scholarly journals The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting

BMJ ◽  
2015 ◽  
Vol 350 (mar04 22) ◽  
pp. h910-h910 ◽  
Author(s):  
E. Roberts ◽  
A. J. Ludman ◽  
K. Dworzynski ◽  
A. Al-Mohammad ◽  
M. R. Cowie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Acute Care ◽  
Natriuretic Peptides ◽  
Care Setting ◽  
Meta Analysis ◽  
Acute Care Setting

scholarly journals PL03: Prophylactic administration of diphenhydramine to reduce neuroleptic side-effects in the acute care setting: a systematic review and meta-analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S5-S6
Author(s):  
A. Mokhtari ◽  
O. Yip ◽  
J. Alain ◽  
A. Turgeon ◽  
S. Berthelot
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Acute Care ◽  
Care Setting ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Acute Care Setting ◽  
Quality Of Evidence ◽  
Prophylactic Administration

Introduction: Neuroleptics are commonly used drugs to treat different conditions (e.g. psychosis, migraines) in the acute care setting and the emergency department. Their side effects can be disabling or, worse, fatal. The use of diphenhydramine to prevent those side-effects is widespread, but remains controversial. We performed a systematic review to determine if prophylactic administration of diphenhydramine (PAD) reduces the incidence of neuroleptic side-effects. Methods: Data sources: Medline, Embase, Cochrane Library, PsycInfo and Web of Science were searched. References from reviews that were identified in the search and from included studied were also reviewed for inclusion. Study selection: Randomized controlled trials evaluating any neuroleptic with PAD versus the same neuroleptic alone or with any inactive agent. Primary outcome was incidence of any extra-pyramidal side-effect. Secondary outcomes were akathisia, usage of rescue medication, subjective restlessness, neuroleptic malignant syndrome, sedation and sedation intensity. Data extraction: Independent reviewers scanned identified citations, extracted data and assessed for risk of bias. Data analysis: Meta-analysis was performed using random effect models. Heterogeneity and quality of evidence were assessed using, respectively, I2 and the GRADE approach. Results: Results: Of 1566 identified citations, nine studies (n=1436) met all eligibility criteria. Four studies were specifically designed to assess for neuroleptic side-effects. Four studies were at high risk of bias. In primary analysis, PAD had no effect on the incidence of extra-pyramidal symptoms (7 studies, n=1393 patients, RR 0.70 [0.40-1.22]), akathisia (5 studies, n=1094 patients, RR 0.81 [0.36-1.82]) and sedation (5 studies; n=1079, RR 1,48 [0.90-2.42]). Higher dosage of diphenhydramine was not associated with a greater reduction of extra-pyramidal side-effects. In a sensitivity analysis excluding an outlier study (n=120, RR 6.63 [1.55-28,35]), PAD was associated with a significant decrease in extra-pyramidal side-effects (6 studies, n=1273, RR 0.56 [0,38-0.82]), but not with any of the secondary outcome measures. Conclusion: Conclusion: When excluding an outlier study, PAD was associated with a significant reduction of extra-pyramidal side-effects. However, PAD did not significantly influence the incidence of akathisia. Overall quality of evidence is low. Further studies are warranted. PAD represents an interesting treatment option against neuroleptic side-effects, but its widespread usage whitout strong evidence to support it raises concerns.

scholarly journals Diagnostic Accuracy of Natriuretic Peptides for Heart Failure in Patients with Pleural Effusion: A Systematic Review and Updated Meta-Analysis

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0134376 ◽  
Author(s):  
Zhi-Jun Han ◽  
Xiao-Dan Wu ◽  
Juan-Juan Cheng ◽  
Shi-Di Zhao ◽  
Ming-Zhu Gao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Natriuretic Peptides ◽  
Meta Analysis

scholarly journals Diagnostic accuracy of pocket-size handheld echocardiographs used by cardiologists in the acute care setting

2012 ◽  
Vol 14 (1) ◽  
pp. 38-42 ◽  
Author(s):  
A. Testuz ◽  
H. Muller ◽  
P.-F. Keller ◽  
P. Meyer ◽  
T. Stampfli ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Acute Care ◽  
Care Setting ◽  
Acute Care Setting

scholarly journals LO18: The effectiveness of parenteral agents to reduce relapse in patients with acute migraine in emergency settings: a systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S13
Author(s):  
J. Meyer ◽  
L. Visser ◽  
S. Kirkland ◽  
C. Villa-Roel ◽  
D. Junqueira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Acute Care ◽  
Care Setting ◽  
Grey Literature ◽  
Third Party ◽  
Acute Care Setting ◽  
Acute Migraine ◽  
Common Occurrence ◽  
Headache Recurrence

Introduction: Although a variety of parenteral agents exist for the treatment of acute migraine, relapse after an emergency department (ED) visit is still a common occurrence. The objective of this systematic review was to update a previous review examining the effectiveness of parenteral agents for the treatment of acute migraine in the ED or equivalent acute care setting; our review focused on those studies aiming a reduction in relapse after an ED visit. Methods: A comprehensive search of 10 electronic databases and grey literature was conducted to identify comparative studies to supplement the previous systematic review. Two independent reviewers completed study selection, quality assessment, and data extraction. Any discrepancies were resolved by third party adjudication. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity (I2) was reported. Results: Titles and abstracts of 5039 unique studies were reviewed, of which, 51 studies were included. Sixty-four studies from the original review were included, resulting in a total of 115 included studies. Relapse was reported in 44 (38%) included studies and occurred commonly in patients receiving placebo or no interventions (median = 39%; IQR: 14%, 47%). Overall, no differences in headache relapse were found between patients receiving sumatriptan or placebo (RR = 1.09; 95% CI: 0.55, 2.17; I2 = 93%; n = 8). Conversely, patients receiving neuroleptic agents experienced fewer relapses compared to placebo (RR = 0.27; 95% CI: 0.12, 0.58; I2 = 0%; n = 3); however, patients receiving neuroleptics reported an increase in adverse events (RR = 1.87; 95% CI: 1.17, 3.00; I2 = 0%; n = 3). Compared to placebo, patients receiving dexamethasone were less likely to experience a headache recurrence (RR = 0.71; 95% CI: 0.53, 0.95; I2 = 60%, n = 9); however, no differences were found in reported adverse events (RR = 1.09; 95% CI: 0.81, 1.47; I2 = 0%; n = 3). Conclusion: Relapse is a common occurrence for patients with migraine headaches. This review found patients receiving neuroleptics or dexamethasone experienced fewer headache recurrences. Conversely, triptan agents appear to have minimal effect on reducing the risk for headache recurrence following discharge from an acute care setting. Limited available data on adverse events is an important limitation to inform decision-making. Guidelines should be revised to reflect these results.

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