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Physiotherapy Canada. Physiotherapie... 2021A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of...
A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of stay, duration of ventilation, oxygenation, secretion clearance, and pulmonary mechanics for invasively ventilated adults with pneumonia. Five databases were searched for randomized trials published between January 1995 and November 2018. Study quality was assessed using a standardized Joanna Briggs Institute critical appraisal tool, and Review Manager software was used to pool the studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the level of certainty of the evidence. A total of 14 studies of moderate quality included 251 subjects with pneumonia. Eight studies were pooled for meta-analysis. Interventions that increased inspiratory volume appeared to benefit secretion clearance by nearly 2 grams (mean difference [MD] 1.97; 95% CI: 0.80, 3.14; very low GRADE evidence) and increase static lung compliance immediately after treatment by more than 5 millilitres/centimetre H0 (MD 5.40 mL/cm HO; 95% CI: 2.37, 8.43; very low GRADE evidence) or by more than 6 millilitres/centimetre HO after a 20- to 30-minute delay (MD 6.86 mL/cm HO; 95% CI: 2.86, 10.86; very low GRADE evidence). No adverse events were found. Respiratory physiotherapy that increases tidal volume may benefit secretion clearance and lung compliance in invasively ventilated adults with pneumonia, but its impact on other outcomes, including mortality, length of stay, and other patient-centred outcomes, is unclear, and further research is required.
PubMed: 35106019
DOI: 10.3138/ptc-2019-0025 -
PloS One 2016Fluoroquinolone is recommended as a pivotal antituberculous agent for treating multi-drug-resistant pulmonary tuberculosis. However, its effectiveness as first-line... (Meta-Analysis)
Meta-Analysis Review
The Effectiveness and Safety of Fluoroquinolone-Containing Regimen as a First-Line Treatment for Drug-Sensitive Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis.
BACKGROUND
Fluoroquinolone is recommended as a pivotal antituberculous agent for treating multi-drug-resistant pulmonary tuberculosis. However, its effectiveness as first-line treatment remains controversial. The present study was conducted to validate the fluoroquinolone-containing regimen for drug-sensitive pulmonary tuberculosis.
METHODS
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials until June 5, 2015. Randomized controlled trials (RCTs) that compared antituberculous regimens containing fluoroquinolone with the standard regimen were included.
RESULTS
Eleven RCTs that included 6,334 patients were selected. Fluoroquinolone-containing regimens had a higher rate of sputum culture conversion at 2 months of treatment (M-H fixed odds ratio [OR], 1.36; 95% confidence interval [CI], 1.20-1.54). However, the outcomes were less favorable (M-H fixed OR, 0.69; 95% CI, 0.59-0.82) and the associated total adverse events were more frequent (M-H fixed OR, 1.84; 95% CI, 1.46-2.31) in the fluoroquinolone-containing regimen group, without a significant heterogeneity according to treatment duration. Treatment with the fluoroquinolone-containing regimen for 4 months showed a higher relapse rate.
CONCLUSIONS
Despite a higher culture conversion rate at 2 months of treatment, the fluoroquinolone-containing regimen had limitations, including less favorable outcomes and more adverse events, as the first-line therapy for drug-sensitive pulmonary tuberculosis.
Topics: Antitubercular Agents; Drug Therapy, Combination; Fluoroquinolones; Humans; Medication Adherence; Odds Ratio; Recurrence; Sputum; Treatment Failure; Treatment Outcome; Tuberculosis, Pulmonary
PubMed: 27455053
DOI: 10.1371/journal.pone.0159827 -
Journal of the American Heart... Apr 2022Background Pulmonary arterial end-diastolic forward flow (EDFF) following repaired tetralogy of Fallot has been thought to represent right ventricular (RV) restrictive... (Meta-Analysis)
Meta-Analysis Review
Background Pulmonary arterial end-diastolic forward flow (EDFF) following repaired tetralogy of Fallot has been thought to represent right ventricular (RV) restrictive physiology, but is not fully understood. This systematic review and meta-analysis sought to clarify its physiological and clinical correlates, and to define a framework for understanding EDFF and RV restrictive physiology. Methods and Results PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for observational studies published before March 2021. Random-effects meta-analysis was performed to identify factors associated with EDFF. Forty-two individual studies published between 1995 and 2021, including a total of 2651 participants (1132 with EDFF; 1519 with no EDFF), met eligibility criteria. The pooled estimated prevalence of EDFF among patients with repaired tetralogy of Fallot was 46.5% (95% CI, 41.6%-51.3%). Among patients with EDFF, the use of a transannular patch was significantly more common, and their stay in the intensive care unit was longer. EDFF was associated with greater RV indexed volumes and mass, as well as smaller E-wave velocity at the tricuspid valve. Finally, pulmonary regurgitation fraction was greater in patients with EDFF, and moderate to severe pulmonary regurgitation was more common in this population. Conclusions EDFF is associated with dilated, hypertrophied RVs and longstanding pulmonary regurgitation. Although several studies have defined RV restrictive physiology as the presence of EDFF, our study found no clear indicators of poor RV compliance in patients with EDFF, suggesting that EDFF may have multiple causes and might not be the precise equivalent of RV restrictive physiology.
Topics: Diastole; Humans; Pulmonary Valve Insufficiency; Tetralogy of Fallot; Tricuspid Valve; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 35301867
DOI: 10.1161/JAHA.121.024036 -
International Journal of Medical... Apr 2014This systematic review aimed to provide a comprehensive description of the methodologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary... (Review)
Review
AIM
This systematic review aimed to provide a comprehensive description of the methodologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease (COPD) and to explore patients' adherence and satisfaction with the use of telemonitoring systems.
METHODS
A literature search was performed from June to August and updated until December of 2012 on Medline, Embase, Web of Science and B-on databases using the following keywords: [tele(-)monitoring, tele(-)health, tele(-)homecare, tele(-)care, tele-home health or home monitoring] and [Chronic Obstructive Pulmonary Disease or COPD]. References of all articles were also reviewed.
RESULTS
Seventeen articles were included, 12 of them published from 2010 to the present. The methodologies were similar in the training provided to patients and in the data collection and transmission processes. However, differences in the type of technology used, telemonitoring duration and provision of prompts/feedback, were found. Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision. Nevertheless, they reported some difficulties in their use, which in some studies were related to lower compliance rates.
CONCLUSIONS
Telemonitoring interventions are a relatively new field in COPD research. Findings suggest that these interventions, although promising, present some usability problems that need to be considered in future research. These adjustments are essential before the widespreading of telemonitoring.
Topics: Home Care Services; Humans; Monitoring, Physiologic; Patient Compliance; Pulmonary Disease, Chronic Obstructive; Telemedicine
PubMed: 24529402
DOI: 10.1016/j.ijmedinf.2014.01.008 -
Cancer Epidemiology, Biomarkers &... Jul 2016Many studies have reported that adherence to health promotion guidelines for diet, physical activity, and maintenance of healthy body weight may decrease cancer... (Review)
Review
Many studies have reported that adherence to health promotion guidelines for diet, physical activity, and maintenance of healthy body weight may decrease cancer incidence and mortality. A systematic review was performed to examine associations between adherence to established cancer prevention guidelines for diet and physical activity and overall cancer incidence and mortality. PubMed, Google Scholar, and Cochrane Reviews databases were searched following the current recommendations of Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA). Twelve studies met inclusion criteria for this review. High versus low adherence to established nutrition and physical activity cancer prevention guidelines was consistently and significantly associated with decreases of 10% to 61% in overall cancer incidence and mortality. Consistent significant reductions were also shown for breast cancer incidence (19%-60%), endometrial cancer incidence (23%-60%), and colorectal cancer incidence in both men and women (27%-52%). Findings for lung cancer incidence were equivocal, and no significant relationships were found between adherence and ovarian or prostate cancers. Adhering to cancer prevention guidelines for diet and physical activity is consistently associated with lower risks of overall cancer incidence and mortality, including for some site-specific cancers. Cancer Epidemiol Biomarkers Prev; 25(7); 1018-28. ©2016 AACR.
Topics: Diet; Exercise; Female; Humans; Incidence; Male; Neoplasms; Patient Compliance; Practice Guidelines as Topic; Prospective Studies; Risk; Treatment Outcome
PubMed: 27340121
DOI: 10.1158/1055-9965.EPI-16-0121 -
International Journal of Clinical... Dec 2014In chronic obstructive pulmonary disease (COPD), the value of pharmacist care is not clear. Aim of the review A systematic review was conducted to clarify the impact of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In chronic obstructive pulmonary disease (COPD), the value of pharmacist care is not clear. Aim of the review A systematic review was conducted to clarify the impact of pharmacist care for outpatients with COPD.
METHODS
The PubMed, EMBASE, CINAHL, CBMdisc, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials that involved pharmacist-care interventions among outpatients with COPD. The reference lists were also screened for any additional relevant studies not identified through the electronic database searching. Two reviewers independently assessed each paper for methodological quality and extracted the data.
RESULTS
Fourteen articles were included. These articles described eight randomized controlled trials (1,327 patients) that pharmacist care was compared with usual care. The pharmacist interventions included those exclusively conducted by pharmacists and those conducted in collaboration with a multidisciplinary team. Although the current evidences failed to illustrate significant improvement in the health-related quality of life in intervention patients, results indicated that pharmacist care was associated with a significant reduction in the risk of hospital admissions [six studies (684 patients); risk ratio 0.50 (95% CI 0.39-0.64)]. However, no significant effect was found either in emergency department visits or in lung function. In addition, pharmacist care improved medication compliance of patients [four studies (743 patients); risk ratio 1.23 (95% CI 1.11-1.36)] while reduced health-related cost [three studies (318 patients); standardized mean difference -0.37 (95% CI -0.59 to -0.15)].
CONCLUSION
Pharmacist care resulted in improvements in the medication compliance as well as reductions in hospital admissions and health-related costs. It is therefore a potent strategy for management of outpatients with COPD.
Topics: Humans; Medication Adherence; Pharmaceutical Services; Pharmacists; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic
PubMed: 25330865
DOI: 10.1007/s11096-014-0024-9 -
The Journal of Thoracic and... Apr 2022The selection of tidal volumes for 1-lung ventilation remains unclear, because there exists a trade-off between oxygenation and risk of lung injury. We conducted a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The selection of tidal volumes for 1-lung ventilation remains unclear, because there exists a trade-off between oxygenation and risk of lung injury. We conducted a systematic review and meta-analysis to determine how oxygenation, compliance, and clinical outcomes are affected by tidal volume during 1-lung ventilation.
METHODS
A systematic search of MEDLINE and EMBASE was performed. A systematic review and random-effects meta-analysis was conducted. Pooled mean difference estimated arterial oxygen tension, compliance, and length of stay; pooled odds ratio was calculated for composite postoperative pulmonary complications. Risk of bias was determined using the Cochrane risk of bias and Newcastle-Ottawa tools.
RESULTS
Eighteen studies were identified, comprising 3693 total patients. Low tidal volumes (5.6 [±0.9] mL/kg) were not associated with significant differences in partial pressure of oxygen (-15.64 [-88.53-57.26] mm Hg; P = .67), arterial oxygen tension to fractional intake of oxygen ratio (14.71 [-7.83-37.24]; P = .20), or compliance (2.03 [-5.22-9.27] mL/cmH2O; P = .58) versus conventional tidal volume ventilation (8.1 [±3.1] mL/kg). Low versus conventional tidal volume ventilation had no significant impact on hospital length of stay (-0.42 [-1.60-0.77] days; P = .49). Low tidal volumes are associated with significantly decreased odds of pulmonary complications (pooled odds ratio, 0.40 [0.29-0.57]; P < .0001).
CONCLUSIONS
Low tidal volumes during 1-lung ventilation do not worsen oxygenation or compliance. A low tidal volume ventilation strategy during 1-lung ventilation was associated with a significant reduction in postoperative pulmonary complications.
Topics: Acute Lung Injury; Humans; Length of Stay; Respiration, Artificial; Tidal Volume
PubMed: 33518385
DOI: 10.1016/j.jtcvs.2020.12.054 -
Chronic Respiratory Disease 2011Pulmonary rehabilitation is an essential component of care for people with chronic obstructive pulmonary disease (COPD) and is supported by strong scientific evidence.... (Review)
Review
Pulmonary rehabilitation is an essential component of care for people with chronic obstructive pulmonary disease (COPD) and is supported by strong scientific evidence. Despite this, many people with COPD do not complete their program or choose not to attend at all. The aim of this study was to determine the factors associated with uptake and completion of pulmonary rehabilitation for people with COPD. Seven electronic databases were searched for qualitative or quantitative studies that documented factors associated with uptake and completion of pulmonary rehabilitation in people with COPD. Two reviewers independently extracted data, which was synthesized to provide overall themes. Travel and transport were consistently identified as barriers to both uptake and completion. A lack of perceived benefit of pulmonary rehabilitation also influenced both uptake and completion. The only demographic features that consistently predicted non-completion were being a current smoker (pooled odds ratio 0.17, 95% confidence interval 0.10 to 0.32) and depression. The limited data available regarding barriers to uptake indicated that disruption to usual routine, influence of the referring doctor and program timing were important. In conclusion poor access to transport and lack of perceived benefit affect uptake of pulmonary rehabilitation. Current smokers and patients who are depressed are at increased risk of non-completion. Enhancing attendance in pulmonary rehabilitation will require more attention to transportation, support for those at risk of non-completion and greater involvement of patients in informed decisions about their care.
Topics: Depression; Health Knowledge, Attitudes, Practice; Humans; Patient Compliance; Perception; Physician-Patient Relations; Pulmonary Disease, Chronic Obstructive; Smoking; Social Support; Transportation; Treatment Refusal
PubMed: 21596892
DOI: 10.1177/1479972310393756 -
Australian Critical Care : Official... Nov 2023Patients requiring mechanical ventilation in the intensive care unit (ICU) have diminished respiratory defences and are at high risk of respiratory compromise, leading... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Patients requiring mechanical ventilation in the intensive care unit (ICU) have diminished respiratory defences and are at high risk of respiratory compromise, leading to an increased risk of pulmonary infection and prolonged ventilation. Ventilator hyperinflation (VHI) is an airway clearance technique used by physiotherapists and is suggested to improve respiratory mechanics. The objective of this study was to review the evidence for the benefits and risks of VHI in intubated and mechanically ventilated patients in the ICU.
REVIEW METHOD USED
We conducted a systematic review.
DATA SOURCES
We searched PubMed, Embase, CINAHL, CENTRAL, and Scopus from inception to 31st May 2022 for all randomised control trials evaluating VHI in intubated and mechanically ventilated adults in the ICU.
REVIEW METHODS
Two authors independently performed study selection and data extraction. Individual study risk of bias was assessed using the Physiotherapy Evidence Database scale, and certainty in outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework.
RESULTS
We included 10 studies enrolling 394 patients. Compared to standard care, VHI had significant effects on sputum clearance (Standardise mean difference: 0.36, 95% confidence interval [CI]: 0.12 to 0.61; very low certainty), static pulmonary compliance (mean difference [MD]: 4.77, 95% CI: 2.40 to 7.14; low certainty), dynamic pulmonary compliance (MD: 1.59, 95% CI: 0.82 to 2.36; low certainty) and oxygenation (MD: 0.28, 95% CI: 0.01 to 0.55; low certainty). No significant adverse events or immediate side effects relating to VHI were reported. There is a paucity of data available on the effects of VHI on clinical outcomes including mechanical ventilation duration, ICU length of stay, and mortality.
CONCLUSIONS
Our findings suggest VHI has potential short-term respiratory benefits including increased secretion clearance, pulmonary compliance, and oxygenation, with no immediate adverse effects in intubated and mechanically ventilated ICU patients. However, there remains limited data on the longer term influence of VHI on clinical outcomes, and further research to inform clinical practice is needed.
REGISTRATION
This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022341421).
Topics: Adult; Humans; Respiration, Artificial; Critical Care; Ventilators, Mechanical; Intensive Care Units; Risk Assessment
PubMed: 36822978
DOI: 10.1016/j.aucc.2023.01.005 -
British Journal of Health Psychology Sep 2019To systematically review the evidence for health coaching as an intervention to improve health-related quality of life (HRQoL) and reduce hospital admissions in people... (Meta-Analysis)
Meta-Analysis
Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis.
PURPOSE
To systematically review the evidence for health coaching as an intervention to improve health-related quality of life (HRQoL) and reduce hospital admissions in people with chronic obstructive pulmonary disease (COPD).
METHODS
We systematically searched MEDLINE, EMBASE, PsycINFO, and CINAHL from database inception to August 2018 to identify all randomized controlled trials (RCTs) of health coaching for people with COPD. Eligible health coaching interventions had to include three components: goal setting, motivational interviewing, and COPD-related health education. Data were extracted on study characteristics and the effects of the intervention on HRQoL, hospital admissions, physical activity, self-care behaviour, and mood. Study quality was appraised by two authors using the Cochrane tool for assessing the risk of bias in RCTs. Effect sizes (standardized mean differences [SMD] or odds ratios [OR]) with 95% confidence intervals (CIs) were calculated and pooled using random effects meta-analyses.
RESULTS
Of 1578 articles, 10 RCTs were included. Meta-analysis showed that health coaching has a significant positive effect on HRQoL (SMD = -0.69, 95% CI: -1.28, -0.09, p = .02, from k = 4) and leads to a significant reduction in COPD-related hospital admissions (OR = 0.46, 95% CI: 0.31, 0.69, p = .0001, from k = 5), but not in all-cause hospital admissions (OR = 0.70, 95% CI: 0.41-1.12, p = .20, from k = 3). Three of four studies reported significant improvements to self-care behaviours such as medication adherence and exercise compliance.
CONCLUSIONS
This is the first systematic review to show that health coaching may be a candidate intervention to improve HRQoL and reduce costly hospital admissions in people with COPD. Statement of contribution What is already known on this subject? COPD is a leading cause of death worldwide and considerably reduces HRQoL. In turn, HRQoL is associated with a range of adverse health outcomes in COPD. Health coaching is a self-management intervention for people with long-term conditions such as COPD. Studies have examined whether health coaching improves HRQOL and other health outcomes in people with COPD, but no systematic review has been conducted. What does this study add? The first systematic review and meta-analysis of RCTs of health coaching for people with COPD. Health coaching may be a candidate intervention for improving HRQoL and reducing COPD-related hospital admissions in people with COPD. The need to establish the most effective health coaching components, delivery modality, and economic impact.
Topics: Exercise; Health Promotion; Humans; Mentoring; Pulmonary Disease, Chronic Obstructive; Qualitative Research; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 31033121
DOI: 10.1111/bjhp.12366