/j.fertnstert.2022.03.013 -
BMJ Sexual & Reproductive Health Apr 2023Intrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended... (Review)
Review
BACKGROUND
Intrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden.
METHODS
This systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type. English language articles indexed in MEDLINE, Embase, and Cochrane from January 2010-October 2021 were included.
RESULTS
133 articles met the inclusion criteria (46% interventional studies; 54% observational; n=87 from lower-income countries; n=46 from higher-income countries). PPIUD use was low in higher-income countries (6/10 000 US deliveries in 2013-2016) and varied widely in lower-income countries (2%-46%). Across both higher- and lower-income countries, in most studies (79%), >80% of women with PPIUDs had an IUD in place by 3 months; at 6 and 12 months, 76% and 54% of included studies reported that >80% of women had an IUD in place; reason for discontinuation was infrequently reported. Pregnancies were rare (96 pregnancies across 12 191 women from 37 studies reporting data) and were generally unrelated to device failure, but rather occurred in women no longer using a PPIUD. Expulsions occurred mainly in the early outpatient period and ranged widely (within 3 months: 0-41%). Abnormal bleeding, infections, or perforations were rare.
CONCLUSIONS
PPIUDs are safe and effective. Long-term follow-up data are limited. Future research elucidating reasons underlying lack of PPIUD use is warranted.
Topics: Pregnancy; Female; Humans; Contraception; Postpartum Period; Intrauterine Devices; Pregnancy, Unplanned
PubMed: 36600467
DOI: 10.1136/bmjsrh-2022-201579 -
American Journal of Obstetrics and... May 2020Changes in menstrual bleeding concern many users of the 52 mg Levonorgestrel Intrauterine System. Prescribing information for Levonorgestrel Intrauterine System devices... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Changes in menstrual bleeding concern many users of the 52 mg Levonorgestrel Intrauterine System. Prescribing information for Levonorgestrel Intrauterine System devices describe an overall decrease in bleeding and spotting days over time; however, estimates derived from a variety of existing clinical data are currently unavailable.
OBJECTIVE
The objective of the study was to systematically calculate the mean days of bleeding-only, spotting-only, and bleeding and/or spotting experienced by a population of reproductive-aged Levonorgestrel Intrauterine System users with normal regular menses prior to insertion during the first year of use.
DATA SOURCES
We identified clinical trials, including randomized controlled trials and randomized comparative trials, as well as cohort studies published in English between January 1970 and November 2018 through searching 12 biomedical and scientific literature databases including MEDLINE and ClinicalTrials.gov.
STUDY ELIGIBILITY CRITERIA
We considered studies that reported data on Levonorgestrel Intrauterine System devices releasing 20 μg of levonorgestrel per day, collected daily menstrual bleeding data for at least 90 consecutive days, defined bleeding and spotting per World Health Organization standards and evaluated participants with normal regular menses prior to insertion.
STUDY APPRAISAL AND SYNTHESIS METHODS
We assessed study quality using established guidelines. Two reviewers independently conducted all review stages and rated the quality of evidence for each article; any disagreements were resolved by a third. Where possible, we pooled data using a random-effects model.
RESULTS
Among 3403 potentially relevant studies, we included 7 in our meta-analysis. We calculated the mean days of bleeding-only, spotting-only, and bleeding and/or spotting for the first four 90 day intervals after Levonorgestrel Intrauterine System insertion. Combined menstrual bleeding and/or spotting days gradually decreased throughout the first year, from 35.6 days (95% confidence interval, 32.2-39.1) during the first 90 day interval to 19.1 (95% confidence interval, 16.6-21.5), 14.2 (95% confidence interval, 11.7-16.8), and 11.7 days (95% confidence interval, 9.7-13.7) in the second, third, and fourth intervals. Measures for bleeding-only and spotting-only days similarly decreased throughout the first year, with the greatest decreases occurring between the first and second intervals.
CONCLUSION
Our study provides 90 day reference period measures that characterize menstrual patterns for Levonorgestrel Intrauterine System users with normal regular menses prior to insertion during the first year of use. Our findings provide broader generalizability and more detail than patterns described in the prescribing information. These findings quantify an overall decrease in menstrual bleeding days with longer duration of use, with the greatest decrease occurring between months 3 and 6. Accurately establishing expectations with the Levonorgestrel Intrauterine System may improve informed selection and decrease discontinuation.
Topics: Adult; Contraceptive Agents, Female; Female; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Menstruation; Metrorrhagia; Time Factors
PubMed: 31589865
DOI: 10.1016/j.ajog.2019.09.044 -
Contraception Dec 2012Although a large amount of studies in the literature evaluated the effects of hormonal contraception on bone, many questions remained still unclear, such as the effect... (Review)
Review
BACKGROUND
Although a large amount of studies in the literature evaluated the effects of hormonal contraception on bone, many questions remained still unclear, such as the effect of these therapies on fracture risk.
STUDY DESIGN
We performed a systematic search of the published studies from January 1975 through January 2012 on the effects of hormonal contraceptives on bone metabolism. We analyzed the overall effect on bone mineral density (BMD) and on fracture risk of combined oral contraceptives (COCs), progestogen-only contraceptives, transdermal contraceptives and vaginal ring.
RESULTS
COC therapy does not seem to exert any significant effect on BMD in the general population. In adolescents, the effects of COCs on BMD seem to be mainly determined by estrogen dose. The use of COCs in perimenopausal women seems to reduce bone demineralization and may significantly increase BMD even at a 20-mcg dose. Use of depot medroxyprogesterone acetate is associated with a decrease in BMD, although this decrease seems to be partially reversible after discontinuation. Data on other progestogen-only contraceptives, transdermal patch and vaginal ring are still limited, although it seems that these contraceptive methods do not exert any influence on BMD.
CONCLUSIONS
Hormonal contraceptives do not seem to exert any significant effect on bone in the general population. However, other randomized controlled trials are needed to evaluate the effects on fracture risk since the data available are derived from studies having the effects on BMD as the primary end point, and BMD may not accurately reflect the real fracture risk.
Topics: Animals; Bone Density; Bone Density Conservation Agents; Bone and Bones; Contraceptive Agents, Female; Contraceptive Devices, Female; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Estradiol Congeners; Female; Fractures, Bone; Humans; Osteoporotic Fractures; Progesterone Congeners; Risk; Transdermal Patch
PubMed: 22717184
DOI: 10.1016/j.contraception.2012.04.009 -
Preventive Medicine Nov 2015To systematically review the literature on contraceptive use by women with opioid and other substance use disorders in order to estimate overall contraceptive use and to... (Review)
Review
AIM
To systematically review the literature on contraceptive use by women with opioid and other substance use disorders in order to estimate overall contraceptive use and to examine method choice given the alarmingly high rate of unintended pregnancy in this population.
METHOD
Pubmed (1948-2014) and PsycINFO (1806-2014) databases were searched for peer-reviewed journal articles using a systematic search strategy. Only articles published in English and reporting contraceptive use within samples of women with opioid and other substance use disorders were eligible for inclusion.
RESULTS
Out of 580 abstracts reviewed, 105 articles were given a full-text review, and 24 studies met the inclusion criteria. The majority (51%) of women in these studies reported using opioids, with much smaller percentages reporting alcohol and cocaine use. Across studies, contraceptive prevalence ranged widely, from 6%-77%, with a median of 55%. Results from a small subset of studies (N=6) suggest that women with opioid and other substance use disorders used contraception less often than non-drug-using comparison populations (56% vs. 81%, respectively). Regarding method choice, condoms were the most prevalent method, accounting for a median of 62% of contraceptives used, while use of more effective methods, especially implants and intrauterine devices (IUDs), was far less prevalent 8%.
CONCLUSIONS
Women with opioid and other substance use disorders have an unmet need for contraception, especially for the most effective methods. Offering contraception services in conjunction with substance use treatment and promoting use of more effective methods could help meet this need and reduce unintended pregnancy in this population.
Topics: Adult; Analgesics, Opioid; Choice Behavior; Contraceptive Agents; Family Planning Services; Female; Humans; Opioid-Related Disorders; Pregnancy; Substance-Related Disorders
PubMed: 25900803
DOI: 10.1016/j.ypmed.2015.04.008 -
Sensors (Basel, Switzerland) Nov 2022Low back pain represents the leading cause of disability since 1990. In 90% of cases, it is classified as non-specific low back pain, being chronic in 10% of subjects.... (Review)
Review
Low back pain represents the leading cause of disability since 1990. In 90% of cases, it is classified as non-specific low back pain, being chronic in 10% of subjects. Ultrasound has proven to be an effective measurement tool to observe changes in the activity and morphology of the abdominal muscles. This article reviews which core synergies are studied with ultrasound in healthy subjects and with chronic non-specific low back pain. A systematic review was conducted on studies analyzing synergies between two or more core muscles. Publications from 2005 until July 2021 were identified by performing structured searched in Pubmed/MEDLINE, PEDro and WOS. Fifteen studies were eligible for the final systematic review. A total of 56% of the studies established synergies between the core muscles and 44% between the homo and contralateral sides of the core muscles. The most studied core synergies were transversus abdominis, internal oblique and external oblique followed by the rectus abdominis and the lumbar multifidus. No studies establishing synergies with diaphragm and pelvic floor were found. Eight studies were conducted in healthy subjects, five studies in subjects with chronic non-specific low back pain compared to healthy subjects and two studies in subjects with chronic non-specific low back pain.
Topics: Humans; Low Back Pain; Healthy Volunteers; Abdominal Muscles; Ultrasonography; Thorax
PubMed: 36433283
DOI: 10.3390/s22228684 -
Journal of Gynecology Obstetrics and... Apr 2022Our study aims to compare the effects of using hyaluronan gel, an intrauterine device, and their combination to prevent intrauterine adhesions. (Meta-Analysis)
Meta-Analysis Review
Comparison of effectiveness of hyaluronan gel, intrauterine device and their combination for prevention adhesions in patients after intrauterine surgery: Systematic review and meta-analysis.
OBJECTIVE
Our study aims to compare the effects of using hyaluronan gel, an intrauterine device, and their combination to prevent intrauterine adhesions.
METHODS
The systematic review was conducted according to the PRISMA 2020 checklist and has been registered in the PROSPERO.
INCLUSION AND EXCLUSION CRITERIA
randomized controlled trials (RCTs) in English, patients after intrauterine surgery were included. Patients with hypersensitivity and pelvic inflammatory disease were excluded.
DATA SOURCES
PubMed, The Cochrane Library, ClinicalTrials.gov, Embase, and MEDLINE. The search was performed on studies published before February 1, 2021 to identify articles evaluating the effectiveness of hyaluronan gel, an intrauterine device, and their combination in the prevention of intrauterine adhesions.
RESULTS
8 RCTs were included for qualitative analysis reporting on 1226 participants. Five randomized trials compared recurrence rates between two groups: hyaluronan gel and control (RR = 0.53, 95% CI: 0.40 to 0.69, P < .00001). Hyaluronan gel had a significant role on reducing adhesion formation after surgical intervention. Meta-analysis of pregnancy rates compared hyaluronan gel usage and group with IUD or lack of treatment (RR = 1.58, 95% CI: 1.10 to 2.27, P = .01). Hyaluronan gel group had significantly higher pregnancy rates compared with another group in this meta-analysis.
CONCLUSION
Based on our study, it has become more evident that hyaluronic acid is an effective and safe method after adhesiolysis to prevent recurrence and lead to pregnancy in comparison with other techniques. Nevertheless, further research is needed to achieve more answers regarding adhesions prevention.
Topics: Female; Gels; Humans; Hyaluronic Acid; Hysteroscopy; Intrauterine Devices; Pregnancy; Tissue Adhesions
PubMed: 35134573
DOI: 10.1016/j.jogoh.2022.102334 -
Contraception Dec 2012Copper intrauterine devices (copper-IUDs) are relatively safer, more effective and inexpensive compared with hormonal methods and are the most widely used reversible... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Copper intrauterine devices (copper-IUDs) are relatively safer, more effective and inexpensive compared with hormonal methods and are the most widely used reversible contraception in the world, but are underused in developed countries. We systematically reviewed randomized controlled trials and controlled before-and-after studies to determine the effectiveness of interventions for improving uptake of copper-IUDs.
STUDY DESIGN
We searched electronic databases for eligible trials. RevMan 5.1 was used to calculate Peto odd ratios with 95% confidence interval for dichotomous outcomes.
RESULTS
Nine studies representing 7960 women met our inclusion criteria, including seven randomized controlled trials and two controlled before-and-after studies. Meta-analysis from three studies showed contraceptive provision by community workers doubled uptake of IUD, and studies on antenatal contraceptive counselling showed similar increases. One study reported major increases in IUD uptake with postnatal couple contraceptive counselling; a study on postnatal home visits and two studies on postabortion contraceptive counselling did not reach statistical significance.
CONCLUSIONS
Community-based interventions and antenatal contraceptive counselling improved uptake of copper-IUD in studies mainly conducted in developing counties. Further research is needed on postabortion contraceptive counselling as well as longer-term effectiveness of interventions to improve use of copper-IUD.
Topics: Contraception Behavior; Developing Countries; Evidence-Based Medicine; Family Characteristics; Family Planning Services; Female; Humans; Intrauterine Devices, Copper; Male; Patient Education as Topic; Perinatal Care; Postnatal Care
PubMed: 22762708
DOI: 10.1016/j.contraception.2012.05.015 -
PloS One 2023Surface Electromyography (sEMG) has been used to monitor respiratory muscle function and contractility in several clinical situations, however there is the lack of...
BACKGROUND
Surface Electromyography (sEMG) has been used to monitor respiratory muscle function and contractility in several clinical situations, however there is the lack of standardization for the analysis and processing of the signals.
OBJECTIVE
To summarize the respiratory muscles most assessed by sEMG in the critical care setting and the assessment procedure details employed on those muscles regarding electrode placement, signal acquisition, and data analysis.
METHODS
A systematic review of observational studies was registered on PROSPERO (number CRD42022354469). The databases included PubMed; SCOPUS; CINAHL, Web of Science and ScienceDirect. Two independent reviewers ran the quality assessment of the studies using the Newcastle-Ottawa Scale and Downs & Black checklists.
RESULTS
A total of 311 participants were involved across the 16 studies, from which 62.5% (10) assessed the diaphragm muscle and 50% (8) assessed the parasternal muscle with similar electrode placement in both of them. We did not identify common patterns for the location of the electrodes in the sternocleidomastoid and anterior scalene muscles. 12/16 reported sample rate, 10/16 reported band-pass and 9/16 reported one method of cardiac-interference filtering technique. 15/16 reported Root Mean Square (RMS) or derivatives as sEMG-obtained variables. The main applicabilities were the description of muscle activation in different settings (6/16), testing of reliability and correlation to other respiratory muscles assessment techniques (7/16), and assessment of therapy response (3/16). They found sEMG feasible and useful for prognosis purposes (2/16), treatment guidance (6/16), reliable monitoring under stable conditions (3/16), and as a surrogate measure (5/16) in mechanically ventilated patients in elective or emergency invasive procedures (5/16) or in acute health conditions (11/16).
CONCLUSIONS
The diaphragm and parasternal muscles were the main muscles studied in the critical care setting, and with similar electrodes placement. However, several different methods were observed for other muscles electrodes placement, sEMG signals acquisition and data analysis.
Topics: Humans; Electromyography; Critical Illness; Reproducibility of Results; Respiratory Muscles; Diaphragm; Electrodes; Muscle, Skeletal
PubMed: 37104255
DOI: 10.1371/journal.pone.0284911