Medical Procedure Services in Internal Medicine Residencies in the US: a Systematic Review and Meta-Analysis

OBJECTIVES: This study aimed to systematically review and quantitatively synthesize the association between HLA-B*5701 and abacavir-induced hypersensitivity reaction (ABC-HSR). METHODS: We searched for studies that investigated the association between HLA-B genotype and ABC-HSR and provided information about the frequency of carriers of HLA-B genotypes among cases and controls. We then performed a meta-analysis with a random-effects model to pool the data and to investigate the sources of heterogeneity. RESULTS: From 1,026 articles identified, ten studies were included. Five using clinical manifestation as their diagnostic criteria, 409 and 1,883 subjects were included as cases and controls. Overall OR was 23.6 (95% CI = 15.4 – 36.3). Whereas, the another five studies using confirmed immunologic test as their diagnostic criteria, 110 and 1,968 subjects were included as cases and controls, respectively. The association of ABC-HSR was strong in this populations with HLA-B*5701. Overall OR was 1,056.2 (95% CI = 345.0 – 3,233.3). CONCLUSIONS: Using meta-analysis technique, the association between HLA-B*5701 and ABC-HSR is strong in the studies using immunologic confirmation to identify ABC-HSR. These results support the US FDA recommendations for screening HLA-B*5701 allele before initiating abacavir therapy.This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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A systematic review and meta-analysis of the efficacy and safety of remdesivir in COVID-19 patients

Journal of Ideas in Health ◽

10.47108/jidhealth.vol4.iss1.99 ◽

2021 ◽

Vol 4 (1) ◽

pp. 298-303

Author(s):

Sumanta Saha ◽

Sujata Saha

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Random Effect ◽

Fixed Effect Model ◽

Evidence Based ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Effect Model ◽

Pubmed Database ◽

The Us

Background: This systematic review compares the efficacy and safety of remdesivir between its recipient and non-recipient COVID-19 patients from the recently published randomized controlled trials (RCT). Methods: For eligible trials comparing the above outcomes, a literature search took place in the PubMed database. The reviewed trials data were abstracted and critically appraised using the Cochrane tool. Then, a random-effect meta-analysis followed to compare the risk between the compared interventions in risk ratio (RR). By plying the I2 and Chi2 statistics, the heterogeneity estimation happened. A sensitivity analysis iterated the preliminary meta-analysis using a fixed-effect model. Results: Two eligible RCTs included in this review sourced data from about 833 COVID-19 patients from 115 hospitals in Asia, Europe, and the US. The risk of bias was primarily low. Random-effect meta-analysis suggested a clinical improvement (RR: 1.09; 95% CI: 1.02, 1.16; P=0.02; I2: 0%) and decrease in the risk of any serious side effects (RR: 0.64; 95% CI: 0.43, 0.94; P<0.001; I2: 0%) in the remdesivir treated COVID-19 patients. The rest of the outcomes did not vary between the juxtaposed interventions. Conclusion: Evidence-based on early RCTs suggest that remdesivir is a clinically useful and safe drug to treat COVID-19 patients.

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The Impact of Block Ambulatory Scheduling on Internal Medicine Residencies: a Systematic Review

Journal of General Internal Medicine ◽

10.1007/s11606-019-04887-x ◽

2019 ◽

Vol 34 (5) ◽

pp. 731-739 ◽

Cited By ~ 2

Author(s):

Ami L. DeWaters ◽

Hilda Loria ◽

Helen Mayo ◽

Alia Chisty ◽

Oanh K. Nguyen

Keyword(s):

Internal Medicine ◽

Systematic Review ◽

The Impact ◽

Internal Medicine Residencies

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The cost of chemotherapy administration: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.810 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 810-810

Author(s):

Gursharan Kaur Sohi ◽

Jordan Levy ◽

Victoria Delibasic ◽

Laura Davis ◽

Alyson Mahar ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

A Priori ◽

Outpatient Setting ◽

Sensitivity Analyses ◽

Administration Cost ◽

Chemotherapy Administration ◽

Canadian Studies ◽

The Us ◽

The Cost

810 Background: Cancer treatment is a significant driver of healthcare costs worldwide, however, the economic impact of treating patients with anti-neoplastic agents is poorly elucidated. Hence, we conducted a systematic review and meta-analysis to estimate the direct costs associated with administering intravenous chemotherapy in an outpatient setting. Methods: We systematically searched four databases from 2010 to present and extracted hourly administration costs and the respective components of each estimate. Separate analyses were conducted of Canadian and United States (US) studies, respectively, to address a priori hypotheses regarding heterogeneity amongst administration cost estimates. The Drummond checklist was used to assess risk-of-bias. Data were summarized using medians with interquartile ranges and five outliers were identified; costs were presented in 2019 USD. Results: A total of 44 studies were analyzed, including sub-analyses of 19 US and seven Canadian studies. 26/44 studies were of moderate or high quality. When components of administration cost were evaluated, physician costs were reported most frequently (24 studies), followed by lab tests (13) and overhead costs (9). The median cost estimate when outliers were excluded was $142/hour (IQR = $103-166). Sensitivity analyses determined the median administration cost in the US was $149/hour (IQR = $118-158), and was $128/hour (IQR = $102-137) in Canada. Conclusions: There is currently a paucity of literature addressing the costs of chemotherapy administration, and existing studies utilize a patchwork of reporting methodologies which renders direct comparison challenging. Our results demonstrate that the cost of administering chemotherapy is approximately $125-150/hour, globally. This value is dependent upon the region of analysis, inclusiveness of cost subcomponents as well as the methodology used to estimate unit prices, as described here.

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Ultrasound-guided access to the axillary vein for implantation of cardiac implantable electronic devices: A systematic review and meta-analysis

The Journal of Vascular Access ◽

10.1177/11297298211054621 ◽

2021 ◽

pp. 112972982110546

Author(s):

Sonia D’Arrigo ◽

Francesco Perna ◽

Maria Giuseppina Annetta ◽

Mauro Pittiruti

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Statistical Significance ◽

Intervention Group ◽

Late Complications ◽

Control Group ◽

Complication Rates ◽

Axillary Vein ◽

Cardiac Implantable Electronic Devices ◽

The Us

The aims of our systematic review were to quantify the expected rate of procedural success, early and late complications during CIED implantation using US-guided puncture of the axillary vein and to perform a meta-analysis of those studies that compared the US technique (intervention) versus conventional techniques (control) in terms of complication rates. MEDLINE, ISI Web of Science, and EMBASE were searched for eligible studies. Pooled Odds Ratio (OR) and Pooled Mean Difference (PMD) for each predictor were calculated. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Thirteen studies were included a total of 2073 patients. The overall success of US-guided venipuncture for CIED implantation was 96.8%. As regards early complications, pneumothorax occurred in 0.19%, arterial puncture in 0.63%, and severe hematoma/bleeding requiring intervention in 1.1%. No cases of hemothorax, brachial plexus, or phrenic nerve injury were reported. As regards late complications, the incidence of pocket infection, venous thromboembolism, and leads dislodgement was respectively 0.4%, 0.8%, and 1.2%. In the meta-analysis (five studies), the intervention group (US-guided venipuncture) had a trend versus a lower likelihood of having a pneumothorax (0.19% vs 0.75%, p = 0.21), pocket hematoma (0.8% vs 1.7%, p = 0.32), infection (0.28% vs 1.05%, p = 0.29) than the control group, but this did not reach statistical significance. The overall QOE was low or very low. In conclusions we found that the US-guided axillary venipuncture for CIEDs implantation was associated with a low incidence of early and late complications and a steep learning curve.

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Systematic Review and Meta-Analysis of Multi-Component Interventions Through Schools to Increase Physical Activity

Journal of Physical Activity and Health ◽

10.1123/jpah.2014-0244 ◽

2015 ◽

Vol 12 (10) ◽

pp. 1436-1446 ◽

Cited By ~ 49

Author(s):

Laura B. Russ ◽

Collin A. Webster ◽

Michael W. Beets ◽

David S. Phillips

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Meta Analysis ◽

After School ◽

Inverse Variance ◽

The Us ◽

School Day ◽

Intervention Impact ◽

K 12 ◽

Multicomponent Interventions

Background:A “whole-of-school” approach is nationally endorsed to increase youth physical activity (PA). Aligned with this approach, comprehensive school physical activity programs (CSPAP) are recommended. Distinct components of a CSPAP include physical education (PE), PA during the school day (PADS), PA before/after school (PABAS), staff wellness (SW), and family/community engagement (FCE). The effectiveness of interventions incorporating multiple CSPAP components is unclear. A systematic review and meta-analysis were conducted examining the effectiveness of multicomponent interventions on youth total daily PA.Methods:Electronic databases were searched for published studies that (1) occurred in the US; (2) targeted K–12 (5–18 years old); (3) were interventions; (4) reflected ≥ 2 CSPAP components, with at least 1 targeting school-based PA during school hours; and (5) reported outcomes as daily PA improvements. Standardized mean effects (Hedge’s g) from pooled random effects inverse-variance models were estimated.Results:Across 14 studies, 12 included PE, 5 PADS, 1 PABAS, 2 SW, and 14 FCE. No studies included all 5 CSPAP components. Overall, intervention impact was small (0.11, 95% CI 0.03–0.19).Conclusions:As designed, there is limited evidence of the effectiveness of multicomponent interventions to increase youth total daily PA. Increased alignment with CSPAP recommendations may improve intervention effectiveness.

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The Effect of Pulsed Radiofrequency on Radicular Pain in Lumbal Herniated Nucleus Pulposus: A Systematic Review and Meta-Analysis

Anesthesiology and Pain Medicine ◽

10.5812/aapm.111420 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Anita Marliana ◽

Ismail Setyopranoto ◽

Indarwati Setyaningsih ◽

Sholahuddin Rhatomy

Keyword(s):

Systematic Review ◽

Nucleus Pulposus ◽

Meta Analysis ◽

Radicular Pain ◽

Medical Procedure ◽

Pulsed Radiofrequency ◽

Pain Scores ◽

Radiofrequency Therapy ◽

Clinical Recommendation ◽

Herniated Nucleus Pulposus

Context: Radiofrequency therapy is a medical procedure mainly used to reduce pain with a low complication rate (less than 1%), ease of application, and low cost. This review’s objective was to (1) evaluate the pulsed radiofrequency (PRF) effectiveness in treating radicular pain and (2) assess the PRF procedure’s safety in managing radicular pain in lumbar herniated nucleus pulposus (HNP). Methods: A systematic review and meta-analysis. A tertiary care center and an academic medical center. Six full articles with the following features were selected for this review: (1) Articles published in English; (2) studies on the PRF effect on radicular pain in lumbar HNP; and (3) randomized control trials. Results: The studies showed that the PRF group had a reduction in pain scores at each evaluation. In four of the studies, the PRF group showed a more significant reduction in pain scores than the control, and in two of the studies, the reduction in pain scores was not significant in the PRF group compared to the control. An adverse effect was reported in one patient experiencing increased radicular pain after PRF. Lack of data required for statistical analysis, and lack use of a uniform duration for the PRF procedure by all the studies. Conclusions: PRF can be used as a promising clinical recommendation for pain management with minimally invasive radicular pain techniques due to lumbar HNP.

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Systematic review of Swedish snus for smoking cessation based on primary subject data from randomised clinical trials

The Journal of Smoking Cessation ◽

10.1017/jsc.2013.10 ◽

2013 ◽

Vol 8 (1) ◽

pp. 33-44 ◽

Cited By ~ 3

Author(s):

L. E. Rutqvist ◽

J. S. Fry ◽

P. N. Lee

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Smoking Cessation ◽

Primary Outcome ◽

Meta Analysis ◽

Randomised Clinical Trials ◽

Cochrane Library ◽

Population Surveys ◽

The Us ◽

Swedish Snus

Introduction: The ability of Swedish snus to serve as a smoking cessation aid has been documented in several observational, population surveys from Scandinavia, but randomised clinical trials provide more reliable information on efficacy. Aims: To perform a systematic review and meta-analysis of randomised clinical trials of Swedish snus as an aid to smoking cessation. Methods: Literature searches were conducted in MedLine, Cochrane Library, and Embase to identify relevant clinical trials. The primary outcome was defined as biologically confirmed smoking cessation during around six months. Meta-analyses based on primary subject data tested for effect of allocated treatment as well as selected baseline characteristics. Results: There were two relevant clinical trials, one conducted at five sites in the US (n = 250), the other at two sites in Serbia (n = 319). Based on the primary outcome, success was higher in the treated group in both Serbia (5.7% vs 1.9%) and the US (4.0% vs 1.6%). Meta-analysis estimated the relative success rate at 2.83 (95% CI 1.03–7.75), which was of borderline significance (exact p = 0.06, chi-squared p = 0.03). For smoking cessation in the last 4 weeks of each study, rates were 12.4% for snus and 6.6% for placebo (RR 1.86, 95% CI 1.09-3.18). Efficacy of snus was not clearly related to any baseline characteristic. Conclusions: Swedish snus increased quit rates similarly in US and Serbia. These results confirm and extend previous information based on observational population surveys.

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Impact and Effectiveness of Legislative Smoking Bans and Anti-Tobacco Media Campaigns in Reducing Smoking among Women in the US: A Systematic Review and Meta-Analysis

Healthcare ◽

10.3390/healthcare8010020 ◽

2020 ◽

Vol 8 (1) ◽

pp. 20

Author(s):

Yelena Bird ◽

Ladan Kashaniamin ◽

Chijioke Nwankwo ◽

John Moraros

Keyword(s):

Systematic Review ◽

Subgroup Analysis ◽

Odds Ratio ◽

Meta Analysis ◽

Random Effects Model ◽

Smoking Bans ◽

Inclusion Criteria ◽

Media Campaigns ◽

School Based ◽

The Us

Background: The purpose of this study is to systematically review the literature addressing the effectiveness of legislative smoking bans and anti-tobacco media campaigns in reducing smoking among women. Methods: MEDLINE, PubMed, CINAHL, and ABI/INFORM were searched for studies published from 2005 onwards. Meta-analysis was conducted using a random effects model and subgroup analysis on pre-selected characteristics. Results: In total, 652 articles were identified, and five studies satisfied the inclusion criteria. The studies varied from school-based to workplace settings and had a total of 800,573 women participants, aged 12 to 64 years old. Three studies used legislative bans, one study used anti-tobacco campaigns and another one used both as their intervention. The overall pooled effect of the five studies yielded an odds ratio (OR) = 1.137 (C.I. = 0.976–1.298 and I2 = 85.6%). Subgroup analysis by intervention revealed a significant pooled estimate for studies using legislative smoking bans OR = 1.280 (C.I. = 1.172–1.389 and I2 = 0%). Conclusion: Legislative smoking bans were found to be associated with a reduction in the smoking rates among women compared to anti-tobacco media campaigns. Further research in this area is needed.

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