scholarly journals P054: The effectiveness of emergency department-based interventions for patients with advanced or end-stage illness: a systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S82
Author(s):  
A. Ghalab ◽  
M. Kruhlak ◽  
S. Kirkland ◽  
H. Ruske ◽  
S. Campbell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Quality Care ◽  
Grey Literature ◽  
Cost Effective ◽  
Third Party ◽  
High Quality ◽  
End Stage ◽  
The Impact

Introduction: Patients with advanced or end-stage illness frequently present to emergency departments (EDs), many of whom are in need of palliative care (PC). Emergency physicians have struggled in providing high quality care to these patients and there is a need to identify cost-effective PC interventions delivered in the ED to improve patient outcomes. The objective of this systematic review was to examine the effectiveness of ED-based PC interventions. Methods: A comprehensive search of nine electronic databases and grey literature sources was conducted to identify any comparative studies assessing the effectiveness of ED-based PC interventions to improve health outcomes of patients with advanced or end-stage illness. Two independent reviewers completed study selection, quality assessment, and data extraction. Differences were mediated via third-party adjudication. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity (I2) was reported. Results: From 5882 potentially eligible citations, 12 studies were included. Two studies are currently on-going clinical trials, and as such, 10 studies were included in this analysis. The studies consisted of before-after studies (n = 5), RCTs (n = 4), and an observational cohort (n = 1). Interventions assessed among the included studies consisted primarily of ED-directed PC consultations (n = 6), while other studies assessed screening of patients with advanced or end-stage illness and PC needs (n = 2), education on PC for ED-staff (n = 1), and an ED-based critical care unit (n = 1). Infrequent reporting of important outcomes (e.g., Mortality, ED relapse) limited the ability of this review to conduct meaningful meta-analysis. There was no difference in patient mortality between two studies assessing ED-directed PC consultations (RR = 0.89; 95% CI: 0.71, 1.13; I2 = 0%). One before-after study (RR = 0.73; 95% CI: 0.47, 1.13) and two RCTs (RR = 2.19; 95% CI: 0.40, 11.92; I2 = 96%) did not identify significant differences in PC consultations intervention (implementation of ED-directed PC consultations) and control (usual care) patients. Conclusion: This review found limited evidence to support the recommendation of any particular ED-based intervention for patients presenting to the ED with advanced or end-stage illness. High quality studies and standardized outcome reporting are needed to better understand the impact of PC interventions in the ED setting.

scholarly journals Misuse of medication in adult substance misuse services: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047283
Author(s):  
Rosalind Gittins ◽  
Louise Missen ◽  
Ian Maidment
Keyword(s):  
Systematic Review ◽  
Substance Misuse ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Opioid Analgesics ◽  
Physical And Mental Health ◽  
Qualitative Synthesis ◽  
Treatment Services ◽  
The Impact

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.

scholarly journals Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis—protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035360
Author(s):  
Britzer Paul Vincent ◽  
Gurch Randhawa ◽  
Erica Cook
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Secondary Data ◽  
Organ Donor ◽  
Indian Origin ◽  
Ethical Approval ◽  
Registration Number ◽  
End Stage

IntroductionThe need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally.Methods and analysisA systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made.Ethics and disseminationAs this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy.PROSPERO registration numberCRD42019155274.

scholarly journals Oxymetazoline for the treatment of rosacea-associated persistent facial erythema. Systematic review and meta-analysis protocol

2020 ◽  
Author(s):  
Geovanna Cárdenas ◽  
Francisco Novillo ◽  
Shuheng Lai ◽  
Héctor Fuenzalida ◽  
Francisca Verdugo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Eligibility Criteria ◽  
Facial Erythema ◽  
Central Register ◽  
The Impact

ABSTRACTObjectiveThe objective of this systematic review is to assess the impact of oxymetazoline in patients with moderate to severe rosacea.Data SourcesWe will conduct a comprehensive search in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Lilacs, the International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, US National Institutes of Health (NIH) and grey literature, to identify all relevant randomized controlled trials regardless of language or publication status (published, unpublished, in press and in progress).Eligibility criteria for selecting studies and methodsWe will include randomized trials evaluating the effect of oxymetazoline in patients with moderate to severe rosacea. Two reviewers will independently screen each study for eligibility, data extraction, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE [1] system to assess the certainty of the evidence for each outcome.Ethics and DisseminationNo ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.Protocol and RegistrationThis protocol was adapted to the specificities of the question assessed in this review and registered to PROSPERO with the ID CRD42020150262.

scholarly journals Periodontal therapy on disease activity of Rheumatoid Arthritis. Systematic review and meta-analysis

2020 ◽  
Author(s):  
Francisco Novillo ◽  
Shuheng Lai ◽  
Geovanna Cárdenas ◽  
Francisca Verdugo ◽  
Gabriel Rada
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Disease Activity ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Periodontal Therapy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
The Impact

AbstractObjectiveThe objective of this systematic review is to assess the impact of periodontal therapy on disease activity of patients with Rheumatoid ArthritisData SourcesWe will conduct a comprehensive search in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Lilacs, the International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, US National Institutes of Health (NIH) and grey literature, to identify all relevant randomized controlled trials regardless of language or publication status (published, unpublished, in press and in progress).Elegibility Criteria for Selecting Studies and MethodsWe will include randomised trials evaluating the effect of periodontal therapy on disease activity of rheumatoid arthritis. Two reviewers will independently screen each study for eligibility, data extraction, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome.Ethics and DisseminationNo ethics approval is considered necessary. The results of this review will be disseminated via peer-reviewed publications, social networks and traditional media.PROSPERO Registration IDCRD42020150286.

scholarly journals Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e035978
Author(s):  
Justin Lee ◽  
Ahmed Negm ◽  
Ryan Peters ◽  
Eric K C Wong ◽  
Anne Holbrook
Keyword(s):  
Systematic Review ◽  
Fall Risk ◽  
Data Extraction ◽  
Financial Burden ◽  
Meta Analysis ◽  
Grey Literature ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Eligibility Criteria ◽  
The Impact

ObjectivesPrevention of falls and fall-related injuries is a priority due to the substantial health and financial burden of falls on patients and healthcare systems. Deprescribing medications known as ‘fall-risk increasing drugs’ (FRIDs) is a common strategy to prevent falls. We conducted a systematic review to determine its efficacy for the prevention of falls and fall-related complications.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL and grey literature from inception to 1 August 2020.Eligibility criteria for selecting studiesRandomised controlled trials of FRID withdrawal compared with usual care evaluating the rate of falls, incidence of falls, fall-related injuries, fall-related fractures, fall-related hospitalisations or adverse effects related to the intervention in adults aged ≥65 years.Data extraction and synthesisTwo reviewers independently performed citation screening, data abstraction, risk of bias assessment and certainty of evidence grading. Random-effects models were used for meta-analyses.ResultsFive trials involving 1305 participants met eligibility criteria. Deprescribing FRIDs did not change the rate of falls (rate ratio (RaR) 0.98, 95% CI 0.63 to 1.51), the incidence of falls (risk difference 0.01, 95% CI −0.06 to 0.09; relative risk 1.04, 95% CI 0.86 to 1.26) or rate of fall-related injuries (RaR 0.89, 95% CI 0.57 to 1.39) over a follow-up period of 6–12 months. No trials evaluated the impact of deprescribing FRIDs on fall-related fractures or hospitalisations.ConclusionThere is a paucity of robust high-quality evidence to support or refute that a FRID deprescribing strategy alone is effective at preventing falls or fall-related injury in older adults. Although there may be other reasons to deprescribe FRIDs, our systematic review found that it may result in little to no difference in the rate or risk of falls as a sole falls reduction strategy.PROSPERO registration numberCRD42016040203.

scholarly journals The Seroprevalence of SARS-CoV-2 in Europe: A Systematic Review

2021 ◽  
Author(s):  
Natasha Marcella Vaselli ◽  
Daniel Hungerford ◽  
Ben Shenton ◽  
Arwa Khashkhusha ◽  
Nigel A. Cunliffe ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Meta Analysis ◽  
Grey Literature ◽  
Age Groups ◽  
Significant Heterogeneity ◽  
Community Studies ◽  
Past Infection ◽  
Significant Difference ◽  
The Impact

AbstractBackgroundA year following the onset of the COVID-19 pandemic, new infections and deaths continue to increase in Europe. Serological studies, through providing evidence of past infection, can aid understanding of the population dynamics of SARS-CoV-2 infection.ObjectivesThis systematic review of SARS-CoV-2 seroprevalence studies in Europe was undertaken to inform public health strategies including vaccination, that aim to accelerate population immunity.MethodsWe searched the databases Web of Science, MEDLINE, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews and grey literature sources for studies reporting seroprevalence of SARS-CoV-2 antibodies in Europe published between 01/12/2019 - 30/09/20. We provide a narrative synthesis of included studies. Studies were categorized into subgroups including healthcare workers (HCWs), community, outbreaks, pregnancy and children/school. Due to heterogeneity in other subgroups, we only performed a random effects meta-analysis of the seroprevalence amongst HCWs stratified by their country.Results109 studies were included spanning 17 European countries, that estimated the seroprevalence of SAR-CoV2 from samples obtained between November 2019 – August 2020. A total of 53/109 studies included HCWs with a reported seroprevalence among HCWs ranging from 0.7% to 45.3%, which did not differ significantly by country. In community studies significant heterogeneity was reported in the seroprevalence among different age groups and the majority of studies reported there was no significant difference by gender.ConclusionThis review demonstrates a wide heterogeneity in reported seroprevalence of SARS-CoV-2 antibodies between populations. Continued evaluation of seroprevalence is required to understand the impact of public health measures and inform interventions including vaccination programmes.

scholarly journals Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020991 ◽  
Author(s):  
Wen Wang ◽  
Wenwen Chen ◽  
Yanmei Liu ◽  
Reed Alexander C Siemieniuk ◽  
Ling Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Meta Analysis ◽  
Late Recurrence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
High Quality ◽  
Moderate Quality ◽  
The Impact ◽  
Risk Of Treatment

ObjectiveTo assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.Study selectionA BMJ Rapid Recommendation panel provided input on design, important outcomes and the interpretation of the results. Eligible randomised controlled trials (RCTs) included a comparison of antibiotics against no antibiotics or a comparison of different antibiotics in patients with uncomplicated skin abscesses, and reported outcomes prespecified by the linked guideline panel.Review methodsReviewers independently screened abstracts and full texts for eligibility, assessed risk of bias and extracted data. We performed random-effects meta-analyses that compared antibiotics with no antibiotics, along with a limited number of prespecified subgroup hypotheses. We also performed network meta-analysis with a Bayesian framework to compare effects of different antibiotics. Quality of evidence was assessed with The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsFourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95% CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). However, relative to no use, antibiotics probably increase the risk of gastrointestinal side effects (trimethoprim and sulfamethoxazole (TMP-SMX): OR 1.28, 95% CI 1.04 to 1.58; moderate quality; clindamycin: OR 2.29, 95% CI 1.35 to 3.88; high quality) and diarrhoea (clindamycin: OR 2.71, 95% CI 1.50 to 4.89; high quality). Cephalosporins did not reduce the risk of treatment failure compared with placebo (moderate quality).ConclusionsIn patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective.

scholarly journals Assessment of humoral and cell-mediated immune responses to pertussis vaccination: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028109 ◽  
Author(s):  
Funbi Akinola ◽  
Rudzani Muloiwa ◽  
Gregory, D Hussey ◽  
Violette Dirix ◽  
Benjamin Kagina ◽  
...  
Keyword(s):  
Systematic Review ◽  
Immune Response ◽  
Immune Responses ◽  
Public Space ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Assessment Tools ◽  
Population Type

IntroductionGlobally, some studies show a resurgence of pertussis. The risks and benefits of using whole-cell pertussis (wP) or acellular pertussis (aP) vaccines in the control of the disease have been widely debated. Better control of pertussis will require improved understanding of the immune response to pertussis vaccines. Improved understanding and assessment of the immunity induced by pertussis vaccines is thus imperative. Several studies have documented different immunological outcomes to pertussis vaccination from an array of assays. We propose to conduct a systematic review of the different immunological assays and outcomes used in the assessment of the humoraland cell-mediated immune response following pertussis vaccination.Methods and analysisThe primary outcomes for consideration are quality and quantity of immune responses (humoral and cell-mediated) post-pertussis vaccination. Of interest as secondary outcomes are types of immunoassays used in assessing immune responses post-pertussis vaccination, types of biological samples used in assessing immune responses post-pertussis vaccination, as well as the types of antigens used to stimulate these samples during post-pertussis vaccination immune response assessments. Different electronic databases (including PubMed, Cochrane, EBSCO Host, Scopus and Web of Science) will be accessed for peer-reviewed published and grey literature evaluating immune responses to pertussis vaccines between 1990 and 2019. The quality of included articles will be assessed using standardised risk and quality assessment tools specific to the study design used in each article. Data extraction will be done using a data extraction form. The extracted data will be analysed using STATA V.14.0 and RevMan V.5.3 software. A subgroup analysis will be conducted based on the study population, type of vaccine (wP or aP) and type of immune response (cell-mediated or humoral). Guidelines for reporting systematic reviews in the revised 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement will be used in this study.Ethics and disseminationEthics approval is not required for this study as it is a systematic review. We will only make use of data already available in the public space. Findings will be reported via publication in a peer-reviewed journal and presented at scientific meetings and workshops.Trial registration numberCRD42018102455.

scholarly journals Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

BMJ ◽  
2019 ◽  
pp. l4185 ◽  
Author(s):  
Maria Panagioti ◽  
Kanza Khan ◽  
Richard N Keers ◽  
Aseel Abuzour ◽  
Denham Phipps ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Medical Care ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cost Effective ◽  
Mitigation Strategies ◽  
Patient Harm ◽  
Pooled Prevalence ◽  
Preventable Harm

Abstract Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. Design Systematic review and meta-analysis. Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched. Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I 2 statistic, and publication bias was evaluated. Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10). Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

scholarly journals The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review

Dysphagia ◽  
2019 ◽  
Vol 35 (5) ◽  
pp. 745-761 ◽  
Author(s):  
Sana Smaoui ◽  
Amy Langridge ◽  
Catriona M. Steele
Keyword(s):  
Systematic Review ◽  
Resistance Training ◽  
Data Extraction ◽  
Meta Analysis ◽  
Quality Data ◽  
Tongue Pressure ◽  
Swallowing Function ◽  
Temporal Measures ◽  
The Impact ◽  
Training Protocols

Abstract Lingual resistance training has been proposed as an intervention to improve decreased tongue pressure strength and endurance in patients with dysphagia. However, little is known about the impact of lingual resistance training on swallow physiology. This systematic review scrutinizes the available evidence regarding the effects of lingual resistance training on swallowing function in studies using Videofluoroscopic Swallowing Studies (VFSS) with adults. Seven articles met the inclusion criteria and underwent detailed review for study quality, data extraction, and planned meta-analysis. Included studies applied this intervention to a stroke and brain injury patient populations or to healthy participants, applied different training protocols, and used a number of outcome measures, making it difficult to generalize results. Lingual resistance training protocols included anterior and posterior tongue strengthening, accuracy training, and effortful press against hard palate with varying treatment durations. VFSS protocols typically included a thin barium stimulus along with one other consistency to evaluate the effects of the intervention. Swallowing measures included swallow safety, efficiency, and temporal measures. Temporal measures significantly improved in one study, while safety improvements showed mixed results across studies. Reported improvements in swallowing efficiency were limited to reductions in thin liquid barium residue in two studies. Overall, the evidence regarding the impact of lingual resistance training for dysphagia is mixed. Meta-analysis was not possible due to differences in methods and outcome measurements across studies. Reporting all aspects of training and details regarding VFSS protocols is crucial for the reproducibility of these interventions. Future investigations should focus on completing robust analyses of swallowing kinematics and function following tongue pressure training to determine efficacy for swallowing function.

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