scholarly journals Damage-control surgery in patients with non-traumatic abdominal emergencies: A meta-analysis

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
T Haltmeier ◽  
M Falke ◽  
O Quaile ◽  
D Candinas ◽  
B Schnüriger
Keyword(s):  
Mortality Rate ◽  
Literature Search ◽  
Damage Control ◽  
Meta Analysis ◽  
Damage Control Surgery ◽  
Categorical Variables ◽  
Successful Implementation ◽  
Abdominal Emergencies ◽  
Meta Analyses ◽  
Expected Mortality

Abstract Objective After the successful implementation in trauma patients, damage control surgery (DCS) is being increasingly used in non-traumatic abdominal emergencies, too. However, non-trauma DCS (NT-DCS) is currently a matter of debate and has not yet been comprehensively assessed. The aim of this meta-analysis was to investigate the effect of NT-DCS on mortality in patients with abdominal emergencies. Methods Systematic literature search using PubMed. Original articles addressing mortality in patients undergoing NT-DCS or non-trauma conventional surgery (NT-CS) for abdominal emergencies were included. Descriptive statistics and two meta-analyses were performed. Meta-analysis 1 compared mortality in patients undergoing NT-DCS vs. NT-CS. Meta-analysis 2 assessed the observed vs. expected mortality rate, based on APACHE, POSSUM and SAPS scores, in the NT-DCS group. Continuous and categorical variables were reported as weighted means and proportions. Effect sizes were described as risk differences (RD) with 95% confidence intervals (CI). Results Literature search revealed 1314 articles. Of these, 21 studies published 2004-2019 were included. NT-DCS was performed in 1238 and NT-CS in 936 patients. In the NT-DCS vs. NT-CS group mean age was 61.0 vs. 64.9 years and the proportion of male patients 58.6% vs. 52.9%, respectively. Most frequent indications for NT-DCS were hollow viscus perforation (28.4%), mesenteric ischemia (26.5%), anastomotic leak (19.6%), haemorrhage (18.4%), abdominal compartment syndrome (17.4%), bowel obstruction (15.5%), and pancreatitis (13.1%). In meta-analysis 1, mortality was not significantly different in the NT-DCS vs. NT-CS group (RD 0.09, 95% CI -0.06/0.24). Meta-analysis 2 revealed a significantly lower observed than the expected mortality rate in patients undergoing NT-DCS (RD -0.18, 95 % CI -0.29/-0.06). Heterogeneity of included studies was high in both meta-analyses (I2=89.0% and 79.9%, respectively). Conclusion This meta-analysis revealed no significantly different mortality in patients with abdominal emergencies undergoing NT-DCS vs. NT-CS. However, observed mortality was significantly lower than the expected mortality rate in the NT-DCS group, suggesting a benefit of the DCS approach. Based on these results, the effect of DCS in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.

Clinical outcomes of cancer patients with COVID-19: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18600-e18600
Author(s):  
Maryam Alasfour ◽  
Salman Alawadi ◽  
Malak AlMojel ◽  
Philippos Apolinario Costa ◽  
Priscila Barreto Coelho ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Small Sample ◽  
Prediction Intervals ◽  
Invasive Ventilation ◽  
Newcastle Ottawa Scale ◽  
Small Sample Sizes ◽  
Meta Analyses

e18600 Background: Patients with coronavirus disease 2019 (COVID-19) and cancer have worse clinical outcomes compared to those without cancer. Primary studies have examined this population, but most had small sample sizes and conflicting results. Prior meta-analyses exclude most US and European data or only examine mortality. The present meta-analysis evaluates the prevalence of several clinical outcomes in cancer patients with COVID-19, including new emerging data from Europe and the US. Methods: A systematic search of PubMED, medRxiv, JMIR and Embase by two independent investigators included peer-reviewed papers and preprints up to July 8, 2020. The primary outcome was mortality. Other outcomes were ICU and non-ICU admission, mild, moderate and severe complications, ARDS, invasive ventilation, stable, and clinically improved rates. Study quality was assessed through the Newcastle–Ottawa scale. Random effects model was used to derive prevalence rates, their 95% confidence intervals (CI) and 95% prediction intervals (PI). Results: Thirty-four studies (N = 4,371) were included in the analysis. The mortality prevalence rate was 25.2% (95% CI: 21.1–29.7; 95% PI: 9.8-51.1; I 2 = 85.4), with 11.9% ICU admissions (95% CI: 9.2-15.4; 95% PI: 4.3-28.9; I 2= 77.8) and 25.2% clinically stable (95% CI: 21.1-29.7; 95% PI: 9.8-51.1; I 2 = 85.4). Furthermore, 42.5% developed severe complications (95% CI: 30.4-55.7; 95% PI: 8.2-85.9; I 2 = 94.3), with 22.7% developing ARDS (95% CI: 15.4-32.2; 95% PI: 5.8-58.6; I 2 = 82.4), and 11.3% needing invasive ventilation (95% CI: 6.7-18.4; 95% PI: 2.3-41.1; I 2 = 79.8). Post-follow up, 49% clinically improved (95% CI: 35.6-62.6; 95% PI: 9.8-89.4; I 2 = 92.5). All outcomes had large I 2 , suggesting high levels of heterogeneity among studies, and wide PIs indicating high variability within outcomes. Despite this variability, the mortality rate in cancer patients with COVID-19, even at the lower end of the PI (9.8%), is higher than the 2% mortality rate of the non-cancer with COVID-19 population, but not as high as what other meta-analyses conclude, which is around 25%. Conclusions: Patients with cancer who develop COVID-19 have a higher probability of mortality compared to the general population with COVID-19, but possibly not as high as previous studies have shown. A large proportion of them developed severe complications, but a larger proportion recovered. Prevalence of mortality and other outcomes published in prior meta-analyses did not report prediction intervals, which compromises the clinical utilization of such results.

scholarly journals Comparative clinical trials in psychotherapy: Have large effects been replicated?

2020 ◽  
Vol 29 ◽  
Author(s):  
Nickolas D. Frost ◽  
Thomas W. Baskin ◽  
Bruce E. Wampold
Keyword(s):  
Clinical Trials ◽  
Treatment Efficacy ◽  
Literature Search ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Depression And Anxiety ◽  
Inclusion Criteria ◽  
Average Quality ◽  
Meta Analyses

Abstract Aims The purpose of this review is to examine the replication attempts of psychotherapy clinical trials for depression and anxiety. We focus specifically on replications of trials that exhibit large differences between psychotherapies. The replicability of these trials is especially important for meta-analysis, where the inclusion of false-positive trials can lead to erroneous conclusions about treatment efficacy. Methods Standard replication criteria were developed to distinguish direct from conceptual replication methodologies. Next, an exhaustive literature search was conducted for published meta-analyses of psychotherapy comparisons. Trials that exhibited large effects (d > 0.8) were culled from these meta-analyses. For each trial, a cited replication was conducted to determine if the trial had been subsequently replicated by either ‘direct’ or ‘conceptual’ methods. Finally, a broader search was conducted to examine the extent of replication efforts in the psychotherapy literature overall. Results In the meta-analytic search, a total of N = 10 meta-analyses met the inclusion criteria. From these meta-analyses, N = 12 distinct trials exhibited large effect sizes. The meta-analyses containing more than two large effect trials reported evidence for treatment superiority. A cited replication search yielded no direct replication attempts (N = 0) for the trials with large effects, and N = 4 conceptual replication attempts of average or above average quality. However, of these four attempts, only two partially corroborated the results from their original trial. Conclusion Meta-analytic reviews are influenced by trials with large effects, and it is not uncommon for these reviews to contain several such trials. Since we find no evidence that trials with such large effects are directly replicable, treatment superiority conclusions from these reviews are highly questionable. To enhance the quality of clinical science, the development of authoritative replication criteria for clinical trials is needed. Moreover, quality benchmarks should be considered before trials are included in a meta-analysis, or replications are attempted.

Systematic Reviews and Meta-analyses

2018 ◽  
Vol 157 (04) ◽  
pp. 392-399
Author(s):  
Sebastian Scheidt ◽  
Patrick Vavken ◽  
Cornelius Jacobs ◽  
Sebastian Koob ◽  
Davide Cucchi ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Scientific Knowledge ◽  
Literature Search ◽  
Meta Analysis ◽  
Review Article ◽  
Systematic Literature Search ◽  
Meta Analyses

AbstractThe rising number of medical publications makes it difficult to keep up-to-date on scientific knowledge. In recent years, reviews in the form of narrative or systematic publications and meta-analyses have increased. These can only be interpreted and evaluated if the reader understands the techniques used. This review article describes the differences between narrative and systematic reviews, together with the characteristics of meta-analysis, and discusses their interpretation. The concept of systematic reviews and meta-analysis includes a systematic literature search and summary, together with an appraisal of the quality of the publications. Systematic reviews are often considered to be original studies due to their structure and ability to reduce bias.

Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

2019 ◽  
Vol 27 (2) ◽  
pp. 150-159
Author(s):  
Francesco Mongelli ◽  
Davide La Regina ◽  
Irin Zschokke ◽  
Marcello Ceppi ◽  
Antonjacopo Ferrario di Tor Vajana ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Literature Search ◽  
Operative Time ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trocar Site ◽  
First Choice ◽  
Significant Difference ◽  
Meta Analyses ◽  
Adequate Data

Purpose. To date, no evidence supports the retrieval of the gallbladder through a specific trocar site, and this choice is left to surgeons’ preference. The aim of this meta-analysis was to investigate the influence of the trocar site used to extract the gallbladder on postoperative outcomes. Methods. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Google Scholar, Cochrane Library, and EMBASE databases was performed. Terms used were: (“gallbladder” OR “cholecystectomy”) AND “umbilical” AND (“epigastric” OR “subxiphoid”). Randomized trials comparing the gallbladder retrieval from different trocar sites were considered for further analysis. Results. Literature search revealed 145 articles, of which 7 matched inclusion criteria and reported adequate data about postoperative pain, operative time, port-site infections, and hernias. A total of 876 patients were included, and the gallbladder was extracted through epigastric or umbilical trocar site in 441 and in 435 patients, respectively. A statistically significant difference among groups was noted in terms of postoperative pain at 1, 6, 12, and 24 hours in favor of the umbilical trocar site ( P < .001). No significant differences were noted in postoperative hernia and infection rate, nor in terms of operative time. Conclusions. This meta-analysis shows a statistically significant reduction in terms of postoperative pain at 1, 6, 12, and 24 hours after surgery when the gallbladder is extracted through the umbilical port. Retrieval time, infections, and hernias rate implicate no contraindication for the choice of a specific trocar site to extract specimens. Despite limitations of this study, the umbilical trocar should be favored as the first choice to retrieve the gallbladder.

Direct Peritoneal Resuscitation: A Novel Adjunct to Damage Control Laparotomy

2019 ◽  
Vol 39 (6) ◽  
pp. 37-45
Author(s):  
Steven Wiseman ◽  
Ellen M. Harvey ◽  
Katie Love Bower
Keyword(s):  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Care Practice ◽  
Successful Implementation ◽  
Resuscitation Strategy ◽  
Physiological Benefits ◽  
Procedural Components ◽  
Management Priorities ◽  
Abdominal Compartment

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation. Strategies for successful implementation of a novel multidisciplinary intervention in critical care practice are explored.

scholarly journals The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 11 ◽  
Author(s):  
Jiaqi Wei ◽  
Jianhua Hou ◽  
Bin Su ◽  
Taiyi Jiang ◽  
Caiping Guo ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Categorical Variables ◽  
Diagnostic Process ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Continuous Variables ◽  
Clinical Prognosis ◽  
Public Health Burden ◽  
Hiv Associated Neurocognitive Disorder ◽  
Meta Analyses

Background: The HIV associated mortality is decreasing in most countries due to the widespread use of antiretroviral therapy. However, HIV-associated neurocognitive disorder (HAND) remains a problematic issue that lowers the quality of life and increases the public health burden among people living with HIV. The prevalence of HAND varies across studies and selected samples. Therefore, we aimed to quantitatively summarize the pooled prevalence of Frascati-criteria-based HAND and to explore the potential demographic, clinical, and immunological factors.Methods: A comprehensive literature search in PubMed/Medline, Web of Science, Embase, and PsycINFO was performed. A random-effects meta-analysis was conducted using the event rate (ER) for the estimation of the incidence of HAND. Subgroup meta-analyses were used to evaluate between-group differences in categorical variables. Meta-regression with the unrestricted maximum likelihood (ML) method was used to evaluate associations of continuous variables.Results: Eighteen studies whose sample sizes ranged from 206 to 1555 were included in the final analyses. The estimated prevalence of HAND, ANI, MND and HAD were 44.9% (95% CI 37.4–52.7%), 26.2% (95% CI 20.7–32.7%), 8.5% (95% CI 5.6–12.7%), 2.1% (95% CI 1.2–3.7%), respectively. Factors associated with HAND were percent female, current CD4 count, education level and country development level (all ps &lt; 0.05).Conclusion: Longitudinal cohort and multimodal neuroimaging studies are needed to verify the clinical prognosis and the underlying neurocognitive mechanism of HAND. In addition, it is urgently necessary to establish a standardized HAND diagnostic process.

scholarly journals Compliance of systematic reviews in veterinary journals with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) literature search reporting guidelines

2017 ◽  
Vol 105 (3) ◽  
Author(s):  
Lorraine C. Toews
Keyword(s):  
Systematic Reviews ◽  
Literature Search ◽  
Meta Analysis ◽  
Grey Literature ◽  
Primary Objective ◽  
Search Process ◽  
Validity And Reliability ◽  
Journal Editors ◽  
Meta Analyses ◽  
Accurate Reporting

Objective: Complete, accurate reporting of systematic reviews facilitates assessment of how well reviews have been conducted. The primary objective of this study was to examine compliance of systematic reviews in veterinary journals with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for literature search reporting and to examine the completeness, bias, and reproducibility of the searches in these reviews from what was reported. The second objective was to examine reporting of the credentials and contributions of those involved in the search process.Methods: A sample of systematic reviews or meta-analyses published in veterinary journals between 2011 and 2015 was obtained by searching PubMed. Reporting in the full text of each review was checked against certain PRISMA checklist items.Results: Over one-third of reviews (37%) did not search the CAB Abstracts database, and 9% of reviews searched only 1 database. Over two-thirds of reviews (65%) did not report any search for grey literature or stated they excluded grey literature. The majority of reviews (95%) did not report a reproducible search strategy.Conclusions: Most reviews had significant deficiencies in reporting the search process that raise questions about how these searches were conducted and ultimately cast serious doubts on the validity and reliability of reviews based on a potentially biased and incomplete body of literature. These deficiencies also highlight the need for veterinary journal editors and publishers to be more rigorous in requiring adherence to PRISMA guidelines and to encourage veterinary researchers to include librarians or information specialists on systematic review teams to improve the quality and reporting of searches.

scholarly journals Damage control surgery for abdominal emergencies

2013 ◽  
Vol 101 (1) ◽  
pp. e109-e118 ◽  
Author(s):  
D. G. Weber ◽  
C. Bendinelli ◽  
Z. J. Balogh
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Emergencies

scholarly journals Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia

2017 ◽  
Vol 6 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Carlos A Ordóñez ◽  
Albaro J Nieto ◽  
Javier A Carvajal ◽  
Juan M Burgos ◽  
Adriana Messa ◽  
...  
Keyword(s):  
Damage Control ◽  
Case Series ◽  
Damage Control Surgery ◽  
Descriptive Study ◽  
Clinical Severity ◽  
Damage Control Resuscitation ◽  
Obstetric Hemorrhage ◽  
Rapid Control ◽  
Expected Mortality ◽  
Overall Mortality

ABSTRACT Objective The aim of this case series is to describe the experience of implementing damage control resuscitation (DCR) in patients with major obstetric hemorrhage (MOH) between January 2005 and December 2015 in the Fundación Valle del Lili, Cali, Colombia. Materials and methods This is a prospective descriptive study of a case series from 108 patients with MOH who were subjected to DCR. All patients were operated on using a standardized surgical technique in accordance with the institutional protocol. Results The median age was 28 years, with a gestational age of 38 weeks. The principal associated diagnosis was severe preeclampsia (in 39% of cases). A total of 96 patients presented massive postpartum hemorrhage, and 75% of these cases presented after a cesarean section. In all patients, normal control of bleeding was achieved, 60% during the first surgical period. The Acute Physiology and Chronic Health Evaluation score was 14, with an overall mortality of 6.48%, far below the expected mortality according to the clinical severity of these patients. Conclusion This study includes the biggest series of pregnant women with MOH, in a critical condition, in whom DCR was used, during which rapid control of bleeding was achieved, associated with a significantly lower mortality than expected. How to cite this article Escobar MF, Carvajal JA, Burgos JM, Messa A, Ordoñez CA, García AF, Granados M, Forero AM, Casallas JD, Thomas LS, Nieto AJ. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017;6(1):1-7.

scholarly journals Mortality of Diabetes-related Acute Metabolic Emergencies in COVID-19 patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Vasileios P. Papadopoulos ◽  
Peny Avramidou ◽  
Stefania-Aspasia Bakola ◽  
Dimitra-Geogia Zikoudi ◽  
Ntilara Touzlatzi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Diabetic Ketoacidosis ◽  
Critical Appraisal ◽  
Case Reports ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Meta Analyses

AbstractPurposeLittle is known on the mortality rate in COVID-19 related acute metabolic emergencies, namely diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS), combined DKA/HHS, and euglycaemic diabetic ketoacidosis (EDKA).MethodsA systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 1, 2020 to January 9, 2021 to identify all case report series, cross-sectional studies, and meta-analyses of case reports describing mortality rate in DKA, HHS, and EDKA, in COVID-19 patients. The Joanna Briggs Institute critical appraisal checklist for case reports was used for quality assessment.ResultsFrom 313 identified publications, 4 fulfilled the inclusion criteria and analyzed qualitatively and quantitatively. A systematic review and meta-analysis with subgroup analyses examined mortality rate in a total of 152 COVID-19 patients who had developed DKA, HHS, combined DKA/HHS, or EDKA. Combined mortality rate and confidence intervals (CI) were estimated using random effects model. The study was registered to PROSPERO database (ID: 230737).ResultsCombined mortality rate was found to be 27.1% [95% CI: 11.2-46.9%]. Heterogeneity was considerable (I2=83%; 95% CI: 56-93%), corrected to 67% according to Von Hippel adjustment for small meta-analyses. Funnel plot presented no apparent asymmetry; Egger’s and Begg’s test yielded in P=0.44 and P=0.50, respectively. Sensitivity analysis failed to explain heterogeneity.ConclusionCOVID-19 related acute metabolic emergencies (DKA, HHS, and EDKA) are characterized by considerable mortality; thus, clinicians should be aware of timely detection and immediate treatment commencing.

Sign in / Sign up

Export Citation Format

Share Document