A systematic review of the use of tourniquets and topical haemostatic agents in conflicts in Afghanistan and Iraq

2015 ◽  
Vol 101 (2) ◽  
pp. 147-154
Author(s):  
AC Mawhinney ◽  
SJ Kirk
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Hospital Setting ◽  
Control Groups ◽  
Haemostatic Agents ◽  
Extremity Trauma ◽  
Haemorrhage Control ◽  
Continued Use ◽  
And Control ◽  
The Military

AbstractIntroductionThe recent conflicts in Afghanistan and Iraq have seen increased use of tourniquets and topical haemostatic agents in the management of battlefield trauma. The aim of this paper is to review the available evidence for their efficacy and continued use.MethodsA systematic review of the medical literature published as a consequence of conflicts in Iraq in Afghanistan was conducted to determine the clinical outcomes from the use of tourniquets and haemostatic agents for haemorrhage control in limb extremity injury.ResultsStudies were retrospective cohort or prospective observational studies by design. None were eligible for meta-analysis and control groups were rarely available for ethical reasons. Despite methodological limitations, tourniquets were shown to save lives if applied prior to the onset of shock or in a pre-hospital setting. Topical haemostatic agents were shown to be useful adjuncts in haemorrhage control with small numbers of complications.ConclusionIn the military setting, tourniquet use in extremity trauma improves survival when used prior to the onset of shock. Topical haemostatic agents provide additional means of haemorrhage control, though further studies to identify the most effective types are necessary. Adequate training and protocols for use must be implemented to prevent complications through use.

scholarly journals Dexmedetomidine Versus Propofol Sedation in Flexible Bronchoscopy: A Randomized Controlled Trial and a Systematic Review and Meta-Analysis

2022 ◽  
Author(s):  
Barak Pertzov ◽  
Boris Krasulya ◽  
Karam Azem ◽  
Yael Shostak ◽  
Shimon Izhakian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Flexible Bronchoscopy ◽  
Control Groups ◽  
Randomized Controlled ◽  
Study Results ◽  
Alpha2 Adrenoceptor ◽  
And Control

Abstract Background:Dexmedetomidine (DEX), is a highly selective alpha2 adrenoceptor (α2-AR) agonist, successfully used in various procedures including flexible bronchoscopy. Randomized controlled trials (RCTs) evaluating DEX sedation during bronchoscopy report equivocal results regarding respiratory and hemodynamic outcomes. Methods We conducted an RCT to evaluate the efficacy of dexmedetomidine compared to propofol for sedation during bronchoscopy. The primary outcome was desaturation events, secondary outcomes were transcutaneous Pco2 level, hemodynamic adverse events and physician and patient satisfaction. We have also conducted A systematic review and meta-analysis of all RCTs evaluating DEX sedation during flexible bronchoscopy, included current study results.ResultsOverall, 63 patients were included, 30 and 33 in the DEX and propofol groups, respectively. The number of desaturation events was similar between groups, median (IQR) 1 (0-1) and 1 (0-2) in the DEX and control groups, respectively (P=0.29). Median desaturation time was 1 (0-2) and 1 (0-3) minutes in the DEX and control groups, respectively (P=0.48). Adverse events included hypotension, 33% vs 21.1% in intervention and control groups, respectively (P=0.04), bradycardia, cough, and delayed recovery from sedation. Total adverse events were 22 and 7 in DEX and propofol groups, respectively (P=0.009). The pooled meta-analysis included 13 trials (1604 participants) showed a significantly lower rate of desaturation events in the DEX group (RR 0.67, 95% CI 0.57 to 0.79) with a significantly higher rate of hypotension and bradycardia events (RR 1.55, 95% CI 1.16 to 2.06 and RR 1.91, 95% CI 1.04 to 3.5, respectively)ConclusionDexmedetomidine sedation resulted in a significantly reduced rate of desaturation events in comparison to propofol, midazolam and fentanyl. However, it was also associated with a higher rate of hypotension and bradycardia.Trial registration : NCT04211298, registration date: 26/12/2019

Association between serum amyloid A levels and cancers: a systematic review and meta-analysis

2018 ◽  
Vol 94 (1115) ◽  
pp. 499-507 ◽  
Author(s):  
Jielin Zhou ◽  
Jie Sheng ◽  
Yong Fan ◽  
Xingmeng Zhu ◽  
Qi Tao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Serum Amyloid A ◽  
Meta Analysis ◽  
Serum Amyloid ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Control Groups ◽  
Amyloid A ◽  
Mean Differences ◽  
And Control

ObjectiveIncreased serum amyloid A (SAA) levels have been investigated in various human malignancies, but a consistent perspective has not been established to date. This study systematically reviewed the association between SAA levels and cancers.MethodsCochrane Library, PubMed and Embase were carefully searched for available studies. The following keywords were used in database searches: ‘serum amyloid A’, ‘SAA’, ‘cancer’, ‘tumour’, ‘carcinoma’, ‘nubble’, ‘knurl’ and ‘lump’. Pooled standard mean differences (SMDs) with corresponding 95% CIs were calculated using random-effects model analysis.ResultsTwenty studies, which contained 3682 cancer cases and 2424 healthy controls, were identified in this systematic review and meta-analysis. Our study suggested that the average SAA concentrations in the case groups were significantly higher than those in control groups (SMD 0.77, 95% CI 0.55 to 1.00, p<0.001). Subgroup analysis revealed that continent, age and cancer location were associated with SAA level differences between case groups and control groups. Sensitivity analyses showed the robustness and credibility of our results. In addition, we further stratified analyses for cancer stages and found that the concentrations of SAA increased gradually with the aggravation of cancer stages.ConclusionHigh circulating SAA levels were markedly associated with the developing risks of cancer, especially for participants from Asia, Oceania and Europe, or subject age more than 50, or locations in oesophageal squamous cell, ovarian, breast, lung, renal and gastric cancers. In addition, our study found that the concentrations of SAA increased with the severity of cancer stages.

What is the Impact of Extracorporeal Shock Wave Lithotripsy on Semen Parameters? A Systematic Review and Meta-Analysis

2016 ◽  
Vol 84 (1) ◽  
pp. 28-34
Author(s):  
Mohammad H. Radfar ◽  
Nasser Simforoosh ◽  
Mehdi Sotoudeh ◽  
Mehdi H. Ramezani ◽  
Mohammad J. Mollakoochakian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shock Wave ◽  
Confidence Interval ◽  
Shock Wave Lithotripsy ◽  
Meta Analysis ◽  
Sperm Concentration ◽  
Semen Parameters ◽  
Control Groups ◽  
Extracorporeal Shock Wave ◽  
And Control

Background Extracorporeal shock wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effects of shockwaves on tissues are established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi. Methods Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included six trials that investigated the effects of ESWL on semen parameters, including sperm concentration, motility, and hematospermia. Meta-analyses were performed using fixed and random-effects models with tests for publication bias and heterogeneity. Results Significant worsening was detected in sperm concentration and motility after ESWL between case and control groups (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p<0.00001, mean difference -10.82, 95% confidence interval -18.56 to -3.07, p = 0.006). Rate of microscopic and macroscopic hematospermia was significantly higher after ESWL between case and control groups [risk ratio (RR) 40.00, 95% confidence interval 10.11-158.30, p<0.00001, RR 14.33, 95% confidence interval 2.82-72.90, p = 0.001]. All parameters recovered after 3 months. Conclusions This study showed sperm concentration, motility, and rate of hematospermia (microscopic and macroscopic) were affected by ESWL that was used for the treatment of lower ureteral stone. Long-term studies with a focus on male fertility (i.e., pregnancy rates) after ESWL are warranted.

scholarly journals The Use of Platelet-Rich Plasma for Treatment of Tenodesmic Lesions in Horses: A Systematic Review and Meta-Analysis of Clinical and Experimental Data

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 793
Author(s):  
Chiara Montano ◽  
Luigi Auletta ◽  
Adelaide Greco ◽  
Dario Costanza ◽  
Pierpaolo Coluccia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Definitive Evidence ◽  
Dichotomous Data ◽  
And Control ◽  
Risk Ratios

The use of platelet-rich plasma (PRP) to enhance tenodesmic lesion healing has been questioned over the years. The aim of this study was to evaluate current literature to establish the effectiveness of PRP for treating tenodesmic lesions through a systematic review, in accordance with the PRISMA guidelines, and a meta-analysis. Studies comparing PRP with placebo or other treatments for horses with tenodesmic injuries or evaluated PRP effect on tendon and ligament explants were included. Outcomes were clinical, ultrasound, histologic, molecular evaluation, and adverse effects. Two authors independently extracted data and assessed each study’s risk of bias. Treatment effects were evaluated using risk ratios for dichotomous data, together with 95% CI. Data were pooled using the random-effects model. The quality of the evidence for each outcome was assessed using GRADE criteria. Twenty-four trials met inclusion criteria for systematic review, while fifteen studies were included in the meta-analysis. Results showed no significant differences in the outcomes between PRP and control groups. Finally, there is no definitive evidence that PRP enhances tendons and ligaments healing. Therefore, there is a need for more controlled trials to draw a firmer conclusion about the efficacy of PRP as a treatment for tenodesmic lesions in the horse.

scholarly journals Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712199317
Author(s):  
Alex E. White ◽  
Peters T. Otlans ◽  
Dylan P. Horan ◽  
Daniel B. Calem ◽  
William D. Emper ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Patellar Instability ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
Control Groups ◽  
And Control

Background: Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies. Purpose: To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review of the literature using the PubMed, SCOPUS, and Cochrane databases. Each database was searched for variations of the terms “patellar instability,” “patellar dislocation,” “trochlear dysplasia,” “radiographic measures,” “computed tomography,” and “magnetic resonance imaging.” Studies were included if they were published after May 1, 2009, and before May 1, 2019. A meta-analysis using a random effects model was performed on several measurements, comparing instability and control groups to generate pooled values. Results: A total of 813 articles were identified, and 96 articles comprising 7912 patients and 106 unique metrics were included in the analysis. The mean patient age was 23.1 years (95% CI, 21.1-24.5), and 41% were male. The tibial tubercle–trochlear groove (TT-TG) distance was the most frequently included metric (59 studies), followed by the Insall-Salvati ratio and Caton-Deschamps index (both 26 studies). The interobserver intraclass correlation coefficients were excellent or good for the TT-TG distance and Insall-Salvati ratio in 100% of studies reporting them; however, for the Caton-Deschamps index and Blackburne-Peel ratio, they were excellent or good in only 43% and 40% of studies. Pooled magnetic resonance imaging values for TT-TG distance ( P < .01), Insall-Salvati ratio ( P = .01), and femoral sulcus angle ( P = .02) were significantly different between the instability and control groups. Values for tibial tubercle–posterior cruciate ligament distance ( P = .36) and Caton-Deschamps index ( P = .09) were not significantly different between groups. Conclusion: The most commonly reported measurements for evaluating patellar instability assessed patellar tracking and trochlear morphology. The TT-TG distance was the most common measurement and was greater in the patellar instability group as compared with the control group. In addition, the TT-TG, tibial tubercle–posterior cruciate ligament, and patellar tendon–trochlear groove distances were highly reproducible measurements for patellar tracking, and the Insall-Salvati ratio had superior reproducibility for assessing patellar height.

P–625 Does endogenous progesterone play a role in unexplained infertility? A systematic review

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Raperport ◽  
E Chronopoulou ◽  
R Homburg ◽  
K Khan ◽  
P Bhide
Keyword(s):  
Systematic Review ◽  
Luteal Phase ◽  
Meta Analysis ◽  
Endometrial Receptivity ◽  
Unexplained Infertility ◽  
Receptor Expression ◽  
Control Groups ◽  
Significant Difference ◽  
And Control

Abstract Study question Does endogenous progesterone play a role in unexplained infertility? A systematic review investigating the possibility of altered progesterone-mediated change leading to reduced endometrial receptivity in women with unexplained infertility. Summary answer The evidence suggests that many of the measurable actions of endogenous progesterone are reduced in women with unexplained infertility when compared with controls. What is known already Unexplained infertility is the diagnosis given to heterosexual couples who fail to conceive despite normal semen analysis, regular ovulation and patent tubes. The underlying pathology is likely to relate to embryonic failure to implant. Endometrial receptivity is largely mediated by luteal phase progesterone which controls many different molecular pathways involved in secretory transformation. It is possible that defective actions of progesterone could contribute to this condition. To date however, there is minimal published literature on the role of progesterone in unexplained infertility. We therefore felt it important to combine the results of all trials measuring progesterone-related outcomes in unexplained infertility. Study design, size, duration A systematic review was performed using standard Cochrane methodology. We searched Medline, Embase and CINAHL databases from inception to December 2020 and additionally hand-searched. The study was prospectively registered on Prospero (CRD42020141041). The search strategy was designed to identify all types of primary research published in English that investigated women with unexplained infertility and reported outcomes that relate to progesterone. Newcastle Ottawa Scoring and NHLBI assessment of bias scoring was performed. Participants/materials, setting, methods The study population was women with unexplained infertility. Included studies had no controls, fertile controls or controls with other diagnoses associated with subfertility. Outcomes were either upstream affecting progesterone production/release or receptor expression or downstream measuring results of progesterone-mediated processes. The results were summarised in a narrative review. Meta-analysis was not possible due to varying methodological heterogeneity. Main results and the role of chance 36 studies were included. No difference was found in 18 studies in progesterone levels (serum, peritoneal and salivary) between women with unexplained infertility and control groups. Despite this, 32 of the 36 included studies demonstrated a significant difference between progesterone-mediated outcomes in the unexplained infertile and control groups. 5 ultrasound studies all reported increased resistance and decreased flow on doppler studies of uterine, ovarian and spiral arteries and reduced endometrial and sub-endometrial perfusion. No significant difference was found in luteal phase endometrial thickness in 2 studies. Endometrial dating was reported by 11 studies. 8/11 studies reported significantly higher numbers (20–38%) of ‘out-of-phase’ endometrium in women with unexplained infertility compared with controls. Endometrial biopsy results measuring different cell adhesion molecules, monoclonal antibodies and other molecules involved in endometrial transformation as well as expression of responsible genes and steroid hormone receptors were included. All the progesterone-mediated outcome measures listed above were reduced in unexplained infertile women except β3 integrin which reported contradictory results and SGK1 expression which was reported in 1 study. This trend towards support for the hypothesis may be more important than any individual finding. The quality of the included studies was variable and hence the strength of the recommendations moderate. Limitations, reasons for caution The number of studies measuring each outcome was limited. The study quality varied from good to poor. Methodological heterogeneity between studies prevented meta-analysis. The strength of the study however comes from the originality of the research, the variety of included outcomes and that 32/36 papers reported results supporting the hypothesis. Wider implications of the findings: The findings of this systematic review support the need for larger, well designed research on this topic. If altered progesterone-mediated receptivity is implicated in unexplained infertility, it may be possible to offer other therapeutic interventions to improve outcomes as an alternative or adjunct to standard fertility treatment. Trial registration number NA

scholarly journals Age at menarche and risk of multiple sclerosis (MS): a systematic review and meta-analysis

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amirreza Azimi ◽  
Sara Hanaei ◽  
Mohammad Ali Sahraian ◽  
Mehdi Mohammadifar ◽  
Sreeram V. Ramagopalan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Odds Ratio ◽  
Case Reports ◽  
Meta Analysis ◽  
Final Analysis ◽  
Age At Menarche ◽  
Significant Heterogeneity ◽  
Control Groups ◽  
And Control

Abstract Background Some studies have looked at the age at menarche and risk of Multiple Sclerosis (MS).We aimed to conduct a systematic review and meta-analysis to estimate a pooled odds ratio of developing MS by increasing age at menarche. Methods We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, google scholar and gray literature (references of references, congress abstracts) up to 10th April 2019. Results The literature search found 312 articles. After eliminating duplicates, reviews, case reports and trials, 18 articles remained. Three articles were ultimately included in the final analysis. Two studies were from Iran, and one from Canada. The pooled odds ratio (OR) for increasing 1 year of age at menarche was 0.88 (95% CI:0.82-0.94), with no significant heterogeneity (I2 = 49%, p = 0.1). Mean age at menarche was significantly different between case and control groups (mean difference = − 0.22, 95% CI = -0.42,-0.02). Conclusion The result of this systematic review showed that the risk of MS decreases by increasing age at menarche.

scholarly journals Distinctive prosodic features of people with autism spectrum disorder: a systematic review and meta-analysis study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seyedeh Zahra Asghari ◽  
Sajjad Farashi ◽  
Saeid Bashirian ◽  
Ensiyeh Jenabi
Keyword(s):  
Systematic Review ◽  
Speech Rate ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Typically Developing ◽  
Prosodic Features ◽  
Control Groups ◽  
Pitch Range ◽  
Study Heterogeneity ◽  
And Control

AbstractIn this systematic review, we analyzed and evaluated the findings of studies on prosodic features of vocal productions of people with autism spectrum disorder (ASD) in order to recognize the statistically significant, most confirmed and reliable prosodic differences distinguishing people with ASD from typically developing individuals. Using suitable keywords, three major databases including Web of Science, PubMed and Scopus, were searched. The results for prosodic features such as mean pitch, pitch range and variability, speech rate, intensity and voice duration were extracted from eligible studies. The pooled standard mean difference between ASD and control groups was extracted or calculated. Using I2 statistic and Cochrane Q-test, between-study heterogeneity was evaluated. Furthermore, publication bias was assessed using funnel plot and its significance was evaluated using Egger’s and Begg’s tests. Thirty-nine eligible studies were retrieved (including 910 and 850 participants for ASD and control groups, respectively). This systematic review and meta-analysis showed that ASD group members had a significantly larger mean pitch (SMD =  − 0.4, 95% CI [− 0.70, − 0.10]), larger pitch range (SMD =  − 0.78, 95% CI [− 1.34, − 0.21]), longer voice duration (SMD =  − 0.43, 95% CI [− 0.72, − 0.15]), and larger pitch variability (SMD = − 0.46, 95% CI [− 0.84, − 0.08]), compared with typically developing control group. However, no significant differences in pitch standard deviation, voice intensity and speech rate were found between groups. Chronological age of participants and voice elicitation tasks were two sources of between-study heterogeneity. Furthermore, no publication bias was observed during analyses (p > 0.05). Mean pitch, pitch range, pitch variability and voice duration were recognized as the prosodic features reliably distinguishing people with ASD from TD individuals.

scholarly journals The Role of Choice in Weight Loss Strategies: A Systematic Review and Meta-Analysis

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1136 ◽  
Author(s):  
Jill Leavy ◽  
Peter Clifton ◽  
Jennifer Keogh
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Dietary Intervention ◽  
Meta Analysis ◽  
American Psychological Association ◽  
Control Groups ◽  
Weight Loss Strategies ◽  
And Control ◽  
Weight Loss Strategy

Effective strategies to achieve weight loss and long-term weight loss maintenance have proved to be elusive. This systematic review and meta-analysis aims to explore whether the choice of weight loss strategy is associated with greater weight loss. An electronic search was conducted using the MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO (Database of Abstracts of Literature in the Field of Psychology, produced by the American Psychological Association and distributed on the association’s APA PsycNET) databases for clinical trials and randomized controlled trials, investigating the role of choice in weight loss strategies. A total of nine studies were identified as meeting the pre-specified criteria. All of the studies included a ‘Choice’ or preference arm and a ‘No Choice’ arm or group who did not receive their preference as a control. A total of 1804 subjects were enrolled in these studies, with weight loss observed in both experimental and control groups of all studies, irrespective of dietary intervention, study duration, or follow-up length. Twelve interventions in nine trials were used for the meta-analysis, with results indicating a greater weight loss in the control groups, 1.09 ± 0.28 (overall mean difference in weight loss between groups ± standard error; p = 0). There was no significant effect of duration or attrition. In this meta-analysis, the choice of weight loss strategy did not confer a weight loss benefit.

Indicated preventive interventions for anxiety in children and adolescents: a review and meta-analysis of school based programs

2019 ◽  
Author(s):  
Siobhan Hugh-Jones ◽  
Sophie Beckett ◽  
Pavan Mallikarjun
Keyword(s):  
Meta Analysis ◽  
Child And Adolescent ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Control Groups ◽  
Adolescent Anxiety ◽  
School Based ◽  
Intervention Intensity ◽  
Randomised Controlled ◽  
And Control

Schools are promising sites for the delivery of prevention and early intervention programs to reduce child and adolescent anxiety. It is unclear whether universal or targeted approaches are most effective. This review and meta-analysis examines the effectiveness of school-based indicated interventions and was registered with PROSPERO [CRD42018087628].MEDLINE, EMBASE, PsycINFO and the Cochrane Library were searched for randomised controlled trials comparing indicated school programs for child and adolescent anxiety to active or inactive control groups. Twenty original studies, with 2076 participants, met the inclusion criteria and 18 were suitable for meta-analysis. Sub-group and sensitivity analyses explored intervention intensity, delivery agent and control type. A small beneficial effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = -0.28, CI = -0.50, -0.05, k= 18). The small effect was maintained at 6 (g = -0.35, CI= -0.58, -0.13, k = 9) and 12 months (g = -0.24, CI = -0.48, 0.00, k = 4). Based on two studies, &gt;12 month effects were very small (g = -0.01, CI= -0.38, 0.36). No differences were found based on intervention intensity, delivery agent and control type. There was evidence of publication bias and a relatively high risk of contamination in studies. Findings support the value of school based indicated programs for child and adolescent anxiety. Effects at 12 months outperform many universal programs. High quality, randomised controlled and pragmatic trials are needed, with attention control groups and beyond 12 month diagnostic assessments are needed.

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