Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

2021 ◽  
Author(s):  
Kellie A. Mitchell ◽  
Alison J. Haddock ◽  
Hamad Husainy ◽  
Lauren A. Walter ◽  
Indranee Rajapreyar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Maternal Mortality ◽  
Social Services ◽  
Full Text ◽  
Postpartum Period ◽  
English Language ◽  
Case Reports ◽  
Private Insurance ◽  
Maternal Deaths

Objective Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source. Study Design We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy. Results A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED. Conclusion As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. Systematic Review Registration CRD42020151126. Key Points

Reticular erythematous mucinosis: Literature review and case report of a 24-year-old patient with systemic erythematosus lupus

Lupus ◽  
2020 ◽  
pp. 096120332096570
Author(s):  
Juliana P Ocanha-Xavier ◽  
Camila O Cola-Senra ◽  
Jose Candido C Xavier-Junior
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Literature Review ◽  
English Language ◽  
Case Reports ◽  
Histopathological Diagnosis ◽  
Skin Disorders ◽  
Histopathological Findings ◽  
Inflammatory Skin

Reticular erythematous mucinosis (REM) was first described 50 years ago, but only around 100 case reports in English have been published. Its relation with other inflammatory skin disorders is still being debated. We report a case of REM, including the clinical and histopathological findings. Also, a systematic review of 94 English-language reported cases is provided. The described criteria for clinical and histopathological diagnosis are highlighted in order to REM can be confidently diagnosed.

scholarly journals Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018568 ◽  
Author(s):  
Jeffrey Braithwaite ◽  
Luke Testa ◽  
Gina Lamprell ◽  
Jessica Herkes ◽  
Kristiana Ludlow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Health Systems ◽  
Full Text ◽  
English Language ◽  
Secondary Data ◽  
Primary Data ◽  
Change Strategies ◽  
Screening Process ◽  
Sustainable Health

IntroductionThe sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system.Methods and analysisThe protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies.Ethics and disseminationAs no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems.

scholarly journals Artificial Intelligence Techniques: Analysis, Application, and Outcome in Dentistry—A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Naseer Ahmed ◽  
Maria Shakoor Abbasi ◽  
Filza Zuberi ◽  
Warisha Qamar ◽  
Mohamad Syahrizal Bin Halim ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Full Text ◽  
Patient Management ◽  
English Language ◽  
Clinical Performance ◽  
Research Question ◽  
Time Saving ◽  
Artificial Intelligence Techniques ◽  
Clinical Scenarios

Objective. The objective of this systematic review was to investigate the quality and outcome of studies into artificial intelligence techniques, analysis, and effect in dentistry. Materials and Methods. Using the MeSH keywords: artificial intelligence (AI), dentistry, AI in dentistry, neural networks and dentistry, machine learning, AI dental imaging, and AI treatment recommendations and dentistry. Two investigators performed an electronic search in 5 databases: PubMed/MEDLINE (National Library of Medicine), Scopus (Elsevier), ScienceDirect databases (Elsevier), Web of Science (Clarivate Analytics), and the Cochrane Collaboration (Wiley). The English language articles reporting on AI in different dental specialties were screened for eligibility. Thirty-two full-text articles were selected and systematically analyzed according to a predefined inclusion criterion. These articles were analyzed as per a specific research question, and the relevant data based on article general characteristics, study and control groups, assessment methods, outcomes, and quality assessment were extracted. Results. The initial search identified 175 articles related to AI in dentistry based on the title and abstracts. The full text of 38 articles was assessed for eligibility to exclude studies not fulfilling the inclusion criteria. Six articles not related to AI in dentistry were excluded. Thirty-two articles were included in the systematic review. It was revealed that AI provides accurate patient management, dental diagnosis, prediction, and decision making. Artificial intelligence appeared as a reliable modality to enhance future implications in the various fields of dentistry, i.e., diagnostic dentistry, patient management, head and neck cancer, restorative dentistry, prosthetic dental sciences, orthodontics, radiology, and periodontics. Conclusion. The included studies describe that AI is a reliable tool to make dental care smooth, better, time-saving, and economical for practitioners. AI benefits them in fulfilling patient demand and expectations. The dentists can use AI to ensure quality treatment, better oral health care outcome, and achieve precision. AI can help to predict failures in clinical scenarios and depict reliable solutions. However, AI is increasing the scope of state-of-the-art models in dentistry but is still under development. Further studies are required to assess the clinical performance of AI techniques in dentistry.

scholarly journals Everywhere is Nowhere: A Systematic Review of Menstrual Health and Hygiene Management (MHHM) as a Human Right

2020 ◽  
Author(s):  
Suruchi Sood ◽  
Sarah Stevens ◽  
Maho Okumura ◽  
Astha Ramaiya ◽  
Michael Hauer
Keyword(s):  
Systematic Review ◽  
Human Rights ◽  
Full Text ◽  
Child Protection ◽  
English Language ◽  
Grey Literature ◽  
Hygiene Management ◽  
Sanitation And Hygiene ◽  
Menstrual Health ◽  
Rights Issue

Abstract Background: In many countries, stigma surrounds menstruation, which impacts several Sustainable Development Goals, including good health, quality education, gender equality, and water and sanitation. Despite its relationship with several development issues, menstrual health and hygiene management among adolescents has until recently been ignored by practitioners and researchers. This paper is a systematic review of existing literature and argues that menstrual health and hygiene management is a human rights issue, cross-cutting through development domains of health, education, nutrition, child protection, and water, sanitation, and hygiene. Methods: Four coders independently screened PubMed, Academic OneFile, and Google Scholar to obtain articles using iterations of the key terms: menstrual health; adolescents; health outcomes; education; nutrition; water, sanitation, and hygiene; and child protection. English language primary studies in peer-reviewed or grey literature articles published after 2000, that mentioned adolescents, health or hygiene, and menstruation or menstrual were included. A 9-item scale was used to rate selected full-text articles as strong, moderate, or weak. Synthesis of the results were narrative and examined the relationships between menstrual health and hygiene management and the cross-cutting domains.Results: In total, 28,745 articles were screened, with 84 articles included in the full-text review and quality assessment. Nine articles were coded as “strong” (10.8%), 46 (55.4%) as “moderate,” and 28 (33.7%) as “weak.” More than 60% of the articles examined the relationship between menstrual health and hygiene management and health (37.3%) or water, sanitation, and hygiene (25.3%). Only 11 manuscripts examined menstrual health and hygiene management as a cross-cutting issue impacting more than one development domain.Conclusions: Access to adequate facilities and menstrual health and hygiene management resources are the most common relationships documented within literature. However, there is little focus on menstrual health and hygiene management in the context of other development domains, highlighting the fact that poor menstrual health and hygiene management has not been studied as a human rights issue, negatively impacting millions of girls. Using a cross-cutting, human rights framework to address inadequate menstrual health and hygiene management is fundamental to promoting menstrual health and hygiene management with dignity among girls and women across the globe.

scholarly journals Information Registry System on Congenital Hypothyroidism: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 197-208
Author(s):  
Morteza Ghasempour ◽  
◽  
Hamideh Ehtesham ◽  
Nooshin Rostampou ◽  
Shahram Tahmasbian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Congenital Hypothyroidism ◽  
English Language ◽  
Screening Program ◽  
Case Reports ◽  
Endocrine System ◽  
National Registry ◽  
Current Status ◽  
Letters To The Editor ◽  
Other Information

Background: Congenital hypothyroidism is the most common congenital disorder of the endocrine system, leading to preventable mental retardation. Objectives: We aimed to evaluate the current status of congenital hypothyroidism information registry systems. Methods: In this systematic review 290 papers identified. A total of 254 articles were screened, of which 17 qualified articles were selected through the databases of Scopus, science direct ProQuest, PubMed, as well as the search engine Google scholar (no restriction on date of publication) up to 2020, were searched. Inclusion criteria were the Articles with the English language that examining information registry systems on congenital hypothyroidism. Articles whose full texts were not accessible, case reports, and letters to the editor had to be excluded. Results: This study showed that the primary goal of nearly half (50%) of the information registry systems for congenital hypothyroidism is to evaluate the efficiency and effectiveness of the screening program. Other information registry systems for congenital hypothyroidism have examined the epidemiology of the disease in 4 studies (23.6%), monitoring iodine deficiency in 3 studies (18%), surveillance disease in 1 study (6%), and describing the clinical and familial features of the patient in 1 study (6%). Conclusions: Few studies have been done on developing information registry systems, and most studies have focused on the use of information systems in this field. Further comprehensive reviews are recommended to investigate the infrastructure of the commission national registry and world network to record information units on congenital hypothyroidism.

scholarly journals Transcutaneous electrical nerve stimulation (TENS) in the management of post-thoracotomy pain: A systematic review

2021 ◽  
Author(s):  
Caio de Almeida Lellis ◽  
Kamylla Lohannye Fonseca e Silva ◽  
Weldes Francisco da Silva Junior
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Postoperative Pain ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Case Reports ◽  
Lung Resection ◽  
Pharmacological Therapy ◽  
Transcutaneous Electric Nerve Stimulation ◽  
Electrical Nerve Stimulation

Introduction: Thoracotomy is considered one of the most painful operative procedures in surgical practice, and postoperative pain control is a challenge. Objectives: To evaluate transcutaneous electrical nerve stimulation (TENS) as a form of treatment for post-thoracotomy pain. Design and setting: A systematic review conducted at the Pontifical Catholic University of Goiás. Methods: A systematic literature review was performed in the PubMed and Lilacs databases with the terms: “Post-thoracotomy pain AND (Transcutaneous Electric Nerve Stimulation OR TENS)”, being selected randomized controlled trials, clinical trials and case reports. Studies that did not fit the objectives were excluded. Results: TENS was shown to be a safe and effective therapy in the management of acute post-thoracotomy pain in the emergency department; however, the technique did not decrease the length of hospital stay or early pulmonary complications. One such study pointed to decreased shoulder flexion pain in patients undergoing axillary thoracotomy for lung resection, with pain sensation significantly decreased in the experimental group. In consonance, other trials emphasized the importance of the association of TENS with pharmacological therapy already employed in the emergency department, because patients who received fentanyl and bupivacaine associated with TENS perceived an immediate reduction in pain intensity at rest. Conclusion: TENS has proven to be a very effective and safe therapy in the treatment of postoperative pain in patients undergoing thoracotomy, improving their quality of life and reducing the consumption of analgesics.

scholarly journals Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies

2020 ◽  
Author(s):  
Juan Juan ◽  
María M. Gil ◽  
Zhihui Rong ◽  
Yuanzhen Zhang ◽  
Huixia Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Case Reports ◽  
Case Series ◽  
Severe Pneumonia ◽  
Outcome Data ◽  
Neonatal Outcomes ◽  
Eligibility Criteria ◽  
Maternal Deaths

ABSTRACTObjectiveTo perform a systematic review of available published literature on pregnancies affected by COVID-19 to evaluate the effects of COVID-19 on maternal, perinatal and neonatal outcomes.MethodsWe performed a systematic review to evaluate the effects of COVID-19 on pregnancy, perinatal and neonatal outcomes. We conducted a comprehensive literature search using PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure Database and Wan Fang Data until April 20, 2020 (studies were identified through PubMed alert after April 20, 2020). For the research strategy, combinations of the following keywords and MeSH terms were used: SARS-CoV-2, COVID-19, coronavirus disease 2019, pregnancy, gestation, maternal, mothers, vertical transmission, maternal-fetal transmission, intrauterine transmission, neonates, infant, delivery. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient was pregnant on admission, availability of clinical characteristics, including maternal, perinatal or neonatal outcomes. Exclusion criteria were unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, and unreported maternal or perinatal outcomes. No language restrictions were applied.ResultsWe identified several case-reports and case-series but only 19 studies, including a total of 266 pregnant women with COVID-19, met eligibility criteria and were finally included in the review. In the combined data from seven case-series, the maternal age ranged from 20 to 41 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath and fatigue. The rate of severe pneumonia was relatively low, with the majority of the cases requiring intensive care unit admission. Almost all cases from the case-series had positive computer tomography chest findings. There were six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, which were negative for SARS-CoV-2. Only a few cases had spontaneous miscarriage or abortion. 177 cases had delivered, of which the majority by Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at 1 and 5 minutes ranged from 7 to 10 and 8 to 10, respectively. A few neonates had birthweight less than 2500 grams and over one-third of cases were transferred to neonatal intensive care unit. There was one case each of neonatal asphyxia and neonatal death. There were 113 neonates that had nucleic-acid testing in throat swab, which was negative for SARS-CoV-2. From the case-reports, two maternal deaths among pregnant women with COVID-19 were reported.ConclusionsThe clinical characteristics of pregnant women with COVID-19 are similar to those of nonpregnant adults with COVID-19. Currently, there is no evidence that pregnant women with COVID-19 are more prone to develop severe pneumonia, in comparison to nonpregnant patients. The subject of vertical transmission of SARS-CoV-2 remains controversial and more data is needed to investigate this possibility. Most importantly, in order to collect meaningful pregnancy and perinatal outcome data, we urge researchers and investigators to reference previously published cases in their publications and to record such reporting when the data of a case is being entered into a registry or several registries.ContributionWhat are the novel findings of this work?Amongst a few cases from the case-series that had qRT-PCR testing in vaginal mucus and breast milks, the results were negative for SARS-CoV-2. Similarly, some of the cases from the case-series had qRT-PCR testing in amniotic fluid, cord blood, neonatal throat swab and neonatal feces, and the results were negative for SARS-CoV-2. Amongst the case-reports, there were two maternal deaths and two neonates tested positive for SARS-CoV-2 at 16 / 24 hours of life.What are the clinical implications of this work?The subject of vertical transmission of SARS-CoV-2 remains controversial and more data is needed to investigate this possibility. In order to collect meaningful pregnancy and perinatal outcome data, we urge researchers and investigators to reference previously published cases in their publications and to record such reporting when the data of a case is being entered into a registry or several registries.

Incidence of metastasis in circumflex iliac nodes in patients with cervical cancer: a systematic review

2021 ◽  
pp. ijgc-2021-003005
Author(s):  
David Viveros-Carreño ◽  
Juliana Rodriguez ◽  
Rene Pareja
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Lymph Node ◽  
English Language ◽  
Early Stage ◽  
Case Reports ◽  
Pelvic Lymphadenectomy ◽  
Positive Lymph Node ◽  
Cochrane Central Register ◽  
Early Stage Disease

ObjectiveThe circumflex iliac nodes distal to the external iliac nodes are frequently removed when bilateral pelvic lymphadenectomy is performed in patients with cervical cancer. The objective of this systematic review was to assess the incidence of metastasis in the circumflex iliac nodes in patients with cervical cancer.MethodsPubMed/Medline, ClinicalTrials, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Ovid databases were searched from inception to May 2021. We included articles published in English language reporting all types of studies, except for case reports and commentaries. Abstracts and unpublished studies were excluded. The inclusion criteria were diagnosis of cervical cancer, FIGO 2009 stages IA–IIB, squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma, and primary surgery including pelvic lymph node dissection.ResultsA total of 3037 articles were identified. Overall, 1165 eligible patients from four studies were included in the analysis. A total of 696 (59.7%) patients had early-stage disease (FIGO 2009 stages IA, IB1, IIA1). The median number of extracted circumflex iliac nodes, which was reported in two studies, was one (range not reported) and three (range 1–13). The positive lymph node rate for the entire population and circumflex iliac node involvement were 26.9% and 3.1%, respectively. Isolated metastases were reported for 904 patients (three studies) and in one patient nodal spread was detected (0.11%).ConclusionThe rate of isolated metastases in circumflex iliac nodes is small and excision of these lymph nodes as part of routine lymphadenectomy should be avoided.

scholarly journals Estimating the incubation period of acute Q fever, a systematic review

2018 ◽  
Vol 146 (6) ◽  
pp. 665-672 ◽  
Author(s):  
D. Todkill ◽  
T. Fowler ◽  
J.I. Hawker
Keyword(s):  
Systematic Review ◽  
Incubation Period ◽  
Full Text ◽  
English Language ◽  
Q Fever ◽  
Expert Advice ◽  
Evidence Based ◽  
Individual Level ◽  
Level Data ◽  
Acute Q Fever

AbstractEstimates of the incubation period for Q fever vary substantially between different reviews and expert advice documents. We systematically reviewed and quality appraised the literature to provide an evidence-based estimate of the incubation period of the Q fever by the aerosolised infection route. Medline (OVIDSP) and EMBASE were searched with the search limited to human studies and English language. Eligible studies included persons with symptomatic, acute Q fever, and defined exposure toCoxiella burnetti. After review of 7115 titles and abstracts, 320 records were screened at full-text level. Of these, 23 studies contained potentially useful data and were quality assessed, with eight studies (with 403 individual cases where the derivation of incubation period was possible) being of sufficient quality and providing individual-level data to produce a pooled summary. We found a median incubation period of 18 days, with 95% of cases expected to occur between 7 and 32 days after exposure.

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