Systematic review and meta-analysis of external ventricular drain placement accuracy and narrative review of guidance devices

Background An ‘ethnic’ or ‘group’ density effect in psychosis has been observed, whereby the risk of psychosis in minority group individuals is inversely related to neighbourhood-level proportions of others belonging to the same group. However, there is conflicting evidence over whether this effect differs between minority groups and limited investigation into other moderators. Aims To conduct a comprehensive systematic review and meta-analysis of the group density effect in psychosis and examine moderators. Method Four databases were systematically searched. A narrative review was conducted and a three-level meta-analysis was performed. The potential moderating effect of crudely and specifically defined minority groups was assessed. Country, time, area size and whether studies used clinical or non-clinical outcomes were also tested as moderators. Results Thirty-two studies were included in the narrative review and ten in the meta-analysis. A 10 percentage-point decrease in own-group density was associated with a 20% increase in psychosis risk (OR = 1.20, 95% CI 1.09−1.32, P < 0.001). This was moderated by crudely defined minority groups (F6,68 = 6.86, P < 0.001), with the strongest associations observed in Black populations, followed by a White Other sample. Greater heterogeneity was observed when specific minority groups were assessed (F25,49 = 7.26, P < 0.001). Conclusions This is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density varies across minority groups, with the strongest associations observed in Black individuals. Heterogeneity in effect sizes may reflect distinctive social experiences of specific minority groups. Potential mechanisms are discussed, along with the implications of findings and suggestions for future research.

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External ventricular drain management in subarachnoid haemorrhage: a systematic review and meta-analysis

Neurosurgical Review ◽

10.1007/s10143-021-01627-w ◽

2021 ◽

Author(s):

Joanna Palasz ◽

Linda D’Antona ◽

Sarah Farrell ◽

Mohamed A. Elborady ◽

Laurence D. Watkins ◽

...

Keyword(s):

Systematic Review ◽

Subarachnoid Haemorrhage ◽

Meta Analysis ◽

External Ventricular Drain ◽

Drain Management

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Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420951315 ◽

2020 ◽

Vol 54 (8) ◽

pp. 697-706

Author(s):

Sarah M. Jackson ◽

Luke A. Perry ◽

Carla Borg ◽

Dhruvesh M. Ramson ◽

Ryan Campbell ◽

...

Keyword(s):

Systematic Review ◽

Risk Stratification ◽

Vascular Surgery ◽

Vascular Disease ◽

Meta Analysis ◽

Narrative Review ◽

Cochrane Library ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Chi Squared

Objective: The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery. Methods: We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively. Results: Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review. Conclusions: NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.

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Impact of an External Ventricular Drain Placement and Handling Protocol on Infection Rates: A Meta-Analysis and Single Institution Experience

World Neurosurgery ◽

10.1016/j.wneu.2018.03.160 ◽

2018 ◽

Vol 115 ◽

pp. e53-e58 ◽

Cited By ~ 1

Author(s):

Emily P. Sieg ◽

Abraham C. Schlauderaff ◽

Russell A. Payne ◽

Michael J. Glantz ◽

Scott D. Simon

Keyword(s):

Meta Analysis ◽

External Ventricular Drain ◽

Infection Rates ◽

Single Institution ◽

Drain Placement

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Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis

Neurosurgical FOCUS ◽

10.3171/2021.10.focus21509 ◽

2022 ◽

Vol 52 (1) ◽

pp. E10

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Screw Placement ◽

Intraoperative Blood Loss ◽

Robot Assisted ◽

Training Requirements ◽

3D Fluoroscopy ◽

Placement Accuracy

OBJECTIVE Several approaches have been studied for internal fixation of the spine using pedicle screws (PSs), including CT navigation, 2D and 3D fluoroscopy, freehand, and robotic assistance. Robot-assisted PS placement has been controversial because training requirements, cost, and previously unclear benefits. This meta-analysis compares screw placement accuracy, operative time, intraoperative blood loss, and overall complications of PS insertion using traditional freehand, navigated, and robot-assisted methods. METHODS A systematic review was performed of peer-reviewed articles indexed in several databases between January 2000 and August 2021 comparing ≥ 2 PS insertion methods with ≥ 10 screws per treatment arm. Data were extracted for patient outcomes, including PS placement, misplacement, and accuracy; operative time, overall complications, intraoperative blood loss, postoperative hospital length of stay, postoperative Oswestry Disability Index (ODI) score, and postoperative visual analog scale (VAS) score for back pain. Risk of bias was assessed using the Newcastle-Ottawa score and Cochrane tool. A network meta-analysis (NMA) was performed to estimate PS placement accuracy as the primary outcome. RESULTS Overall, 78 studies consisting of 6262 patients and > 31,909 PSs were included. NMA results showed that robot-assisted and 3D-fluoroscopy PS insertion had the greatest accuracy compared with freehand (p < 0.01 and p < 0.001, respectively), CT navigation (p = 0.02 and p = 0.04, respectively), and 2D fluoroscopy (p < 0.01 and p < 0.01, respectively). The surface under the cumulative ranking (SUCRA) curve method further demonstrated that robot-assisted PS insertion accuracy was superior (S = 0.937). Optimal screw placement was greatest in robot-assisted (S = 0.995) placement, and misplacement was greatest with freehand (S = 0.069) approaches. Robot-assisted placement was favorable for minimizing complications (S = 0.876), while freehand placement had greater odds of complication than robot-assisted (OR 2.49, p < 0.01) and CT-navigation (OR 2.15, p = 0.03) placement. CONCLUSIONS The results of this NMA suggest that robot-assisted PS insertion has advantages, including improved accuracy, optimal placement, and minimized surgical complications, compared with other PS insertion methods. Limitations included overgeneralization of categories and time-dependent effects.

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