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Critical Care Explorations Jul 2024Older adults may be under-represented in critical care research, and results may not apply to this specific population. Our primary objective was to evaluate the...
OBJECTIVES
Older adults may be under-represented in critical care research, and results may not apply to this specific population. Our primary objective was to evaluate the prevalence of inclusion of older adults across critical care trials focused on common ICU conditions or interventions. Our secondary objective was to evaluate whether older age was used as a stratification variable for randomization or outcome analysis.
DESIGN SETTING AND SUBJECTS
We performed a systematic review of previously published systematic reviews of randomized controlled trials (RCTs) in critical care. We searched PubMed, Ovid, CENTRAL, and Cochrane from 2009 to 2022. Systematic reviews of any interventions across five topics: acute respiratory distress syndrome (ARDS), sepsis/shock, nutrition, sedation, and mobilization were eligible.
MAIN RESULTS
We identified 216 systematic reviews and included a total of 253 RCTs and 113,090 patients. We extracted baseline characteristics and the reported proportion of older adults. We assessed whether any upper age limit was an exclusion criterion for trials, whether age was used for stratification during randomization or data analysis, and if age-specific subgroup analysis was present. The most prevalent topic was sepsis (78 trials, 31%), followed by nutrition (62 trials, 25%), ARDS (39 trials, 15%), mobilization (38 trials, 15%), and sedation (36 trials, 14%). Eighteen trials (7%) had exclusion criteria based on older age. Age distribution with information on older adults prevalence was given in six trials (2%). Age was considered in the analysis of ten trials (5%) using analytic methods to evaluate the outcome stratified by age.
CONCLUSIONS
In this systematic review, the proportion of older critically ill patients is undetermined, and it is unclear how age is or is not an effect modifier or to what extent the results are valid for older adult groups. Reporting age is important to guide clinicians in personalizing care. These results highlight the importance of incorporating older critically ill patients in future trials to ensure the results are generalizable to this growing population.
Topics: Humans; Critical Illness; Aged; Randomized Controlled Trials as Topic; Critical Care; Aged, 80 and over; Sepsis; Respiratory Distress Syndrome; Patient Selection; Age Factors; Intensive Care Units
PubMed: 38919511
DOI: 10.1097/CCE.0000000000001107 -
Iranian Journal of Public Health Mar 2024The prevalence of pelvic organ prolapse is varied in different countries. For validating the results of numerous studies on the prevalence of Pelvic organ prolapse in... (Review)
Review
BACKGROUND
The prevalence of pelvic organ prolapse is varied in different countries. For validating the results of numerous studies on the prevalence of Pelvic organ prolapse in the world, a meta-analysis study seems necessary to provide an accurate and valid prevalence for planners and researchers in this field. Therefore, we aimed to investigate the worldwide prevalence of pelvic organ prolapse using the meta-analysis method.
METHODS
By using valid keywords, searching was done in ISI Web of Science, PubMed, Scopus, and Medline databases, and 22 articles were selected based on inclusion criteria between 2009 and 2021. The quality of articles was checked using The Joanna Briggs Institute (JBI) checklist. Meta-analysis was performed on collected data using Comprehensive Meta-Analysis Software (CMA, Version 2). Meta-analysis of data was done with a random-effects model. The heterogeneity of the study was checked using the I2 index. Publication bias was assessed by the Egger test and funnel graph.
RESULTS
The overall prevalence of included studies was 30.9% (95% confidence interval: 24.4-38.2%), (<0.001, heterogeneity I2=99.8%). Meta-analysis of subgroups in studies that used a questionnaire to estimate the prevalence rate showed the prevalence was 25.0% and, in the studies, used the physical examination was 41.8%.
CONCLUSION
Studies carried out in different parts of the world have examined the prevalence of pelvic organ prolapse using different tools. Since some cases are asymptomatic, especially in the low stage of prolapse, physical examination of pelvic organ prolapse should be considered an essential tool in evaluating pelvic organ prolapse.
PubMed: 38919293
DOI: 10.18502/ijph.v53i3.15134 -
BMC Gastroenterology Jun 2024Crohn's disease (CD) is a chronic condition characterized by a high recurrence rate after surgery, which seriously affects the quality of life of patients. Many studies...
BACKGROUND
Crohn's disease (CD) is a chronic condition characterized by a high recurrence rate after surgery, which seriously affects the quality of life of patients. Many studies have explored the risk factors for the recurrence of CD after surgery, there is a lack of meta-analysis focusing on endoscopic postoperative recurrence (ePOR) as a clinical outcome. Therefore, this paper aims to identify the risk factors for ePOR in CD patients through systematic review and meta-analysis.
METHODS
PubMed, Embase, Cochrane Library, and Web of Science databases were searched for related literature from inception to 17th October 2023. Two researchers independently screened the literature and extracted information. Data analysis was performed using Stata18.0.
RESULTS
Twenty-three papers were included, with 5 case-control studies and 18 cohort studies. The National Institutes of Health quality assessment tool rated 17 studies as good and 6 studies as fair. The sample size of the 23 studies ranged from 40 to 346, and the number of patients with ePOR ranged from 23 to 169. The results of multivariate meta-analysis showed that smoking [OR = 2.06, 95% CI (1.65, 2.57), P = 0.0001], previous ileocolonic resection [OR = 1.71, 95% CI (1.23, 2.38), P = 0.002], disease localization at ileocolic resection [OR = 2.68, 95% CI (1.38, 5.22), P = 0.004], perianal disease [OR = 1.47, 95% CI (1.07, 2.03), P = 0.017], and anastomotic scattered ulcer [OR = 3.39, 95% CI (1.83, 6.28), P = 0.001] were risk factors for ePOR in CD patients. Postoperative prophylactic medication [OR = 0.53, 95% CI (0.38,0.75), P = 0.0001] was a protective factor for ePOR in CD patients.
CONCLUSIONS
This systematic review identified multiple factors for ePOR in CD patients, as well as a protective factor. However, the number of articles included was limited. More high-quality clinical studies are required to further validate the conclusions.
TRIAL REGISTRATION
This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023483671).
Topics: Crohn Disease; Humans; Risk Factors; Recurrence; Systematic Reviews as Topic; Meta-Analysis as Topic; Research Design; Postoperative Complications
PubMed: 38918740
DOI: 10.1186/s12876-024-03301-z -
PharmacoEconomics Jun 2024Multiple myeloma is a rare incurable hematological cancer in which most patients relapse or become refractory to treatment. This systematic literature review aimed to...
A Systematic Review of Modeling Approaches to Evaluate Treatments for Relapsed Refractory Multiple Myeloma: Critical Review and Considerations for Future Health Economic Models.
BACKGROUND AND OBJECTIVE
Multiple myeloma is a rare incurable hematological cancer in which most patients relapse or become refractory to treatment. This systematic literature review aimed to critically review the existing economic models used in economic evaluations of systemic treatments for relapsed/refractory multiple myeloma and to summarize how the models addressed differences in the line of therapy and exposure to prior treatment.
METHODS
Following a pre-approved protocol, literature searches were conducted on 17 February, 2023, in relevant databases for models published since 2014. Additionally, key health technology assessment agency websites were manually searched for models published as part of submission dossiers since 2018. Reported information related to model conceptualization, structure, uncertainty, validation, and transparency were extracted into a pre-defined extraction sheet.
RESULTS
In total, 49 models assessing a wide range of interventions across multiple lines of therapy were included. Only five models specific to heavily pre-treated patients and/or those who were refractory to multiple treatment classes were identified. Most models followed a conventional simple methodology, such as partitioned survival (n = 28) or Markov models (n = 9). All included models evaluated specific interventions rather than the whole treatment sequence. Where subsequent therapies were included in the model, these were generally only considered from a cost and resource use perspective. The models generally used overall and progression-free survival as model inputs, although data were often immature. Sensitivity analyses were frequently reported (n = 41) whereas validation was only considered in less than half (n = 19) of the models.
CONCLUSIONS
Published economic models in relapsed/refractory multiple myeloma rarely followed an individual patient approach, mainly owing to the higher need for complex data assumptions compared with simpler modeling approaches. As many patients experience disease progression on multiple treatment lines, there is a growing need for modeling complex treatment strategies, leading to more sophisticated approaches in the future. Maintaining transparency, high reporting standards, and thorough analyses of uncertainty are crucial to support these advancements.
PubMed: 38918342
DOI: 10.1007/s40273-024-01399-3 -
International Journal of Nursing Studies Jun 2024Physical activity during pregnancy has been recommended as an effective measure to prevent various pregnancy complications. However, global physical activity... (Review)
Review
BACKGROUND
Physical activity during pregnancy has been recommended as an effective measure to prevent various pregnancy complications. However, global physical activity participation during pregnancy is not optimal, and the factors influencing physical activity participation during pregnancy need to be further investigated. In China, where there are no localized guidelines for physical activity during pregnancy, the prevalence of meeting recommended physical activity levels among Chinese pregnant women is still unclear.
OBJECTIVES
This study aimed to comprehensively review the prevalence of meeting recommended physical activity levels among pregnant women in China and to further explore the factors influencing physical activity participation during pregnancy.
DESIGN
This was a systematic review and meta-analysis.
METHODS
A systematic review was conducted in both English and Chinese databases from inception until August 1, 2023. Two reviewers independently screened literature, assessed study eligibility and extracted data. The Agency for Healthcare Research and Quality was used to evaluate methodological quality of included studies. The pooled prevalence was calculated using a random-effects model. Subgroup analyses were conducted to explore sources of heterogeneity.
RESULTS
A total of 12 cross-sectional studies, including 11,323 Chinese pregnant women with a mean age ranging from 27.0 to 33.0 years, met the inclusion criteria. The prevalence of meeting recommended physical activity levels among pregnant women in China was 21.0 % (95 % confidence interval (CI):12.5 %-29.5 %). A higher prevalence of meeting recommended physical activity levels was observed among pregnant women who were in their second trimester, who were living in the southern region, who were assessed by validated questionnaires, and who used 150 min physical activity per week as a criterion for meeting recommendation.
CONCLUSIONS
The findings suggested a low prevalence of meeting recommended physical activity levels among Chinese pregnant women, which was affected by a variety of factors. It is recommended that further research be conducted in the future to explore physical activity intervention strategies for women of childbearing age before and during pregnancy based on the factors affecting physical activity to improve physical activity compliance, maternal and child health and population quality.
REGISTRATION NUMBER
CRD42022372722 (PROSPERO).
PubMed: 38917748
DOI: 10.1016/j.ijnurstu.2024.104841 -
Journal of the American Medical... Jun 2024ABO blood types have widespread clinical use and robust associations with disease. The purpose of this study is to evaluate the portability and suitability of tag...
OBJECTIVES
ABO blood types have widespread clinical use and robust associations with disease. The purpose of this study is to evaluate the portability and suitability of tag single-nucleotide polymorphisms (tSNPs) used to determine ABO alleles and blood types across diverse populations in published literature.
MATERIALS AND METHODS
Bibliographic databases were searched for studies using tSNPs to determine ABO alleles. We calculated linkage between tSNPs and functional variants across inferred continental ancestry groups from 1000 Genomes. We compared r2 across ancestry and assessed real-world consequences by comparing tSNP-derived blood types to serology in a diverse population from the All of Us Research Program.
RESULTS
Linkage between functional variants and O allele tSNPs was significantly lower in African (median r2 = 0.443) compared to East Asian (r2 = 0.946, P = 1.1 × 10-5) and European (r2 = 0.869, P = .023) populations. In All of Us, discordance between tSNP-derived blood types and serology was high across all SNPs in African ancestry individuals and linkage was strongly correlated with discordance across all ancestries (ρ = -0.90, P = 3.08 × 10-23).
DISCUSSION
Many studies determine ABO blood types using tSNPs. However, tSNPs with low linkage disequilibrium promote misinference of ABO blood types, particularly in diverse populations. We observe common use of inappropriate tSNPs to determine ABO blood type, particularly for O alleles and with some tSNPs mistyping up to 58% of individuals.
CONCLUSION
Our results highlight the lack of transferability of tSNPs across ancestries and potential exacerbation of disparities in genomic research for underrepresented populations. This is especially relevant as more diverse cohorts are made publicly available.
PubMed: 38917427
DOI: 10.1093/jamia/ocae161 -
International Journal of Biometeorology Jun 2024Mud therapy is a safe, cost-effective approach for Knee Osteoarthritis (OA), promoting healing through warmth and minerals, providing pain relief, and improving... (Review)
Review
Mud therapy is a safe, cost-effective approach for Knee Osteoarthritis (OA), promoting healing through warmth and minerals, providing pain relief, and improving function. The main objective of the current review is to assess the effectiveness of local mud application for pain management in patients with Knee OA. The published papers were obtained from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrails.gov, Web of Science, and references from relevant systematic reviews from 1990 January to February 2023. Trials meeting the predefined criteria were included in this meta-analysis. The main focus of this study was to assess pain as a primary outcome measure. R software version 4.3.1 and Cochrane Risk of Bias Tool 1 were used to derive meta-analysis and risk of bias in the included studies. A meta-analysis was performed using the fixed-effects model to obtain a summary of treatment effects, which calculated the effect size (standardized mean difference; SMD) along with a 95% Confidence Interval (CI).In the current meta-analysis, a total of ten studies with 560 Knee OA patients were included. Findings demonstrated significant effects of local mud application on pain (SMD: -0.36, 95% CI: -0.56, -0.16), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale (SMD: -0.49, 95% CI: -0.68, -0.29) for individuals suffering from Knee OA. The current study identified compelling evidence to support the recommendation of mud application as an effective intervention for individuals with Knee OA. While local mud application may serve as a supplementary therapy alongside conventional medical approaches for improved Knee OA management, additional high-quality randomized controlled trials are required to validate these findings.
PubMed: 38916766
DOI: 10.1007/s00484-024-02725-2 -
World Journal of Urology Jun 2024The aim of this study is to critically evaluate the existing body of evidence regarding the efficacy of Retzius-sparing radical prostatectomy (RS-RARP) in achieving...
PURPOSE
The aim of this study is to critically evaluate the existing body of evidence regarding the efficacy of Retzius-sparing radical prostatectomy (RS-RARP) in achieving improved functional outcomes. Moreover, we explored possible strategies to further optimize functional outcomes.
METHODS
Following PRISMA guidelines, a systematic review (PROSPERO ID CRD42024539915) was performed on 9th September 2023 on PubMed, Scopus, and Web of Science. Only original articles in the English language reporting functional outcomes after RS-RARP were included.
RESULTS
Overall, the search string yielded 99 results on PubMed, 122 on Scopus, and 120 on Web Of Science. After duplicate exclusion, initial screening and eligibility evaluation, a total of 47 studies were included in the qualitative analysis, corresponding to a cohort of 13.196 patients. All studies reported continence recovery. RS-RARP appeared to achieve better and faster continence recovery compared to S-RARP. However, it should be noted that continence definition was heterogeneous and not based on validated condition-specific questionnaires. Seven (15%) studies provided for any sort of rehabilitation for urinary incontinence after RS-RARP. 22 studies analyzed potency recovery rates, showing no difference between RS-RARP and S-RARP. The evaluation of this outcome poses a great challenge due to the lack of standardized assessment tools and reporting methods. Only two studies reported on the consistent use of post-operative PDE5i as penile rehabilitation.
CONCLUSIONS
The current review highlights the satisfactory functional results of Retzius-sparing robot assisted radical prostatectomy, which holds true irrespective of disease stage and prostate volume, with promising results even in patients previously treated for BPH or in the salvage setting. How can we optimize those results? The answer does not probably lie in further refinement of the surgical technique, but in giving greater attention to patient counselling and rehabilitation strategies in order to minimize regret and maximize satisfaction.
Topics: Prostatectomy; Humans; Male; Robotic Surgical Procedures; Prostatic Neoplasms; Organ Sparing Treatments; Recovery of Function; Urinary Incontinence; Treatment Outcome
PubMed: 38916624
DOI: 10.1007/s00345-024-05066-2 -
International Journal of... Apr 2024The current meta-analysis aims to explore the potential correlation between natural resistance-associated macrophage protein 1 (NRAMP1) (3'-Untranslated region [3'-UTR])... (Meta-Analysis)
Meta-Analysis Review
A Systemic Review and Meta-analysis on Natural Resistance-associated Macrophage Protein 1 (3'-Untranslated Region) and Nucleotide-binding Oligomerization Domain-2 (rs8057341) Polymorphisms and Leprosy Susceptibility in Asian and Caucasian Populations.
The current meta-analysis aims to explore the potential correlation between natural resistance-associated macrophage protein 1 (NRAMP1) (3'-Untranslated region [3'-UTR]) and nucleotide-binding oligomerization domain-2 (NOD2 [rs8057341]) gene polymorphisms and their association with leprosy susceptibility in both Asian and Caucasian populations. Datas were retrieved from case control studies with NOD 2 and NRAMP 1 gene polymorphism associated with leprosy disease. Leprosy emerges as a particularly distinctive ailment among women on a global scale. The NRAMP1 (3'-UTR) and NOD2 (rs8057341) genetic variations play a crucial role in the progression of leprosy. A systematic review of relevant case-control studies was conducted across several databases, including ScienceDirect, PubMed, Google Scholar, and Embase. Utilizing MetaGenyo and Review Manager 5.4 Version, statistical analyses were carried out. Nine case-control studies totaling 3281 controls and 3062 leprosy patients are included in the research, with the objective of examining the potential association between NRAMP1 (3'-UTR) and NOD2 (rs8057341) gene polymorphisms and leprosy risk. The review methodology was registered in PROSPERO (ID520883). The findings reveal a robust association between NRAMP1 (3'-UTR) and NOD2 (rs8057341) gene polymorphisms and leprosy risk across various genetic models. Although the funnel plot analysis did not identify publication bias, bolstering these findings and elucidating potential gene-gene and gene-environment interactions require further comprehensive epidemiological research. This study identified a strong correlation between polymorphisms in the NOD2 (rs8057341) genes and susceptibility to leprosy across two genetic models. Further comprehensive epidemiological investigations are warranted to validate these findings and explore potential interactions between these genes and environmental factors.
Topics: Humans; Leprosy; Genetic Predisposition to Disease; Asian People; White People; Cation Transport Proteins; Nod2 Signaling Adaptor Protein; 3' Untranslated Regions; Polymorphism, Single Nucleotide; Case-Control Studies; Female; Polymorphism, Genetic; Male
PubMed: 38916380
DOI: 10.4103/ijmy.ijmy_43_24 -
The American Journal of Gastroenterology Jun 2024Diagnostic paracentesis is recommended for patients with cirrhosis admitted to the hospital, but adherence is suboptimal with unclear impact on clinical outcomes. This...
INTRODUCTION
Diagnostic paracentesis is recommended for patients with cirrhosis admitted to the hospital, but adherence is suboptimal with unclear impact on clinical outcomes. This meta-analysis aimed to assess the outcomes of early vs. delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites.
METHODS
We searched multiple databases for studies comparing early vs. delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites. The pooled odds ratio (OR) and mean difference (MD) with confidence intervals (CI) for proportional and continuous variables were calculated using the random-effects model. Early diagnostic paracentesis was defined as receiving diagnostic paracentesis within 12-24 hours of admission. The primary outcome was in-hospital mortality. Secondary outcomes were length-of-hospital-stay (LOS), acute kidney injury (AKI), and 30-day readmission.
RESULTS
Seven studies (n=78,744) (n=45,533 early vs. n=33,211 delayed diagnostic paracentesis) were included. Early diagnostic paracentesis was associated with lower in-hospital mortality (OR 0.61, 95% CI 0.46-0.82, P=0.001), LOS (MD -4.85 days; 95% CI -6.45, -3.20; P<0.001), and AKI (OR 0.62, 95% CI 0.42-0.92, P=0.02) compared to delayed diagnostic paracentesis, with similar 30-day readmission (OR 1.11, 95% CI 0.52-2.39, P=0.79). Subgroup analysis revealed consistent results for in-hospital mortality whether early diagnostic paracentesis performed within 12 hours (OR 0.51, 95% CI 0.32-0.79, P=0.003, I2=0%) or within 24 hours of admission (OR 0.67, 95% CI 0.45-0.98, P=0.04, I2=82%). Notably, the mortality OR was numerically lower when diagnostic paracentesis was performed within 12 hours, and the results were precise and homogenous (I2=0%).
CONCLUSIONS
Findings from this meta-analysis suggest that early diagnostic paracentesis is associated with better patient outcomes. Early diagnostic paracentesis within 12 hours of admission may be associated with the greatest mortality benefit. Data from large-scale randomized trials are needed to validate our findings, especially if there is a greater mortality benefit for early diagnostic paracentesis within 12 hours.
PubMed: 38916217
DOI: 10.14309/ajg.0000000000002906