scholarly journals What is the evidence for mirtazapine in treating cancer-related symptomatology? A systematic review

2019 ◽  
Vol 28 (4) ◽  
pp. 1597-1606 ◽  
Author(s):  
Guillaume Economos ◽  
Natasha Lovell ◽  
Anna Johnston ◽  
Irene J. Higginson
Keyword(s):  
Systematic Review ◽  
Small Sample Size ◽  
Poor Quality ◽  
Small Sample ◽  
Assessment Tools ◽  
Data Synthesis ◽  
Small Sample Sizes ◽  
Randomised Controlled ◽  
Multiple Symptoms ◽  
The Impact

Abstract Purpose Cancer patients often experience multiple distressing symptoms which are challenging to manage. It would therefore be helpful to find a treatment that alleviates more than one symptom, to avoid polypharmacy: mirtazapine has been used in several studies for this purpose. The objective of this study was to assess the effectiveness and safety of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms. Methods Systematic review of clinical trials in English or French. Eight databases were searched. Included studies assessed the effectiveness of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms. Comparator and validated assessment tools were required. Studies were independently appraised by two investigators before data synthesis. Results The search yielded 1898 references, from which we identified 12 relevant articles evaluating highly heterogeneous outcomes. These were two randomised-controlled (RCTs), three non-randomised controlled, and seven non-randomised non-controlled trials. In total, 392 participants were included and 185 were in RCTs. No study assessed the effectiveness of mirtazapine in alleviating symptoms at the same time, but some considered more than one symptom. Overall, the data was of poor quality, limited by small sample size and bias. However, mirtazapine showed effectiveness in treating depression, anxiety, sleep disorders, emesis and neuropathic pain. Across all studies, mirtazapine is safe to use, with drowsiness and dizziness the most common side-effects. Conclusion Study design and small sample sizes limit the ability to interpret results. Trials to assess the impact of mirtazapine or other medicines in alleviating multiple symptoms would be valuable.

scholarly journals Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

2021 ◽  
Vol 10 (8) ◽  
pp. 1740
Author(s):  
Marion Bareille ◽  
Michaël Hardy ◽  
Jonathan Douxfils ◽  
Stéphanie Roullet ◽  
Dominique Lasne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Strength ◽  
Small Sample ◽  
The Common ◽  
Small Sample Sizes ◽  
Definition Of ◽  
Reported Data ◽  
Prophylactic Anticoagulation ◽  
The Impact ◽  
Heparin Neutralization

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

scholarly journals Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2664
Author(s):  
Ethan Lowry ◽  
Joanne Marley ◽  
Joseph G. McVeigh ◽  
Emeir McSorley ◽  
Philip Allsopp ◽  
...  
Keyword(s):  
Systematic Review ◽  
Small Sample Size ◽  
Evidence Synthesis ◽  
Nutritional Intervention ◽  
Poor Quality ◽  
Chronic Widespread Pain ◽  
Small Sample ◽  
Vegan Diet ◽  
Poor Sleep ◽  
Best Evidence Synthesis

Fibromyalgia syndrome (FMS) is characterised by chronic widespread pain alongside fatigue, poor sleep quality and numerous comorbidities. It is estimated to have a worldwide prevalence of 1.78%, with a predominance in females. Treatment interventions for fibromyalgia have limited success, leading to many patients seeking alternative forms of treatment, including modifications to their diet and lifestyle. The effectiveness of dietary changes in fibromyalgia has not been widely researched or evaluated. This systematic review identified twenty-two studies, including 18 randomised control trials (RCTs) and four cohort studies which were eligible for inclusion. In total these studies investigated 17 different nutritional interventions. Significant improvements in reported pain were observed for those following a vegan diet, as well as with the low fermentable oligo di-mono-saccharides and polyols (FODMAP) diets. Supplementation with Chlorella green algae, coenzyme Q10, acetyl-l-carnitine or a combination of vitamin C and E significantly improved measures of pain. Interpretation of these studies was limited due to the frequent poor quality of the study design, the wide heterogeneity between studies, the small sample size and a high degree of bias. Therefore, there is insufficient evidence to recommend any one particular nutritional intervention for the management of fibromyalgia and further research is needed.

scholarly journals Evidence generation for the clinical impact of myCOPD in patients with mild, moderate and newly diagnosed COPD: a randomised controlled trial

2020 ◽  
Vol 6 (4) ◽  
pp. 00460-2020
Author(s):  
Michael G. Crooks ◽  
Jack Elkes ◽  
William Storrar ◽  
Kay Roy ◽  
Mal North ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Usual Care ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Small Sample ◽  
Self Management ◽  
Open Label ◽  
Management Interventions ◽  
Randomised Controlled ◽  
The Impact

Self-management interventions in COPD aim to improve patients' knowledge, skills and confidence to make correct decisions, thus improving health status and outcomes. myCOPD is a web-based self-management app known to improve inhaler use and exercise capacity in individuals with more severe COPD.We explored the impact of myCOPD in patients with mild–moderate or recently diagnosed COPD through a 12-week, open-label, parallel-group, randomised controlled trial of myCOPD compared with usual care. The co-primary outcomes were between-group differences in mean COPD assessment test (CAT) score at 90 days and critical inhaler errors. Key secondary outcomes were app usage and patient activation measurement (PAM) score.Sixty patients were randomised (29 myCOPD, 31 usual care). Groups were balanced for forced expiratory volume in 1 s (FEV1 % pred) but there was baseline imbalance between groups for exacerbation frequency and CAT score. There was no significant adjusted mean difference in CAT score at study completion, −1.27 (95% CI −4.47–1.92, p=0.44) lower in myCOPD. However, an increase in app use was associated with greater CAT score improvement. The odds of ≥1 critical inhaler error was lower in the myCOPD arm (adjusted OR 0.30 (95% CI 0.09–1.06, p=0.061)). The adjusted odds ratio for being in a higher PAM level at 90 days was 1.65 (95% CI 0.46–5.85) in favour of myCOPD.The small sample size and phenotypic difference between groups limited our ability to demonstrate statistically significant evidence of benefit beyond inhaler technique. However, our findings provide important insights into associations between increased app use and clinically meaningful benefit warranting further study in real world settings.

scholarly journals Fecal Microbiota Transplantation in the Treatment of Chronic Pouchitis: A Systematic Review

2020 ◽  
Vol 8 (9) ◽  
pp. 1433
Author(s):  
Frederik Cold ◽  
Sabrina Just Kousgaard ◽  
Sofie Ingdam Halkjaer ◽  
Andreas Munk Petersen ◽  
Hans Linde Nielsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fecal Microbiota Transplantation ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Case Series ◽  
Fecal Microbiota ◽  
Poor Quality ◽  
Small Sample ◽  
Cochrane Central Register ◽  
Length Of Treatment

The objective was to evaluate available literature on treatment of chronic pouchitis with fecal microbiota transplantation (FMT) focusing on clinical outcomes, safety, and different approaches to FMT preparation and delivery. A systematic review of electronic databases was conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials Library from inception through April 2020. Human studies of all study types reporting results of FMT to treat chronic pouchitis were included. Nine studies, reporting FMT treatment of 69 patients with chronic pouchitis were found eligible for the review. Most studies were case series and cohort studies rated as having fair to poor quality due to high risk of bias and small sample size. Only one randomized controlled trial was included, finding no beneficial effect of FMT. In total clinical response after FMT was reported in 14 (31.8%) out of 44 evaluated patients at various timepoints after FMT, and clinical remission in ten (22.7%) patients. Only minor self-limiting adverse events were reported. FMT varied greatly regarding preparation, length of treatment, and route of delivery. The effects of FMT on symptoms of chronic pouchitis are not established, though some studies show promising results. Future controlled well-designed studies are warranted.

scholarly journals The Impact of Mindfulness-Based Programmes on Self-Compassion in Nonclinical Populations: a Systematic Review and Meta-Analysis

Mindfulness ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 29-52
Author(s):  
Hannah L. Golden ◽  
Jane Vosper ◽  
Jessica Kingston ◽  
Lyn Ellett
Keyword(s):  
Publication Bias ◽  
Meta Analysis ◽  
Small Sample ◽  
Medium Effect ◽  
Future Research ◽  
Significant Heterogeneity ◽  
Self Compassion ◽  
Small Sample Sizes ◽  
Randomised Controlled ◽  
The Impact

Abstract Objectives Self-compassion has been proposed as a mechanism of change in mindfulness-based programmes (MBPs). The current study systematically reviewed the evidence for the effect of MBPs on self-compassion, in randomised controlled trials addressing broad mental health outcomes (depression, anxiety and stress) in nonclinical populations, and statistically synthesisesd these findings in a meta-analysis. Methods Three databases were systematically searched, and pre-post programme between group effect sizes (Hedges g) were calculated and synthesised using meta-analytic procedures. Correlation between change in self-compassion and distress (r) was also assessed. Moderator analyses were conducted and publication bias was assessed. Results Twenty-six studies met inclusion criteria (n = 598). A significant medium effect of pre-post change on self-compassion was found for MBPs compared to control conditions (g = 0.60, 95% CI = 0.41 to 0.80, p < 0.001). There was significant heterogeneity in the study sample, and no differences found for any of the moderators tested. There was no strong evidence for publication bias. Meta-analysis of correlation between change in self-compassion and distress was underpowered and found no significant effect. The improvement in self-compassion following MBI was not always consistent with improvements in depression or anxiety. Conclusions The results suggest that MBPs can increase self-compassion in nonclinical populations, though the moderators of this effect remain unknown. Methodological limitations include small sample sizes, over-reliance on wait-list control conditions and limitations in how self-compassion is measured. Theoretical and clinical implications of the review, and future research directions, are also discussed.

Employment programmes and interventions targeting adults with autism spectrum disorder: A systematic review of the literature

Autism ◽  
2016 ◽  
Vol 21 (8) ◽  
pp. 929-941 ◽  
Author(s):  
Darren Hedley ◽  
Mirko Uljarević ◽  
Lauren Cameron ◽  
Santoshi Halder ◽  
Amanda Richdale ◽  
...  
Keyword(s):  
Systematic Review ◽  
Autism Spectrum Disorder ◽  
Family System ◽  
Small Sample Size ◽  
Empirical Studies ◽  
Autism Spectrum ◽  
Small Sample ◽  
Spectrum Disorder ◽  
Future Research ◽  
The Impact

Individuals with autism spectrum disorder face significant challenges entering the workforce; yet research in this area is limited and the issues are poorly understood. In this systematic review, empirical peer-reviewed studies on employment programmes, interventions and employment-related outcomes in individuals with autism spectrum disorder over 18 years with and without intellectual disability were identified and evaluated. The review was prefaced by a summary of previous systematic reviews in the area. Web of Science, Medline, PsychINFO, ERIC and Scopus databases were systematically searched through to October 2015. From 32,829 records identified in the initial search, 10 review and 50 empirical articles, comprising N = 58,134 individuals with autism spectrum disorder, were included in the review. Selected articles were organised into the following themes: employment experiences, employment as a primary outcome, development of workplace skills, non-employment-related outcomes, assessment instruments, employer-focused and economic impact. Empirical studies were limited by poor participant characterisation, small sample size and/or a lack of randomisation and use of appropriate controls. Poor conceptualisation and measurement of outcomes significantly limited study quality and interpretation. Future research will require a multidisciplinary and multifaceted approach to explore employment outcomes on the individual, the family system, co-workers and the employer, along with the impact of individual differences on outcome.

scholarly journals A systematic review of the effects of psychiatric medications on social cognition

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zoë Haime ◽  
Andrew J. Watson ◽  
Nadia Crellin ◽  
Louise Marston ◽  
Eileen Joyce ◽  
...  
Keyword(s):  
Systematic Review ◽  
Social Cognition ◽  
Emotional Processing ◽  
Drug Effects ◽  
Small Sample ◽  
Narrative Synthesis ◽  
Amygdala Activity ◽  
Drug Treatments ◽  
Small Sample Sizes ◽  
The Impact

Abstract Introduction Social cognition is an important area of mental functioning relevant to psychiatric disorders and social functioning, that may be affected by psychiatric drug treatments. The aim of this review was to investigate the effects of medications with sedative properties, on social cognition. Method This systematic review included experimental and neuroimaging studies investigating drug effects on social cognition. Data quality was assessed using a modified Downs and Black checklist (Trac et al. CMAJ 188: E120-E129, 2016). The review used narrative synthesis to analyse the data. Results 40 papers were identified for inclusion, 11 papers investigating benzodiazepine effects, and 29 investigating antipsychotic effects, on social cognition. Narrative synthesis showed that diazepam impairs healthy volunteer’s emotion recognition, with supporting neuroimaging studies showing benzodiazepines attenuate amygdala activity. Studies of antipsychotic effects on social cognition gave variable results. However, many of these studies were in patients already taking medication, and potential practice effects were identified due to short-term follow-ups. Conclusion Healthy volunteer studies suggest that diazepam reduces emotional processing ability. The effects of benzodiazepines on other aspects of social cognition, as well as the effects of antipsychotics, remain unclear. Interpretations of the papers in this review were limited by variability in measures, small sample sizes, and lack of randomisation. More robust studies are necessary to evaluate the impact of these medications on social cognition.

scholarly journals A-070 Parental Perception of the Utility of Pediatric Neuropsychological Evaluation: A Systematic Review

2020 ◽  
Vol 35 (6) ◽  
pp. 861-861
Author(s):  
Deluco T ◽  
Katz N ◽  
Spano P ◽  
Stein C ◽  
Montalto D
Keyword(s):  
Systematic Review ◽  
Small Sample Size ◽  
Parent Satisfaction ◽  
Small Sample ◽  
Cochrane Library ◽  
Parental Perception ◽  
Neuropsychological Evaluation ◽  
Qualitative Synthesis ◽  
Neuropsychological Evaluations ◽  
The Impact

Abstract Objective Pediatric neuropsychological evaluations are intended to support children in their development and ability to function successfully in their everyday settings; however, limited efforts have been made to synthesize the available literature regarding the utility of these evaluations. To improve the impact of pediatric neuropsychological evaluations, a systematic review was conducted to identify components of the assessment and feedback process that are associated with parents’ perception of helpfulness (help parent understand child), usefulness (provide actionable information/elicit change) and overall parent satisfaction. Data Selection We followed PRISMA guidelines to conduct a systematic review of the literature to identify research on parental perception of the utility of pediatric neuropsychological evaluations for children aged 3–21 years. We searched PubMed, PsychINFO, Cochrane Library, and Web of Science databases using the terms “neuropsychology,” “pediatric,” “neuropsychological evaluation,” “neurodevelopmental disorders,” “perceived utility,” and “parental utility.” Data Synthesis We identified 1,029 abstracts and after full review included 9 articles in our qualitative synthesis. Conclusions Parents generally reported high levels of satisfaction with their child’s evaluation. The research has also suggested that parents find evaluations and feedback helpful for understanding their child’s pattern of strengths and weaknesses. Recommendations from the neuropsychologists provided useful information for obtaining support and eliciting change. Limitations of the studies reviewed included small sample size, variability in methods, and reduced generalizability of results.

scholarly journals A Systematic Review of the Effects of Psychiatric Medications on Social Cognition

2021 ◽  
Author(s):  
Zoë Haime ◽  
Andrew J Watson ◽  
Nadia Crellin ◽  
Louise Marston ◽  
Eileen Joyce ◽  
...  
Keyword(s):  
Systematic Review ◽  
Social Cognition ◽  
Emotional Processing ◽  
Drug Effects ◽  
Small Sample ◽  
Processing Ability ◽  
Amygdala Activity ◽  
Drug Treatments ◽  
Small Sample Sizes ◽  
The Impact

Abstract IntroductionSocial cognition is an important area of mental functioning relevant to psychiatric disorders and social functioning, that may be affected by psychiatric drug treatments. The aim of this review was to investigate the effects of medications with sedative properties, on social cognition. MethodThis systematic review included experimental and neuroimaging studies investigating drug effects on social cognition. Data quality was assessed using a modified Downs and Black checklist [40]. The review used narrative synthesis to analyse the data.Results40 papers were identified for inclusion, 11 papers investigating benzodiazepine effects, and 29 investigating antipsychotic effects, on social cognition.Narrative synthesis showed that diazepam impairs healthy volunteer’s emotion recognition, with supporting neuroimaging studies showing benzodiazepines attenuate amygdala activity. Studies of antipsychotic effects on social cognition gave variable results. However, many of these studies were in patients already taking medication, and potential practice effects were identified due to short-term follow-ups.ConclusionHealthy volunteer studies suggest that diazepam reduces emotional processing ability. The effects of benzodiazepines on other aspects of social cognition, as well as the effects of antipsychotics, remain unclear. Interpretations of the papers in this review were limited by variability in measures, small sample sizes, and lack of randomisation. More robust studies are necessary to evaluate the impact of these medications on social cognition.

The impact of younger-onset dementia on relationships, intimacy, and sexuality in midlife couples: a systematic review

2017 ◽  
Vol 30 (1) ◽  
pp. 15-29 ◽  
Author(s):  
Kristen Holdsworth ◽  
Marita McCabe
Keyword(s):  
Systematic Review ◽  
Later Life ◽  
Small Sample ◽  
Future Research ◽  
Roles And Responsibilities ◽  
Small Sample Sizes ◽  
The Individual ◽  
Person With Dementia ◽  
The Impact

ABSTRACTBackground:The impact of dementia on relationships, intimacy, and sexuality has been documented in later life couples. However, little is known about the experiences of couples living with younger-onset dementia. The aim of this systematic review was to analyze the literature describing the impact of younger-onset dementia on relationships, intimacy, and sexuality in midlife couples.Methods:A systematic literature search was conducted in July 2016 for relevant research papers. Five databases were searched: Web of Science, PsycINFO, MedLine, Scopus, and CINAHL. A quality appraisal checklist was used to assess the methodological quality of included studies.Results:Eleven studies were identified that explored relationships, intimacy, and sexuality from the perspective of the spouse, the person with dementia or both members of the dyad. Several themes were identified including shifts in roles and responsibilities, declines in relationship quality, changes in identity, and self-esteem, increasing social isolation and loneliness, shifts in intimacy, and changes in sexual activity.Conclusions:Many of the reviewed studies were subject to a range of methodological issues including small sample sizes, small number of studies, and a reliance on the perspective of only one member of the dyad. Future research should follow couples longitudinally to gain a clearer picture of the impact of younger-onset dementia on the couple relationship over time. The inclusion of people living with younger-onset dementia in research will assist in developing a deeper understanding of the experiences of the individual and dyad.

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