The impact of specific HIV treatment-related adverse events on adherence to antiretroviral therapy: A systematic review and meta-analysis

Abstract Purpose: Several studies have reported adopting prone positioning (PP) in non-intubated patients with COVID-19-related hypoxaemic respiratory failure. This systematic review and meta-analysis evaluated the impact of PP on oxygenation and clinical outcomes.Methods: We searched PubMed, Embase and the COVID-19 living systematic review from December 1, 2019 to July 23, 2020. We included studies that reported using PP in hypoxaemic, non-intubated adult patients with COVID-19. Primary outcome measureed was the weighted mean difference (MD) in oxygenation parameters (PaO2/FiO2, PaO2 or SpO2) pre and post-PP. Results: Fifteen single arm observational studies reporting PP in 449 patients were included. Substantial heterogeneity was noted in terms of, location within hospital where PP was instituted, respiratory supports during PP, and frequency and duration of PP. Significant improvement in oxygenation was reported post-PP: PaO2/FiO2 (MD 37.6, 95% CI 18.8-56.5); PaO2 (MD 30.4 mmHg, 95% CI 10.9 to 49.9); and SpO2 (MD 5.8%, 95% CI 3.7 to 7.9). Patients with a pre-PP PaO2/FiO2 ≤150 experienced greater oxygenation improvements compared with those with a pre-PP PaO2/FiO2 >150 (MD 40.5, 95% CI -3.5 to 84.6) vs. 37, 95% CI 17.1 to 56.9). Respiratory rate decreased post-PP (MD -2.9, 95% CI -5.4 to -0.4). Overall intubation and mortality rates were 21% (90/426) and 26% (101/390) respectively. There were no major adverse events reported. Conclusions: Despite the significant variability in frequency and duration of PP and respiratory supports applied, PP was associated with improvements in oxygenation parameters without any reported serious adverse events. The results are limited by lack of control arm and adjustment for confounders. Clinical trials are required to determine the effect of awake PP on patient-centred outcomes.Systematic review registration: Registration/protocol in PROSPERO (CRD42020194080).

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Effectiveness of trauma centre verification: a systematic review and meta-analysis

Canadian Journal of Surgery ◽

10.1503/cjs.016219 ◽

2021 ◽

Vol 64 (1) ◽

pp. E25-E38

Author(s):

Brice Batomen ◽

Lynne Moore ◽

Mabel Carabali ◽

Pier-Alexandre Tardif ◽

Howard Champion

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Resource Use ◽

Meta Analysis ◽

The United States ◽

Trauma Centre ◽

Trauma Centres ◽

Processes Of Care ◽

Injured Patients ◽

The Impact

Background: There is a growing trend toward verification of trauma centres, but its impact remains unclear. This systematic review aimed to synthesize available evidence on the effectiveness of trauma centre verification. Methods: We conducted a systematic search of the CINAHL, Embase, HealthStar, MEDLINE and ProQuest databases, as well as the websites of key injury organizations for grey literature, from inception to June 2019, without language restrictions. Our population consisted of injured patients treated at trauma centres. The intervention was trauma centre verification. Comparison groups comprised nonverified trauma centres, or the same centre before it was first verified or re-verified. The primary outcome was in-hospital mortality; secondary outcomes included adverse events, resource use and processes of care. We computed pooled summary estimates using random-effects meta-analysis. Results: Of 5125 citations identified, 29, all conducted in the United States, satisfied our inclusion criteria. Mortality was the most frequently investigated outcome (n = 20), followed by processes of care (n = 12), resource use (n = 12) and adverse events (n = 7). The risk of bias was serious to critical in 22 studies. We observed an imprecise association between verification and decreased mortality (relative risk 0.74, 95% confidence interval 0.52 to 1.06) in severely injured patients. Conclusion: Our review showed mixed and inconsistent associations between verification and processes of care or patient outcomes. The validity of the published literature is limited by the lack of robust controls, as well as any evidence from outside the US, which precludes extrapolation to other health care jurisdictions. Quasiexperimental studies are needed to assess the impact of trauma centre verification. Systematic reviews registration: PROSPERO no. CRD42018107083

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Efficaciousness of dexmedetomidine in children undergoing cleft lip and palate repair: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-046798 ◽

2021 ◽

Vol 11 (8) ◽

pp. e046798

Author(s):

Dengfeng Liu ◽

Li Pan ◽

Yin Gao ◽

Jiefan Liu ◽

Feng Li ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Meta Analysis ◽

Cochrane Review ◽

Random Effect Model ◽

Control Group ◽

Paediatric Patients ◽

The Impact

ObjectiveTo systematically assess the efficacy and safety of dexmedetomidine as an anaesthesia adjuvant for cleft lip and palate (CLP) repair in children.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang (up to October 2020). Studies in languages other than English and Chinese were excluded.Eligibility criteria for selecting studiesRandomised controlled trials (RCTs) evaluating the impact of dexmedetomidine on emergence agitation (EA), the need for postoperative rescue analgesics, postoperative nausea and vomiting (PONV), and other adverse events in paediatric patients during CLP repair.Data extraction and synthesisThe quality of evidence was assessed by using the Cochrane Review Methods and the Grading of Recommendations Assessment, Development and Evaluation approach. Data were screened, extracted and assessed by two independent authors. Outcomes were reported as a risk ratio (RR) with a 95% CI. A random-effect model was used when heterogeneity was detected.ResultsThirteen studies including 1040 children met the inclusion criteria. The incidence of EA was significantly decreased in the dexmedetomidine group (RR, 0.19; 95% CI 0.10 to 0.36; p<0.00001; I2=56%) as compared with the control group. Paediatric patients receiving dexmedetomidine had lower postoperative analgesic requirements (RR, 0.27; 95% CI 0.10 to 0.73; p=0.01; I2=84%) and a lower incidence of respiratory adverse events (RR, 0.49; 95% CI 0.31 to 0.78; p=0.003; I2=0%). There were no significant differences in the risk of PONV and cardiovascular adverse events.ConclusionsThere was a lack of high-quality studies in this field. Perioperative administration of dexmedetomidine reduced the need for postoperative rescue analgesics and the incidence of EA in children without side effects undergoing CLP repair. However, further verification with larger samples and higher-quality RCTs is needed.

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The impact of laryngeal mask versus other airways on perioperative respiratory adverse events in children: A systematic review and meta-analysis of randomized controlled trials

International Journal of Surgery ◽

10.1016/j.ijsu.2019.02.020 ◽

2019 ◽

Vol 64 ◽

pp. 40-48 ◽

Cited By ~ 3

Author(s):

Lingzhi Li ◽

Zhimin Zhang ◽

Zihan Yao ◽

Hongjie Wang ◽

Hebin Wang ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Laryngeal Mask ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

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The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0112017 ◽

2014 ◽

Vol 9 (11) ◽

pp. e112017 ◽

Cited By ~ 42

Author(s):

Anna Odone ◽

Silvia Amadasi ◽

Richard G. White ◽

Theodore Cohen ◽

Alison D. Grant ◽

...

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Meta Analysis ◽

Tuberculosis Treatment ◽

Hiv Positive ◽

The Impact

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The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2016-209421 ◽

2017 ◽

Vol 72 (6) ◽

pp. 559-575 ◽

Cited By ~ 27

Author(s):

P J Dodd ◽

A J Prendergast ◽

C Beecroft ◽

B Kampmann ◽

J A Seddon

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Meta Analysis ◽

The Impact

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Relationship between management and resilience in healthcare: a study protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-047855 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047855

Author(s):

Erika E Petersen ◽

Hilda Bø Lyng ◽

Eline Ree ◽

Siri Wiig

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Adverse Events ◽

Meta Analysis ◽

Integrated Approach ◽

Flow Diagram ◽

Primary Data ◽

Ethical Approval ◽

Management Approaches ◽

The Impact

IntroductionManagement has been identified as a critical component of organisational resilience when responding to adverse events and crises, as managers must ensure an effective operational response and provide direction and guidance to teams. While there are many management approaches, strategies and interventions that have been applied and studied in healthcare, the impact of them in relation to resilience in healthcare has not been explored, particularly at the organisational level. Understanding the impact of management approaches, strategies and interventions on resilience has the potential to inform healthcare organisations on how to better use management to prepare and respond to organisational adverse events. The objective of this mixed-methods systematic review is to understand the relationship between management and organisational resilience in healthcare, including management approaches and strategies that promote resilience in healthcare.Methods and analysisA search through MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PubMed and EMBASE will be conducted between 1 August 2021 and 31 December 21. This review will consider empirical quantitative, qualitative and mixed-methods studies published in English from 2010 to the present that meet the inclusion and exclusion criteria. Selected studies will be assessed in detail and extracted data will be reviewed by two independent reviewers. Results of the search will be reported in full in the final systematic review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram. This review will follow a convergent integrated approach to data synthesis and integration.Ethics and disseminationThis systematic literature review includes no collection of primary data; hence ethical approval will not be sought. The outcomes from this review will be disseminated in a peer-reviewed journal, as conference presentation, and as condensed summary for managers in healthcare and policy-makers.PROSPERO registration numberCRD42020223362.

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Prone positioning of non-intubated patients with COVID-19 - A Systematic Review and Meta-analysis

10.1101/2020.10.12.20211748 ◽

2020 ◽

Author(s):

Mallikarjuna Ponnapa Reddy ◽

Ashwin Subramaniam ◽

Zheng Jie Lim ◽

Alexandr Zubarev ◽

Afsana Afroz ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Prone Position ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Primary Outcome Measure ◽

Prone Positioning ◽

Bottom Line ◽

Serious Adverse Events ◽

The Impact

ABSTRACTPurposeSeveral studies have reported adopting prone positioning (PP) in non-intubated patients with COVID-19-related hypoxaemic respiratory failure. This systematic review and meta-analysis evaluated the impact of PP on oxygenation and clinical outcomes.MethodsWe searched PubMed, Embase and COVID-19 living systematic review from December1st 2019 to July23rd 2020. We included studies that reported using PP in hypoxaemic, non-intubated adult COVID-19 patients. Primary outcome measure was the weighted mean difference (MD) in oxygenation parameters (PaO2/FiO2, PaO2 or SpO2) pre and post-PP.ResultsFifteen single arm observational studies reporting PP in 449 patients were included. Substantial heterogeneity was noted in terms of, location within hospital where PP was instituted, respiratory supports, frequency and duration of PP. Significant improvement in oxygenation was reported post-PP: PaO2/FiO2, (MD 37.6, 95%CI 18.8, 56.5); PaO2, (MD 30.4 mmHg, 95%CI 10.9, 49.9); and SpO2, (MD 5.8%, 95%CI 3.7, 7.9). Patients with a pre-PP PaO2/FiO2 ≤150 experienced greater oxygenation improvements compared with those with a pre-PP PaO2/FiO2 >150 (MD 40.5, 95%CI −3.5, 84.6) vs. 37, 95%CI 17.1, 56.9). Respiratory rate decreased post-PP (MD −2.9, 95%CI −5.4, −0.4). Overall intubation and mortality rates were 21% (90/426) and 26% (101/390) respectively. No major adverse events were reported.ConclusionsDespite significant variability in frequency and duration of PP and respiratory supports, PP was associated with improvements in oxygenation parameters without any reported serious adverse events. Major limitation being lack of control arm and adjustment for confounders. Clinical trials are required to determine the effect of awake PP on patient-centred outcomes.Systematic review registrationRegistration/protocol in PROSPERO (CRD42020194080).What is the key question?Is the novel approach of prone positioning in non-intubated patients associated with improvement in oxygenation?What is the bottom line?Prone position in non-intubated severe COIVD 19 suffers is associated with improvement of oxygenation while the short- and long-term patient centred out comes in this awake prone patient need more investigation.Why read on?Our study is first of its kind (Systematic review and Meta-analysis) summarising the evidence surrounding the less invasive innovate technique of prone position in non-intubated COVID-19 patients.

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