Evidence-based risk assessment and recommendations for physical activity clearance: pregnancy1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S33-S48 ◽  
Author(s):  
Sarah Charlesworth ◽  
Heather J.A. Foulds ◽  
Jamie F. Burr ◽  
Shannon S.D. Bredin
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Adverse Event ◽  
Pregnant Women ◽  
Event Rate ◽  
Scientific Information ◽  
Well Being ◽  
Adverse Event Rate ◽  
Evidence Based ◽  
Exercise During Pregnancy

Recommendations for physical activity during pregnancy have progressed significantly in the last 30 years and continue to evolve as an increasing body of scientific evidence becomes available. In addition, there is an increasing number of women who wish to either maintain physical fitness levels during the prenatal period or initiate exercise for a healthier lifestyle during pregnancy. As such, consistent evaluation of the risks associated with exercise during pregnancy is warranted for maternal and fetal well-being. The primary purpose of this systematic review was to evaluate the scientific information available regarding maternal and fetal responses as it relates to the occurrence of adverse exercise-related events in pregnant women without contraindications to exercise. A systematic and evidence-based approach was used to analyze critically the level of evidence for risks associated with acute and chronic exercise during pregnancy in healthy pregnant women. All articles were screened according to standardized evaluation criteria developed by a panel of experts. A total of 74 investigations that involved 3766 pregnant women were included in the analysis. Of the 74 studies, only 35 studies documented the presence or absence of adverse events. The serious adverse event rate for these studies was 1.4 per 10 000 h of exercise. The adverse event rate increased to 6.8 per 10 000 h of exercise when including the occurrence of more mild events and exercise-related fetal bradycardia and tachycardia. Previously inactive or active women (without contraindications) are at a low risk for adverse fetal or maternal events if they participate in routine physical activity during pregnancy.

scholarly journals Levofloxacin Versus Ciprofloxacin in the Treatment of Urinary Tract Infections: Evidence-Based Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Dehong Cao ◽  
Yinzhi Shen ◽  
Yin Huang ◽  
Bo Chen ◽  
Zeyu Chen ◽  
...  
Keyword(s):  
Adverse Event ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Eradication Rate ◽  
Event Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Adverse Event Rate ◽  
Evidence Based ◽  
Tract Infections

Urinary tract infections (UTIs) are one of the most common bacterial infections acquired both in community and hospital. Fluoroquinolones, represented by levofloxacin and ciprofloxacin, are widely used for treatment of UTIs. However, it remains controversial for the comparison between the 2 drugs, which propelled us to conduct the first evidence-based research on this topic. To establish their relative efficacy and safety, we searched Pubmed, embase, and Web of Science for randomized controlled trials (RCTs) for UTIs. A total of 5 RCTs were finally included, involving 2,352 patients and a systematic review and meta-analysis were performed to compare the end-of-therapy and posttherapy clinical success rate, microbial eradication rate and adverse event rate. Jadad score and Review Manager 5.3.0 version were applied respectively to evaluate the study quality and heterogeneity. There was no significant difference between levofloxacin and ciprofloxacin group in end-of-therapy or posttherapy clinical success rate and microbial eradication rate (p > 0.05). As for adverse event rate, the 2 drugs were comparable and both safe for clinical use. Based on one included trial and pharmacological research, we raised hypothesis that levofloxacin was superior to ciprofloxacin for treatment of E. coli-induced chronic bacterial prostatitis (CBP) and it required a further study to prove it.

Evidence-based risk assessment and recommendations for physical activity clearance: cancer1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

2011 ◽  
Vol 36 (S1) ◽  
pp. S101-S112 ◽  
Author(s):  
Lee W. Jones
Keyword(s):  
Physical Activity ◽  
Risk Assessment ◽  
Exercise Training ◽  
Cancer Patients ◽  
Exercise Testing ◽  
Peer Review Process ◽  
Evaluation Criteria ◽  
Adverse Event Rate ◽  
Evidence Based ◽  
Data Reporting

Physical activity is becoming increasingly acknowledged as an integral component of in the multidisciplinary management of cancer patients. Intensive inquiry in this area is likely to increase further over the next decade; however, cancer-specific, evidence-based risk assessment and recommendations for physical activity are not available. A systematic literature review was performed of all studies conducting an exercise training intervention and (or) any form of objective exercise test among adults diagnosed with cancer. Studies were assessed according to evaluation criteria developed by a panel of experts. A total of 118 studies involving 5529 patients were deemed eligible. Overall, the results suggest that exercise training and maximal and submaximal exercise testing are relatively safe procedures with a total nonlife-threatening adverse event rate of <2%. There was only 1 exercise training-related death. However, the quality of exercise testing methodology and data reporting is less than optimal. Thus, whether the low incidence of events reflects the true safety of exercise training and exercise testing in cancer patients or less than optimal methodology and (or) data reporting remains to be determined. Evidence-based absolute and relative contraindications to physical activity and exercise training and testing are provided as well as probing decision-trees to optimize the adoption and safety of physical activity in persons diagnosed with cancer.

scholarly journals Microalbuminuria is associated with high adverse event rate following cardiac surgery

2011 ◽  
Vol 39 (6) ◽  
pp. 932-938 ◽  
Author(s):  
Martin Majlund Mikkelsen ◽  
Niels Holmark Andersen ◽  
Thomas Decker Christensen ◽  
Troels Krarup Hansen ◽  
Hans Eiskjaer ◽  
...  
Keyword(s):  
Adverse Event ◽  
Cardiac Surgery ◽  
Event Rate ◽  
Adverse Event Rate ◽  
High Adverse Event

Missed acute myocardial infarction in the emergency department–standardizing measurement of misdiagnosis-related harms using the SPADE method

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Adam L. Sharp ◽  
Aileen Baecker ◽  
Najlla Nassery ◽  
Stacy Park ◽  
Ahmed Hassoon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Chest Pain ◽  
Administrative Data ◽  
Diagnostic Performance ◽  
Event Rate ◽  
Public Health Problem ◽  
Diagnostic Error ◽  
Adverse Event Rate ◽  
Disease Pair

AbstractObjectivesDiagnostic error is a serious public health problem. Measuring diagnostic performance remains elusive. We sought to measure misdiagnosis-related harms following missed acute myocardial infarctions (AMI) in the emergency department (ED) using the symptom-disease pair analysis of diagnostic error (SPADE) method.MethodsRetrospective administrative data analysis (2009–2017) from a single, integrated health system using International Classification of Diseases (ICD) coded discharge diagnoses. We looked back 30 days from AMI hospitalizations for antecedent ED treat-and-release visits to identify symptoms linked to probable missed AMI (observed > expected). We then looked forward from these ED discharge diagnoses to identify symptom-disease pair misdiagnosis-related harms (AMI hospitalizations within 30-days, representing diagnostic adverse events).ResultsA total of 44,473 AMI hospitalizations were associated with 2,874 treat-and-release ED visits in the prior 30 days. The top plausibly-related ED discharge diagnoses were “chest pain” and “dyspnea” with excess treat-and-release visit rates of 9.8% (95% CI 8.5–11.2%) and 3.4% (95% CI 2.7–4.2%), respectively. These represented 574 probable missed AMIs resulting in hospitalization (adverse event rate per AMI 1.3%, 95% CI 1.2–1.4%). Looking forward, 325,088 chest pain or dyspnea ED discharges were followed by 508 AMI hospitalizations (adverse event rate per symptom discharge 0.2%, 95% CI 0.1–0.2%).ConclusionsThe SPADE method precisely quantifies misdiagnosis-related harms from missed AMIs using administrative data. This approach could facilitate future assessment of diagnostic performance across health systems. These results correspond to ∼10,000 potentially-preventable harms annually in the US. However, relatively low error and adverse event rates may pose challenges to reducing harms for this ED symptom-disease pair.

scholarly journals The ‘new normal’ includes online prenatal exercise: Exploring pregnant women’s experiences during the pandemic and the role of virtual group fitness on maternal mental health

2021 ◽  
Author(s):  
Cristina Silva-Jose ◽  
Taniya S Nagpal ◽  
Javier Coterón ◽  
Ruben Barakat ◽  
Michelle F Mottola
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Pregnant Women ◽  
Maternal Mental Health ◽  
Exercise Program ◽  
Well Being ◽  
Group Exercise ◽  
Exercise Classes ◽  
Prenatal Exercise ◽  
Online Group

Abstract Background: Prenatal anxiety and depressive symptoms have significantly increased since the onset of the coronavirus (COVID-19) pandemic. Furthermore, home confinement regulations have caused a drastic increase in time spent sedentary. Online group fitness classes may be an effective strategy that can increase maternal physical activity and improve mental health outcomes by providing an opportunity for social connectedness. The present study explores the experiences of pregnant women who participated in an online group exercise program during the pandemic and identifies relationships with maternal mental health and well-being. In addition, we present person-informed recommendations on how to improve the delivery of future online prenatal exercise programs.Methods: Semi-structured interviews were conducted with pregnant women (8-39 weeks of pregnancy) who participated in an online group exercise program, from March to October 2020 in Spain. A phenomenological approach was taken, and open-ended questions were asked to understand women’s experiences throughout the pandemic and the role the online exercise classes may have had on their physical activity levels, mental health, and other health behaviours such as diet. A thematic analysis was performed to evaluate data. In addition, women completed the State-Trait Anxiety Inventory (STAI) and these data supplemented qualitative findings. Results: Twenty-four women were interviewed, and the average STAI score was 32.23 ± 9.31, ranging from low to moderate anxiety. Thematic analysis revealed that women felt safe exercising from home, an increased availability of time to schedule a structured exercise class, and consequently an improvement in their adherence to the program and other behaviours (i.e., healthier diet). Women emphasized feeling connected to other pregnant women when they exercised online together, and overall, this had a positive effect on their mental well-being. Women suggested that future online exercise programs should include flexible options, detailed instructions and facilitation by a qualified exercise professional.Conclusion: Pregnant women are receptive to online group exercise classes and expressed that these are an accessible option to accommodating physical activity during the pandemic. In addition, the online group environment provides an important sense of connectivity among pregnant women exercising together and this may mitigate the detrimental effect of COVID-19 on maternal mental health.

scholarly journals Assessment of physical activity status among pregnant women in southwestern China

2019 ◽  
Vol 6 (2) ◽  
pp. 135-141 ◽  
Author(s):  
Ya-Nan Yin ◽  
Yan Huang ◽  
Xing-Hui Liu ◽  
Bi-Ru Luo
Keyword(s):  
Physical Activity ◽  
Pregnant Women ◽  
Health Care Providers ◽  
Chinese Women ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Southwestern China ◽  
Care Providers ◽  
Cross Sectional ◽  
Exercise During Pregnancy

Abstract Objective To assess the patterns and intensities of physical activity among pregnant women in southwestern China, which help us create a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists (ACOG) guidelines for exercise during pregnancy. Methods A cross-sectional study was performed to recruit pregnant women at a prenatal checking visit clinic with the self-administered Chinese version of Pregnancy Physical Activity Questionnaire (PPAQ). Results A total of 1179 Chinese pregnant women were enrolled, of whom 92.60% were classified as not meeting the ACOG guidelines. By intensity, 47.36% of the score was attributed to light-intensity activities (1.5 to <3.0 metabolic equivalent [MET]) in the first trimester; the other 2 trimesters were similar. By patterns, about 45.15% of the score was attributed to inactivity. More than 82.35% of enrolled pregnant women regarded slowly walking as the most common type of exercise during pregnancy. Conclusions This study represents a group of Chinese women who maintained an inactive lifestyle, including low-intensity activities and unitary type of exercises during their pregnancy. Health-care providers are advised to provide appropriate physical activity guidelines to pregnant women. Development of MET-hours/week recommendations is warranted to promote greater physical activity during pregnancy.

scholarly journals A Smartphone-Assisted Brief Behavioral Intervention for Pregnant Women with Depression: a Study Protocol of a Randomized Controlled Trial

2020 ◽  
Author(s):  
Pedro Zuccolo ◽  
Mariana O. Xavier ◽  
Alicia Matijasevich ◽  
Guilherme Polanczyk ◽  
Daniel Fatori
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Social Support ◽  
Pregnant Women ◽  
Maternal Depression ◽  
Active Control ◽  
Well Being ◽  
Smartphone Applications ◽  
Educational Content ◽  
Randomized Controlled

Background: Pregnancy is strongly associated with increased risk for depression. Approximately 25% of pregnant women develop depression. Treatment for depression during pregnancy has several complexities: the use of psychiatric medications during pregnancy might result in developmental problems in the child and must be used with caution. Psychosocial interventions are effective, but they require specialized professionals. Low- and middle-income countries (LMIC) countries such as Brazil do not have enough mental health professionals needed to meet this demand. In this context, smartphone-based interventions show immense potential. We developed Motherly, a smartphone application (app) designed to treat maternal depression. We aim to test the efficacy of Motherly in addition to brief cognitive-behavioral therapies (CBT) to treat maternal depression. Methods: We will conduct a 2-arm parallel randomized controlled clinical trial in which 70 pregnant women aged between 16-40 years with depression will be randomized to intervention or active control. The intervention group will have access to Motherly, a smartphone app based on three concepts: psychoeducation, behavior monitoring, and gaming elements. Motherly is composed of a package of interventions composed of modules: mental health, sleep, nutrition, physical activity, social support, prenatal/postnatal support, and educational content. The main focus of Motherly is delivering behavioral activation (BA), a brief and structured psychological treatment. The app allows participants to schedule and engage in, and monitor activities according to a plan to avoid acting exclusively according to their mood. The active control group will have access to a simplified version of the app consisting of educational content about various aspects of pregnancy, maternal physical and mental health, and infant development (BA, activity scheduling, sleep hygiene, among other functionalities, will not be present in this version). Both groups will receive four sessions of brief CBT in 8 weeks. Participants will be evaluated by assessors blind to randomization and allocation status. Assessments will occur at baseline (T0), midpoint (T1, week 4-5), posttreatment (T2, week 8), and follow-up (T3, when the child is two months-old). Maternal mental health (prenatal anxiety, psychological well-being, perceived stress, depression, depression severity, and sleep quality), quality of life, physical activity levels, and infant developmental milestones and social/emotional problems will be measured. Our primary outcome is the change in maternal prenatal depression from baseline to posttreatment (8 weeks). Discussion: The potential of digital technology to deliver mental health interventions has been increasingly recognized worldwide. There is a growing literature on interventions using smartphone applications to promote mental health, both with or without the intermediation of a mental health professional. Our study adds to the literature by testing whether an app providing an intervention package, including CBT, psychoeducation, nutrition, physical activity, and social support, can promote maternal and child health and well-being. In particular, we aim to treat depression, for which the use of digital technologies is still scarce. Smartphone applications designed to treat maternal depression are especially relevant because of the potential to circumvent barriers that prevent pregnant women from accessing mental health care.

scholarly journals Ramipril therapy in the framework of evidence-based medicine

2009 ◽  
Vol 15 (2) ◽  
pp. 242-245
Author(s):  
N. Goncharova ◽  
O. M. Moiseeva
Keyword(s):  
Antihypertensive Effect ◽  
Event Rate ◽  
Antiarrhythmic Activity ◽  
Adverse Event Rate ◽  
Evidence Based ◽  
High Cardiovascular Risk ◽  
Atherosclerosis Progression ◽  
Target Organs ◽  
The Everyday ◽  
Based Medicine

The article summarizes the available data on ramipril in hypertensive patients of high cardiovascular risk. The results of studies demonstrate strong and long-lasting antihypertensive effect of ramipril. Moreover, ramipril treatment decreases cardiovascular events rate, damage of target organs, atherosclerosis progression and new cases of diabetes mellitus. The treatment by ramipril represents vasculoprotective and renoprotective effects in diabetes patients. Possible antiarrhythmic activity of ramipril is of particular interest in atrial fi brillation. Ramipril shows both high effi cacy and low adverse event rate. All this properties make ramipril extremely attractive for the everyday practice.

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