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European Journal of Obstetrics,... Jan 2024Cesarean delivery rate is increasing, with no prediction of this rate to drop. Implementation of Early Recovery After Surgery (ERAS) program adapted to this high... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cesarean delivery rate is increasing, with no prediction of this rate to drop. Implementation of Early Recovery After Surgery (ERAS) program adapted to this high prevalent obstetrical surgical procedure proposes better peri-operative care achievement with improved maternal medical care, namely reduced morbidity, faster return to normal daily activities and improved impact on quality of life. Our aim was to analyze the outcomes of ERAS guidelines implementation in cesarean sections (CS).
MATERIAL AND METHODS
A systematic review was performed across 3 databases (MEDLINE (Pubmed), Scopus and Web of Science), with no time or language filters, for articles comparing outcomes on pregnant women who delivered via CS with ERAS guidelines implementation versus the traditional approach without ERAS implementation. Outcomes established: primary - hospital length of stay; secondary - opioid consumption, readmission rates and maternal complications (overall, surgical site infection and emetic morbidity). Statistical analyses were conducted using Review Manager 5.4 and its results were expressed as mean difference, standardized mean difference and odds ratio, with 95% of confidence intervals. This systematic review was reported according to the PRISMA statement.
RESULTS
This systematic review included 16 studies (3 randomized controlled trials (RCT), 4 prospective cohorts and 9 retrospective cohorts), with a pool analysis of 19,001 women (9752 with the traditional approach and 9249 following ERAS guidelines). Our results showed a significative decrease in length of hospital stay (MD: -13.78 h; CI 95 % -19.28 to -8.28; p < 0.00001) and opioid consumption (SMD: -0.91; CI 95 % -1.51 to -0.32; p = 0.003), with similar readmission rates (OR: 0.85; CI 95 % 0.50 to 1.44; p = 0.53) and maternal complications, namely: overall (OR: 0.87; CI 95 % 0.56 to 1.35; p = 0.53); surgical site infection (OR: 1.13; CI 95 % 0.72 to 1.77; p = 0.60) and emetic morbidity (OR: 0.78; CI 95 % 0.31 to 1.96; p = 0.60).
CONCLUSIONS
ERAS guidelines applied at CS management are associated with decreased length of stay and opioid consumption, without negatively impact on readmission rates and overall maternal complications, including surgical site infection and emetic morbidity. The reduced number of RCT studies and the heterogeneity of the studies (heterogeneous inter-study protocols) constitutes the major limitation of the evidence found. Still, these findings may be a foremost help to confirm the beneficial impact of an ERAS approach during peri-cesarean management.
Topics: Female; Pregnancy; Humans; Enhanced Recovery After Surgery; Surgical Wound Infection; Analgesics, Opioid; Emetics; Cesarean Section; Length of Stay; Postoperative Complications
PubMed: 38042118
DOI: 10.1016/j.ejogrb.2023.11.028 -
Respiratory Medicine Jan 2024Asthma treatments based solely on diagnostic label do not benefit patients equally. To identify patient traits that may be associated with improved treatment response to...
Systematic literature review of traits and outcomes reported in randomised controlled trials of asthma with regular dosing of inhaled corticosteroids with short-acting β-agonist reliever, as-needed ICS/formoterol, or ICS/formoterol maintenance and reliever therapy.
INTRODUCTION
Asthma treatments based solely on diagnostic label do not benefit patients equally. To identify patient traits that may be associated with improved treatment response to regular inhaled corticosteroid (ICSs) dosing with short-acting β-agonist reliever or ICS/formoterol-containing therapy, a systematic literature review (SLR) was conducted.
METHODS
Searches of databases including MEDLINE and Embase identified randomised controlled trials (RCTs) of patients with asthma, aged ≥12 years, published 1998-2022, containing ≥1 regular ICS dosing or ICS/formoterol-containing treatment arm, and reporting patient traits and outcomes of interest. Relevant data was extracted and underwent a feasibility assessment to determine suitability for meta-analysis.
RESULTS
The SLR identified 39 RCTs of 72,740 patients and 90 treatment arms, reporting 11 traits and 11 outcomes. Five patient traits (age, body mass index, FEV, smoking history, asthma control) and five outcomes (exacerbation rate, lung function, asthma control, adherence, time to first exacerbation) were deemed feasible for inclusion in meta-analyses due to sufficient comparable reporting. Subgroups of clinical outcomes stratified by levels of patient traits were reported in 16 RCTs.
CONCLUSION
A systematic review of studies of regular ICS dosing with SABA or ICS/formoterol-containing treatment strategies in asthma identified consistent reporting of five traits and outcomes, allowing exploration of associations with treatment response. Conversely, many other traits and outcomes, although being potentially relevant, were inconsistently reported and limited subgroup reporting meant analyses of treatment response for subgroups of traits was not possible. We recommend more consistent measurement and reporting of clinically relevant patient traits and outcomes in respiratory RCTs.
Topics: Humans; Administration, Inhalation; Adrenal Cortex Hormones; Anti-Asthmatic Agents; Asthma; Bronchodilator Agents; Budesonide; Drug Therapy, Combination; Formoterol Fumarate; Randomized Controlled Trials as Topic; Meta-Analysis as Topic
PubMed: 38008385
DOI: 10.1016/j.rmed.2023.107478 -
Medical Science Monitor : International... Oct 2023BACKGROUND The purpose of this meta-analysis was to evaluate the effectiveness of electroacupuncture in preventing and treating postoperative nausea and vomiting (PONV)... (Meta-Analysis)
Meta-Analysis
BACKGROUND The purpose of this meta-analysis was to evaluate the effectiveness of electroacupuncture in preventing and treating postoperative nausea and vomiting (PONV) after general anesthesia. MATERIAL AND METHODS We searched for papers on randomized controlled trials on electroacupuncture for PONV prevention after general anesthesia published in PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) since October 1, 2016. Primary outcome was incidence of PONV; secondary outcomes were incidence of postoperative nausea (PON) at 6 h, postoperative vomiting (POV) at 6 h, and postoperative antiemetic requirement. Data were combined and analyzed using RevMan 5.4.1 software. RESULTS Eight randomized controlled trials, with 899 total participants, were included. Findings showed (1) there was no significant difference in occurrence rate of PONV between electroacupuncture and control groups (OR=0.31, 95% CI [0.06, 1.49], P=0.14, I²=82%); (2) electroacupuncture reduced incidence of PON at 6 h postoperatively, compared with controls (OR=0.43, 95% CI [0.27, 0.67], P=0.0002, I²=0%); (3) compared with control group, electroacupuncture reduced POV incidence 0-6 h postoperatively (OR=0.38, 95% CI [0.23, 0.63], P=0.0001, I²=0%); (4) electroacupuncture group demonstrated a significant reduction in postoperative requirement for antiemetic medications (OR=0.44, 95% CI [0.25, 0.78], P=0.005, I²=61%); (5) one study reported adverse reactions during observation, with 3 patients experiencing pain and itching at acupuncture site and 2 patients refusing a second acupuncture treatment; all symptoms lasted less than 2 h. CONCLUSIONS Based on current evidence, electroacupuncture significantly reduces the occurrence rate of PON and POV at 6 h after surgery and the use of antiemetic medication postoperatively. However, more high-quality, large-sample randomized controlled trials are needed to further validate its efficacy.
Topics: Humans; Postoperative Nausea and Vomiting; Antiemetics; Electroacupuncture; Randomized Controlled Trials as Topic; Acupuncture Therapy
PubMed: 37849245
DOI: 10.12659/MSM.941262 -
International Journal of Chronic... 2023Clinically important deterioration (CID) is a composite endpoint developed to quantify the impact of pharmacological treatment in clinical trials for Chronic Obstructive... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Clinically important deterioration (CID) is a composite endpoint developed to quantify the impact of pharmacological treatment in clinical trials for Chronic Obstructive Pulmonary Disease (COPD), also showing a prognostic value. CID is defined as any of the following condition: forced expiratory volume in 1 s decrease ≥100 mL from baseline, and/or St. George's Respiratory Questionnaire total score increase ≥4-unit from baseline, and/or the occurrence of a moderate-to-severe exacerbation of COPD. Although most COPD patients experience a clinical worsening as they get older, to date, no specific studies assessed the correlation between ageing and CID in COPD. Therefore, the aim of this study was to investigate the impact of ageing on CID in COPD patients.
PATIENTS AND METHODS
Data obtained from 55219 COPD patients were extracted from 17 papers, mostly post-hoc analyses. A pairwise meta-analysis and a meta-regression analysis were performed according to PRISMA-P guidelines to quantify the impact of pharmacological therapy on CID and to determine whether ageing might modulate the risk of CID in COPD patients.
RESULTS
Inhaled treatments resulted generally effective in reducing the risk of CID in COPD (relative risk: 0.81, 95% confidence interval 0.79-0.84; P < 0.001). The meta-regression analysis indicated a trend toward significance (P = 0.063) in the linear relationship between age and the risk of CID. Of note, age significantly (P < 0.05) increased the risk of CID when associated with lower post-bronchodilator FEV. These results were not affected by a significant risk of bias.
CONCLUSION
This quantitative synthesis suggests that inhaled therapy is effective in reducing the risk of CID in COPD, although such a protective effect may be affected in older patients with impaired lung function. Further studies specifically designed on CID in COPD are needed to confirm these results.
Topics: Aged; Humans; Aging; Bronchodilator Agents; Forced Expiratory Volume; Meta-Analysis as Topic; Pulmonary Disease, Chronic Obstructive; Systematic Reviews as Topic; Treatment Outcome; Clinical Deterioration
PubMed: 37841747
DOI: 10.2147/COPD.S396945 -
Korean Journal of Radiology Oct 2023To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of non-ionic iodinated contrast media (ICM) between patients... (Meta-Analysis)
Meta-Analysis
Effects of Fasting versus Non-Fasting on Emetic Complications in Radiological Examinations Using Intravascular Non-Ionic Iodinated Contrast Media: A Systematic Review and Meta-Analysis.
OBJECTIVE
To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of non-ionic iodinated contrast media (ICM) between patients who fasted before contrast injection and those who did not.
MATERIALS AND METHODS
Ovid-MEDLINE and Embase databases were searched from their inception dates until September 2022 to identify original articles that met the following criteria: 1) randomized controlled trials or observational studies, 2) separate reports of the incidence of aspiration pneumonia, nausea, and vomiting after intravascular injection of non-ionic ICM, and 3) inclusion of patients undergoing radiological examinations without fasting. A bivariate beta-binomial model was used to compare the risk difference in adverse events between fasting and non-fasting groups. The I² statistic was used to assess heterogeneity across the studies.
RESULTS
Ten studies, encompassing 308013 patients (non-fasting, 158442), were included in this meta-analysis. No cases of aspiration pneumonia were reported. The pooled incidence of nausea was 4.6% (95% confidence interval [CI]: 1.4%, 7.8%) in the fasting group and 4.6% (95% CI: 1.1%, 8.1%) in the non-fasting group. The pooled incidence of vomiting was 2.1% (95% CI: 0.0%, 4.2%) in the fasting group and 2.5% (95% CI: 0.7%, 4.2%) in the non-fasting group. The risk difference (incidence in the non-fasting group-incidence in the fasting group) in the incidence of nausea and vomiting was 0.0% (95% CI: -4.7%, 4.7%) and 0.4% (95% CI: -2.3%, 3.1%), respectively. Heterogeneity between the studies was low (I² = 0%-13.5%).
CONCLUSION
Lack of fasting before intravascular administration of non-ionic ICM for radiological examinations did not increase the risk of emetic complications significantly. This finding suggests that hospitals can relax fasting policies without compromising patient safety.
Topics: Humans; Emetics; Contrast Media; Vomiting; Nausea; Fasting; Pneumonia, Aspiration
PubMed: 37793670
DOI: 10.3348/kjr.2023.0399 -
Frontiers in Endocrinology 2023Hypoglycaemia has been linked to an increased risk of cardiac arrhythmias by causing autonomic and metabolic alterations, which may be associated with detrimental... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypoglycaemia has been linked to an increased risk of cardiac arrhythmias by causing autonomic and metabolic alterations, which may be associated with detrimental outcomes in individuals with diabetes(IWD), such as cardiovascular diseases (CVDs) and mortality, especially in multimorbid or frail people. However, such relationships in this population have not been thoroughly investigated. For this reason, we conducted a systematic review and meta-analysis.
METHODS
Relevant papers published on PubMed, Embase, Cochrane, Web of Knowledge, Scopus, and CINHAL complete from inception to December 22, 2022 were routinely searched without regard for language. All of the selected articles included odds ratio, hazard ratio, or relative risk statistics, as well as data for estimating the connection of hypoglycaemia with cardiac arrhythmia, CVD-induced death, or total death in IWD. Regardless of the heterogeneity assessed by the I statistic, pooled relative risks (RRs) and 95% confidence intervals (CI) were obtained using random-effects models.
RESULTS
After deleting duplicates and closely evaluating all screened citations, we chose 60 studies with totally 5,960,224 participants for this analysis. Fourteen studies were included in the arrhythmia risk analysis, and 50 in the analysis of all-cause mortality. Hypoglycaemic patients had significantly higher risks of arrhythmia occurrence (RR 1.42, 95%CI 1.21-1.68), CVD-induced death (RR 1.59, 95% CI 1.24-2.04), and all-cause mortality (RR 1.68, 95% CI 1.49-1.90) compared to euglycaemic patients with significant heterogeneity.
CONCLUSION
Hypoglycaemic individuals are more susceptible to develop cardiac arrhythmias and die, but evidence of potential causal linkages beyond statistical associations must await proof by additional specifically well planned research that controls for all potential remaining confounding factors.
Topics: Humans; Diabetes Mellitus; Hypoglycemia; Arrhythmias, Cardiac; Hypoglycemic Agents; Cardiovascular Diseases
PubMed: 37645418
DOI: 10.3389/fendo.2023.1222409 -
Asian Journal of Surgery Oct 2023
Meta-Analysis
Topics: Humans; Vomiting; Nausea; Acupuncture Therapy; Laparoscopy; Antiemetics
PubMed: 37149451
DOI: 10.1016/j.asjsur.2023.04.107