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Wideochirurgia I Inne Techniki... Jun 2023To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) in the oblique supine position (OSP) and the prone position (PP).
INTRODUCTION
To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) in the oblique supine position (OSP) and the prone position (PP).
AIM
To perform a systematic review and meta-analysis to evaluate the efficacy and safety of OSP versus PP for PCNL.
MATERIAL AND METHODS
A systematic literature search of PubMed, Ovid, SCOPUS, and citation lists was conducted to identify eligible comparative studies up to November 2022. All studies comparing OSP versus PP for PCNL were included. Statistical analysis was performed with the Collaboration's Review Manager (RevMan) 5.4 software.
RESULTS
Overall, eight studies were included involving 1185 patients (OSP = 634; PP = 551). There were no statistically significant differences between OSP and PP in age (WMD = -0.95 years; 95% CI: -2.12 to 0.21; p = 0.83) or proportion of male patients (OR = 0.02; 95% CI: -0.03 to 0.08; p = 0.43). We found that OSP was performed more frequently for smaller stone size and patients with higher BMI (WMD = -0.1 cm, 95% CI: -0.18 to -0.02; p = 0.01) and patients with higher BMI (WMD = 0.66 kg/m; 95% CI: 0.29 to 1.03; p = 0.0005). The operation time was shorter in OSP than PP (WMD = -14 min; 95% CI: -27.00 to -1.00; p = 0.03). The reduction of hemoglobin was lower in OSP than PP (WMD = -0.39 g/dl; 95% CI: -0.60 to -0.13; p = 0.03). There was no significant difference in stone-free rate and hospitalization between the two groups (OR = 1.32; 95% CI: 0.98 to 1.78; p = 0.07; WMD = -5.99 h; 95% CI: -17.15 to 5.16; p = 0.29). The overall complications were fewer in OSP than in PP (OR = 0.59; 95% CI: 0.43 to 0.81; p = 0.001), but no difference was observed between the positions with regard to the major complications (Clavien-Dindo score ≥ 3) (OR = 0.76; 95% CI: 0.43 to 1.34; p = 0.35).
CONCLUSIONS
OSP showed non-inferior stone-free rate, blood loss, and hospitalization compared with PP. OSP may be superior in terms of operative time and complications than PP.
PubMed: 37680735
DOI: 10.5114/wiitm.2023.126453 -
Clinical Psychology Review Aug 2021People differ in their self-reported propensities to experience positive affect (PA). Even those prone to internalizing symptoms show varied proclivities to PA; social... (Meta-Analysis)
Meta-Analysis Review
People differ in their self-reported propensities to experience positive affect (PA). Even those prone to internalizing symptoms show varied proclivities to PA; social anxiety (SA), for instance, unlike other types of anxiety, shows a strong negative association with PA that cannot be explained by diminished reward sensitivity. Heightened reliance on suppression of emotional displays (expressive suppression; ES) may be an alternate contributor to attenuated PA among people with elevated SA, relative to people with other types of anxiety. A first step toward testing this hypothesis is clarifying the ES-PA association and examining whether it varies as a function of anxiety type (social anxiety vs. other types of anxiety). This meta-analysis (k = 41; n = 11,010) revealed a significant, negative association between ES and PA (r = -0.158); however, this relationship was not significant for individuals with social or other anxiety disorders. Moreover, two moderators (sample culture-Western: r = -0.16; Eastern: r = 0.003; type of emotion suppressed-Negative: r = 0.18; Positive: r = -0.12) accounted for significant heterogeneity in effect sizes. This review synthesizes the literature on ES and PA in healthy and anxious samples; findings suggest moderating variables merit closer attention in future studies.
Topics: Anxiety; Anxiety Disorders; Emotions; Fear; Humans
PubMed: 34325115
DOI: 10.1016/j.cpr.2021.102068 -
Annals of Intensive Care Dec 2017Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a... (Review)
Review
Veno-venous extracorporeal membrane oxygenation (ECMO) for refractory acute respiratory distress syndrome (ARDS) is a rapidly expanding technique. We performed a systematic review and meta-analysis of the most recent literature to analyse complications and hospital mortality associated with this technique. Using the PRISMA guidelines for systematic reviews and meta-analysis, MEDLINE and EMBASE were systematically searched for studies reporting complications and hospital mortality of adult patients receiving veno-venous ECMO for severe and refractory ARDS. Studies were screened for low bias risk and assessed for study size effect. Meta-analytic pooled estimation of study variables was performed using a weighted random effects model for study size. Models with potential moderators were explored using random effects meta-regression. Twelve studies fulfilled inclusion criteria, representing a population of 1042 patients with refractory ARDS. Pooled mortality at hospital discharge was 37.7% (CI 95% = 31.8-44.1; I = 74.2%). Adjusted mortality including one imputable missing study was 39.3% (CI 95% = 33.1-45.9). Meta-regression model combining patient age, year of study realization, mechanical ventilation (MV) days and prone positioning before veno-venous ECMO was associated with hospital mortality (p < 0.001; R = 0.80). Patient age (b = 0.053; p = 0.01) and maximum cannula size during treatment (b = -0.075; p = 0.008) were also independently associated with mortality. Studies reporting H1N1 patients presented inferior hospital mortality (24.8 vs 40.6%; p = 0.027). Complication rate was 40.2% (CI 95% = 25.8-56.5), being bleeding the most frequent 29.3% (CI 95% = 20.8-39.6). Mortality due to complications was 6.9% (CI 95% = 4.1-11.2). Mechanical complications were present in 10.9% of cases (CI 95% = 4.7-23.5), being oxygenator failure the most prevalent (12.8%; CI 95% = 7.1-21.7). Despite initial severity, significant portion of patients treated with veno-venous ECMO survive hospital discharge. Patient age, H1N1-ARDS and cannula size are independently associated with hospital mortality. Combined effect of patient age, year of study realization, MV days and prone positioning before veno-venous ECMO influence patient outcome, and although medical complications are frequent, their impact on mortality is limited.
PubMed: 28500585
DOI: 10.1186/s13613-017-0275-4 -
Cureus Jan 2024Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural... (Review)
Review
Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.
PubMed: 38361721
DOI: 10.7759/cureus.52330 -
Zoonoses and Public Health Jun 2014This article is the second article in a series of six focusing on systematic reviews in animal agriculture and veterinary medicine. This article addresses the strengths... (Review)
Review
This article is the second article in a series of six focusing on systematic reviews in animal agriculture and veterinary medicine. This article addresses the strengths and limitations of study designs commonly used in animal agriculture and veterinary research to assess interventions (preventive or therapeutic treatments) and discusses the appropriateness of their use in systematic reviews of interventions. Different study designs provide different evidentiary value for addressing questions about the efficacy of interventions. Experimental study designs range from in vivo proof of concept experiments to randomized controlled trials (RCTs) under real-world conditions. The key characteristic of experimental design in intervention studies is that the investigator controls the allocation of individuals or groups to different intervention strategies. The RCT is considered the gold standard for evaluating the efficacy of interventions and, if there are well-executed RCTs available for inclusion in a systematic review, that review may be restricted to only this design. In some instances, RCTs may not be feasible or ethical to perform, and there are fewer RCTs published in the veterinary literature compared to the human healthcare literature. Therefore, observational study designs, where the investigator does not control intervention allocation, may provide the only available evidence of intervention efficacy. While observational studies tend to be relevant to real-world use of an intervention, they are more prone to bias. Human healthcare researchers use a pyramid of evidence diagram to describe the evidentiary value of different study designs for assessing interventions. Modifications for veterinary medicine are presented in this article.
Topics: Agriculture; Animals; Evidence-Based Medicine; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Research Design; Review Literature as Topic; Veterinary Medicine
PubMed: 24905992
DOI: 10.1111/zph.12127 -
European Journal of Medical Research Dec 2022Prone position has already been demonstrated to improve survival in non-COVID acute respiratory distress syndrome and has been widely performed in COVID-19 patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prone position has already been demonstrated to improve survival in non-COVID acute respiratory distress syndrome and has been widely performed in COVID-19 patients with respiratory failure, both in non-intubated and intubated patients. However, the beneficial effect of the prone position in COVID-19 pneumonia still remains controversial. Therefore, we aimed to evaluate the effectiveness and safety of the prone position compared with the non-prone in non-intubated and intubated COVID-19 patients, respectively.
METHODS
We searched the MEDLINE, EMBASE, and Cochrane databases, as well as one Korean domestic database, on July 9, 2021, and updated the search 9 times to September 14, 2022. Studies that compared prone and non-prone positions in patients with COVID-19 were eligible for inclusion. The primary outcomes were mortality, need for intubation, and adverse events.
RESULTS
Of the 1259 records identified, 9 randomized controlled trials (RCTs) and 23 nonrandomized studies (NRSs) were eligible. In the non-intubated patients, the prone position reduced the intubation rate compared with the non-prone position in 6 RCTs (n = 2156, RR 0.81, P = 0.0002) and in 18 NRSs (n = 3374, RR 0.65, P = 0.002). In the subgroup analysis according to the oxygen delivery method, the results were constant only in the HFNC or NIV subgroup. For mortality, RCTs reported no difference between prone and non-prone groups, but in NRSs, the prone position had a significant advantage in mortality [18 NRSs, n = 3361, relative risk (RR) 0.56, P < 0.00001] regardless of the oxygen delivery methods shown in the subgroup analysis. There was no RCT for intubated patients, and mortality did not differ between the prone and non-prone groups in NRSs. Adverse events reported in both the non-intubated and intubated groups were mild and similar between the prone and non-intubated groups.
CONCLUSION
For non-intubated patients with COVID-19, prone positioning reduced the risk of intubation, particularly in patients requiring a high-flow oxygen system. However, the survival benefit was unclear between the prone and non-prone groups. There was insufficient evidence to support the beneficial effects of prone positioning in intubated patients. Trial registration This study was registered in the Prospective Register of Systematic Reviews on February 16, 2022 (Registration No.: CRD42022311150 ).
Topics: Humans; COVID-19; Respiratory Insufficiency; Oxygen; Patient Positioning; Respiratory Distress Syndrome
PubMed: 36572946
DOI: 10.1186/s40001-022-00953-z -
Cornea Jun 2022The purpose of this study was to assess whether migraine might be associated with the increased risk of dry eye disease and to determine the strength of the association... (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this study was to assess whether migraine might be associated with the increased risk of dry eye disease and to determine the strength of the association between migraine and dry eye disease.
METHODS
We searched EMBASE, PubMed, Web of Science databases and China National Knowledge Infrastructure, WanFang, and VIP databases for studies that investigated the association between dry eye and migraine from inception to September 8, 2020. Relevant data were extracted by 2 investigators independently. Publication bias and heterogeneity were evaluated. Odds ratio (OR) and 95% confidence interval (CI) were computed by metaanalysis using random-effects models.
RESULTS
Of the 565 studies identified, 7 studies met the inclusion criteria and were included in this metaanalysis. Patients with migraine had significantly higher morbidity of dry eye compared with the control group (OR = 1.55; 95% CI = 1.32-1.82; P < 0.001). Subgroup analysis showed that the association between dry eye and migraine was stronger in hospital-based studies (OR = 1.97, P = 0.036) than population-based studies (OR = 1.42, P < 0.001). In addition, differences in geographic location and diagnostic criteria have no effect on the results.
CONCLUSIONS
There was a significant association between dry eye and migraine. Patients with migraine are more prone to suffer from dry eye than subjects without migraine, and the association strength varies among populations studied.
Topics: China; Dry Eye Syndromes; Humans; Migraine Disorders; Odds Ratio
PubMed: 34743091
DOI: 10.1097/ICO.0000000000002851 -
Journal of Nuclear Cardiology :... Jun 2022Although prone position is considered as a complementary protocol in myocardial perfusion imaging (MPI), there is no consensus on its capability to find coronary artery... (Meta-Analysis)
Meta-Analysis Review
Diagnostic performance of prone-only myocardial perfusion imaging versus coronary angiography in the detection of coronary artery disease: A systematic review and meta-analysis.
STUDY DESIGN
Although prone position is considered as a complementary protocol in myocardial perfusion imaging (MPI), there is no consensus on its capability to find coronary artery disease (CAD), independently. The primary aim of this review was to report pooled sensitivity and specificity for prone position MPI in detection of CAD. In addition, the results were compared to the supine position's performance.
METHODS
Electronic bibliographic databases, The Cochrane Library, Web of Science (Science and Social Science Citation Index), Scopus, PubMed, and EMBASE until the end of June 2020 were searched. Studies were included based on the inclusion criteria of (1) evaluated the prone position MPI, (2) defined CAD with coronary angiography (CAG), using the threshold of ≥ 50% stenosis, (3) Adequate data were provided to extract the diagnostic performance. QUADAS-2 tool was utilized to assess the quality of included studies. Pooled sensitivity and specificity were calculated for prone and supine positions, separately. The hierarchical summary ROC curves were also drawn.
RESULTS
Ten individual studies with the data of the 1490 patients for the prone position and 1138 patients for the supine position were included. Pooled sensitivity and specificity for the prone position were 83% and 79%, respectively. These results were calculated for the supine position as the sensitivity of 86% and specificity of 67%. The pooled sensitivity and specificity of the prone position in detecting the right coronary artery territory defects were 70% and 84%, in turn.
CONCLUSION
In the suspicion for the CAD, prone position with comparable sensitivity and higher specificity can be an acceptable alternative to the supine position as the standard method. Also, in the cases of possible defects in the RCA territory, prone position showed to be a superior standard.
Topics: Coronary Angiography; Coronary Artery Disease; Humans; Myocardial Perfusion Imaging; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon
PubMed: 33025477
DOI: 10.1007/s12350-020-02376-x -
BMC Public Health Jul 2013All-cause mortality in the population<65 years is 30% higher in Glasgow than in equally deprived Liverpool and Manchester. We investigated a hypothesis that low vitamin... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
All-cause mortality in the population<65 years is 30% higher in Glasgow than in equally deprived Liverpool and Manchester. We investigated a hypothesis that low vitamin D in this population may be associated with premature mortality via a systematic review and meta-analysis.
METHODS
Medline, EMBASE, Web of Science, the Cochrane Library and grey literature sources were searched until February 2012 for relevant studies. Summary statistics were combined in an age-stratified meta-analysis.
RESULTS
Nine studies were included in the meta-analysis, representing 24,297 participants, 5,324 of whom died during follow-up. The pooled hazard ratio for low compared to high vitamin D demonstrated a significant inverse association (HR 1.19, 95% CI 1.12-1.27) between vitamin D levels and all-cause mortality after adjustment for available confounders. In an age-stratified meta-analysis, the hazard ratio for older participants was 1.25 (95% CI 1.14-1.36) and for younger participants 1.12 (95% CI 1.01-1.24).
CONCLUSIONS
Low vitamin D status is inversely associated with all-cause mortality but the risk is higher amongst older individuals and the relationship is prone to residual confounding. Further studies investigating the association between vitamin D deficiency and all-cause mortality in younger adults with adjustment for all important confounders (or using randomised trials of supplementation) are required to clarify this relationship.
Topics: Adult; Aged; Female; Humans; Incidence; Male; Middle Aged; Mortality, Premature; United Kingdom; Vitamin D Deficiency
PubMed: 23883271
DOI: 10.1186/1471-2458-13-679 -
Cerebral oxygenation and body position in the preterm infant: A systematic review and meta-analysis.Acta Paediatrica (Oslo, Norway : 1992) Jan 2023After preterm birth, supine head midline position is supported for stable cerebral blood flow (CBF) and prevention of intraventricular haemorrhage (IVH), while prone... (Meta-Analysis)
Meta-Analysis Review
AIM
After preterm birth, supine head midline position is supported for stable cerebral blood flow (CBF) and prevention of intraventricular haemorrhage (IVH), while prone position supports respiratory function and enables skin-to-skin care. The prone compared to supine position could lead to a change in near-infrared derived cerebral tissue oxygen saturation (rScO2), which is a surrogate for cerebral blood flow (CBF). By monitoring rScO2 neonatologists aim to stabilise CBF during intensive care and prevent brain injury. In this systematic review and meta-analysis, we investigate the effect of the body position on rScO2.
METHODS
A comprehensive literature search was performed to identify all trials that included preterm infants in the first 2 weeks after birth and compared rScO2 in the prone versus supine head in midline position of the infant. A meta-analysis, including two subgroup analyses based on postnatal age (PNA) and gestational age (GA), was performed.
RESULTS
Six observational cohort studies were included. In the second, but not the first week after birth, a significant higher rScO2 in the prone position was found with a mean difference of 1.97% (95% CI 0.87-3.07). No rScO2 difference was observed between positions in the extremely preterm nor the preterm group.
CONCLUSION
No consistent evidence was found that body position influences rScO2 in the first 2 weeks after preterm birth. Subgroup analysis suggests that in the second week after birth, the prone position might result in higher cerebral rScO2 than the supine position with head in midline. Multiple factors determine the best body position in preterms.
Topics: Infant, Newborn; Humans; Female; Infant, Premature; Premature Birth
PubMed: 36177661
DOI: 10.1111/apa.16558