scholarly journals Chlorhexidine Dressings to Prevent Catheter-Related Bloodstream Infections: A Systematic Literature Review and Meta-analysis

2020 ◽  
Vol 41 (S1) ◽  
pp. s165-s166
Author(s):  
Mireia Puig-Asensio ◽  
Alexandre R. Marra ◽  
Christopher A Childs ◽  
Eli N. Perencevich ◽  
Marin L. Schweizer
Keyword(s):  
Meta Analysis ◽  
Random Effect ◽  
Intervention Group ◽  
Experimental Studies ◽  
Bloodstream Infections ◽  
Cochrane Library ◽  
Control Group ◽  
Quasi Experimental ◽  
Pediatric Populations

Background: Catheter-related bloodstream infections (CRBSIs) are associated with significant morbidity and mortality. We aimed to determine the effectiveness of chlorhexidine (CHG) dressings in preventing incident CRBSI in different settings and types of catheters. Methods: We searched PubMed, Cochrane Library, CINAHL, Embase, and ClinicalTrials.gov through March 2019 for studies with the following inclusion criteria: (1) population consisted of patients requiring short or long-term catheters; (2) CHG dressing was used in the intervention group and a nonantimicrobial impregnated dressing was used in the control group; (3) CRBSI was reported as an outcome. Randomized controlled trials (RCTs) and quasi-experimental studies were included. We used a random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I 2 test and the Cochran Q statistic. Results: The review included 21 studies (17 RCTs). The use of CHG dressings was associated with a lower incidence of CRBSI (pooled RR, 0.63; 95% CI, 0.53–0.76). There was no evidence of publication bias. In stratified analyses, CHG dressing reduced CRBSI in ICU adult patients (9 studies, pRR, 0.52; 95% CI, 0.38–0.72) and adults with oncohematological disease (3 studies, pRR, 0.53; 95% CI, 0.35–0.81) but not in neonates and pediatric populations (6 studies, pRR, 0.90; 95% CI, 0.57–1.40). When stratified by type of catheter, CHG dressing remained protective against CRBSI in short-term venous catheters (11 studies, pRR, 0.65; 95% CI, 0.48–0.88) but not in long-term catheters (3 studies, pRR, 0.76:; 95% CI, 0.19–3.06). Other subgroup analyses are shown in Table 1. Conclusions: CHG dressings reduce the incidence of CRBSI, particularly in adult ICU patients and adults with an onco-hematological disease. Future studies need to evaluate the benefit of CHG in non-ICU settings, in neonates and pediatric populations, and in long-term catheters.Funding: NoneDisclosures: None

Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis

2020 ◽  
Vol 41 (12) ◽  
pp. 1388-1395
Author(s):  
Mireia Puig-Asensio ◽  
Alexandre R. Marra ◽  
Christopher A. Childs ◽  
Mary E. Kukla ◽  
Eli N. Perencevich ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Intervention Group ◽  
Bloodstream Infections ◽  
Control Group ◽  
Exit Site ◽  
Short Term ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Pediatric Populations

AbstractObjective:To evaluate the effectiveness of chlorhexidine (CHG) dressings to prevent catheter-related bloodstream infections (CRBSIs).Design:Systematic review and meta-analysis.Methods:We searched PubMed, CINAHL, EMBASE, and ClinicalTrials.gov for studies (randomized controlled and quasi-experimental trials) with the following criteria: patients with short- or long-term catheters; CHG dressings were used in the intervention group and nonantimicrobial dressings in the control group; CRBSI was an outcome. Random-effects models were used to obtain pooled risk ratios (pRRs). Heterogeneity was evaluated using the I2 test and the Cochran Q statistic.Results:In total, 20 studies (18 randomized controlled trials; 15,590 catheters) without evidence of publication bias and mainly performed in intensive care units (ICUs) were included. CHG dressings significantly reduced CRBSIs (pRR, 0.71; 95% CI, 0.58–0.87), independent of the CHG dressing type used. Benefits were limited to adults with short-term central venous catheters (CVCs), including onco-hematological patients. For long-term CVCs, CHG dressings decreased exit-site/tunnel infections (pRR, 0.37; 95% CI, 0.22–0.64). Contact dermatitis was associated with CHG dressing use (pRR, 5.16; 95% CI, 2.09–12.70); especially in neonates and pediatric populations in whom severe reactions occurred. Also, 2 studies evaluated and did not find CHG-acquired resistance.Conclusions:CHG dressings prevent CRBSIs in adults with short-term CVCs, including patients with an onco-hematological disease. CHG dressings might reduce exit-site and tunnel infections in long-term CVCs. In neonates and pediatric populations, proof of CHG dressing effectiveness is lacking and there is an increased risk of serious adverse events. Future studies should investigate CHG effectiveness in non-ICU settings and monitor for CHG resistance.

scholarly journals EFFECTIVENESS OF INTERVENTIONS IN PATIENTS WITH SPEECH DISORDERS. A META-ANALYSIS OF EXPERIMENTAL STUDIES

2021 ◽  
Vol 20 (2) ◽  
pp. 145-152
Author(s):  
Camelia Daniela Cucu ◽  
◽  
Florinda Golu ◽  
Andreea Raluca Adam ◽  
◽  
...  
Keyword(s):  
Meta Analysis ◽  
Statistical Significance ◽  
Intervention Group ◽  
Experimental Studies ◽  
Speech Disorders ◽  
Cochrane Library ◽  
Control Group ◽  
Wide Range ◽  
Post Test ◽  
The Difference

Objectives. The study aims to conduct a meta-analysis on the existence of solid experimental evidence to highlight the effectiveness of interventions in the improvement of speech disorders in patients who have suffered a stroke. It is desired to identify those moderating variables that can influence the effectiveness of these interventions over time, or that demonstrate the extent to which chronicity of stroke may lead to inferior results in speech improvement. Materials and methods. A search was conducted in three databases: Cochrane Library, Web of Science and PubMed, to identify those studies that meet the criterion for intervention, starting with the first records and until now. The qualitative analysis of the studies was performed using Risk of Bias, and the quantitative analysis through Comprehensive Meta-Analysis. Results. As a result of selection, 31 randomized clinical studies were included in the current research, out of the 1923 existing studies. These have been the subject of investigation on aphasia and dysphagia, with a wide range of types and methods of intervention. The results show that the difference in averages between the intervention group and the post-test control group is a significant one (g = 0.528; 95% CI 0.067; 0.004; p = 0.000), while the moderation analysis did not record a statistical significance. Conclusions. Non-pharmacological interventions based on the recovery of speech disorders as a result of stroke have been shown to be effective in many of the researches in specialized literature. Their results show that, as a result of therapies, patients experience improvements in quality of life, communication and many psychiatric disorders. However, it is not clear how effective these interventions are in recovering or ameliorating speech disorders.

The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis

2021 ◽  
pp. 106002802110098
Author(s):  
Linguang Gan ◽  
Xiaohong Zhao ◽  
Xiangjian Chen
Keyword(s):  
Pediatric Population ◽  
Meta Analysis ◽  
Procedural Sedation ◽  
Cochrane Library ◽  
Control Group ◽  
High Dose ◽  
Efficacy Evaluation ◽  
Safety And Efficacy ◽  
Ovid Medline ◽  
Pediatric Populations

Background: This study systematically evaluated the safety and efficacy of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population as well as whether the results met the information required to draw conclusions. Objective: To evaluate the safety and efficacy evaluation of dexmedetomidine for procedural sedation and postoperative behaviors in a pediatric population. Methods: PubMed, Cochrane library, Web of Science and Ovid MEDLINE were searched to obtain randomized controlled trials (RCTs) comparing dexmedetomidine with control medicine and comparing different doses of dexmedetomidine. Results: There were a total of 16 RCTs for a total of 3240 patients. Dexmedetomidine slowed down the heart rate (HR; mean difference: −13.27; 95% CI: −16.41 to 10.14; P < 0.001) and reduced postoperative delirium (risk ratio [RR]: 0.31; 95% CI: 0.20-0.50; P < 0.001), the number of pain patients (RR: 0.48; 95% CI: 0.30-0.75; P = 0.002), and desaturation (RR: 0.34; 95% CI: 0.13-0.89; P = 0.03) compared with the control group. The limitation was that it was difficult to determine the range of low- and high-dose dexmedetomidine. Conclusion and Relevance: Dexmedetomidine slowed down intraoperative HR within the normal range, which might reduce myocardial oxygen consumption. It reduced postoperative pain and postoperative complications: delirium and desaturation. Dexmedetomidine showed no dose-dependent increase in the procedural sedation time of pediatric patients. Clinically, dexmedetomidine can improve pediatric procedural sedation and postoperative behavior, and it can be considered as a related medicine for safety in pediatric surgery.

scholarly journals Does Coaching, Mentoring, and Supervision Matter for Pre-Service Teachers’ Planning Skills and Clarity of Instruction? A Meta-Analysis of Experimental and Quasi-Experimental Studies

2020 ◽  
Author(s):  
Sog Yee Mok ◽  
Fritz C. Staub
Keyword(s):  
Cognitive Modeling ◽  
Cooperating Teachers ◽  
Meta Analysis ◽  
Lesson Planning ◽  
Experimental Studies ◽  
Control Group ◽  
Control Group Design ◽  
Instructional Skills ◽  
Quasi Experimental ◽  
Significant Moderator

During the practicum, pre-service teachers (PSTs) practice instructional skills such as lesson planning and clarity of instruction. Different approaches to assisting PSTs with coaching, mentoring, or supervision have been developed to improve PSTs’ instructional skills during the practicum. We conducted a meta-analysis based on quasi-experimental and experimental control group design studies. The results showed a small and significant overall effect on instructional skills (d = .41). Cooperating teachers’ or supervisors’ cognitive modeling (i.e., making cognitive processes explicit in demonstrating teaching-related practices) of lesson planning and teaching practices based on the cognitive apprenticeship framework was a significant moderator (d = .89).

scholarly journals The Safety and Efficacy of the Interleukin-1 Antagonist Anakinra in Severe Cases of COVID-19- A Systematic Review and Meta-analysis.

2020 ◽  
Author(s):  
Manoj Kumar Reddy Somagutta ◽  
Maria Kezia Lourdes Pormento ◽  
Pousette Hamid ◽  
Alaa Hamdan ◽  
Muhammad Adnan Khan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Interleukin 1 ◽  
Intervention Group ◽  
Case Series ◽  
Cochrane Library ◽  
Control Group ◽  
Safety And Efficacy ◽  
Liver Transaminases ◽  
The Difference ◽  
Enzyme Elevation

Abstract This study aims to assess anakinra's safety and efficacy for treating severe coronavirus disease in 2019 (COVID-19). PubMed, Google Scholar, Cochrane Library, Embase, Scopus, medRxiv, and bioRxiv were searched. Three retrospective studies and five case series involving 3,274 adult patients with severe COVID-19 were included, 621 treated with anakinra (whether administered alone or in combination with other drugs) and 1,565 in the control group arm. All-cause mortality of severe COVID-19 patients among the anakinra group was 20% (16/81), which was lower than that in the control group (65%; 39/60). The difference was statistically significant [hazard ratio (HR) = 0.13, 95% confidence interval (CI) 0.06–0.29, I2= 0%]. The mechanical ventilation requirement with OR 0.57 (0.11-2.84, I2=87%) was not significantly better compared to the control group. For the safety of anakinra, we evaluated thromboembolism risk and liver enzyme elevation. Thromboembolism risk with OR: 1.48 (0.55- 3.99, I2=0%) and elevation in liver transaminases with OR 0.67 (0.11-3.93, I2=66%) were not statistically significant over the control group. However, these non-significant differences between the anakinra and control groups may have been the result of baseline characteristics of the intervention group, and further studies are essential in evaluating anakinra's safety profile.

Meta-analysis of Perinatal Pelvic Floor Muscle Training on Urinary Incontinence

2020 ◽  
pp. 019394592096077
Author(s):  
Ji Lu ◽  
Hong Zhang ◽  
Li Liu ◽  
Wei Jin ◽  
Jie Gao ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Intervention Group ◽  
Cochrane Library ◽  
Control Group ◽  
Muscle Training

This study was to evaluate the effect of pelvic floor muscle training (PFMT) on urinary incontinence (UI) in prenatal and postnatal women. The relevant literatures were searched from Pubmed, Embase, Cochrane Library, and Web of Science until January 20, 2020. Meta-analysis was performed with STATA 15.1 and the Begg’s test was used for the publication bias. Results of the meta-analysis demonstrated that the rate of UI in the intervention group was lower than that in the control group [relative risk (RR): 0.712, 95%confidence intervals (CI): 0.622–0.816, P<0.001); the strength of pelvic floor muscle in the intervention group was higher than that in the control group [weighted mean difference (WMD): 8.448, 95%CI: 2.300–14.595, P=0.007); and the urine leakage measured by the urinal pad in the intervention group was less than that in the control group (WMD: -1.699, 95%CI:-2.428–-0.970, P<0.001). PFMT showed a better effect for UI than the routine nursing.

scholarly journals Prophylactic donor lymphocyte infusion for relapse prevention: a meta-analysis

2020 ◽  
Vol 50 (6) ◽  
pp. 661-670
Author(s):  
Kittika Poonsombudlert ◽  
Jakrin Kewcharoen ◽  
Chattip Prueksapraopong ◽  
Nath Limpruttidham
Keyword(s):  
Relapse Prevention ◽  
Meta Analysis ◽  
Random Effect ◽  
Donor Lymphocyte Infusion ◽  
Cochrane Library ◽  
Control Group ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Graft Versus Host ◽  
Donor Lymphocytes

Abstract Objective Primary disease relapse (PDR) of malignant hematologic conditions after standard hematopoietic stem cell transplant (HSCT) is one of the most challenging diseases; therefore ongoing researches are aiming at relapse prevention and minimizing the transplant-related side effects. Prophylactic donor lymphocytes (pDLI) had been proposed as a valuable strategy for PDR prevention, but early studies had been discouraging due to the limited benefit and possible association with acute graft-versus-host disease (aGVHD). Therefore, we conducted a meta-analysis to evaluate the association between pDLI use, PDR, aGVHD and OS. Method We performed a comprehensive literature search in MEDLINE, Cochrane library and Embase database from inception to May 2019 for studies that evaluated the association between pDLI and PDR. We conducted a random effect meta-analysis of 9 studies involving a total of 748 participants (pDLI = 398, non-pDLI = 350) and reported the pooled odd ratio (OR) for association of pDLI use, PDR, aGVHD and OS. Result We found a significant decreased odd of PDR in the pDLI group (pooled OR = 0.42, 95% CI 0.30–0.58, I2 = 0%), but there was no significant increased odd of aGVHD (pooled OR of 0.98, 95% CI 0.56–1.72, I2 = 0.8%). We also found that there was an increased odd of overall survival (OS) (pooled OR 3.17, 95% CI 1.85–5.45, I2 = 50.2%). Conclusion There are significantly decreased odd of PDR and increased odd of OS in the pDLI group compared to the control group, but there is no statistically significant increased odd of aGVHD as suggested by previous studies. We concluded that pDLI is a potentially valuable method for post-transplant PDR prevention.

scholarly journals Effects of reflexology on premenstrual syndrome: a systematic review and meta-analysis

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Marzieh Hasanpour ◽  
Mohammad Mehdi Mohammadi ◽  
Habib Shareinia
Keyword(s):  
Systematic Review ◽  
Premenstrual Syndrome ◽  
Treatment Time ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Intervention Group ◽  
Care Program ◽  
Cochrane Library ◽  
Control Group ◽  
The Impact

Abstract Background Premenstrual syndrome (PMS) refers to a set of somatic and psychological symptoms that occur cyclically in the luteal phase of a menstrual cycle. There is no report of final result of reflexology on PMS. Therefore, the present study aimed to determine the effect of reflexology on PMS through a systematic review and meta-analysis study. Method The present study was a systematic review and meta-analysis that was conducted by searching in 8 electronic databases including PubMed, EMBASE, Cochrane Library, Web of Science, ProQuest, Scopus, Google Scholar, and SID until December 28, 2018. In this regard, interventional studies, which examined the impact of reflexology on women with premenstrual syndrome, were included. These studies were published during 1993 to 2018. The Cochrane Collaboration’s Risk of Bias Tool was used to assess the quality of studies. Meta-analysis was performed by the help of CMA 2 software. Results Nine out of 407 studies finally remained after screening, and quantitative and quantitative analyses were performed on them. The total number of research samples was 475. The mean treatment time with reflexology was 40.55 min per session that was performed in 6 to 10 sessions of treatment in 66.67% of studies. According to the meta-analysis and based on the random effects model, the reflexology could decrease the severity of PMS in the intervention group compared to the control group (SMD = − 2.717, 95% CI: − 3.722 to − 1.712). Meta-regression results indicated that the duration of intervention sessions (β = − 0.1124, 95% CI − 0.142 to − 0.084, p < 0.001) had a significant impact on the severity of PMS. Reflexology could also significantly affect somatic (SMD = − 1.142, 95% CI: − 1.481 to − 0.803) and psychological (SMD = − 1.380, 95% CI: − 2.082 to − 0.677) symptoms arising from PMS. Conclusion In general, results of the present study indicated that the reflexology could relieve PMS symptoms, so that overall scores, somatic and psychological symptoms of PMS decreased by applying the reflexology intervention. Furthermore, an increase in the length of reflexology time in each session increased its efficiency. Reflexology can be used as an effective intervention in a patient care program by nurses and its efficiency can be enhanced by increasing intervention time in each reflexology treatment session.

scholarly journals Efficacy and Safety of Immunosuppressive Monotherapy Agents for IgA Nephropathy: A Network Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Shisheng Han ◽  
Tianwen Yao ◽  
Yan Lu ◽  
Min Chen ◽  
Yanqiu Xu ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Clinical Remission ◽  
Meta Analysis ◽  
Immunosuppressive Agents ◽  
Cochrane Library ◽  
Control Group ◽  
Efficacy And Safety ◽  
Long Term Effects

Background: The efficacy and safety of immunosuppressive monotherapy agents were evaluated for immunoglobulin A nephropathy (IgAN) using a network meta-analysis approach.Methods: Randomized controlled trials (RCTs) published prior to October 1, 2019, using immunosuppressive agents for treating IgAN, were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science databases. Relative risks (RRs) or standard mean differences with 95% confidence intervals (CIs) were estimated using the random-effects model. The primary outcomes were clinical remission, end-stage renal disease (ESRD), and serious adverse events (SAEs). The secondary outcomes were urinary protein excretion and serum creatinine.Results: Twenty-five RCTs with 2,005 participants were deemed eligible. Six medications were evaluated: corticosteroids, mycophenolate mofetil (MMF), tacrolimus (TAC), cyclosporine, leflunomide, and hydroxychloroquine (HCQ). Steroids (RR 1.50, 95% CI 1.17–1.93), MMF (RR 2.05, 95% CI 1.15–3.65), TAC (RR 3.67, 95% CI 1.06–12.63), and HCQ (RR 3.25, 95% CI 1.05–10.09) significantly improved clinical remission rates compared to supportive care alone. Only steroids reduced the risk of ESRD (RR 0.35, 95% CI 0.12–0.98); however, there were significantly more SAEs than in the control group (RR 2.90, 95% CI 1.37–6.13). No significantly different effects in serum creatinine levels were found among the therapies. MMF showed no significant improvement in remission when excluding studies with a follow-up of fewer than 2 years in the sensitivity analysis (RR 1.41, 95% CI 0.40–4.92). The effect of TAC in the decrease of proteinuria was reversed after discontinuing medication for 3 months; the long-term effects of HCQ could not be evaluated due to the short follow-up duration.Conclusion: Corticosteroids might induce remission and increase renal survival in IgAN; however, adverse reactions should be taken into consideration. MMF, TAC, and HCQ might improve the remission of proteinuria when treating IgAN, but showed no superiority compared to steroids, and the long-term effects require further study.

scholarly journals A Meta-Analysis of the Efficacy of Panax Ginseng on Menopausal Women’s Sexual Function

2018 ◽  
Vol 7 (1) ◽  
pp. 124-133 ◽  
Author(s):  
Zahra Ghorbani ◽  
Mojgan Mirghafourvand
Keyword(s):  
Sexual Dysfunction ◽  
Adverse Events ◽  
Sexual Function ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Cochrane Library ◽  
Control Group ◽  
Placebo Control ◽  
Significant Difference

Objectives: An increase in life expectancy results in the aging population growth. This study was designed to evaluate the efficacy and adverse events of ginseng that could be used as a herbal medicine in women with sexual dysfunction. Materials and Methods: The authors of this study searched Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases without a time limitation until May 2018 and examined all the randomized clinical trials (RCTs) that compared the effect of different types of ginseng on sexual function of menopausal women as compared to the placebo controls. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. The heterogeneity was determined using the I2 index. In addition, standardized mean difference (SMD) was used instead of mean differences (MD) and a random effect was reported instead of fixed effect in meta-analysis. Results: The eligibility criteria were found in five RCTs. All the included studies were placebo-controlled. Two trials had a parallel design while three studies used a crossover design. Although four trials indicated that ginseng significantly improved sexual function, they didn’t report any treatment effect compared to the placebo group. Based on the results of meta-analysis obtained from five studies including 531 women, there was no statistically significant effect of ginseng on female sexual dysfunction (FSD) compared to the placebo control group (SMD: 0.26; 95% CI: -0.26 to 0.76). Nonetheless, there was a considerable heterogeneity among the studies (I2 = 81%; P < 0.0001). Moreover, all the included studies assessed adverse events, but in three of the RCTs, there was no significant difference between the placebo and ginseng groups. Conclusions: The evidence regarding ginseng as a therapeutic agent for sexual dysfunction is unjustifiable. Rigorous studies seem warranted in this respect.

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