Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta‐analysis

IntroductionHigh blood pressure (BP) in acute stroke has adverse outcomes. Transdermal glyceryl trinitrate (GTN) has beneficial properties in controlling BP. The 2016 meta-analysis and 2017 Cochrane review showed that transdermal GTN was beneficial in a small patient subgroup with stroke onset ≤6 hours. Larger studies focusing on this patient subgroup have since been conducted. We report the protocol for an updated systematic review and meta-analysis on the safety and benefits of transdermal GTN in acute stroke.Methods and analysisWe will search Medline, Pubmed, Embase, CINAHL and Cochrane Library from inception until June 2020 for randomised trials that report the efficacy and safety of transdermal GTN versus placebo/control therapy among adult patients with acute stroke. Primary outcomes include in-hospital mortality, BP lowering and late functional status. Secondary outcomes include early, late, resource utilisation and surrogate outcomes. Safety outcomes include reported adverse events. Reviewers will first screen titles and abstracts, and then full texts, to identify eligible studies. Independently and in duplicate, they will extract data, assess risk of bias (RoB) using a modified Cochrane RoB tool and quality of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Disagreement will be resolved by discussion and consultation with an external reviewer if necessary. Using a random-effects model, we will report effect sizes using relative risks and 95% CIs. We will perform predefined subgroup analyses: intracerebral haemorrhage versus ischaemic stroke; minor (NIHSS (National Institutes of Health Stroke Scale) ≤five) versus major (NIHSS >five) ischaemic stroke; ischaemic stroke with versus without thrombolysis; prehospital versus non-prehospital settings; time from stroke to randomisation ≤6 versus >6 hours and high versus low overall RoB studies. We will also perform trial sequential analysis for the primary outcomes.Ethics and disseminationEthics board approval is unnecessary. PROSPERO registration has been obtained. The results will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020173093.

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Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis

Neurological Sciences ◽

10.1007/s10072-016-2570-5 ◽

2016 ◽

Vol 37 (8) ◽

pp. 1195-1202 ◽

Cited By ~ 19

Author(s):

Weibin Zhong ◽

Na Geng ◽

Pengfei Wang ◽

Zhenguang Li ◽

Lili Cao

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Stroke ◽

Transient Ischemic Attack ◽

Meta Analysis ◽

Hospital Readmissions ◽

Ischemic Attack ◽

Causes And Risk Factors

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Intravenous Insulin Treatment in Acute Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

International Journal of Stroke ◽

10.1111/ijs.12225 ◽

2013 ◽

Vol 9 (4) ◽

pp. 489-493 ◽

Cited By ~ 22

Author(s):

G. Ntaios ◽

V. Papavasileiou ◽

A. Bargiota ◽

K. Makaritsis ◽

P. Michel

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Acute Stroke ◽

Insulin Treatment ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Intravenous Insulin

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Seroprevalence of hepatitis C virus infection in Cameroon: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-015748 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015748 ◽

Cited By ~ 8

Author(s):

Jean Joel Bigna ◽

Marie A Amougou ◽

Serra Lem Asangbeh ◽

Angeladine Malaha Kenne ◽

Jobert Richie Nansseu

Keyword(s):

Systematic Review ◽

Hepatitis C ◽

Methodological Quality ◽

Meta Analysis ◽

Hcv Infection ◽

Representative Study ◽

East Region ◽

Pooled Prevalence ◽

Rural Settings

ObjectiveBetter knowledge of hepatitis C virus (HCV) seroprevalence at the national level can help to implement pertinent strategies to address the HCV-related burden. The aim of this paper was to estimate the seroprevalence of HCV infection in Cameroon.DesignSystematic review and meta-analysis.ParticipantsPeople residing in Cameroon.Data sourcesElectronic databases including PubMed/MEDLINE, AJOL, WHO-Afro Library, Africa Index Medicus, National Institute of Statistics and National AIDS Control Committee, Cameroon from 1 January 2000 to 15 December 2016 were searched. English and French languages papers were considered. Two independent investigators selected studies. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale.Results31 studies including 36 407 individuals were finally considered. There was no national representative study. The overall pooled prevalence was 6.5% (95% CI 4.5% to 8.8%; I²=98.3%). A sensitivity analysis of individuals at low risk of HCV infection showed a pooled prevalence of 3.6% (95% CI 2.3% to 5.2%, I²=97.7%, 18 studies) among 22 860 individuals (general population, blood donors and pregnant women), which was higher than for a high-risk population (healthcare workers and people with other identified comorbidities), 12.2% (95% CI 4.9% to 22.2%; I²=98.3%, 13 studies); p=0.018. The prevalence was higher in the East region, in rural settings, and when using an enzyme immunoassay technique for detecting HCV antibodies. Sex, sites, study period, sample size, timing of data collection and methodological quality of studies were not sources of heterogeneity.LimitationOne-third of studies (29.0%) had a low risk bias in their methodology and most were facility-based (87.1%).ConclusionThe seroprevalence of HCV infection in Cameroon indicates the need for comprehensive and effective strategies to interrupt HCV transmission in the Cameroonian population. Specific attention is needed for the East region of the country, rural settings and high-risk populations. A national representative study is needed to provide better estimates.

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