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Journal of Cancer Research and Clinical... Feb 2024A meta-analysis was performed to assess the benefits and safety profile of approved immune checkpoint inhibitors in hepatocellular carcinoma patients. Eligible studies... (Meta-Analysis)
Meta-Analysis
A meta-analysis was performed to assess the benefits and safety profile of approved immune checkpoint inhibitors in hepatocellular carcinoma patients. Eligible studies were searched from Cochrane, Embase, and PubMed databases based on a well-established strategy. Following the exclusion of ineligible studies, 12 studies were included in this meta-analysis. Compared with control group, immune checkpoint inhibitors were associated with improved ORR (OR 3.03, 95% CI 2.26-4.05, P < 0.00001), SD (OR 0.77, 95% CI 0.62-0.95, P = 0.02), OS (HR 0.75, 95% CI 0.68-0.83, P < 0.00001), and PFS (HR 0.74, 95% CI 0.63-0.87, P < 0.0003). However, no significant differences were observed in DCR (OR 1.33, 95% CI 0.97-1.81, P = 0.07), PD (OR 0.90, 95% CI 0.67-1.21, P = 0.48), and all caused any-grade adverse events (OR 1.22, 95% CI 0.62-2.39, P = 0. 57), all caused ≥ grade 3 adverse events (OR 1.10, 95% CI 0.97-1.25, P = 0.14), treatment-related any-grade adverse events (OR 1.13, 95% CI 0.55-2.32, P = 0.73), and treatment-related ≥ grade 3 events (OR 0.82, 95% CI 0.34-1.97, P = 0.65) between the two groups. After subgroup analysis conducted, patients in the immune checkpoint inhibitor group compared with targeted drug group showed significant improvements in OS (HR 0.74, 95% CI 0.66-0.84, P < 0.00001) and PFS (HR 0.75, 95% CI 0.61-0.91, P = 0.004). Immune checkpoint inhibitors have demonstrated peculiar benefits in the treatment of HCC with an acceptable safety profile. Compared to targeted drugs, immune checkpoint inhibitors still offer advantages in the treatment of hepatocellular carcinoma. However, there is still considerable room for further improvement.
Topics: Humans; Carcinoma, Hepatocellular; Immune Checkpoint Inhibitors; Liver Neoplasms; Databases, Factual; Drug Delivery Systems
PubMed: 38319412
DOI: 10.1007/s00432-023-05539-8 -
AJOG Global Reports Feb 2024This review examined the quantitative relationship between group care and overall maternal satisfaction compared with standard individual care. (Review)
Review
OBJECTIVE
This review examined the quantitative relationship between group care and overall maternal satisfaction compared with standard individual care.
DATA SOURCES
We searched CINAHL, Clinical Trials, The Cochrane Library, PubMed, Scopus, and Web of Science databases from the beginning of 2003 through June 2023.
STUDY ELIGIBILITY CRITERIA
We included studies that reported the association between overall maternal satisfaction and centering-based perinatal care where the control group was standard individual care. We included randomized and observational designs.
METHODS
Screening and independent data extraction were carried out by 4 researchers. We extracted data on study characteristics, population, design, intervention characteristics, satisfaction measurement, and outcome. Quality assessment was performed using the Cochrane tools for Clinical Trials (RoB2) and observational studies (ROBINS-I). We summarized the study, intervention, and satisfaction measurement characteristics. We presented the effect estimates of each study descriptively using a forest plot without performing an overall meta-analysis. Meta-analysis could not be performed because of variations in study designs and methods used to measure satisfaction. We presented studies reporting mean values and odds ratios in 2 separate plots. The presentation of studies in forest plots was organized by type of study design.
RESULTS
A total of 7685 women participated in the studies included in the review. We found that most studies (ie, 17/20) report higher satisfaction with group care than standard individual care. Some of the noted results are lower satisfaction with group care in both studies in Sweden and 1 of the 2 studies from Canada. Higher satisfaction was present in 14 of 15 studies reporting CenteringPregnancy, Group Antenatal Care (1 study), and Adapted CenteringPregnancy (1 study). Although indicative of higher maternal satisfaction, the results are often based on statistically insignificant effect estimates with wide confidence intervals derived from small sample sizes.
CONCLUSION
The evidence confirms higher maternal satisfaction with group care than with standard care. This likely reflects group care methodology, which combines clinical assessment, facilitated health promotion discussion, and community-building opportunities. This evidence will be helpful for the implementation of group care globally.
PubMed: 38318267
DOI: 10.1016/j.xagr.2023.100301 -
Social Work in Health Care 2024The purpose of this systematic literature was to summarize the literature on pregnancy options counseling for women and patients who experience an unintended pregnancy...
INTRODUCTION
The purpose of this systematic literature was to summarize the literature on pregnancy options counseling for women and patients who experience an unintended pregnancy across healthcare and social service settings.
METHODS
We conducted a systematic literature review using the PRISMA Checklist. Following the literature search of 8 electronic databases, we used a three-stage search process to screen articles for inclusion.
RESULTS
A total of 20 peer-reviewed articles met the inclusion criteria for this study. Half ( = 10) of the articles reviewed were empirical studies utilizing quantitative or qualitative methodology while the other half ( = 10) were conceptual or non-empirical. The articles affirmed a shared definition of pregnancy options counseling, but terminology differences were noted over time. Lastly, variations of intervention practices appeared across practice settings, with referral practice variations being the most notable.
CONCLUSION
Pregnancy options counseling practices varied across settings, suggesting patients who received this intervention may not have accessed equitable or ethical care.
Topics: Pregnancy; Humans; Female; United States; Pregnancy, Unplanned; Delivery of Health Care; Counseling; Empirical Research
PubMed: 38288975
DOI: 10.1080/00981389.2024.2304016 -
BJOG : An International Journal of... Apr 2024Microplastics, produced through degradation of environmental plastic pollution, have been detected in human tissues including placenta and fetal meconium. Cell culture...
BACKGROUND
Microplastics, produced through degradation of environmental plastic pollution, have been detected in human tissues including placenta and fetal meconium. Cell culture and animal studies have demonstrated potential reproductive toxicity of these particles; however, their association with adverse fertility or pregnancy outcomes in humans is not known.
OBJECTIVES
To synthesise evidence for the presence of microplastics in human reproductive tissue and their associations with environmental exposures and reproductive outcomes.
SEARCH STRATEGY
MEDLINE, Embase, Emcare, CINAHL, ClinicalTrials.gov and ICTRP were searched from inception to 03/02/2023.
SELECTION CRITERIA
Studies of human participants, assessing presence of microplastics in reproductive tissues, environmental exposures to microplastics, and fertility- or pregnancy-related outcomes.
DATA COLLECTION AND ANALYSIS
Two independent reviewers selected studies and extracted data on study characteristics, microplastics detected, environmental exposures and reproductive outcomes. Narrative synthesis was performed due to methodological heterogeneity.
MAIN RESULTS
Of 1094 citations, seven studies were included, covering 96 participants. Microplastics composed of 16 different polymer types were detected in both placental and meconium samples. Two studies reported associations between lifestyle factors (daily water intake, use of scrub cleanser or toothpaste, bottled water and takeaway food) and placental microplastics. One study reported associations between meconium microplastics and reduced microbiota diversity. One reported placental microplastic levels correlated with reduced birthweights and 1-minute Apgar scores.
CONCLUSIONS
There is a need for high-quality observational studies to assess the effects of microplastics on human reproductive health.
Topics: Female; Humans; Pregnancy; Microplastics; Placenta; Plastics; Pregnancy Outcome; Prenatal Care
PubMed: 38287142
DOI: 10.1111/1471-0528.17756 -
International Journal of Environmental... Dec 2023International prenatal care guidelines set a standard for clinicians to discuss gestational weight gain with their patients along with the complications associated with... (Review)
Review
BACKGROUND
International prenatal care guidelines set a standard for clinicians to discuss gestational weight gain with their patients along with the complications associated with prepregnancy obesity and excessive gestational weight gain. Clinicians often lack evidence-based eating, nutrition, and activity strategies to share with patients.
METHODS
This systematic review aimed to find eating patterns and behaviors that could be used safely during pregnancy to limit excessive gestational weight gain. PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews performed in the United States or Canada and published in English from 2013 to 2023. Keyword search terms included weight, manage, behavior, strategy, strategies, gestational weight gain, and nutrition. Excluded research used pediatric or adolescent populations, restrictive diets, such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry or profit-earning programs using food brands, or specific diet programs.
RESULTS
A total of 844 abstracts were retrieved, with 103 full-text studies reviewed. Behaviors had to be useful for maintaining a healthy gestational weight gain and had to be safe for use during pregnancy. Behaviors useful during pregnancy included meal planning, home meal preparation, portion control, using diets such as the Mediterranean diet, the low-glycemic index diet, and the Dietary Approaches to Stop Hypertension diet (DASH), regular physical activity, sleeping 6-7 h a night, mindful eating, intuitive eating, and regular seif-weighing.
CONCLUSION
The evidence-based strategies outlined in this review are safe for use during pregnancy and can assist patients in avoiding excessive gestational weight gain while maintaining the nutrition needed for healthy fetal growth.
Topics: Pregnancy; Female; Adolescent; Humans; Child; Gestational Weight Gain; Exercise; Pregnancy Complications; Weight Gain; Diet; Diet, Mediterranean
PubMed: 38276803
DOI: 10.3390/ijerph21010015 -
Journal of Pain and Symptom Management May 2024The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a... (Review)
Review
INTRODUCTION
The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs.
AIM
To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings.
METHODS
A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0-18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT).
RESULTS
We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria.
DISCUSSION
Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs.
Topics: Child; Infant, Newborn; Female; Pregnancy; Humans; Infant; Child, Preschool; Adolescent; Developing Countries; Social Support; Grief; Parents; Bereavement
PubMed: 38244706
DOI: 10.1016/j.jpainsymman.2024.01.023 -
Obstetrics and Gynecology Feb 2024
Topics: Female; Humans; Pregnancy; Perinatal Death; Perinatal Mortality; Prenatal Diagnosis; Vasa Previa
PubMed: 38237163
DOI: 10.1097/AOG.0000000000005486 -
Ultrasound in Obstetrics & Gynecology :... Apr 2024To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA).
METHODS
An individual participant data meta-analysis was performed to report on the strength of association and diagnostic accuracy of different ultrasound signs in detecting CoA prenatally. MEDLINE, EMBASE and CINAHL were searched for studies published between January 2000 and November 2021. Inclusion criteria were fetuses with suspected isolated CoA, defined as ventricular and/or great vessel disproportion with right dominance on ultrasound assessment. Individual participant-level data were obtained by two leading teams. PRISMA-IPD and PRISMA-DTA guidelines were used for extracting data, and the QUADAS-2 tool was used for assessing quality and applicability. The reference standard was CoA, defined as narrowing of the aortic arch, diagnosed after birth. The most commonly evaluated parameters on ultrasound, both in B-mode and on Doppler, constituted the index test. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and likelihood ratios were computed using the hierarchical summary receiver-operating-characteristics model.
RESULTS
The initial search yielded 72 studies, of which 25 met the inclusion criteria. Seventeen studies (640 fetuses) were included. On random-effects logistic regression analysis, tricuspid valve/mitral valve diameter ratio > 1.4 and > 1.6, aortic isthmus/arterial duct diameter ratio < 0.7, hypoplastic aortic arch (all P < 0.001), aortic isthmus diameter Z-score of < -2 in the sagittal (P = 0.003) and three-vessel-and-trachea (P < 0.001) views, pulmonary artery/ascending aorta diameter ratio > 1.4 (P = 0.048) and bidirectional flow at the foramen ovale (P = 0.012) were independently associated with CoA. Redundant foramen ovale was inversely associated with CoA (P = 0.037). Regarding diagnostic accuracy, tricuspid valve/mitral valve diameter ratio > 1.4 had a sensitivity of 72.6% (95% CI, 48.2-88.3%), specificity of 65.4% (95% CI, 46.9-80.2%) and DOR of 5.02 (95% CI, 1.82-13.9). The sensitivity and specificity values were, respectively, 75.0% (95% CI, 61.1-86.0%) and 39.7% (95% CI, 27.0-53.4%) for pulmonary artery/ascending aorta diameter ratio > 1.4, 47.8% (95% CI, 14.6-83.0%) and 87.6% (95% CI, 27.3-99.3%) for aortic isthmus diameter Z-score of < -2 in the sagittal view and 74.1% (95% CI, 58.0-85.6%) and 62.0% (95% CI, 41.6-78.9%) for aortic isthmus diameter Z-score of < -2 in the three-vessel-and-trachea view. Hypoplastic aortic arch had a sensitivity of 70.0% (95% CI, 42.0-88.6%), specificity of 91.3% (95% CI, 78.6-96.8%) and DOR of 24.9 (95% CI, 6.18-100). The diagnostic yield of prenatal ultrasound in detecting CoA did not change significantly when considering multiple categorical parameters. Five of the 11 evaluated continuous parameters were independently associated with CoA (all P < 0.001) but all had low-to-moderate diagnostic yield.
CONCLUSIONS
Several prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combinations of parameters are considered. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Pregnancy; Female; Humans; Aortic Coarctation; Ultrasonography, Prenatal; Aorta; Aorta, Thoracic; Ductus Arteriosus; Retrospective Studies
PubMed: 38197327
DOI: 10.1002/uog.27576 -
Women and Birth : Journal of the... Mar 2024Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination non-adherence may lead to adverse pregnancy outcomes. (Meta-Analysis)
Meta-Analysis
PROBLEM
Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination non-adherence may lead to adverse pregnancy outcomes.
BACKGROUND
Pregnancy has been identified as an opportune time for midwives to support women to make health behaviour changes.
AIM
To synthesise existing qualitative research exploring midwives' experiences of discussing health behaviour change with women within routine care.
METHODS
A systematic search was conducted across: Maternity and Infant Care, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Thematic analysis was used to synthesise the data. A professional and public advisory group provided feedback during the synthesis stage.
FINDINGS
Twenty-two studies, published between 2005 and 2023, which represented findings from eight countries, were included in the review. The meta-synthesis revealed three themes: The midwife-woman relationship; Reflective and tailored behaviour change communication; Practical barriers to behaviour change conversations. This led to one overarching theme: Although midwives recognised the importance of behaviour change discussions, these conversations were not prioritised in clinical practice.
CONCLUSION
Health behaviour change discussions were de-prioritised in midwives' clinical practice. Future research should explore intervention development to support midwives with their health behaviour change communication.
Topics: Female; Humans; Pregnancy; Communication; Health Behavior; Midwifery; Prenatal Care; Qualitative Research
PubMed: 38195300
DOI: 10.1016/j.wombi.2024.01.002 -
BMC Pregnancy and Childbirth Jan 2024This systematic review provides an overview of machine learning (ML) approaches for predicting preeclampsia.
BACKGROUND
This systematic review provides an overview of machine learning (ML) approaches for predicting preeclampsia.
METHOD
This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. We searched the Cochrane Central Register, PubMed, EMBASE, ProQuest, Scopus, and Google Scholar up to February 2023. Search terms were limited to "preeclampsia" AND "artificial intelligence" OR "machine learning" OR "deep learning." All studies that used ML-based analysis for predicting preeclampsia in pregnant women were considered. Non-English articles and those that are unrelated to the topic were excluded. The PROBAST was used to assess the risk of bias and applicability of each included study.
RESULTS
The search strategy yielded 128 citations; after duplicates were removed and title and abstract screening was completed, 18 full-text articles were evaluated for eligibility. Four studies were included in this review. Two studies were at low risk of bias, and two had low to moderate risk. All of the study designs included were retrospective cohort studies. Nine distinct models were chosen as ML models from the four studies. Maternal characteristics, medical history, medication intake, obstetrical history, and laboratory and ultrasound findings obtained during prenatal care visits were candidate predictors to train the ML model. Elastic net, stochastic gradient boosting, extreme gradient boosting, and Random forest were among the best models to predict preeclampsia. All four studies used metrics such as the area under the curve, true positive rate, negative positive rate, accuracy, precision, recall, and F1 score. The AUC of ML models varied from 0.860 to 0.973 in four studies.
CONCLUSION
The results of studies yielded high prediction performance of ML models for preeclampsia risk from routine early pregnancy information.
Topics: Pregnancy; Humans; Female; Pre-Eclampsia; Retrospective Studies; Machine Learning; Prenatal Care; Risk
PubMed: 38166801
DOI: 10.1186/s12884-023-06220-1