PP66 Hospital Cleaning: Detergent Or Disinfectant-Detergent? A Rapid Review

2018 ◽  
Vol 34 (S1) ◽  
pp. 92-93
Author(s):  
Kathleen Harkin ◽  
Anne Dee
Keyword(s):  
Systematic Reviews ◽  
Adverse Outcomes ◽  
Controlled Vocabulary ◽  
Rapid Review ◽  
Cochrane Library ◽  
Microbial Resistance ◽  
Low Level ◽  
Healthcare Environment ◽  
Environmental Surfaces ◽  
Routine Cleaning

Introduction:Healthcare-associated infections (HAIs) are an important, potentially preventable reason to maintain a clean healthcare environment. However, guidelines from Europe and North America do not concur—European guidelines recommend using neutral detergent (followed by chlorine-based disinfection (CBD) if required), whilst North American guidelines recommend using detergent or hospital-grade disinfectant-detergents for routine cleaning or decontamination of noncritical healthcare environmental surfaces. The objective of this study was to compare the effectiveness on rates of HAIs of: (i) disinfectant-detergents versus detergents; and (ii) the active ingredient of many disinfectant-detergents—quaternary ammonium compounds (QAC)—versus CBD.Methods:A rapid review of systematic reviews was conducted using the following search terms: keywords and controlled vocabulary terms for the concepts of “healthcare environmental surfaces” AND (“QAC-based disinfectants” OR “disinfectant-detergents” OR “decontamination”) AND (“environmental contamination” OR “colonization” OR “HAIs”). The search filters included systematic reviews, guidelines, and technology reports. The following databases were searched: The Cochrane Library; PubMed; and health technology assessment and guideline websites for gray literature. Systematic reviews of studies comparing the effects of disinfectant-detergents with detergent, or comparing QAC with CBD, on rates of HAIs in the healthcare environment were included. Reviews on the cleaning or disinfection of body surfaces or disinfection of invasive medical devices were excluded. Quality assessment was not conducted. Data extraction was performed using a pro forma.Results:The literature search resulted in 356 titles. From ninety-four potentially relevant abstracts, fifty-seven full-texts were evaluated: fifty-one were excluded (eight non-English) and six were included. All review authors cautioned that the evidence was low level, methodologically poor, subject to confounding, and didn't address adverse outcomes. The reviews identified eight relevant primary studies, three of which compared disinfectant-detergents with detergent and found no difference in rates of HAI. Five studies compared QAC with CBD. All five demonstrated that CBD was superior to QAC and reduced Clostridium difficile infection rates in outbreak contexts. Furthermore, QAC may induce sporulation and microbial resistance.Conclusions:Low-level evidence suggested that: there is no advantage in using disinfectant-detergents for routine cleaning of noncritical surfaces; CBD is superior to QAC-based disinfection in reducing clostridial infections; and QAC agents may induce sporulation or microbial resistance.

scholarly journals Pharmacological treatment of hyperactive delirium in people with COVID-19: rethinking conventional approaches

2020 ◽  
Vol 10 ◽  
pp. 204512532094270
Author(s):  
Giovanni Ostuzzi ◽  
Chiara Gastaldon ◽  
Davide Papola ◽  
Andrea Fagiolini ◽  
Serdar Dursun ◽  
...  
Keyword(s):  
Intensive Care ◽  
Drug Interactions ◽  
Systematic Reviews ◽  
Pharmacological Treatment ◽  
Medical Condition ◽  
Regulatory Elements ◽  
Rapid Review ◽  
Cochrane Library ◽  
Future Research ◽  
Acute Psychosis

People with coronavirus disease (COVID-19) might have several risk factors for delirium, which could in turn notably worsen the prognosis. Although pharmacological approaches for delirium are debated, haloperidol and other first-generation antipsychotics are frequently employed, particularly for hyperactive presentations. However, the use of these conventional treatments could be limited in people with COVID-19, due to the underlying medical condition and the risk of drug–drug interactions with anti-COVID treatments. On these premises, we carried out a rapid review in order to identify possible alternative medications for this particular population. By searching PubMed and the Cochrane Library, we selected the most updated systematic reviews of randomised trials on the pharmacological treatment of delirium in both intensive and non-intensive care settings, and on the treatment of agitation related to acute psychosis or dementia. We identified medications performing significantly better than placebo or haloperidol as the reference treatment in each population considered, and assessed the strength of association according to validated criteria. In addition, we collected data on other relevant clinical elements (i.e. common adverse events, drug-drug interactions with COVID-19 medications, daily doses) and regulatory elements (i.e. therapeutic indications, contra-indications, available formulations). A total of 10 systematic reviews were included. Overall, relatively few medications showed benefits over placebo in the four selected populations. As compared with placebo, significant benefits emerged for quetiapine and dexmedetomidine in intensive care unit (ICU) settings, and for none of the medications in non-ICU settings. Considering also data from indirect populations (agitation related to acute psychosis or dementia), aripiprazole, quetiapine and risperidone showed a potential benefit in two or three different populations. Despite limitations related to the rapid review methodology and the use of data from indirect populations, the evidence retrieved can pragmatically support treatment choices of frontline practitioners involved in the COVID-19 outbreak, and indicate future research directions for the treatment of delirium in particularly vulnerable populations.

scholarly journals Improving palliative care with machine learning and routine data: a rapid review

2019 ◽  
Vol 2 ◽  
pp. 13 ◽  
Author(s):  
Virginia Storick ◽  
Aoife O’Herlihy ◽  
Sarah Abdelhafeez ◽  
Rakesh Ahmed ◽  
Peter May
Keyword(s):  
Machine Learning ◽  
Palliative Care ◽  
Full Text ◽  
Clinical Decision Making ◽  
Grey Literature ◽  
Routine Data ◽  
Adverse Outcomes ◽  
Rapid Review ◽  
Current Evidence ◽  
Cochrane Library

Introduction: Improving palliative care is a priority worldwide as this population experiences poor outcomes and accounts disproportionately for costs. In clinical practice, physician judgement is the core method of identifying palliative care needs but has important limitations. Machine learning (ML) is a subset of artificial intelligence advancing capacity to identify patterns and make predictions using large datasets.  ML has the potential to improve clinical decision-making and policy design, but there has been no systematic assembly of current evidence. Methods: We conducted a rapid review, searching systematically seven databases from inception to December 31st, 2018: EMBASE, MEDLINE, Cochrane Library, PsycINFO, WOS, SCOPUS and ECONLIT.  We included peer-reviewed studies that used ML approaches on routine data to improve palliative care for adults.  Our specified outcomes were survival, quality of life (QoL), place of death, costs, and receipt of high-intensity treatment near end of life.  We did not search grey literature. Results: The database search identified 426 citations. We discarded 162 duplicates and screened 264 unique title/abstracts, of which 22 were forwarded for full text review.  Three papers were included, 18 papers were excluded and one full text was sought but unobtainable.  One paper predicted six-month mortality, one paper predicted 12-month mortality and one paper cross-referenced predicted 12-month mortality with healthcare spending.  ML-informed models outperformed logistic regression in predicting mortality where data inputs were relatively strong, but those using only basic administrative data had limited benefit from ML.  Identifying poor prognosis does not appear effective in tackling high costs associated with serious illness.  Conclusion: While ML can in principle help to identify those at risk of adverse outcomes and inappropriate treatment, applications to policy and practice are formative.  Future research must not only expand scope to other outcomes and longer timeframes, but also engage with individual preferences and ethical challenges.

scholarly journals Characteristics, quality and volume of the first 5 months of the COVID-19 evidence synthesis infodemic: a meta-research study

2021 ◽  
pp. bmjebm-2021-111710
Author(s):  
Rebecca Abbott ◽  
Alison Bethel ◽  
Morwenna Rogers ◽  
Rebecca Whear ◽  
Noreen Orr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Evidence Synthesis ◽  
Rapid Review ◽  
Cochrane Library ◽  
Measurement Tool ◽  
Qualitative Evidence Synthesis ◽  
High Quality ◽  
Definition Of

ObjectiveThe academic and scientific community has reacted at pace to gather evidence to help and inform about COVID-19. Concerns have been raised about the quality of this evidence. The aim of this review was to map the nature, scope and quality of evidence syntheses on COVID-19 and to explore the relationship between review quality and the extent of researcher, policy and media interest.Design and settingA meta-research: systematic review of reviews.Information sourcesPubMed, Epistemonikos COVID-19 evidence, the Cochrane Library of Systematic Reviews, the Cochrane COVID-19 Study Register, EMBASE, CINAHL, Web of Science Core Collection and the WHO COVID-19 database, searched between 10 June 2020 and 15 June 2020.Eligibility criteriaAny peer-reviewed article reported as a systematic review, rapid review, overview, meta-analysis or qualitative evidence synthesis in the title or abstract addressing a research question relating to COVID-19. Articles described as meta-analyses but not undertaken as part of a systematic or rapid review were excluded.Study selection and data extractionAbstract and full text screening were undertaken by two independent reviewers. Descriptive information on review type, purpose, population, size, citation and attention metrics were extracted along with whether the review met the definition of a systematic review according to six key methodological criteria. For those meeting all criteria, additional data on methods and publication metrics were extracted.Risk of biasFor articles meeting all six criteria required to meet the definition of a systematic review, AMSTAR-2 ((A MeaSurement Tool to Assess systematic Reviews, version 2.0) was used to assess the quality of the reported methods.Results2334 articles were screened, resulting in 280 reviews being included: 232 systematic reviews, 46 rapid reviews and 2 overviews. Less than half reported undertaking critical appraisal and a third had no reproducible search strategy. There was considerable overlap in topics, with discordant findings. Eighty-eight of the 280 reviews met all six systematic review criteria. Of these, just 3 were rated as of moderate or high quality on AMSTAR-2, with the majority having critical flaws: only a third reported registering a protocol, and less than one in five searched named COVID-19 databases. Review conduct and publication were rapid, with 52 of the 88 systematic reviews reported as being conducted within 3 weeks, and a half published within 3 weeks of submission. Researcher and media interest, as measured by altmetrics and citations, was high, and was not correlated with quality.DiscussionThis meta-research of early published COVID-19 evidence syntheses found low-quality reviews being published at pace, often with short publication turnarounds. Despite being of low quality and many lacking robust methods, the reviews received substantial attention across both academic and public platforms, and the attention was not related to the quality of review methods.InterpretationFlaws in systematic review methods limit the validity of a review and the generalisability of its findings. Yet, by being reported as ‘systematic reviews’, many readers may well regard them as high-quality evidence, irrespective of the actual methods undertaken. The challenge especially in times such as this pandemic is to provide indications of trustworthiness in evidence that is available in ‘real time’.PROSPERO registration numberCRD42020188822.

scholarly journals Labor Admission Test

2011 ◽  
Vol 2 (3) ◽  
pp. 89-95 ◽  
Author(s):  
Sabaratnam Arulkumaran ◽  
Vikram Sinai Talaulikar
Keyword(s):  
Systematic Reviews ◽  
Well Being ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Cochrane Library ◽  
Amniotic Fluid Index ◽  
Uterine Contractions ◽  
Active Labor ◽  
Admission Test ◽  
Adequate Sample Size

ABSTRACT Labor admission test (LAT) is performed at the onset of labor to establish fetal well-being in low-risk pregnancies and identify those fetuses who either may be hypoxic, needing delivery or at risk of developing hypoxia during labor so that additional measures of fetal surveillance can be instituted to prevent adverse outcomes. We searched the literature in Medline, Cochrane Library and PubMed using the words— cardiotocograph, cardiotocogram, nonstress test, vibroacoustic stimulus (VAS), amniotic fluid index (AFI), Doppler, labor admission test, labor admission cardiotocography (CTG) and reviewed four randomized controlled trials (RCTs) and three systematic reviews to summarize the current evidence regarding use of LAT. Although the existing RCTs and systematic reviews do not favor admission testing, we have critically reviewed the methodology used in some of these major studies. There is a need for robust RCTs with adequate sample size to evaluate the effectiveness of LAT. In clinical practice, while a normal admission CTG reassures the mother and the clinician about the health of the baby, an admission CTG with nonreassuring FHR pattern leads to careful review which may reveal a growth restricted or compromised fetus before onset of active labor when the risk of fetal hypoxia is higher with increasing frequency and duration of uterine contractions. Like in other obstetric interventions, the woman should be offered the choice of LAT after providing appropriate information and her informed decision should be respected.

Liraglutide for the Treatment of Obesity: Analyzing Published Reviews

2019 ◽  
Vol 25 (15) ◽  
pp. 1783-1790 ◽  
Author(s):  
Rosario Pastor ◽  
Josep A. Tur
Keyword(s):  
Weight Loss ◽  
Clinical Trials ◽  
Systematic Reviews ◽  
Randomized Clinical Trials ◽  
Statistical Tests ◽  
Overweight And Obesity ◽  
Cochrane Library ◽  
Medical Subject Headings ◽  
Mesh Terms ◽  
Treatment Of Obesity

Background: Several drugs have been currently approved for the treatment of obesity. The pharmacokinetic of liraglutide, as well as the treatment of type 2 diabetes mellitus, have been widely described. Objective: To analyze the published systematic reviews on the use of liraglutide for the treatment of obesity. Methods: Systematic reviews were found out through MEDLINE searches, through EBSCO host and the Cochrane Library based on the following terms: "liraglutide" as major term and using the following Medical Subject Headings (MesH) terms: "obesity", "overweight", "weight loss". A total of 3 systematic reviews were finally included to be analyzed. Results: From the three systematic reviews selected, only two included the randomized clinical trials, while the third study reviewed both randomized and non-randomized clinical trials. Only one review performed statistical tests of heterogeneity and a meta-analysis, combining the results of individual studies. Another review showed the results of individual studies with odds ratio and confidence interval, but a second one just showed the means and confidence intervals. In all studies, weight loss was registered in persons treated with liraglutide in a dose dependent form, reaching a plateau at 3.0 mg dose, which was reached just in men. Most usual adverse events were gastrointestinal. Conclusion: More powerful and prospective studies are needed to assess all aspects related to liraglutide in the overweight and obesity treatment.

scholarly journals Appraisal of systematic reviews on interventions for postpartum depression: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryan Chow ◽  
Eileen Huang ◽  
Allen Li ◽  
Sophie Li ◽  
Sarah Y. Fu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postpartum Depression ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
A Priori ◽  
Behavioural Therapy ◽  
Therapeutic Interventions ◽  
Current Evidence ◽  
Cochrane Library ◽  
Measurement Tool

Abstract Background Postpartum depression (PPD) is a highly prevalent mental health problem that affects parental health with implications for child health in infancy, childhood, adolescence and beyond. The primary aim of this study was to critically appraise available systematic reviews describing interventions for PPD. The secondary aim was to evaluate the methodological quality of the included systematic reviews and their conclusions. Methods An electronic database search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted to identify systematic reviews that examined an intervention for PPD. A Measurement Tool to Assess Systematic Reviews was utilized to independently score each included systematic review which was then critically appraised to better define the most effective therapeutic options for PPD. Results Of the 842 studies identified, 83 met the a priori criteria for inclusion. Based on the systematic reviews with the highest methodological quality, we found that use of antidepressants and telemedicine were the most effective treatments for PPD. Symptoms of PPD were also improved by traditional herbal medicine and aromatherapy. Current evidence for physical exercise and cognitive behavioural therapy in treating PPD remains equivocal. A significant, but weak relationship between AMSTAR score and journal impact factor was observed (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43) whilst no relationship was found between the number of total citations (p = 0.27, r = 0.12; 95% CI, − 0.09 to 0.34), or source of funding (p = 0.19). Conclusion Overall the systematic reviews on interventions for PPD are of low-moderate quality and are not improving over time. Antidepressants and telemedicine were the most effective therapeutic interventions for PPD treatment.

scholarly journals Letter to the editor. Healthcare workers on the edge of sanity due to COVID-19: Rapid review of the results of systematic reviews and meta-analyzes

2021 ◽  
Vol 83 ◽  
pp. 21-24
Author(s):  
Ivan Lozada-Martínez ◽  
Maria Bolaño-Romero ◽  
Luis Moscote-Salazar ◽  
Daniela Torres-Llinas ◽  
Amit Agrawal
Keyword(s):  
Systematic Reviews ◽  
Healthcare Workers ◽  
Rapid Review ◽  
Letter To The Editor

scholarly journals Efficacy and safety of aliskiren combination therapy: a protocol for an umbrella review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043807
Author(s):  
Jiantong Shen ◽  
Wenming Feng ◽  
Yike Wang ◽  
Qiyuan Zhao ◽  
Billong Laura Flavorta ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Systematic Reviews ◽  
Cochrane Library ◽  
Umbrella Review ◽  
Quality Of Reporting ◽  
Ethical Approval ◽  
Registration Number ◽  
Third Person ◽  
Meta Analyses ◽  
The Impact

IntroductionEfficacy of aliskiren combination therapy with other antihypertensive has been evaluated in the treatment of patients with hypertension in recent systematic reviews. However, most previous reviews only focused on one single health outcome or one setting, none of them made a full summary that assessed the impact of aliskiren combination treatment comprehensively. As such, this umbrella review based on systematic reviews and meta-analyses is aimed to synthesise the evidences on efficacy, safety and tolerability of aliskiren-based therapy for hypertension and related comorbid patients.Methods and analysisA comprehensive search of PubMed, EMBASE, Cochrane Library, CNKI published from inception to August 2020 will be conducted. The selected articles are systematic reviews which evaluated efficacy, safety and tolerability of aliskiren combination therapy. Two reviewers will screen eligible articles, extract data and evaluate quality independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the Assessment of Multiple Systematic Reviews V.2 tool tool. We will take a mixed-methods approach to synthesising the review literatures, reporting summary of findings tables and iteratively mapping the results.Ethics and disseminationEthical approval is not required for the study, as we would only collect data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.PROSPERO registration numberCRD42020192131.

scholarly journals Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e044472
Author(s):  
Saar Hommes ◽  
Ruben Vromans ◽  
Felix Clouth ◽  
Xander Verbeek ◽  
Ignace de Hingh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Decision Making ◽  
Systematic Reviews ◽  
Decision Aids ◽  
Specific Treatment ◽  
Cochrane Library ◽  
Plain Language ◽  
Patient Decision

ObjectivesTo assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.DesignSystematic review.Data sourcesDAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.Eligibility criteriaDAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I–III.Data extraction and synthesisAfter the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.ResultsIn total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.ConclusionsBoth instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

scholarly journals Active Video Games for Improving Mental Health and Physical Fitness—An Alternative for Children and Adolescents during Social Isolation: An Overview

2021 ◽  
Vol 18 (4) ◽  
pp. 1641 ◽  
Author(s):  
Isis Kelly dos Santos ◽  
Rafaela Catherine da Silva Cunha de Medeiros ◽  
Jason Azevedo de Medeiros ◽  
Paulo Francisco de Almeida-Neto ◽  
Dianne Cristina Souza de Sena ◽  
...  
Keyword(s):  
Mental Health ◽  
Video Games ◽  
Physical Fitness ◽  
Children And Adolescents ◽  
Social Isolation ◽  
Systematic Reviews ◽  
Cochrane Library ◽  
Active Video Games ◽  
Moderate Quality ◽  
Active Video

The aim of this study was to synthesize the evidence on the effects of active video games (AVGs) on mental health, physical fitness and body composition of children and adolescents. A search was conducted in the following databases: PubMed; MEDLINE (by Ovid); SportDiscus, Cochrane library systematic reviews (CENTRAL) and EMBASE with no language restrictions during October 2020. Reviews on the use of AVGs were included in the study. We use the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) scale to analyze the methodological quality of the studies. Seventeen systematic reviews and meta-analyzes were included on the effects of AVGs with 30 to 4728 children and adolescents of both sexes with ages ranging from 6 to 19 years. In five studies, the population was overweight or obese. Regarding the quality, 12 studies were of moderate quality, two had high quality, two had low quality and one showed very low quality. The analyzed data indicate that the use of AVGs with a frequency of 1 to 3 times a week with durations of between 10 and 90 min per day shows positive effects on mental health and physical functioning. There was moderate quality evidence that AVGs can result in benefits for self-esteem, increased energy expenditure, physical activity and reduced body mass index in children and adolescents who used AVGs in the home environment. Further research is needed on this tool to help in the process of social isolation and consequently in promoting health and well-being.

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