scholarly journals Impact of Clinicians' Use of Electronic Knowledge Resources on Clinical and Learning Outcomes: Systematic Review and Meta-Analysis

10.2196/13315 ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. e13315 ◽  
Author(s):  
Lauren A Maggio ◽  
Christopher A Aakre ◽  
Guilherme Del Fiol ◽  
Jane Shellum ◽  
David A Cook
Keyword(s):  
Patient Care ◽  
Learning Outcomes ◽  
Meta Analysis ◽  
Implementation Strategies ◽  
Cochrane Library ◽  
Patient Specific ◽  
Evidence Based ◽  
Knowledge Resources ◽  
Knowledge Resource ◽  
Variable Impact

Background Clinicians use electronic knowledge resources, such as Micromedex, UpToDate, and Wikipedia, to deliver evidence-based care and engage in point-of-care learning. Despite this use in clinical practice, their impact on patient care and learning outcomes is incompletely understood. A comprehensive synthesis of available evidence regarding the effectiveness of electronic knowledge resources would guide clinicians, health care system administrators, medical educators, and informaticians in making evidence-based decisions about their purchase, implementation, and use. Objective The aim of this review is to quantify the impact of electronic knowledge resources on clinical and learning outcomes. Methods We searched MEDLINE, Embase, PsycINFO, and the Cochrane Library for articles published from 1991 to 2017. Two authors independently screened studies for inclusion and extracted outcomes related to knowledge, skills, attitudes, behaviors, patient effects, and cost. We used random-effects meta-analysis to pool standardized mean differences (SMDs) across studies. Results Of 10,811 studies screened, we identified 25 eligible studies published between 2003 and 2016. A total of 5 studies were randomized trials, 22 involved physicians in practice or training, and 10 reported potential conflicts of interest. A total of 15 studies compared electronic knowledge resources with no intervention. Of these, 7 reported clinician behaviors, with a pooled SMD of 0.47 (95% CI 0.27 to 0.67; P<.001), and 8 reported objective patient effects with a pooled SMD of 0.19 (95% CI 0.07 to 0.32; P=.003). Heterogeneity was large (I2>50%) across studies. When compared with other resources—7 studies, not amenable to meta-analytic pooling—the use of electronic knowledge resources was associated with increased frequency of answering questions and perceived benefits on patient care, with variable impact on time to find an answer. A total of 2 studies compared different implementations of the same electronic knowledge resource. Conclusions Use of electronic knowledge resources is associated with a positive impact on clinician behaviors and patient effects. We found statistically significant associations between the use of electronic knowledge resources and improved clinician behaviors and patient effects. When compared with other resources, the use of electronic knowledge resources was associated with increased success in answering clinical questions, with variable impact on speed. Comparisons of different implementation strategies of the same electronic knowledge resource suggest that there are benefits from allowing clinicians to choose to access the resource, versus automated display of resource information, and from integrating patient-specific information. A total of 4 studies compared different commercial electronic knowledge resources, with variable results. Resource implementation strategies can significantly influence outcomes but few studies have examined such factors.

scholarly journals Morning Report: Can an Established Medical Education Tradition Be Validated?

2013 ◽  
Vol 5 (3) ◽  
pp. 374-384 ◽  
Author(s):  
Matthew McNeill ◽  
Sayed K. Ali ◽  
Daniel E. Banks ◽  
Ishak A. Mansi
Keyword(s):  
Medical Education ◽  
Patient Care ◽  
Outcome Measures ◽  
English Language ◽  
Meta Analysis ◽  
The United States ◽  
Cochrane Library ◽  
Clinical Effects ◽  
Morning Report ◽  
Residency Programs

Abstract Background Morning report is accepted as an essential component of residency education throughout different parts of the world. Objective To review the evidence of the educational value, purpose, methods, and outcomes of morning report. Methods A literature search of PubMed, Ovid, and the Cochrane Library for English-language studies published between January 1, 1966, and October 31, 2011, was performed. We searched for keywords and Medical Subject Heading terms related to medical education, methods, attitudes, and outcomes in regard to “morning report.” Title and abstract review, followed by a full-text review by 3 authors, was performed to identify all pertinent articles. Results We identified 71 citations; 40 articles were original studies and 31 were commentaries, editorials, or review articles; 56 studies (79%) originated from internal medicine residency programs; 6 studies (8%) focused on ambulatory morning report; and 63 (89%) originated from the United States. Identified studies varied in objectives, methods, and outcome measures, and were not suitable for meta-analysis. Main outcome measures were resident satisfaction, faculty satisfaction, preparation for professional examinations, use of evidence-based medicine, clinical effects on patient care, adverse event detection, and utilization of a curriculum in case selection. Conclusions Morning report has heterogeneous purposes, methods, and settings. As an educational tool, morning report is challenging to define, its outcome is difficult to measure, and this precludes firm conclusions about its contribution to resident education or patient care. Residency programs should tailor morning report to meet their own unique educational objectives and needs.

scholarly journals Rates, predictors and mortality of sepsis-associated acute kidney injury: systematic review and meta-analysis

2020 ◽  
Author(s):  
Jie feng Liu ◽  
Hebin Xie ◽  
ziwei ye ◽  
Lesan Wang
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Predisposing Factors ◽  
Cochrane Library ◽  
Patient Specific ◽  
Cumulative Number

Abstract Objective:The incidence and mortality of sepsis-induced acute kidney injury is high. Many studies have explored the causes of sepsis-induced acute kidney injury (AKI). However, its predictors are still uncertain; additionally, a complete overview is missing. A systematic review and a meta-analysis were performed to determine the predisposing factors for sepsis-induced AKI. Method: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed and Web of Science databases, with an end date parameter of May 25, 2019. Valid data were retrieved in compliance with the inclusion and exclusion criteria. Result: Forty-seven observational studies were included for analysis. A cumulative number of 55911sepsis patients were evaluated. The incidence of AKI caused by septic shock is the highest. 30 possible risk factors were included in the meta-analysis. The results showed that 20 factors were found to be significant. The odds ratio(OR),95% confidence interval (CI) and Prevalence of the most prevalent predisposing factors for sepsis-induced AKI were as the following: Septic shock[2.88(2.36-3.52), 60.47%], Hypertension[1.43(1.20-1.70),38.39%), Diabetes mellitus[1.59(1.47-1.71),27.57%],Abdominal infection[1.44(1.32-1.58),30.87%], Vasopressors use[2.95(1.67-5.22),64.61%],vasoactive drugs use [3.85(1.89-7.87),63.22%], Mechanical ventilation[1.64(1.24-2.16),68.00%), Positive blood culture[1.60(1.35-1.89), 41.19%], Smoke history[1.60(1.09-2.36),43.09%]. Other risk factors include cardiovascular, coronary artery disease, liver disease, unknow infection, diuretics use, ACEI or ARB, gram-negative bacteria and organ transplant. Conclusion: A large number of factors are associated with AKI development in sepsis patients. Our review can guide risk-reducing interventions, clinical prediction rules, and patient-specific treatment and management strategies for sepsis-induced acute kidney injury.

Return to Play After Hip Arthroscopy: A Systematic Review and Meta-analysis

2018 ◽  
Vol 46 (11) ◽  
pp. 2780-2788 ◽  
Author(s):  
Michaela O’Connor ◽  
Anas A. Minkara ◽  
Robert W. Westermann ◽  
James Rosneck ◽  
T. Sean Lynch
Keyword(s):  
Systematic Review ◽  
Hip Arthroscopy ◽  
Meta Analysis ◽  
Return To Play ◽  
Sufficient Evidence ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Evidence Based ◽  
Rehabilitation Protocols ◽  
The Mean

Background: The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete’s preparedness for sporting activities. Purpose: To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. Study Design: Systematic review and meta-analysis. Methods: The search terms “hip arthroscopy,” “return to play,” and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. Results: A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement ( r = −0.95, P = .0003). Conclusion: Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.

scholarly journals The Use of Prophylactic Anticonvulsants in Patients with Brain Tumours—A Systematic Review

2006 ◽  
Vol 13 (6) ◽  
pp. 222-229 ◽  
Author(s):  
J. Perry ◽  
L. Zinman ◽  
A. Chambers ◽  
K. Spithoff ◽  
N. Lloyd ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Brain Tumours ◽  
Best Practice ◽  
Meta Analysis ◽  
Significant Risk ◽  
Practice Variation ◽  
Cochrane Library ◽  
Evidence Based ◽  
Newly Diagnosed

Questions: Should patients with newly diagnosed brain tumours receive prophylactic anticonvulsants to reduce seizure risk? What is the best practice for patients with brain tumours who are taking anticonvulsant medications but who have never had a seizure? Perspectives: Patients with primary or metastatic brain tumours who have never had a seizure still have a 20% risk of experiencing a seizure over the course of their disease. Because considerable practice variation exists in regard to the management of patients with brain tumours who have never had a seizure, and because conflicting evidence has been reported, the Neuro-oncology Disease Site Group (DSG) of Cancer Care Ontario’s Program in Evidence-based Care felt that a systematic review of the evidence was warranted. Outcomes: Outcomes of interest were incidence of seizures and adverse effects of prophylactic anticonvulsant therapy. Methodology: The MEDLINE and Cochrane Library databases were systematically searched for relevant evidence. The review included fully published reports or abstracts of randomized controlled trials (RCTs), systematic reviews, meta-analyses, and practice guidelines. The present systematic review was reviewed and approved by the Neuro-oncology DSG, which comprises medical and radiation oncologists, surgeons, neurologists, a nurse, and a patient representative. Results: Quality of Evidence: The literature search located one evidence-based practice guideline, one systematic review, and five RCTs that addressed prophylactic anticonvulsants for patients with brain tumours. Evidence for the best management of seizure-naïve patients who are already taking anticonvulsants was limited to one retrospective study and exploratory analyses within several RCTs. Benefits and Harms: Pooled results of the five RCTs suggest that the incidence of seizures in patients who receive prophylactic anticonvulsants is not significantly different from that in patients who do not receive anticonvulsants (relative risk: 1.04; 95% confidence interval: 0.70 to 1.54; p = 0.84). This analysis accords with results from a published meta-analysis. Evidence is insufficient to determine whether patients who are currently taking anticonvulsants but who have never had a seizure should taper the anticonvulsants. Patients who received anticonvulsants reported adverse effects, including rash, nausea, and hypotension, but whether these effects are a result of the anticonvulsants or of other treatments could not be determined. Conclusions: Based on the available evidence, the routine use of postoperative anticonvulsants is not recommended in seizure-naïve patients with newly diagnosed primary or secondary brain tumours, especially in light of a significant risk of serious adverse effects and problematic drug interactions. Because data are insufficient to recommend whether anticonvulsants should be tapered in patients who are already taking anticonvulsants but who have never had a seizure, treatment must be individualized.

scholarly journals Visualizing the Esophagus During Modified Barium Swallow Studies: A Systematic Review

2021 ◽  
pp. 1-11
Author(s):  
Erin L. Reedy ◽  
Teri Lynn Herbert ◽  
Heather Shaw Bonilha
Keyword(s):  
Systematic Review ◽  
Patient Care ◽  
Meta Analysis ◽  
Accurate Diagnosis ◽  
Barium Swallow ◽  
Evidence Based ◽  
Critical Component ◽  
Insufficient Evidence ◽  
Clinical Practices ◽  
Modified Barium Swallow

Purpose Despite the emphasis on using evidence-based practice for patient care, as clinicians, we sometimes find that there is insufficient evidence to support our clinical practices. One example of this is the “contentious” inclusion of routine, standardized visualization of the esophagus during modified barium swallow studies (MBSSs). This review sought to investigate the evidence for inclusion of routine esophageal visualization during the MBSS, a practice that is supported by the long-established interrelationship between all aspects of the oral, pharyngeal, and esophageal swallowing continuum. Method Searches were conducted in PubMed, Scopus, and CINAHL databases. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed to identify articles that met prespecified inclusion and exclusion terms. Results Five articles were included in this review, which identified that esophageal findings were present in 48.67% of those participants whose MBSS included esophageal visualization. Conclusion This review supports a standardized, validated, reliable visualization protocol of the esophagus during the MBSS as a critical component to the accurate diagnosis and formulation of treatment recommendations for patients with swallowing disorders.

scholarly journals The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Le Xiao ◽  
Han Qi ◽  
Wei Zheng ◽  
Yu-Tao Xiang ◽  
Thomas J. Carmody ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Usual Care ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Measurement Based Care ◽  
Evidence Based Care

AbstractSeveral care models have been developed to improve treatment for depression, all of which provide “enhanced” evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13–1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11–1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of −0.42 (95%CI: −0.61–(−0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94–1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668

scholarly journals Referral in a routine Italian optometric examination: towards an evidence-based model.

2021 ◽  
Vol 14 (1) ◽  
pp. 1-11
Author(s):  
Riccardo Cheloni ◽  
Alexander G Swystun ◽  
Mauro Frisani ◽  
Christopher J Davey
Keyword(s):  
Visual Impairment ◽  
Meta Analysis ◽  
Health Assessment ◽  
Preliminary Evidence ◽  
Cochrane Library ◽  
Optimal Time ◽  
Evidence Based ◽  
Wide Range ◽  
The Cochrane Library ◽  
Ocular Health

Italian optometrists refract patients and prescribe optical appliances. The routine optometric examination that is currently conducted in Italy, however, does not include a comprehensive ocular health assessment. Like many other countries, in Italy ophthalmologists are solely responsible for the diagnosis and treatment of ocular pathologies, yet, the care an optometrist provides must be done with the aim of promoting the general and ocular health of patients seen in practice. Such scope has to be pursued using a close collaboration with ophthalmologists, ultimately facilitating the earliest medical diagnosis and minimisation of visual impairment. Referral represents the basis of optometrist-ophthalmologist collaboration, yet, no guidance is available to Italian optometrists indicating when referral is warranted. The purpose of this study was to identify the circumstances deserving a referral in a routine Italian optometric examination in adults, ultimately constituting preliminary evidence-based indications of a referral model oriented to enhance the ocular and general health of patients. A literature review was conducted on Pubmed and the Cochrane Library, mainly targeting high quality secondary literature such as systematic reviews, meta-analysis and clinical guidelines. Several reasons for referral were identified. Further, while a wide range of anomalies of the visual system are likely to be discovered by the Italian optometric examination, up to 20% of patients could suffer an underlying condition undetected by the current assessment. This results in the need to refer seemingly healthy patients if they have not attended routine ophthalmological examinations within optimal time frames. In Italy, and countries with similar settings, the referral is an essential instrument that optometrists must largely use to ensure early diagnosis of ocular conditions by ophthalmologists and minimisation of avoidable visual impairment.

KOLABORASI PUSTAKAWAN DALAM PENGAMBILAN KEPUTUSAN KLINIS BERBASIS BUKTI TERKINI (EVIDENCE BASED MEDICINE ): STUDI KASUS DI FAKULTAS KEDOKTERAN, KESEHATAN MASYARAKAT DAN KEPERAWATAN UNIVERSITAS GADJAH MADA

2021 ◽  
Vol 23 (1) ◽  
pp. 67-75
Author(s):  
Sukirno Sukirno
Keyword(s):  
Systematic Review ◽  
Evidence Based Medicine ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Evidence Based ◽  
Randomised Controlled ◽  
The Cochrane Library ◽  
Clinical Queries ◽  
Based Medicine

Evidence Based Medicine (EBM) merupakan pemanfaatan bukti ilmiah berdasarkan penelitian klinis mutakhir yang sahih dalam tatalaksana proses penyembuhan penyakit. Salah satu syarat utama untuk memfasilitasi pengambilan keputusan klinik yang evidence-based, adalah dengan menyediakan bukti-bukti ilmiah yang relevan. Tipe kajian  diutamakan yang berupa hasil review sistematik, meta-analisis, dan randomised controlled trial (RCT). Salah satu dari lima langkah dalam evidence based medicine yaitu yaitu menelusur  bukti  dari sumber database hasil penelitian yang memuat bukti-bukti ilmiah. PubMed Clinical Queries dan The Cochrane Library merupakan database berisi hasil riset sekunder (systematic-review/meta-analysis) yang mensintesis hasil riset primer. Kolaborasi pustakawan dalam pengambilan keputusan klinis yaitu dengan  memberikan pelatihan  atau menelusur artikel hasil penelitian yang akan digunakan dalam pengambilan klinis dari database yang memuat bukti ilmiah.

scholarly journals Quality assessment of weekend discharge: a systematic review and meta-analysis

2020 ◽  
Vol 32 (6) ◽  
pp. 347-355
Author(s):  
Chia-Yu Chiu ◽  
David Oria ◽  
Peter Yangga ◽  
Dasol Kang
Keyword(s):  
Patient Care ◽  
Meta Analysis ◽  
Emergency Department Visits ◽  
Weekend Effect ◽  
Cochrane Library ◽  
Quality Of Patient Care ◽  
Significant Difference ◽  
The Usa

Abstract Purpose Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the ‘weekend effect.’ However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. Data sources PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. Study selection Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. Data extraction Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. Results of data synthesis There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. Conclusion In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.

scholarly journals Influence of Radiofrequency Electromagnetic Fields on the Fertility System: Protocol for a Systematic Review and Meta-Analysis (Preprint)

2017 ◽  
Author(s):  
Nasibeh Roozbeh ◽  
Fatemeh Abdi ◽  
Azadeh Amraee ◽  
Zahra Atarodi Kashani ◽  
Leili Darvish
Keyword(s):  
Systematic Review ◽  
Electromagnetic Fields ◽  
Mobile Phones ◽  
Reproductive System ◽  
Case Reports ◽  
Meta Analysis ◽  
Harmful Effect ◽  
Case Series ◽  
Cochrane Library ◽  
Evidence Based

BACKGROUND Due to the increased number of users of mobile phones, tablets, and other devices over the past few years, concerns about the potential impact of mobile phones on health are growing. The influence of mobile phone exposure on male fertility has been studied in recent years. Other research has shown that electromagnetic fields (EMFs) increase macrophages in the corpus luteum and growing follicles. Due to conflicting results among studies and since no systematic review has been performed to analyze the effects of radiofrequency EMF exposure from electronic devices on the fertility system in recent years, this evidence-based study is necessary. OBJECTIVE The main objectives of this study are to determine the best evidence associated with the influence of radiofrequency EMFs on the fertility system and to provide insight into a potential mechanism using our observations. METHODS In this systematic review, the databases and gray literature will be searched with no language and date limitation. The following databases will be searched: Cochrane Library, MEDLINE, PubMed, EMBASE, CINAHL, ProQuest, Scopus, Science Direct, Google Scholar, and other Persian databases. The combination of the Medical Subject Heading terms “radiofrequency electromagnetic” and “male reproductive system” or “female reproductive system” will be searched. Observational study designs will be included but case reports, case series, reviews, and letters to the editor will be excluded. Papers selected for retrieval will be evaluated by two independent referees for methodological validation before entering a review using the Newcastle-Ottawa Scale for nonrandomized studies and cohort studies. RESULTS The results of this study will be submitted to a peer-reviewed journal for publication and also presented at PROSPERO. CONCLUSIONS This systematic review will provide evidence-based data on the effect of radiofrequency EMFs on the fertility system. This article will also classify the harmful effect of radiofrequency waves on primary and secondary infertility. This study could be useful for decreasing infertility. This is important because the rate of infertility is growing, leading to negative outcomes for couples and the health care system. CLINICALTRIAL PROSPERO CRD42017072462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72462 (Archived by WebCite at http://www.webcitation.org/6wjiE9R2q)

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