Evaluating the Efficacy of Microsurgical Training Methods in Ophthalmology Education: A Systematic Review and Meta-analysis

Abstract Objective The objective of our paper is to review all of the relevant literature in ophthalmology microsurgical education and identify which teaching methodologies were most effective. Methods A systematic review and meta-analysis of the literature was conducted. Electronic databases, including Ovid MEDLINE, Cochrane CENTRAL, and EMBASE, were searched with preset terms. The search was through December 11, 2019. Eligibility criteria included studies with sufficient data for analyzing associations between surgical teaching techniques and success rates in surgical skills and the organization of the intervention as a microsurgical skills course, curriculum, or program. The articles were independently reviewed by two authors. Each included study was evaluated for quality using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach and risk of bias using the Cochrane Collaboration's tool for assessing bias. Data Extraction and Synthesis Data extraction was performed by two reviewers and disagreements were checked by a third reviewer. A random-effects analysis was used to pool the outcomes of studies. Main Outcomes and Measures Outcomes included time for completion of surgical task, level of preparedness, competency score, and number of surgeries with complications. Results A total of 439 studies were reviewed and 13 studies (n = 8,790 surgical cases; n = 115 trainees) were included in the meta-analysis. Excluded articles studied cataract simulation training as the primary intervention or were not related to ophthalmology. All pooled results demonstrated a positive association with surgical outcomes; however, video-based education (standardized mean difference [SMD] = 2.49 [95% confidence interval (CI): 0.36–4.63]; four effects [four studies]; n = 69; I 2 = 90%) and stepwise teaching method (odds ratio [OR = 3.84 [95% CI: 2.66–5.55]; six effects [six studies]; n = 6,968; I 2 = 39%) interventions were the most favorable. Conclusion and Relevance The following five interventions evaluated in this paper were found to be effective methods of improving performance outcomes in ophthalmic microsurgery: (1) didactic lectures, (2) video-based education, (3) surgical wet-laboratory, (4) stepwise method, and (5) direct supervision and feedback. Our meta-analysis concludes that video-based education and stepwise teaching interventions are the most effective methods for a microsurgical ophthalmology training curriculum. Combining the strengths of the interventions analyzed in this study should be considered when implementing and adjusting ophthalmic surgical skills curriculums.

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Contrast extravasation and outcome of endovascular therapy in acute ischaemic stroke: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044917 ◽

2021 ◽

Vol 11 (7) ◽

pp. e044917

Author(s):

Tao Xu ◽

You Wang ◽

Jinxian Yuan ◽

Yangmei Chen ◽

Haiyan Luo

Keyword(s):

Systematic Review ◽

Ischaemic Stroke ◽

Functional Outcome ◽

Endovascular Therapy ◽

Acute Ischaemic Stroke ◽

Data Extraction ◽

Meta Analysis ◽

Poor Functional Outcome ◽

Eligibility Criteria ◽

Contrast Extravasation

ObjectiveContrast extravasation (CE) after endovascular therapy (EVT) is commonly present in acute ischaemic stroke (AIS) patients. Substantial uncertainties remain about the relationship between CE and the outcomes of EVT in patients with AIS. Therefore, we aimed to evaluate this association.DesignA systematic review and meta-analysis of published studies were performed.Data sourceWe systematically searched the Medline and Embase databases for relevant clinical studies. The last literature search in databases was performed in June 2020.Eligibility criteria for study selectionWe included studies exploring the associations between CE and the outcomes of EVT in patients with AIS undergoing EVT.Data extraction and synthesisTwo reviewers extracted relevant information and data from each article independently. We pooled ORs with CIs using a random-effects meta-analysis to calculate the associations between CE and outcomes of EVT. The magnitude of heterogeneity between estimates was quantified with the I2 statistic with 95% CIs.ResultsFifteen observational studies that enrolled 1897 patients were included. Patients with CE had higher risks of poor functional outcome at discharge (2.38, 95% CI 1.45 to 3.89 p=0.001; n=545) and poor functional outcome at 90 days (OR 2.16, 95% CI 1.20 to 3.90; n=1194). We found no association between CE and in-hospital mortality (OR 0.95, 95% CI 0.27 to 3.30; n=376) or 90-day mortality (OR 1.38, 95% CI 0.81 to 2.36; n=697) after EVT. Moreover, CE was associated with higher risks of post-EVT intracranial haemorrhage (ICH) (OR 6.68, 95% CI 3.51 to 12.70; n=1721) and symptomatic ICH (OR 3.26, 95% CI 1.97 to 5.40; n=1092).ConclusionsThis systematic review and meta-analysis indicates that in patients with AIS undergoing EVT, CE is associated with higher risks of unfavourable functional outcomes and ICH. Thus, we should pay more attention to CE in patients with AIS undergoing EVT.

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Effectiveness and safety of herbal medicines for induction of labour: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-022499 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022499 ◽

Cited By ~ 8

Author(s):

Collins Zamawe ◽

Carina King ◽

Hannah Maria Jennings ◽

Chrispin Mandiwa ◽

Edward Fottrell

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Experimental Studies ◽

Herbal Medicines ◽

Risk Of Bias ◽

Induction Of Labour ◽

Quality Data ◽

Eligibility Criteria ◽

Significant Difference

ObjectiveThe use of herbal medicines for induction of labour (IOL) is common globally and yet its effects are not well understood. We assessed the efficacy and safety of herbal medicines for IOL.DesignSystematic review and meta-analysis of published literature.Data sourcesWe searched in MEDLINE, AMED and CINAHL in April 2017, updated in June 2018.Eligibility criteriaWe considered experimental and non-experimental studies that compared relevant pregnancy outcomes between users and non-user of herbal medicines for IOL.Data extraction and synthesisData were extracted by two reviewers using a standardised form. A random-effects model was used to synthesise effects sizes and heterogeneity was explored through I2statistic. The risk of bias was assessed using ‘John Hopkins Nursing School Critical Appraisal Tool’ and ‘Cochrane Risk of Bias Tool’.ResultsA total of 1421 papers were identified through the searches, but only 10 were retained after eligibility and risk of bias assessments. The users of herbal medicine for IOL were significantly more likely to give birth within 24 hours than non-users (Risk Ratio (RR) 4.48; 95% CI 1.75 to 11.44). No significant difference in the incidence of caesarean section (RR 1.19; 95% CI 0.76 to 1.86), assisted vaginal delivery (RR 0.73; 95% CI 0.47 to 1.14), haemorrhage (RR 0.84; 95% CI 0.44 to 1.60), meconium-stained liquor (RR 1.20; 95% CI 0.65 to 2.23) and admission to nursery (RR 1.08; 95% CI 0.49 to 2.38) was found between users and non-users of herbal medicines for IOL.ConclusionsThe findings suggest that herbal medicines for IOL are effective, but there is inconclusive evidence of safety due to lack of good quality data. Thus, the use of herbal medicines for IOL should be avoided until safety issues are clarified. More studies are recommended to establish the safety of herbal medicines.

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Association between active tobacco use during pregnancy and infant respiratory health: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-037819 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037819

Author(s):

Ediane De Queiroz Andrade ◽

Carla Rebeca Da Silva Sena ◽

Adam Collison ◽

Vanessa E Murphy ◽

Gillian Sandra Gould ◽

...

Keyword(s):

Systematic Review ◽

Lung Function ◽

Tobacco Use ◽

Smokeless Tobacco ◽

Respiratory Health ◽

Data Extraction ◽

Meta Analysis ◽

Maximum Flow ◽

Eligibility Criteria ◽

Residual Capacity

ObjectiveTo evaluate what is known about active tobacco use during pregnancy and the association with infant respiratory health.DesignSystematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMEDLINE, EMBASE, Cochrane, CINAHL, and Maternity and Infant Care were searched thoroughly until June 2020.Eligibility criteria for selecting studiesWe included case–control and cohort studies estimating the association between active tobacco use during pregnancy and infant respiratory health (wheezing and apnoea) and lung function parameters in the first 12 months of life.Data extraction and synthesisExtraction and risk of bias assessment were conducted by two independent reviewers. The odds ratio, relative risk and mean differences were pooled with a 95% CI using the generic inverse variance method. Heterogeneity was assessed and expressed by percentage using I2.ResultsWe identified 4423 abstracts, and 21 publications met the eligibility criteria. Pooled OR showed an increase in wheezing episodes in infants born to mothers who were active tobacco users during pregnancy (OR 1.50, 95% CI 1.27 to 1.77, p<0.01). Mixed results were found on lung function parameters, and a meta-analysis including two studies with comparable methodology showed a trend towards reduced maximum flow rate at functional residual capacity of −34.59 mL/s (95% CI −72.81 to 3.63, p=0.08) in 1-month-old infants born to women who smoked during pregnancy. A higher risk of apnoea was described for infants born to mothers who used smokeless tobacco during pregnancy, while the results in infants born to women who actively smoked tobacco during pregnancy were non-conclusive.ConclusionInfants born to mothers who actively smoked during pregnancy are at higher odds of having wheeze and may have lower lung function. Smokeless tobacco use in pregnancy may increase the risk of apnoea in infancy.PROSPERO registration numberCRD42018083936.

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The efficacy of litter management strategies to prevent morbidity and mortality in broiler chickens: a systematic review and network meta-analysis

Animal Health Research Reviews ◽

10.1017/s1466252319000227 ◽

2019 ◽

Vol 20 (2) ◽

pp. 247-262

Author(s):

Jan M. Sargeant ◽

Michele D. Bergevin ◽

Katheryn Churchill ◽

Kaitlyn Dawkins ◽

Bhumika Deb ◽

...

Keyword(s):

Systematic Review ◽

Broiler Chickens ◽

Data Extraction ◽

Meta Analysis ◽

Relevant Literature ◽

Management Strategies ◽

Antibiotic Use ◽

Peat Moss ◽

Risk Of Mortality ◽

Poor Reporting

AbstractA systematic review and network meta-analysis (NMA) were conducted to address the question, ‘What is the efficacy of litter management strategies to reduce morbidity, mortality, condemnation at slaughter, or total antibiotic use in broilers?’ Eligible studies were clinical trials published in English evaluating the efficacy of litter management in broilers on morbidity, condemnations at slaughter, mortality, or total antibiotic use. Multiple databases and two conference proceedings were searched for relevant literature. After relevance screening and data extraction, there were 50 trials evaluating litter type, 22 trials evaluating litter additives, 10 trials comparing fresh to re-used litter, and six trials evaluating floor type. NMAs were conducted for mortality (61 trials) and for the presence or absence of footpad lesions (15 trials). There were no differences in mortality among the litter types, floor types, or additives. For footpad lesions, peat moss appeared beneficial compared to straw, based on a small number of comparisons. In a pairwise meta-analysis, there was no association between fresh versus used litter on the risk of mortality, although there was considerable heterogeneity among studies (I2 = 66%). There was poor reporting of key design features in many studies, and analyses rarely accounted for non-independence of observations within flocks.

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Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies

BMJ Open ◽

10.1136/bmjopen-2018-028238 ◽

2019 ◽

Vol 9 (11) ◽

pp. e028238 ◽

Cited By ~ 7

Author(s):

Shimels Hussien Mohammed ◽

Tesfa Dejenie Habtewold ◽

Mulugeta Molla Birhanu ◽

Tesfamichael Awoke Sissay ◽

Balewgizie Sileshi Tegegne ◽

...

Keyword(s):

Systematic Review ◽

Socioeconomic Status ◽

Observational Studies ◽

Data Extraction ◽

Meta Analysis ◽

Epidemiological Studies ◽

Cochrane Library ◽

Eligibility Criteria ◽

Cross Sectional ◽

Neighbourhood Socioeconomic Status

ObjectiveLow neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual’s own socioeconomic status. No meta-analysis study has been done on the association. Thus, this study was done to synthesise the existing evidence on the association of NSES with overweight, obesity and body mass index (BMI).DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Scopus, Cochrane Library, Web of Sciences and Google Scholar databases were searched for articles published until 25 September 2019.Eligibility criteriaEpidemiological studies, both longitudinal and cross-sectional ones, which examined the link of NSES to overweight, obesity or BMI, were included.Data extraction and synthesisData extraction was done by two reviewers, working independently. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for the observational studies. The summary estimates of the relationships of NSES with overweight, obesity and BMI statuses were calculated with random-effects meta-analysis models. Heterogeneity was assessed by Cochran’s Q and I2 statistics. Subgroup analyses were done by age categories, continents, study designs and NSES measures. Publication bias was assessed by visual inspection of funnel plots and Egger’s regression test.ResultA total of 21 observational studies, covering 1 244 438 individuals, were included in this meta-analysis. Low NSES, compared with high NSES, was found to be associated with a 31% higher odds of overweight (pooled OR 1.31, 95% CI 1.16 to 1.47, p<0.001), a 45% higher odds of obesity (pooled OR 1.45, 95% CI 1.21 to 1.74, p<0.001) and a 1.09 kg/m2 increase in mean BMI (pooled beta=1.09, 95% CI 0.67 to 1.50, p<0.001).ConclusionNSES disparity might be contributing to the burden of overweight/obesity. Further studies are warranted, including whether addressing NSES disparity could reduce the risk of overweight/obesity.PROSPERO registration numberCRD42017063889

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How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-028280 ◽

2019 ◽

Vol 9 (9) ◽

pp. e028280 ◽

Cited By ~ 20

Author(s):

Jan B. Schmutz ◽

Laurenz L. Meier ◽

Tanja Manser

Keyword(s):

Systematic Review ◽

Clinical Performance ◽

Data Extraction ◽

Meta Analysis ◽

Random Effect ◽

Performance Measure ◽

Task Type ◽

Eligibility Criteria ◽

Expert Rating ◽

The Relationship

ObjectivesTo investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship.DesignSystematic review and meta-analysis.Data sourcePubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email.Eligibility criteriaStudies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting.Data extraction and synthesisModerator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsThe review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation wasr=0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance.ConclusionTeamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.

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Safety and efficiency of gasless laparoscopy: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-020-01365-y ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Haitham Shoman ◽

Simone Sandler ◽

Alexander Peters ◽

Ameer Farooq ◽

Magdalen Gruendl ◽

...

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Data Extraction ◽

Meta Analysis ◽

A Priori ◽

Risk Of Bias ◽

Conventional Laparoscopy ◽

Eligibility Criteria ◽

Gasless Laparoscopy ◽

Resource Setting

Abstract Background Gasless laparoscopy, developed in the early 1990s, was a means to minimize the clinical and financial challenges of pneumoperitoneum and general anaesthesia. It has been used in a variety of procedures such as in general surgery and gynecology procedures including diagnostic laparoscopy. There has been increasing evidence of the utility of gasless laparoscopy in resource limited settings where diagnostic imaging is not available. In addition, it may help save costs for hospitals. The aim of this study is to conduct a systematic review of the available evidence surrounding the safety and efficiency of gasless laparoscopy compared to conventional laparoscopy and open techniques and to analyze the benefits that gasless laparoscopy has for low resource setting hospitals. Methods This protocol is developed by following the Preferred Reporting Items for Systematic review and Meta-Analysis–Protocols (PRISMA-P). The PRISMA statement guidelines and flowchart will be used to conduct the study itself. MEDLINE (Ovid), Embase, Web of Science, Cochrane Central, and Global Index Medicus (WHO) will be searched and the National Institutes of Health Clinical Trials database. The articles that will be found will be pooled into Covidence article manager software where all the records will be screened for eligibility and duplicates removed. A data extraction spreadsheet will be developed based on variables of interest set a priori. Reviewers will then screen all included studies based on the eligibility criteria. The GRADE tool will be used to assess the quality of the studies and the risk of bias in all the studies will be assessed using the Cochrane Risk assessment tool. The RoB II tool will assed the risk of bias in randomized control studies and the ROBINS I will be used for the non-randomized studies. Discussion This study will be a comprehensive review on all published articles found using this search strategy on the safety and efficiency of the use of gasless laparoscopy. The systematic review outcomes will include safety and efficiency of gasless laparoscopy compared to the use of conventional laparoscopy or laparotomy. Trial registration The study has been registered in PROSPERO under registration number: CRD42017078338

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PIWI proteins as prognostic markers in cancer: a systematic review and meta-analysis

10.1101/663468 ◽

2019 ◽

Author(s):

Alexios-Fotios A. Mentis ◽

Efthimios Dardiotis ◽

Athanassios G. Papavassiliou

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Data Extraction ◽

Meta Analysis ◽

Cancer Site ◽

Synthesis Methods ◽

Eligibility Criteria ◽

Cross Sectional ◽

Protein Levels ◽

Low Expression

ABSTRACTBackgroundPIWI proteins, which interact with piRNAs, are implicated in stem cell and germ cell regulation, but have been detected in various cancers, as well.ObjectivesIn this systematic review, we explored, for the first time in the literature (to our knowledge), the association between prognosis in patients with cancer and intratumoral expression of PIWI proteins.Data sourcesPubMed, Embase and Web of Knowledge databases were searched for the relevant cohort studies.Study eligibility criteriaProspective or retrospective cohort studies investigating the association of intratumoral mRNA or protein expression of different types of PIWI proteins with survival, metastasis or recurrence of various types of cancers in the systematic review. Exclusion of cross-sectional studies, of studies on the prognostic value of genetic polymorphism of PIWI genes, of studies re-analyzed previously published databases, and of conference abstracts and non-English articles.ParticipantsTwenty-six studies with 4,299 participants were included in the systematic review.InterventionsPooled Hazard Ratios (HRs) and their 95% Confidence Intervals (CIs) were calculated for different PIWI proteins separately, by pooling of log of the calculated HRs using the random-effects model.Study appraisal and synthesis methodsData extraction was performed using a pre-designed form and quality of the studies was assessed using REMARK criteria. Heterogeneity assessed using the I2 index and the Cochran Q test. Publication bias assessed using funnel plots and Egger’s regression.ResultsThe pooled HR of mortality in high compared to low expression of HIWI, HILI and PIWIL4 was 1.87 (CI95%: 1.31-2.66, p < 0.05), 1.09 (CI95%: 0.58-2.07, p = 0.79) and 0.44 (CI95%: 0.25-0.76, p < 0.05), respectively. The pooled HR of recurrence in in high compared to low expression of HIWI and HILI was 1.72 (CI95%: 1.20-2.49, p < 0.05) and 1.98 (CI95%: 0.65-5.98, p = 0.23), respectively.LimitationsExclusion of studies not in English; Discrepancy between mRNA and protein levels, and the respective analytical methods; Only one cancer site – PIWI protein pair investigated in three or more studies.Conclusions and Implications of Key FindingsThe prognosis of cancer patients is worse with higher HIWI and lower PIWIL4 expression, although the results are highly variable for different cancers. The expression of these proteins can be used for personalized prognostication and treatment of individual patients.Systematic review registration numberNot registered.

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Implementing Digital Storytelling for Health-Related Outcomes in Older Adults: Protocol for a Systematic Review

JMIR Research Protocols ◽

10.2196/15512 ◽

2019 ◽

Vol 8 (12) ◽

pp. e15512

Author(s):

Jennifer Stargatt ◽

Sunil Bhar ◽

Jahar Bhowmik ◽

Abdullah Al Mahmud

Keyword(s):

Systematic Review ◽

Older Adults ◽

Digital Storytelling ◽

Data Extraction ◽

Meta Analysis ◽

Evidence Base ◽

Eligibility Criteria ◽

Psychological Comorbidities ◽

Health Related

Background The number of older adults is increasing rapidly worldwide. Older adults face a unique set of challenges and may experience a range of psychological comorbidities. Advances in multimedia technology have allowed for digital storytelling to be utilized as an intervention for health-related outcomes. Objective The primary aim of the proposed systematic review is to examine the reported health-related outcomes for older adults engaged in digital storytelling. The review also aims to examine the methods associated with digital storytelling, characteristics of digital story products, and implementational considerations. Methods This protocol adheres to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will systematically search selected electronic databases to identify studies that meet our eligibility criteria. From the included studies, data will be extracted and synthesized using a narrative approach and summarized in tables. The methodological quality of the included studies will be assessed using the Mixed Methods Appraisal Tool. Results Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by the end of 2019. Conclusions The proposed systematic review will summarize the existing studies using digital storytelling to improve health-related outcomes for older adults. Results from this review will provide an evidence base for the development of digital storytelling interventions that are effective and implementable with older adults. International Registered Report Identifier (IRRID) PRR1-10.2196/15512

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What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026037 ◽

2019 ◽

Vol 9 (8) ◽

pp. e026037 ◽

Cited By ~ 2

Author(s):

Gillian Sandra Gould ◽

Laura Twyman ◽

Leah Stevenson ◽

Gabrielle R Gribbin ◽

Billie Bonevski ◽

...

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Data Extraction ◽

Meta Analysis ◽

Self Report ◽

Health Providers ◽

Eligibility Criteria ◽

Reporting Practices ◽

Registration Number ◽

Meta Analyses

BackgroundPregnancy is an opportunity for health providers to support women to stop smoking.ObjectivesIdentify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy.DesignA systematic review synthesising original articles that reported on (1) prevalence of health providers’ performing the 5As (‘Ask’, ‘Advise’, ‘Assess’, ‘Assist’, ‘Arrange’), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care.Data sourcesMEDLINE, EMBASE, CINAHL and PsycINFO databases searched using ‘smoking’, ‘pregnancy’ and ‘health provider practices’.Eligibility criteria for selecting studiesStudies included any design except interventions (self-report, audit, observed consultations and women’s reports), in English, with no date restriction, up to June 2017.ParticipantsHealth providers of any profession.Data extraction, appraisal and analysisData were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, ‘often/always’ and ‘always/all’. Meta-regressions were performed of 5As for ‘often/always’.ResultsOf 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices ‘often/always’ were: ‘Ask’ (n=9) 91.6% (95% CI 88.2% to 95%); ‘Advise’ (n=7) 90% (95% CI 72.5% to 99.3%), ‘Assess’ (n=3) 79.2% (95% CI 76.5% to 81.8%), ‘Assist (cessation support)’ (n=5) 59.1% (95% CI 56% to 62.2%), ‘Arrange (referral)’ (n=6) 33.3% (95% CI 20.4% to 46.2%) and ‘prescribing NRT’ (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I2) was 95.9%–99.1%. Meta-regressions for ‘Arrange’ were significant for year (p=0.013) and country (p=0.037).ConclusionsHealth providers ‘Ask’, ‘Advise’ and ‘Assess’ most pregnant women about smoking. ‘Assist’, ‘Arrange’ and ‘prescribing NRT’ are reported at lower rates: strategies to improve these should be considered.PROSPERO registration numberCRD42015029989.

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