scholarly journals LO46: Prognostic value of single serum progesterone in the evaluation of symptomatic pregnant patients: a systematic review and meta-analysis

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S23-S24
Author(s):  
B. Ghaedi ◽  
S. Ameri ◽  
K. Abdulkarim ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Systematic Review ◽  
Ectopic Pregnancy ◽  
English Language ◽  
Selection Index ◽  
First Trimester ◽  
Index Test ◽  
Case Control Studies ◽  
Serum Progesterone ◽  
Predictive Values ◽  
Diagnostic Characteristics

Introduction: Pain and bleeding complicate 30% of pregnancies threatening viability. The objective of this systematic review is to evaluate the role of a single progesterone level in predicting viability. Methods: We comprehensively searched MEDLINE, Embase (OVID), CINAHL and Cochrane databases from inception to July 2019. We included English language studies that enrolled symptomatic first trimester pregnant patients, measured progesterone and reported viability (miscarriage, ectopic or viable). We excluded studies with patients who had progesterone treatment, or conception after induced ovulation/invitro fertilization. We extracted patient characteristics, study setting, mean progesterone, the cut off value and outcome (viability). The quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We extracted data for 2X2 tables and report mean, standard deviation (SD), sensitivity, specificity, positive and negative predictive values (PPV, NPV). Results: Of the 689 studies screened, 51 studies with 15783 patients were included (1 randomized control trial, 36 prospective, 9 retrospective, 5 prospective case control studies) and 7553 were viable pregnancies. Of the 31 studies (n = 10998) that reported ectopic, 1661 patients were diagnosed with ectopic pregnancy. In 35 studies (n = 6003) that reported mean and SD, the levels were higher in viable (26.7 ± 11.2ng/ml) than non-viable (9.5 ± 5.9ng/ml; p < 0.001) or ectopic pregnancy 9.5 ± 6.8ng/ml (p < 0.001). The pooled diagnostic characteristics at different cut-off values were: <6.3ng/mL (9 studies; N = 6033) sensitivity 65.0% (95%CI 63.5,66.5), specificity 97.3% (95%CI 95.5, 98.5), PPV 99.4% (95%CI 99.1,99.7) and NPV 27.4 (95%CI 26.6,28.4); <10 ng/mL (12 studies with 5743 participants) sensitivity 65.0% (95% CI 63.5, 66.5), specificity of 97.3% (95%CI 95.5, 98.5), PPV 99.4% (95% CI 99.1, 99.7) and NPV 27.4% [95% CI 26.5, 29.4); 11-20 ng/mL (24 studies with 7141 participants) sensitivity 77.3% (95% CI 76.2,78.4), specificity 64.6% (95% CI 63.2, 65.9), PPV 73.2% [95% CI 72.3, 73.9) and NPV 69.5% (95% CI 70.7, 72.5). There was low risk of bias for patient selection, index test and low concern regarding applicability. The highest risk (82% of studies) was due to outcome ascertainment bias due to non-blinding of index and additional tests. Conclusion: A single progesterone value is useful in predicting viability of pregnancy among symptomatic patients.

scholarly journals The effective interventions to improve long-term physiotherapy exercise adherence among patients with lower limb osteoarthritis. A systematic review

2021 ◽  
Author(s):  
Pathmanathan Cinthuja ◽  
Nidhya Krishnamoorthy ◽  
Gamalendira Shivapatham
Keyword(s):  
Systematic Review ◽  
Lower Limb ◽  
English Language ◽  
Data Extraction ◽  
Exercise Adherence ◽  
Case Control Studies ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Booster Sessions

Abstract Introduction: Osteoarthritis (OA) is a chronic condition that severely effects work life balance impacting psychosocial and socio-economic aspects. Physiotherapy exercise is one of the intervention methods for the management of OA. Adherence to the exercise by patients is essential for the effective management of OA. Objectives: To determine different methods used to enhance physiotherapy exercise adherence for more than 12 months among patients with osteoarthritis and to report the effective method to enhance exercise adherence among people with lower limb osteoarthritis. Design: Systematic review Methods: PubMed, Pedro, Web of Science, and EMBASE databases searched for randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies published in the English language from 2000 to 2020. The date of data extraction was 04 September 2020. Two independent researchers conducted literature search, assessed eligibility, extracted data, conducted methodology quality assessment using the PEDro scale, and conducted risk of bias assessment. A narrative synthesis of key outcomes is presented; preferred Reporting Items for Systematic review was used to report the review. The study protocol was registered in the Prospero (Prospero ID: CRD42020205653). Results: The primary search strategy identified 5839 potentially relevant articles, of which 5157 remained after discarding duplicates. After screening based on title and abstract, 40 papers were potentially eligible for inclusion. Five of these papers met all predefined eligibility criteria. Introducing methods to enhance exercise adherence has caused a significant increase in exercise adherence for the short term (less than six months or 12 months). There were no significant differences, long-term adherence with different methods, reported. The results indicate that booster sessions (89.69%) and telephone-linked communication (86%) had higher percentages for the exercise adherence. Secondary outcomes such as pain, stiffness, function, show positive outcomes with increasing exercise adherence. However, there were no significant differences reported. Conclusion: The booster sessions and telephone-linked communication appear to enhance exercise adherence for more than 12 months among patients with osteoarthritis. However, a number of high-quality studies are inadequate to confirm our findings. Therefore, more studies with higher methodological quality are needed to determine the best strategies to enhance long-term exercise adherence among people with osteoarthritis. Key terms: Osteoarthritis, Long term, Exercise adherence

scholarly journals Dysphagia screening tools for acute stroke patients available for nurses: A systematic review

2019 ◽  
Author(s):  
Isabel de Jesus Oliveira ◽  
Liliana Andreia Neves Da Mota ◽  
Susana Vaz Freitas ◽  
Pedro Lopes Ferreira
Keyword(s):  
Systematic Review ◽  
Acute Stroke ◽  
Methodological Quality ◽  
Selection Index ◽  
Significant Proportion ◽  
Screening Tools ◽  
Quality Analysis ◽  
Diagnostic Process ◽  
Index Test ◽  
Stroke Patients

Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses? Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion. Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable. Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.  

scholarly journals 93 The Effects of Kinesiophobia on Outcome following Total Knee Replacement: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Brown ◽  
L Hu ◽  
C Demetriou ◽  
T Smith ◽  
C Hing
Keyword(s):  
Systematic Review ◽  
Total Knee Replacement ◽  
Range Of Motion ◽  
Knee Replacement ◽  
Functional Outcomes ◽  
English Language ◽  
Psychological Treatment ◽  
Functional Score ◽  
Case Control Studies ◽  
Total Knee

Abstract Aim Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR. Method A primary search was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials. Results All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r = 0.20 p &lt; 0.05, R = 0.317 p = 0.001, and correlation coefficient 0.197 p = 0.005). TSK score significantly correlated with mean active range of motion (ROM) at six months (105.33 (SD = 12.34) vs 85.53 (SD = 14.77) p = 0.000) post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme (TSK -14.30 (SD = 0.80) vs -2.10 (SD = 0.80) p &lt; 0.001)), an outpatient CBT programme (TSK 27.76 (SD = 4.56) vs 36.54 (SD = 3.58), and video-based psychological treatment (TSK 24 (SD = 5) vs 29 (SD = 5) p &lt; 0.01). Conclusions Kinesiophobia negatively affects functional outcomes up until one year post-operatively, while active ROM is reduced up to six months post procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR.

Prevalence and determinants of ectopic pregnancy in Ethiopia: Systematic review and meta-analysis

2022 ◽  
pp. 228402652110620
Author(s):  
Asteray Ayenew
Keyword(s):  
Systematic Review ◽  
Ectopic Pregnancy ◽  
Publication Bias ◽  
Meta Analysis ◽  
Case Control Studies ◽  
Major Health Problem ◽  
Funnel Plot ◽  
Sexually Transmitted ◽  
Determinant Factors ◽  
History Of

Background: Ectopic pregnancy is a life-threatening obstetric emergency, and is a major health problem for women of fertile age. Therefore, the aim of this systematic review and meta-analysis was to estimate the prevalence, determinant factors, and outcomes of ectopic pregnancy among fertile age women in Ethiopia. Method: International databases (MEDLINE/Pub Med, Hinari, Scopus, Google scholar, African journals, and literatures were searched and nine eligible cross sectional and two case control studies were included in this systematic review and meta-analysis. Eggers test and funnel plot were computed to check publication bias across the studies. Publication bias was computed using a funnel plot and eggers test. Heterogeneity of the studies was checked using Cochrane Q-test and I2 statistic. Results: The pooled prevalence of ectopic pregnancy in Ethiopia was 3.61% (95%CI: 2.24–4.98, I2 = 89.2.0%, p < 0.001). Having cesarean section scar (AOR = 7.44, 95%CI: 5.48–10.09), single marital status (AOR = 5.71, 95%CI: 4.76–6.85), history of sexually transmitted infection (AOR = 4.68, 95%CI: 3.04–7.19), history of abortion (AOR = 3.89, 95%CI: 3.35–4.52), history of ectopic pregnancy (AOR = 5.74, 95%CI: 3.81–8.65), and emergency contraceptive use (AOR = 8.72, 95%CI: 2.90–26.20) were the determinant factors for the occurrence of ectopic pregnancy. Conclusion: This systematic review and meta-analysis showed that the prevalence of ectopic pregnancy was high in Ethiopia. Thus, educating women to limit the number of sexual partners, smoking cessation, using a condom during sex helps prevent sexually transmitted infections and the risk of pelvic inflammatory disease is crucial.

The use of serum progesterone to predict ectopic pregnancy in symptomatic first-trimester patients

1999 ◽  
Vol 34 (4) ◽  
pp. S8
Author(s):  
RG Buckley ◽  
KJ King ◽  
JD Disney ◽  
JD Gorman ◽  
JH Klausen ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
First Trimester ◽  
Serum Progesterone

scholarly journals The Ability of a Single Serum Progesterone Measurement to Predict the Prognosis of First Trimester Pregnancy

2019 ◽  
pp. 1
Author(s):  
Mehmet Nafi Sakar ◽  
Deniz Balsak ◽  
Sureyya Demir ◽  
Mehmet Sukru Budak ◽  
Ali Emre Tahaoglu ◽  
...  
Keyword(s):  
Spontaneous Abortion ◽  
Serum Levels ◽  
First Trimester ◽  
Tertiary Hospital ◽  
Case Group ◽  
Serum Progesterone ◽  
Predictive Values ◽  
Elisa System ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy

<p><strong>OBJECTIVE:</strong> There are cases where ultrasonographic evaluation is inadequate in determining first-trimester healthy pregnancy. In these cases, both the patient and the clinician are involved in a worrying expectation. The single serum progesterone measurement was tried to predict pregnancy prognosis in short time period. This study evaluated the predictive value of a single serum progesterone measurement in first-trimester pregnancy loss.</p><p><strong>STUDY DESIGN:</strong> A prospective case-control study was conducted between July 2013 and July 2014 in Tertiary Hospital. The study compared 106 patients with threatened abortion (vaginal bleeding or spotting) before 13 weeks of gestation with 110 healthy control pregnancies. Samples of serum progesterone were obtained on the day each patient was admitted to the hospital. A Beckman-Coulter macro-Enzyme-linked immunoassay (ELISA) system was used to measure serum levels of progesterone (Beckman-Coulter, Ireland).</p><p><strong>RESULTS:</strong> Progesterone levels were measured when the patients first visited the hospital and they were followed until the end of the first trimester. Progesterone levels differed significantly (p=0.013) between the two groups. The spontaneous abortion rate was significantly (p=0.044) higher in the case group. Progesterone levels differed significantly (p=0.001) between ongoing pregnancy and spontaneous abortion groups. Using a cut-off level of 10.7 ng/mL, the sensitivity, specificity, and positive and negative predictive values were 92.1%, 44%, 92.6%, and 42.3%, respectively, for viable pregnancies.</p><p><strong>CONCLUSION:</strong> A single measurement of progesterone levels in serum can predict the prognosis of a viable first-trimester pregnancy, while it is less effective for identifying non-viable pregnancies.</p>

scholarly journals Comparison of Mifepristone plus Misoprostol with Misoprostol Alone for First Trimester Medical Abortion: A Systematic Review & Meta -Analysis Protocol

2019 ◽  
Author(s):  
Tariku Shimels ◽  
Mebratu Abraha ◽  
Mensur Shafie ◽  
Lemi Belay ◽  
Melsew Getnet
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
English Language ◽  
Meta Analysis ◽  
Medical Abortion ◽  
First Trimester ◽  
Clinical Trial Registry ◽  
Trimester Abortion ◽  
Registration Number ◽  
Randomized Control

Abstract Background Original clinical trials have demonstrated that the combined mifepristone plus misoprostol has a marked effectiveness on first trimester abortion practices compared to the misoprostol alone regimen. However, there is no clear evidence if this effect holds consistent direction for all main outcomes and, whether subsequent complications or side effects are minimal or not. This review is intended to provide aggregated evidence for this question through comparison of the respective regimens based on findings from previous randomized control trial studies. Methods Randomized control trials which compared mifepristone plus misoprostol with misoprostol alone for first trimester medical abortion and published in English language will be included in the review. Articles attempted to evaluate procedures and mechanisms of first trimester abortion other than mifepristone plus misoprostol combined regimen with misoprostol alone will be excluded. An internet based search of different engines will be undertaken to identify articles on the proposed topic. Using text words contained in the titles and abstracts of relevant articles, a full search of PubMed/Medline, Cochrane CENTRAL, EMBASE, WHO international clinical Trial registry platform and google scholar will be made. Data on participants, study methods, interventions, and outcomes will be abstracted. Included studies will be pooled for meta-analysis. Results will be reported in odds or risk ratio at 95% confidence interval. Discussion This systematic review intends to review the available literature on effectiveness of mifepristone plus misoprostol as compared to misoprostol alone for inducing abortion in the first trimester of pregnancy. In addition, we anticipate that the review will evaluate and compare the incidence of potential complications and side effects following administration of the respective regimen in both populations. Systematic review registration number CRD42019134213

Diabetes Education Impact on Hypoglycemia Outcomes: A Systematic Review of Evidence and Gaps in the Literature

2019 ◽  
Vol 45 (4) ◽  
pp. 349-369 ◽  
Author(s):  
Jacqueline LaManna ◽  
Michelle L. Litchman ◽  
Jane K. Dickinson ◽  
Andrew Todd ◽  
Mary M. Julius ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Positive Impact ◽  
Risk Mitigation ◽  
Diabetes Education ◽  
The United States ◽  
Knowledge Gain ◽  
Case Control Studies ◽  
Quasi Experimental ◽  
The Impact

Purpose The primary purpose of this study is to report a systematic review of evidence and gaps in the literature among well-conducted studies assessing the impact of diabetes education on hypoglycemia outcomes and secondarily reporting the impact on other included target outcomes. Methods The authors used a modified Cochrane method to systematically search and review English-language titles, abstracts, and full-text articles published in the United States between January 2001 and December 2017, with diabetes education specified as an intervention and a directly measurable outcome for hypoglycemia risk or events included. Results Fourteen quasi-experimental, experimental, and case-control studies met the inclusion criteria, with 8 articles reporting a positive impact of diabetes self-management education and support (DSMES) on hypoglycemia outcomes; 2 of the 8 reported decreased hypoglycemia events, and 1 reported decreased events in both the intervention and control groups. In addition, 5 studies targeted change in reported hypoglycemia symptoms, with all 5 reporting a significant decrease. DSMES also demonstrated an impact on intermediate (knowledge gain, behavior change) and long-term (humanistic and economic/utilization) outcomes. An absence of common hypoglycemia measures and terminology and suboptimal descriptions of DSMES programs for content, delivery, duration, practitioner types, and participants were identified as gaps in the literature. Conclusions Most retained studies reported that diabetes education positively affected varied measures of hypoglycemia outcomes (number of events, reported symptoms) as well as other targeted outcomes. Diabetes education is an important intervention for reducing hypoglycemia events and/or symptoms and should be included as a component of future hypoglycemia risk mitigation studies.

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