Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis

GUIDELINE TITLE: Anaphylaxis—A 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis RELEASE DATE: April 2020 PRIOR VERSION: Anaphylaxis – a 2019 practice parameter and GRADE analysis DEVELOPER: American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI) FUNDING SOURCE: None TARGET POPULATION: Adult and pediatric patients with anaphylaxis

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A living WHO guideline on drugs to prevent covid-19

BMJ ◽

10.1136/bmj.n526 ◽

2021 ◽

pp. n526

Author(s):

François Lamontagne ◽

Thomas Agoritsas ◽

Reed Siemieniuk ◽

Bram Rochwerg ◽

Jessica Bartoszko ◽

...

Keyword(s):

Systematic Review ◽

Guideline Development ◽

Meta Analysis ◽

World Health ◽

Policy And Practice ◽

Assessment Development ◽

Research Priority ◽

Health Organization ◽

Almost All ◽

Drug Interventions

Abstract Clinical question What is the role of drugs in preventing covid-19? Why does this matter? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. Recommendation The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the new recommendation The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.

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Commonly Reported Adverse Events Associated With Pediatric Immunotherapy: A Systematic Review From the Children’s Oncology Group

Journal of Pediatric Oncology Nursing ◽

10.1177/1043454220966590 ◽

2020 ◽

Vol 38 (1) ◽

pp. 16-25

Author(s):

Janice S. Withycombe ◽

Aimee Carlson ◽

Carly Coleman ◽

Sharon L. Leslie ◽

Micah Skeens ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Pediatric Oncology ◽

Nursing Practice ◽

Evaluation Criteria ◽

Brentuximab Vedotin ◽

Educational Materials ◽

Eligibility Criteria ◽

Assessment Development ◽

Pediatric Cancers

Background: Immunotherapy is a new and promising approach to treating pediatric cancers. These types of therapies have unique mechanisms of action for identifying and fighting cancer, as compared with traditional chemotherapy, and therefore are associated with different therapy-related adverse events (AEs). The purpose of this systematic review was to review available evidence to: (a) identify commonly reported AEs associated with immunotherapy agents frequently used in pediatric oncology and (b) generate recommendations for nursing practice. Method: A clinical question was developed and used to guide the systematic literature review. Five immunotherapy agents (dinutuximab, blinatumomab, rituximab, inotuzumab ozogamicin, brentuximab vedotin) were selected for inclusion secondary to their high relevance to pediatric oncology. A literature search was conducted to locate articles published between January 1, 2003 and October 31, 2018. Results: Seventeen articles met eligibility criteria for inclusion and were evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. The most commonly reported AEs for the selected immunotherapy agents were identified and summarized. Strong recommendations are made for nurses to become familiar with the unique AE profiles associated with individual immunotherapy agents. Agent-specific recommendations for nursing practice regarding AEs associated with dinutuximab and rituximab were generated. Conclusions: Immunotherapy is rapidly emerging as an effective therapy for pediatric cancers. Nurses need to be aware of the breadth of agent-specific, immunotherapy-related AEs to appropriately monitor and manage patients receiving these therapies. Additional work is needed to confidently profile immunotherapy-related AEs in pediatric oncology and to develop agent-specific educational materials for patients/families.

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Use of opioids in patients with cancer with hepatic impairment—a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003065 ◽

2021 ◽

pp. bmjspcare-2021-003065

Author(s):

Lewis Thomas Hughes ◽

David Raftery ◽

Paul Coulter ◽

Barry Laird ◽

Marie Fallon

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Hepatic Impairment ◽

Evaluation System ◽

Meta Analysis ◽

Hepatic Function ◽

Cochrane Central Register ◽

Assessment Development ◽

Patients With Cancer ◽

Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

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Private Rooms in Low Acuity Settings: A Systematic Review of the Literature

HERD Health Environments Research & Design Journal ◽

10.1177/1937586717702597 ◽

2017 ◽

Vol 11 (1) ◽

pp. 57-74 ◽

Cited By ~ 4

Author(s):

Jeffrey Voigt ◽

Michael Mosier ◽

Rabih Darouiche

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Quality Data ◽

Review Of The Literature ◽

Single Patient ◽

Patient Falls ◽

Assessment Development ◽

High Acuity ◽

Data Extraction Form ◽

Quality Evidence

Objectives: Determine if the peer-reviewed evidence supports single-patient ward bedrooms in low-acuity care settings within a hospital. Background: New evidence exists since the 2006 Facility Guideline Institute guideline recommended single-bedded rooms (SBRs) in low-acuity care settings. Additionally, prior studies evaluated high-acuity care settings (e.g., critical care) in their recommendations on SBRs. There is a need to reevaluate the evidence. Methods: A systematic review of the literature was completed including electronic and hand searches of references. A data extraction form was utilized. Two reviewers evaluated the studies independently. Studies that were included examined the effect of single-patient rooms on medical surgical ward beds only. Each study was graded using accepted clinical evidence grading instruments. Results: Over 1,400 records were identified. After excluding studies, a total of 49 records were graded. The highest quality evidence identified (Center for Evidence-Based Medicine [CEBM]: 2a, 2b, and Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] C) did not support the use of single-patient rooms for reducing infections, for minimizing patient falls, for reducing medication errors, or for patient satisfaction. Operational efficiencies were improved with SBRs but only addressed the maternity ward. The lowest quality evidence (CEBM: 4/5 and GRADE D) supported the use of single-patient rooms. Conclusions: Based on CEBM and GRADE assessments, there is a lack of high-quality data supporting the use of low-acuity SBRs throughout the entire hospital. Furthermore, it is recommended that more research be conducted on the effect of SBRs, so higher quality evidence is developed.

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Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Patients: A Systematic Review and International Expert Panel-Based Consensus Recommendations

10.21203/rs.3.rs-1014725/v1 ◽

2021 ◽

Author(s):

Frank A Rasulo ◽

Philip Hopkins ◽

Francisco Almeida Lobo ◽

Pierre Pandin ◽

Basil Matta ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Critically Ill Patients ◽

Level Of Evidence ◽

Assessment Development ◽

Modified Delphi ◽

Delphi Round ◽

Processed Eeg ◽

Grade Of Recommendation ◽

Excessive Sedation

Abstract BackgroundThe literature related to the use of processed EEG (pEEG) for depth of sedation (DOS) monitoring is increasing, however it is unclear how to use this type of monitoring for critical care patients within the intensive care unit (ICU).MethodsWe performed a systematic review of the literature according to the Grade of Recommendation assessment, Development, and Evaluation (GRADE) approach. The modified Delphi method was utilised by a team of experts to produce statements and recommendations derived from study questions. Three separate online rounds discussing 89 statements categorized into four domains were formulated. The panelists rated the appropriateness of each statement and were able to suggest modifications or addition of statements. An analysis of anonymised ratings of the statements by part of the panel followed each Delphi round and previously validated criteria were used to define appropriateness and consensus.ResultsLevel of evidence regarding the four domains was very low. Fourteen panelists participated in the Delphi rounds and consensus was reached for 28 out of 89 statements, from which the reccomendations were created. The main findings were that DOS monitoring should be performed in critically ill patients whenever clinical evaluation is not possible, it should be performed by continuous pEEG techniques and the resulting data depicted with graphical tools to facilitate detection of excessive sedation, a potential cause of burst-suppression, and finally, structured training is suggested to achieve a basic pEEG competency.ConclusionsAlthough evidence on using DOS monitors in ICU is scarce and further research is required in order to better define the benefits of using pEEG, the results of this consensus highlight the general agreement that critically-ill patients would benefit from this type of neuromonitoring.

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Effect of Anticoagulant Administration on the Mortality of Hospitalized Patients With COVID-19: An Updated Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.698935 ◽

2021 ◽

Vol 8 ◽

Author(s):

Luojia Jiang ◽

Yupei Li ◽

Heyue Du ◽

Zheng Qin ◽

Baihai Su

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Anticoagulation Therapy ◽

Hospitalized Patients ◽

Severe Bleeding ◽

Bleeding Events ◽

Assessment Development ◽

Dichotomous Variables ◽

Lower Mortality Risk

Background: Anticoagulation is generally used in hospitalized patients with coronavirus disease 2019 (COVID-19) as thromboprophylaxis. However, results from different studies comparing the effect of anticoagulation on the mortality of COVID-19 patients with non-anticoagulation are inconclusive.Methods: Our systematic review included observational trials if they studied anticoagulant therapy in hospitalized patients with COVID-19 for mortality or bleeding events. Dichotomous variables from individual studies were pooled by risk ratio (RR) and their 95% confidence interval (95% CI) using the random-effects model. Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of evidence.Results: A total of 11 observational studies enrolling 20,748 hospitalized COVID-19 patients overall were included. A pooled meta-analysis of these studies showed that anticoagulation therapy, compared with non-anticoagulation therapy, was associated with lower mortality risk (RR 0.70, 95% CI 0.52–0.93, p = 0.01). The evidence of benefit was stronger among critically ill COVID-19 patients in the intensive care units (RR 0.59, 95% CI 0.43–0.83, p = 0.002). Additionally, severe bleeding events were not associated with the administration of anticoagulants (RR 0.93, 95% CI 0.71–1.23, p = 0.63).Conclusion: Among patients with COVID-19 admitted to hospital, the administration of anticoagulants was associated with a decreased mortality without increasing the incidence of bleeding events.

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Effectiveness and Efficacy of Therapeutic Interventions Performed by Nurses for Anxiety Disorders: A Systematic Review

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211068105 ◽

2022 ◽

pp. 107839032110681

Author(s):

Roslaine Ifran Amaral ◽

Fernanda Cirne Lima Weston ◽

Vânia Naomi Hirakata ◽

Adriana Aparecida Paz ◽

Ana Cristina Wesner

Keyword(s):

Systematic Review ◽

Anxiety Disorders ◽

Negative Impact ◽

Self Control ◽

Therapeutic Interventions ◽

Quality Of Evidence ◽

Assessment Development ◽

Anxiety Levels ◽

The Individual

BACKGROUND: Anxiety disorders are characterized by excessive anxiety, fear, and behavioral disorders that can lead the individual to have losses in daily, social, and work activities, generating a negative impact on their quality of life. AIM: To evaluate the quality of evidence of the therapeutic interventions performed by nurses for anxiety disorders. METHOD: An analysis of the quality of evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The systematic review protocol was registered in the Prospective Register of Systematic Reviews (Prospero), CRD420202939. RESULTS: The interventions performed by nurses were effective ( d = 0.44), with significant improvement in reducing anxiety levels, reducing drug use, and improving self-control. CONCLUSIONS: The study indicates that therapeutic interventions performed by nurses are beneficial for individuals who suffer from anxiety disorders, with significant improvement in reducing anxiety levels, reducing medication use, improving self-control, and remission of anxiety symptoms.

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A Systematic Review of the Relationships Between Physical Activity and Sleep in Early Childhood

Kinesiology Review ◽

10.1123/kr.2020-0066 ◽

2021 ◽

pp. 1-17

Author(s):

Christine W. St. Laurent ◽

Katrina Rodheim ◽

Rebecca M.C. Spencer

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Evaluation Framework ◽

Outcome Studies ◽

Study Quality ◽

Assessment Development ◽

High Prevalence ◽

Study Characteristics ◽

Study Designs

The aim of this systematic review was to examine the associations between physical activity and sleep in children aged less than 6 years. Articles were included if participants were primarily aged less than 6 years and study designs were observational or experimental. Study characteristics were extracted, and the Grading Recommendations Assessment, Development and Evaluation framework was used to assess study quality. Thirty-six studies (16 sleep, 16 physical activity, and three fitness outcomes) from 18 countries reported in 29 articles were included. The majority of sleep and physical activity outcome studies reported mixed effects with very low to low quality of evidence. Fitness outcome studies were limited, and therefore, evidence was insufficient. The high prevalence of mixed and null results could be related to study limitations. Importantly, this review points to the critical need for higher quality studies of sleep and physical activity in young children, which would support health recommendations and intervention strategies for healthier child development.

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Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism

Blood Advances ◽

10.1182/bloodadvances.2019001052 ◽

2020 ◽

Vol 4 (18) ◽

pp. 4296-4311

Author(s):

Parth Patel ◽

Payal Patel ◽

Meha Bhatt ◽

Cody Braun ◽

Housne Begum ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Pulmonary Angiography ◽

Evaluation Framework ◽

Test Accuracy ◽

Assessment Development ◽

Life Threatening ◽

D Dimer

Abstract Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.

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