LO20: Naloxone dosing for suspected opioid and ultra-potent opioid overdoses: A systematic review

Introduction: Optimizing naloxone dosing in the context of increasing fentanyl and ultra-potent opioid (UPO) prevalence is an important consideration for emergency health care providers. The goal of this systematic review was to evaluate the association between initial and cumulative naloxone doses on effective reversal and adverse events in undifferentiated and fentanyl/UPO overdoses. Methods: We searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings from July to October 2018 and back to 1972. Our search included pertinent indexing terms for UPOs. We included interventional and observational studies reporting on naloxone administration for opioid toxicity reversal in people ≥12 years old. Additionally, we accessed non-traditional evidence sources (case reports and series) given this rapidly changing field. We conducted inclusion screens, data extraction and quality assessments in duplicate. We summarized study characteristics and where reported, analyzed number of patients with clinical response. Response was defined as not receiving further naloxone doses and remaining alive. Results: We included 174 studies (108 case reports and series, 55 observational, 9 interventional) with 26,660 subjects (median age 35.1; 74.2% male). We observed lower response among patients exposed to fentanyl/UPO versus heroin for initial naloxone doses ≤0.4mg (56.8% versus 80.2%) and > 0.4mg (27.0% versus 82.1%). Mean cumulative doses were higher for fentanyl/UPO (2.10 mg, SD 1.80 mg) versus heroin (1.48 mg, SD 1.68 mg) overdoses. In North American studies the median cumulative dose used was higher for fentanyl/UPO versus heroin overdoses. A dose-response curve for fentanyl/UPO studies showed marked variability in doses among responders, indicating heterogeneity. Adverse events reporting was inconsistent; 10% of subjects experienced withdrawal based on studies in which they were reported. Conclusion: This is the first systematic review to summarize proportion of patients with clinical response by naloxone dose provided. While variable reporting, study quality, heterogeneity, and our outcome definitions limit the conclusions we can draw, it appears that higher initial doses and in some cases, higher cumulative naloxone doses were used and may be necessary to reverse toxicity due to fentanyl/UPO compared to other opioids. High-quality prospective studies assessing effectiveness and safety are needed.

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Liver-related safety assessment of green tea extracts in humans: a systematic review of randomized controlled trials

European Journal of Clinical Nutrition ◽

10.1038/ejcn.2016.78 ◽

2016 ◽

Vol 70 (11) ◽

pp. 1221-1229 ◽

Cited By ~ 22

Author(s):

T Isomura ◽

S Suzuki ◽

H Origasa ◽

A Hosono ◽

M Suzuki ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Randomized Controlled Trials ◽

Green Tea ◽

Case Reports ◽

Intervention Group ◽

Control Group ◽

Controlled Trials ◽

Cochrane Central Register ◽

Randomized Controlled

Abstract There remain liver-related safety concerns, regarding potential hepatotoxicity in humans, induced by green tea intake, despite being supposedly beneficial. Although many randomized controlled trials (RCTs) of green tea extracts have been reported in the literature, the systematic reviews published to date were only based on subjective assessment of case reports. To more objectively examine the liver-related safety of green tea intake, we conducted a systematic review of published RCTs. A systematic literature search was conducted using three databases (PubMed, EMBASE and Cochrane Central Register of Controlled Trials) in December 2013 to identify RCTs of green tea extracts. Data on liver-related adverse events, including laboratory test abnormalities, were abstracted from the identified articles. Methodological quality of RCTs was assessed. After excluding duplicates, 561 titles and abstracts and 119 full-text articles were screened, and finally 34 trials were identified. Of these, liver-related adverse events were reported in four trials; these adverse events involved seven subjects (eight events) in the green tea intervention group and one subject (one event) in the control group. The summary odds ratio, estimated using a meta-analysis method for sparse event data, for intervention compared with placebo was 2.1 (95% confidence interval: 0.5–9.8). The few events reported in both groups were elevations of liver enzymes. Most were mild, and no serious liver-related adverse events were reported. Results of this review, although not conclusive, suggest that liver-related adverse events after intake of green tea extracts are expected to be rare.

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Updating the use of the Madrid Sonographic Enthesis Index (MASEI): a systematic review of the literature

Rheumatology ◽

10.1093/rheumatology/kez356 ◽

2019 ◽

Vol 59 (5) ◽

pp. 1031-1040 ◽

Cited By ~ 3

Author(s):

Cristina Macía-Villa ◽

Eugenio De Miguel

Keyword(s):

Systematic Review ◽

Psoriatic Arthritis ◽

Data Extraction ◽

Cochrane Central Register ◽

X Rays ◽

Review Of The Literature ◽

Central Register ◽

Study Characteristics ◽

Mediterranean Fever ◽

Ultrasound Score

Abstract Objective To perform a systematic review of the literature to evaluate the use of the enthesis ultrasound Madrid Sonographic Entesis Index (MASEI) from its publication. Methods A systematic search of MEDLINE, EMBASE, and Cochrane Central Register databases was performed. The search strategy was constructed to identify publications containing terms related to enthesis and ultrasound. The only applied filter was studies conducted in humans. One reviewer systematically screened the search. A second reviewer verified the selection. The data extraction was focused on study characteristics, including population and components of the OMERACT filter. Results Sixty-eight of the 1581 identified studies had used MASEI, including 41 (60%) abstracts and 27 (40%) articles. Of the 27 articles, MASEI was mainly used for spondyloarthritis and related diseases in 12 (44%) articles, followed by both psoriatic arthritis and rheumatoid arthritis in five (19%) articles; however, it was also used in diseases such as Behçet disease, FM, familiar Mediterranean fever, SS, crystal arthropathies and systemic sclerosis. The feasibility of MASEI was reported in three (11%) articles, and the reliability in 12 (44%) with good to excellent values. No article evaluated the responsiveness to treatment. The construct validity of MASEI was assessed using biomarkers in seven (26%) articles, clinical examination in 13 (48%) and imaging procedures (only X-rays) in two (7%). The discriminative validity was assessed in 16 (59%) articles, not only in SpAs. Conclusion MASEI is a feasible, reliable and valid ultrasound score for the study of enthesis in spondyloarthritis, psoriatic arthritis and other diseases.

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Blinding Measured: A Systematic Review of Randomized Controlled Trials of Acupuncture

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/708251 ◽

2013 ◽

Vol 2013 ◽

pp. 1-12 ◽

Cited By ~ 27

Author(s):

Alex Moroz ◽

Brian Freed ◽

Laura Tiedemann ◽

Heejung Bang ◽

Melanie Howell ◽

...

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Quantitative Measure ◽

Data Synthesis ◽

Study Selection ◽

Potential Association ◽

Number Of Patients ◽

Study Characteristics ◽

The Subject ◽

Study Participants

Background.There is no agreement among researchers on viable controls for acupuncture treatment, and the assessment of the effectiveness of blinding and its interpretation is rare.Purpose.To systematically assess the effectiveness of blinding (EOB) in reported acupuncture trials; to explore results of RCTs using a quantitative measure of EOB.Data Sources.A systematic review of published sham RCTs that assessed blinding.Study Selection.Five hundred and ninety studies were reviewed, and 54 studies (4783 subjects) were included.Data Extraction.The number of patients who guessed their treatment identity was extracted from each study. Variables with possible influence on blinding were identified.Data Synthesis.The blinding index was calculated for each study. Based on blinding indexes, studies were congregated into one of the nine blinding scenarios. Individual study characteristics were explored for potential association with EOB.Limitations.There is a possibility of publication or reporting bias.Conclusions.The most common scenario was that the subjects believed they received verum acupuncture regardless of the actual treatment received, and overall the subject blinding in the acupuncture studies was satisfactory, with 61% of study participants maintaining ideal blinding. Objectively calculated blinding data may offer meaningful and systematic ways to further interpret the findings of RCTs.

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Integration of physical activity in reablement for community dwelling older adults: a systematic scoping review

10.21203/rs.2.17945/v1 ◽

2019 ◽

Author(s):

Hanne Leirbekk Mjøsund ◽

Cathrine Fredriksen Moe ◽

Elissa Burton ◽

Lisbeth Uhrenfeldt

Keyword(s):

Physical Activity ◽

Older Adults ◽

Health Care Providers ◽

Data Extraction ◽

Community Dwelling ◽

Cochrane Central Register ◽

Care Providers ◽

Limited Evidence ◽

Individual Needs ◽

Community Dwelling Older Adults

Abstract Introduction: Reablement is a rehabilitative intervention provided to homecare receivers (mostly older adults) with the aim of improving function and independence. There is limited evidence of the effectiveness of reablement and the content of these interventions is variable. Physical activity (PA) is known to be important for improving and maintaining function among older adults, but it is unclear how PA is integrated in reablement.Objective: To map existing evidence of how PA strategies are integrated and explored in studies of reablement for community dwelling older adults and to identify knowledge gaps.Methods: An apriori protocol was published. Studies investigating or exploring time-limited (within 6 months), interdisciplinary reablement for community-dwelling older adults, published in English, Norwegian, Danish, Swedish and German were considered for inclusion. PubMed, Cochrane central register of controlled trials, Embase, PsycINFO, AMED, PEDro, CINAHL and Google Scholar were searched for studies published between 1996 and July 2019, in addition to reference and citation searches. Study selection and data extraction were made independently by two reviewers.Results: Forty-three studies were included. Exercise strategies and practice of daily activities were reported to be included in the majority of intervention studies, but in most cases, no information was provided about the degree or intensity of which PA was involved, or how PA interventions were targeted to individual needs. Interventions aiming to increase general PA levels or reduce sedentary behavior were rarely described. None of the studies explored older adults’, health care providers’ or family members’ experiences with PA in a reablement setting, but some of the studies touched upon themes related to PA experiences. Some studies reported outcomes of physical fitness, including mobility, strength and balance, but there was insufficient evidence for any synthesis of these results. None of the studies reported PA levels among older adults receiving reablement.Conclusion: There is limited evidence regarding how PA is integrated in reablement, including how PA strategies are targeted to older adults’ individual needs and preferences in a reablement setting. The feasibility, and effectiveness of PA interventions, as well as experiences or barriers related to PA in a reablement setting should be further investigated.

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Using a 3D printer in cardiac valve surgery: a systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.6.818 ◽

2019 ◽

Vol 65 (6) ◽

pp. 818-824

Author(s):

Liliana Fortini Cavalheiro Boll ◽

Guilherme Oberto Rodrigues ◽

Clarissa Garcia Rodrigues ◽

Felipe Luiz Bertollo ◽

Maria Claudia Irigoyen ◽

...

Keyword(s):

Systematic Review ◽

Heart Valve ◽

Case Reports ◽

Data Extraction ◽

Case Series ◽

Valve Surgery ◽

Heart Valve Prosthesis ◽

3D Printer ◽

Valve Prosthesis ◽

Number Of Patients

SUMMARY BACKGROUND: The use of the 3D printer in complex cardiac surgery planning. OBJECTIVES: To analyze the use and benefits of 3D printing in heart valve surgery through a systematic review of the literature. METHODS: This systematic review was reported following the Preferred Reporting Items for Systematic Review and registered in the Prospero (International Prospective Register of Systematic Reviews) database under the number CRD42017059034. We used the following databases: PubMed, EMBASE, Scopus, Web of Science and Lilacs. We included articles about the keywords “Heart Valves”, “Heart Valve Prosthesis Implantation”, “Heart Valve Prosthesis”, “Printing, Three-Dimensional”, and related entry terms. Two reviewers independently conducted data extraction and a third reviewer solved disagreements. All tables used for data extraction are available at a separate website. We used the Cochrane Collaboration tool to assess the risk of bias of the studies included. RESULTS: We identified 301 articles and 13 case reports and case series that met the inclusion criteria. Our studies included 34 patients aged from 3 months to 94 years. CONCLUSIONS: Up to the present time, there are no studies including a considerable number of patients. A 3D-printed model produced based on the patient enables the surgeon to plan the surgical procedure and choose the best material, size, format, and thickness to be used. This planning leads to reduced surgery time, exposure, and consequently, lower risk of infection.

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Impact of Pharmacist Interventions in Patients with Dyslipidemia: A Systematic Review

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.3821/1913-701x-142.5.247 ◽

2009 ◽

Vol 142 (5) ◽

pp. 247-247 ◽

Cited By ~ 1

Author(s):

Theresa L. Charrois ◽

Monica Zolezzi ◽

Sheri Koshman ◽

Glen Pearson ◽

Mark Makowsky ◽

...

Keyword(s):

Health Care ◽

Total Cholesterol ◽

Health Care Providers ◽

Citation Index ◽

Data Extraction ◽

Risk Of Bias ◽

Cochrane Central Register ◽

Care Providers ◽

Pharmacist Interventions ◽

Lipid Panel

Purpose: To determine the effect of pharmacistled interventions in dyslipidemia on clinical and process outcomes. Methods: Search: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, HealthSTAR, Pascal, MEDLINE In-Process & Other Non-Indexed Citations, CINAHL Plus with Full Text, Health-Source: Nursing Edition, Academic Search Complete, BIOSIS Previews, Science Citation Index Expanded and Social Sciences Citation Index were searched from their inception to September 2008. Where possible an RCT filter was used. Article screening and selection: Inclusion criteria were: 1) RCTs and 2) pharmacist-provided pharmaceutical care, either independently or as part of a health care team or a collaborative agreement (team-directed) with other health care providers. There were no restrictions on language, sample size, study duration or practice setting. Quality assessment: Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and studies were judged as low, high or unclear risk of bias. Data Extraction: Data extraction was performed by 2 independent reviewers using a standardized data collection form. Outcomes: The primary outcome was absolute reduction in LDL cholesterol. Secondary outcomes included proportion of patients at target, initiation/modification of lipid therapy, compliance with lipid therapy, health-related quality of life and patient satisfaction. Data Analysis: Data were analyzed using a random effects model with analysis based on the Der-Simonian-Laird method. Calculations included odds ratio for dichotomous data and weighted mean difference (WMD) or standardized mean differences for continuous data. Subgroup analyses or meta-regression were conducted to investigate possible sources of heterogeneity. An indirect comparison of pharmacist-directed versus pharmacist collaborative care interventions was done. Sensitivity analysis was performed based on risk of bias. Results: A total of 8422 articles were retrieved from the search. From these, 114 articles were selected for full review, and 12 articles were included. The overall difference in LDL ( n = 543 patients) was not statistically significant (WMD −0.09 mmol/L, 95% CI −0.23, 0.04). The difference in total cholesterol was statistically significant (WMD −0.16, 95% CI −0.30, −0.02). Patients followed by a pharmacist were 3 times more likely to be at target (OR 2.9, 95% CI 1.1–7.5) and 2 times more likely to have their cholesterol measured (OR 2.4, 95% CI 1.6–3.6). Conclusions: Pharmacist interventions in a variety of settings have an impact on the lowering of total cholesterol. Patients receiving interventions that included pharmacist care were more likely to be at target and have their lipid panel measured. The types of interventions provided by pharmacists vary in terms of setting and components.

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Statin-Associated Adverse Events

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s18865 ◽

2015 ◽

Vol 7 ◽

pp. CMT.S18865

Author(s):

Wei Cheng Yuet ◽

Htet Khine ◽

Zahid Ahmad

Keyword(s):

Cognitive Impairment ◽

Adverse Effects ◽

Adverse Events ◽

Health Care Providers ◽

Hemorrhagic Stroke ◽

Case Reports ◽

The United States ◽

Incident Diabetes ◽

Care Providers ◽

United States Food

Although statins are well tolerated, their widespread use has raised awareness of rare adverse events. For example, the United States Food and Drug Administration (FDA) has issued product label warnings about statin-associated myopathy, incident diabetes, and cognitive impairment. Additional statin-associated adverse effects include proteinuria, transaminitis, and hemorrhagic stroke. The underlying pathophysiology of these adverse events remains unclear, and thus little guidance exists on addressing these issues at the bedside. Although statin-associated myopathy is common, many patients eventually tolerate a statin – albeit at less than ideal doses. Incident diabetes remains difficult to predict, but high statin potency, increasing age, and preexisting diabetes risk factors may predispose patients. Cognitive impairment – described mostly in case reports – may resolve after discontinuation of the offending statin. Rosuvastatin is linked to dose-dependent proteinuria. Elevated transaminases are reversible and unlikely to cause severe consequences. History of cerebrovascular disease increases the risk of hemorrhagic stroke on statin therapy. Overall, a thorough understanding of statin-associated adverse events will help health care providers manage patients who develop these complications. Here, we review the evidence for several statin-associated adverse effects and the implications for clinical practice.

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Does arts engagement and cultural participation impact depression outcomes in adults: a narrative descriptive systematic review of observational studies

Journal of Public Mental Health ◽

10.1108/jpmh-06-2020-0060 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Esme Elsden ◽

Brenda Roe

Keyword(s):

Mental Health ◽

Systematic Review ◽

Health Care Providers ◽

Data Extraction ◽

Mental Health Disorder ◽

Care Providers ◽

Cultural Participation ◽

Content Type ◽

Cultural Engagement ◽

Arts Engagement

Purpose The purpose of this study is to explore whether engaging with arts and culture affect depression in adults. This is because depression is the most common mental health disorder. Diversification of mental health services, initiatives in arts in health and social prescribing are providing emerging evidence of benefits relating to depression outcomes. Design/methodology/approach A systematic review design adhering to the preferred reporting items for systematic reviews and meta-analyses reporting guidelines. MEDLINE®, Embase and American psychology association PsycINFO were searched and six studies were deemed eligible. Data extraction and quality appraisal enabled a narrative descriptive summary comparing study design, characteristics, populations and key results relating arts and cultural engagement to depression outcomes. Findings The total number of participants across the studies were 49,197. Three studies reported mean age, 58.78 years (15–99 years). Gender reported by five studies was 52.4% (n = 24,689) female and 47.6% (n = 22,439) male. Five studies found that engaging with arts decreased your odds of having depression. Originality/value This systematic review found emerging evidence that arts and cultural engagement benefits a wider population by reducing depression incidence. Establishing and understanding the association between arts engagement and decreasing depression incidence in a population is relevant to health-care providers, the general population and policymakers alike.

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Assessment of the Possibility of Vertical Transmission of COVID-19: A Systematic Review and Meta-analysis Protocol

Journal of Research and Health ◽

10.32598/jrh.11.2.72.3 ◽

2021 ◽

Vol 11 (2) ◽

pp. 71-76

Author(s):

Sareh Dashti ◽

◽

Tahereh Fathi Najafi ◽

Hamid Reza Tohidinik ◽

Narjes Bahri ◽

...

Keyword(s):

Systematic Review ◽

Vertical Transmission ◽

Health Care Providers ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Bibliographic Databases ◽

Care Providers ◽

Case Control Studies ◽

Cross Sectional

Background: The Coronavirus disease 2019 (COVID-19) outbreak has put a great burden on global health and healthcare systems. There is controversy regarding the possibility of vertical transmission of COVID-19. This proposed systematic review will be done to assess the possibility of vertical transmission of COVID-19 based on currently published literature. Methods: In this study, all published observational studies, including cross-sectional, cohort, and case-control studies, as well as case reports and case series, in peer-reviewed journals in any language until the end of July 2020 will be assessed. Editorials, commentaries, and letters to editors will be excluded from the review. Searching will be conducted using international bibliographic databases, including PubMed, Embase, and Web of Science based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. The search strategy will be improved and finalized based on the results of the primary search. Data extraction of the included articles will be performed by two researchers using the Zotero and review manager (revMan) software. The heterogeneity of the articles will be assessed using DerSimonian & Laird Q test and I2 statistic. The pooled estimated prevalence of vertical transmission of COVID-19 will be performed using the Metaprop command. Publication bias will be assessed using Begg’s rank correlation and the Egger weighted regression methods Results: Based on the reviewers comments the results section was deleted because this manuscript was a systematic review protocol. Conclusion: The findings of this study will help practitioners and health care providers in decision-making for the care and management of COVID-19-infected pregnant women.

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Risk of colectomy after conservative treatment of diverticulitis of the left hemicolon complicated by abdominal or pelvic abscess: protocol of a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-042350 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042350

Author(s):

Maximilian Sohn ◽

Ayman Agha ◽

Igors Iesalnieks ◽

Anna Tiefes ◽

Alfred Hochrein ◽

...

Keyword(s):

Systematic Review ◽

Emergency Surgery ◽

Case Reports ◽

Acute Diverticulitis ◽

Meta Analysis ◽

Case Series ◽

Pelvic Abscess ◽

Risk Of Bias ◽

Cochrane Central Register ◽

Review Manager

IntroductionAcute diverticulitis of the sigmoid colon is increasingly treated by a non-operative approach. The need for colectomy after recovery from a flare of acute diverticulitis of the left colon, complicated diverticular abscess is still controversial. The primary aim of this study is to assess the risk of interval emergency surgery by systematic review and meta-analysis.Methods and analysisThe systematic review and meta-analysis will be conducted in accordance to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE will be screened for the predefined searching term: (Diverticulitis OR Diverticulum) AND (Abscess OR pelvic abscess OR pericolic abscess OR intraabdominal abscess) AND (surgery OR operation OR sigmoidectomy OR drainage OR percutaneous drainage OR conservative therapy OR watchful waiting). All studies published in an English or German-speaking peer-reviewed journal will be suitable for this analysis. Case reports, case series of less than five patients, studies without follow-up information, systematic and non-systematic reviews and meta-analyses will be excluded. Primary endpoint is the rate of interval emergency surgery. Using the Review Manager Software (Review Manager/RevMan, V.5.3, Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2012) meta-analysis will be pooled using the Mantel-Haenszel method for random effects. The Risk of Bias in Non-randomized Studies of Interventions tool will be used to assess methodological quality of non-randomised studies. Risk of bias in randomised studies will be assessed using the Cochrane developed RoB 2-tool.Ethics and disseminationAs no new data are being collected, ethical approval is exempt for this study. This systematic review is to provide a new insight on the need for surgical treatment after a first attack of acute diverticulitis, complicated by intra-abdominal or pelvic abscesses. The results of this study will be presented at national and international meetings and published in a peer-reviewed journal.PROSPERO registration numberCRD42020164813.

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