-
Ethiopian Journal of Health Sciences Jan 2024Healthcare systems should ensure the provision of quality services to patients without harming them. However, the provision of services is occasionally accompanied by... (Review)
Review
BACKGROUND
Healthcare systems should ensure the provision of quality services to patients without harming them. However, the provision of services is occasionally accompanied by harm or complications, most of which are preventable. Most studies have focused on secondary healthcare rather than primary healthcare (PHC). Thus, this study aimed to identify various dimensions and components of patient safety in PHC worldwide.
METHODS
This systematic review study was conducted in November 2022 based on PRISMA reporting guidelines. Studies were retrieved from PubMed, Scopus, Cochrane Library, Web of Science, and EMBASE and searched for English documents using the keywords "patient safety" and "PHC" from 2000 to 2022. Finally, two reviewers extracted the data independently and analyzed using thematic content analysis.
RESULTS
Overall, 23 out of the initially 4937 identified articles were selected for the final analysis based on the inclusion and exclusion criteria. Most of these studies used a qualitative-quantitative approach (61.9%, seven studies for both), and 64% had been conducted in European countries. Eventually, five dimensions and 22 components were identified for patient safety in PHC, including management measures, quality management, resources and technology, documents, and patient-related factors.
CONCLUSION
The patient safety dimensions and components identified in this research can help develop a clear definition of patient safety and its assessment standards and criteria in PHC. Considering that most previous studies on patient safety in PHC were conducted in European and developed countries, it is suggested that researchers conduct more studies in developing countries to fill this research gap.
Topics: Humans; Primary Health Care; Patient Safety; Quality of Health Care
PubMed: 38957341
DOI: 10.4314/ejhs.v34i1.9 -
Scandinavian Journal of Pain Jan 2024The aim of this systematic review is to analyze the efficacy of noninvasive brain stimulation (NBS) in the treatment of central post-stroke pain (CPSP). (Review)
Review
BACKGROUND
The aim of this systematic review is to analyze the efficacy of noninvasive brain stimulation (NBS) in the treatment of central post-stroke pain (CPSP).
METHODS
We included randomized controlled trials testing the efficacy of transcranial magnetic stimulation (TMS) or transcranial direct current stimulation versus placebo or other usual therapy in patients with CPSP. Articles in English, Portuguese, Spanish, Italian, and French were included. A bibliographic search was independently conducted on June 1, 2022, by two authors, using the databases MEDLINE (PubMed), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science Core Collection. The risk of bias was assessed using the second version of the Cochrane risk of bias (RoB 2) tool and the certainty of the evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation.
RESULTS
A total of 2,674 records were identified after removing duplicates, of which 5 eligible studies were included, involving a total of 119 patients. All five studies evaluated repetitive TMS, four of which stimulated the primary motor cortex (M1) and one stimulated the premotor/dorsolateral prefrontal cortex. Only the former one reported a significant pain reduction in the short term, while the latter one was interrupted due to a consistent lack of analgesic effect.
CONCLUSION
NBS in the M1 area seems to be effective in reducing short-term pain; however, more high-quality homogeneous studies, with long-term follow-up, are required to determine the efficacy of this treatment in CSPS.
Topics: Humans; Transcranial Magnetic Stimulation; Stroke; Transcranial Direct Current Stimulation; Pain Management; Randomized Controlled Trials as Topic
PubMed: 38956966
DOI: 10.1515/sjpain-2023-0130 -
BMC Anesthesiology Jul 2024As a new type of intravenous anesthetic, ciprofol has the advantages of fast onset of action, fast recovery and high clearance rate. This study aimed to investigate the... (Meta-Analysis)
Meta-Analysis Comparative Study
Comparison of the efficacy and safety of ciprofol and propofol in sedating patients in the operating room and outside the operating room: a meta-analysis and systematic review.
BACKGROUND
As a new type of intravenous anesthetic, ciprofol has the advantages of fast onset of action, fast recovery and high clearance rate. This study aimed to investigate the effectiveness and safety of ciprofol versus traditional propofol for anesthesia and sedation in and out of the operating room.
METHODS
We searched the literature in PubMed, Web of Science, Cochrane Library, and Embase databases from January 2021 to December 2023. All clinical studies comparing the sedative effects of propofol and ciprofol, both inside and outside the operating room, were included in our trial. The main outcome measures were induction time and incidence of injection-site pain. Data are merged using risk ratio and standardized mean difference with 95% confidence interval. Subgroup analysis, meta-regression, sensitivity analysis, and publication bias were performed. The study protocol was prospectively registered with PROSPERO (CRD42023447747).
RESULTS
A total of 15 randomized, controlled trials involving 2002 patients were included in this study. Compared with propofol, ciprofol has a longer induction time in the operating room but a shorter induction time in non-operating room settings. Ciprofol can effectively reduce the risk of injection-site pain and respiratory depression both inside and outside the operating room. In addition, the risk of drug-related hypotension induced with ciprofol in the operating room is lower, but the awakening time is also longer. Meta-regression analysis showed that neither age nor BMI were potential sources of heterogeneity. Funnel plot, egger and begg tests showed no significant publication bias. Sensitivity analyzes indicate that our results are robust and reliable.
CONCLUSION
Ciprofol has absolute advantages in reducing the risk of injection-site pain and respiratory depression, both in and outside operating room. Intraoperative use of ciprofol reduces the risk of drug-related hypotension and may also reduce the risk of intraoperative physical movements. However, ciprofol may have longer induction and awakening time than propofol.
Topics: Propofol; Humans; Operating Rooms; Anesthetics, Intravenous; Hypnotics and Sedatives; Randomized Controlled Trials as Topic
PubMed: 38956515
DOI: 10.1186/s12871-024-02609-3 -
Obstetrics and Gynecology Jul 2024To quantify the association between prophylactic radiologic interventions and perioperative blood loss during cesarean delivery in women with placenta accreta spectrum...
OBJECTIVE
To quantify the association between prophylactic radiologic interventions and perioperative blood loss during cesarean delivery in women with placenta accreta spectrum disorder through a systematic review and network meta-analysis.
DATA SOURCES
On January 3, 2023, a literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science. We also checked ClinicalTrials.gov retrospectively. Prophylactic radiologic interventions to reduce bleeding during cesarean delivery involved preoperative placement of balloon catheters, distal (internal or common iliac arteries) or proximal (abdominal aorta), or sheaths (uterine arteries). The primary outcome was volume of blood loss; secondary outcomes were the number of red blood cell units transfused and adverse events. Studies including women who received an emergency cesarean delivery were excluded.
METHODS OF STUDY SELECTION
Two authors independently screened citations for relevance, extracted data, and assessed the risk of bias of individual studies with the Cochrane Risk of Bias in Non-randomized Studies of Interventions tool.
TABULTATION, INTEGRATION, AND RESULTS
From a total of 1,332 screened studies, 50 were included in the final analysis, comprising 5,962 women. These studies consisted of two randomized controlled trials and 48 observational studies. Thirty studies compared distal balloon occlusion with a control group, with a mean difference in blood loss of -406 mL (95% CI, -645 to -167). Fourteen studies compared proximal balloon occlusion with a control group, with a mean difference of -1,041 mL (95% CI, -1,371 to -710). Sensitivity analysis excluding studies with serious or critical risk of bias provided similar results. Five studies compared uterine artery embolization with a control group, all with serious or critical risk of bias; the mean difference was -936 mL (95% CI, -1,522 to -350). Reported information on adverse events was limited.
CONCLUSION
Although the predominance of observational studies in the included literature warrants caution in interpreting the findings of this meta-analysis, our findings suggest that prophylactic placement of balloon catheters or sheaths before planned cesarean delivery in women with placenta accreta spectrum disorder may, in some cases, substantially reduce perioperative blood loss. Further study is required to quantify the efficacy according to various severities of placenta accreta spectrum disorder and the associated safety of these radiologic interventions.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42022320922.
PubMed: 38954828
DOI: 10.1097/AOG.0000000000005662 -
PloS One 2024Mild hypothermia in hepatic ischemia-reperfusion injury is increasingly being studied. This study aimed to conduct a systematic evaluation of the effectiveness of mild... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIM
Mild hypothermia in hepatic ischemia-reperfusion injury is increasingly being studied. This study aimed to conduct a systematic evaluation of the effectiveness of mild hypothermia in improving hepatic ischemia-reperfusion injury.
METHODS
We systematically searched CNKI, WanFang Data, PubMed, Embase, and Web of Science for original studies that used animal experiments to determine how mild hypothermia(32-34°C) pretreatment improves hepatic ischemia-reperfusion injury(in situ 70% liver IR model). The search period ranged from the inception of the databases to May 5, 2023. Two researchers independently filtered the literature, extracted the data, and assessed the risk of bias incorporated into the study. The meta-analysis was performed using RevMan 5.4.1 and Stata 15 software.
RESULTS
Eight randomized controlled trials (RCTs) involving a total of 117 rats/mice were included. The results showed that the ALT levels in the mild hypothermia pretreatment group were significantly lower than those in the normothermic control group [Standardized Mean Difference (SMD) = -5.94, 95% CI(-8.09, -3.78), P<0.001], and AST levels in the mild hypothermia pretreatment group were significantly lower than those in the normothermic control group [SMD = -4.45, 95% CI (-6.10, -2.78), P<0.001]. The hepatocyte apoptosis rate in the mild hypothermia pretreatment group was significantly lower than that in the normothermic control group [SMD = -6.86, 95% CI (-10.38, -3.33), P<0.001]. Hepatocyte pathology score in the mild hypothermia pretreatment group was significantly lower than that in the normothermic control group [SMD = -4.36, 95% CI (-5.78, -2.95), P<0.001]. There was no significant difference in MPO levels between the mild hypothermia preconditioning group and the normothermic control group [SMD = -4.83, 95% CI (-11.26, 1.60), P = 0.14]. SOD levels in the mild hypothermia preconditioning group were significantly higher than those in the normothermic control group [SMD = 3.21, 95% CI (1.27, 5.14), P = 0.001]. MDA levels in the mild hypothermia pretreatment group were significantly lower than those in the normothermic control group [SMD = -4.06, 95% CI (-7.06, -1.07) P = 0.008].
CONCLUSION
Mild hypothermia can attenuate hepatic ischemia-reperfusion injury, effectively reduce oxidative stress and inflammatory response, prevent hepatocyte apoptosis, and protect liver function.
Topics: Reperfusion Injury; Animals; Hypothermia, Induced; Liver; Mice; Rats; Disease Models, Animal
PubMed: 38954712
DOI: 10.1371/journal.pone.0305213 -
CJEM Jul 2024Acute cannabis use is associated with impaired driving performance and increased risk of motor vehicle crashes. Following the Canadian Cannabis Act's implementation, it...
PURPOSE
Acute cannabis use is associated with impaired driving performance and increased risk of motor vehicle crashes. Following the Canadian Cannabis Act's implementation, it is essential to understand how recreational cannabis legalization impacts traffic injuries, with a particular emphasis on Canadian emergency departments. This study aims to assess the impact of recreational cannabis legalization on traffic-related emergency department visits and hospitalizations in the broader context of North America.
METHODS
A systematic review was conducted according to best practices and reported using PRISMA 2020 guidelines. The protocol was registered on July 5, 2022 (PROSPERO CRD42022342126). MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), and Scopus were searched without language or date restrictions up to October 12, 2023. Studies were included if they examined cannabis-related traffic-injury emergency department visits and hospitalizations before and after recreational cannabis legalization. The risk of bias was assessed. Meta-analysis was not possible due to heterogeneity.
RESULTS
Seven studies were eligible for the analysis. All studies were conducted between 2019 and 2023 in Canada and the United States. We found mixed results regarding the impact of recreational cannabis legalization on emergency department visits for traffic injuries. Four of the studies included reported increases in traffic injuries after legalization, while the remaining three studies found no significant change. There was a moderate overall risk of bias among the studies included.
CONCLUSIONS
This systematic review highlights the complexity of assessing the impact of recreational cannabis legalization on traffic injuries. Our findings show a varied impact on emergency department visits and hospitalizations across North America. This underlines the importance of Canadian emergency physicians staying informed about regional cannabis policies. Training on identifying and treating cannabis-related impairments should be incorporated into standard protocols to enhance response effectiveness and patient safety in light of evolving cannabis legislation.
PubMed: 38951474
DOI: 10.1007/s43678-024-00736-x -
Indian Journal of Orthopaedics Jul 2024Orthobiologic agents play a significant role in regenerative medicine. The quest for newer and more effective Orthobiologic agents is never-ending, leading to the... (Review)
Review
INTRODUCTION
Orthobiologic agents play a significant role in regenerative medicine. The quest for newer and more effective Orthobiologic agents is never-ending, leading to the evolution of more reformed products. GOLDIC (GOLD Induced cytokine) is a recently evolving Orthobiologic agent developed by conditioning autologous serum with gold particles. We aim to collate the available evidence on GOLDIC and provide a systematic literature review.
MATERIALS AND METHODS
Using Cochrane and PRISMA guidelines literature search was done for GOLDIC. After duplicate removal and exclusions, 62 articles were scrutinized, of which 8 articles qualified for full-text review. A risk-of-bias assessment of the included studies was done.
RESULTS
All articles showed standardized preparation methods of GOLDIC and uniformity in the number of doses administered, except one study. Reproducible results were noted like an increase in plasma gelsolin and improved KOOS, WOMAC, and VAS scores.
CONCLUSION
GOLDIC has the potential to be a significant Orthobiologic modality considering its standardized preparation techniques, method of administration, and uniformly reproducible outcome measures. However, further high-quality evidence is needed to analyze the clinical efficiency and safety profile of GOLDIC.
SYSTEMATIC REVIEW REGISTRATION
INPLASY202350027 [https://doi.org/10.37766/inplasy2023.5.0027].
PubMed: 38948367
DOI: 10.1007/s43465-024-01167-7 -
Regional Anesthesia and Pain Medicine Jun 2024The efficacy of spinal cord stimulation (SCS) in chronic pain studies is traditionally assessed by pain scores, which do not reflect the multidimensional nature of pain... (Review)
Review
BACKGROUND
The efficacy of spinal cord stimulation (SCS) in chronic pain studies is traditionally assessed by pain scores, which do not reflect the multidimensional nature of pain perception. Despite the evidence of SCS's influence on emotional functioning comprehensive assessments of its effect remain lacking.
OBJECTIVE
To assess changes in emotional and psychosocial functioning in patients who underwent SCS implantation for chronic pain.
EVIDENCE REVIEW
Ovid MEDLINE, EMBASE, PsychINFO, Cochrane CENTRAL and Scopus databases were searched for original peer-reviewed publications reporting emotional functioning after SCS. The primary outcomes were a pooled mean difference (MD) in anxiety, depression, global functioning, mental well-being and pain catastrophizing at 12 months. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to determine the quality of evidence.
FINDINGS
Thirty-two studies were included in the primary analysis. Statistically significant improvements were observed in anxiety (MD -2.16; 95% CI -2.84 to -1.49; p<0.001), depression (MD -4.66; 95% CI -6.26 to -3.06; p<0.001), global functioning (MD 20.30; 95% CI 14.69 to 25.90; p<0.001), mental well-being (MD 4.95; 95% CI 3.60 to 6.31; p<0.001), and pain catastrophizing (MD -12.09; 95% CI -14.94 to -9.23; p<0.001). Subgroup analyses revealed differences in Global Assessment of Functioning and mental well-being based on study design and in depression based on waveform paradigm.
CONCLUSION
The results highlight the statistically and clinically significant improvements in emotional and psychosocial outcomes in patients with chronic pain undergoing SCS therapy. However, these results need to be interpreted with caution due to the very low certainty of evidence per the GRADE criteria.
PROSPERO REGISTRATION
CRD42023446326.
PubMed: 38942426
DOI: 10.1136/rapm-2024-105523 -
Neurogastroenterology and Motility Jun 2024Measurement of gastro-intestinal motility is increasingly performed under general anesthesia during endoscopic or surgical procedures. The aim of the present study was... (Review)
Review
BACKGROUND AND PURPOSE
Measurement of gastro-intestinal motility is increasingly performed under general anesthesia during endoscopic or surgical procedures. The aim of the present study was to review the impact of different anesthetic agents on digestive motility measurements in humans.
METHODS
This systematic review was performed using the Medline-Pubmed and Web of Science databases. All articles published until October 2023 were screened by identification of key words. Studies were reviewed if patients had an assessment of digestive motility using conventional perfused manometry, high-resolution manometry, electronic barostat or functional lumen impedance planimetry with the use of inhaled or intravenous anesthetic anesthetic agents (propofol, ketamine, halogens, nitrous oxide, opioids, and neuromuscular blockades).
RESULTS
Four hundred and eighty-eight unique citations were identified, of which 42 studies met the inclusion criteria and were included in the present review. The impact of anesthetics was mostly studied in patients who underwent esophageal manometry. There was a heterogeneity in both the dose and timing of administration of anesthetics among the studies. Remifentanil analgesia was the most studied anesthetic drug in the literature, showing a decrease in both distal latency and lower esophageal sphincter pressure after its administration, but the impact on Chicago classification was not studied. Inhaled anesthetics administration elicited a decrease in lower esophageal sphincter pressure, but contradictory findings were shown on esophageal motility following propofol or neuromuscular blocking agents administration.
CONCLUSION
Studies of the impact of anesthetics on digestive motility remain scarce in the literature, although some agents have been reported to profoundly affect gastro-intestinal motility.
PubMed: 38934423
DOI: 10.1111/nmo.14855 -
Journal of Diabetes and Metabolic... Jun 2024The use of natural and herbal products as alternative therapies, in conjunction with blood glucose-lowering medications, is on the rise for patients with diabetes. Our... (Review)
Review
PURPOSE
The use of natural and herbal products as alternative therapies, in conjunction with blood glucose-lowering medications, is on the rise for patients with diabetes. Our objective was to conduct a systematic review and comprehensive meta-analysis of both human and animal models to investigate the impact of chamomile consumption on glycemic control.
METHODS
A systematic search was conducted on all published papers from January 1990 up to January 2022 via Scopus, PubMed/Medline, Google Scholar, and ISI Web of Science. Human and animal articles evaluating the effect of chamomile on serum glycemic markers were included. We used the random-effects model to establish the pooled effect size. The dose-dependent effect was also assessed.
RESULTS
Overall, 4 clinical trials on human and 8 studies on animals met the inclusion criteria. With regard to RCTs, a favorable effect of chamomile consumption on serum fasting blood glucose (Standardized Mean Differences (SMD): -0.65, 95% CI: -1.00, -0.29, P < 0.001; I = 0%) and hemoglobin A1C (HbA1C) levels (SMD: -0.90, 95% CI: -1.39, -0.40, P < 0.001; I = 45.4%) was observed. Considering animal studies, consumption of chamomile extracts significantly reduced serum blood glucose (SMD: -4.37, 95% CI: -5.76, -2.98, P < 0.001; I = 61.2%). Moreover, each 100 mg/d increase in chamomile extract intervention resulted in a significantly declined blood glucose concentrations (MD: -54.35; 95% CI: -79.77, -28.93, P < 0.001; I = 94.8).
CONCLUSION
The current meta-analysis revealed that chamomile consumption could exert favorable effects on serum blood glucose and HbA1C. However, additional randomized controlled trials are needed to further confirm these findings.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40200-023-01345-8.
PubMed: 38932814
DOI: 10.1007/s40200-023-01345-8