scholarly journals Effectiveness of birthing kits for clean childbirth: a systematic review

2019 ◽  
Vol 12 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Zohra S Lassi ◽  
Zeshi Fisher ◽  
Prabha Andraweera ◽  
Alexandra Cummins ◽  
Claire T Roberts
Keyword(s):  
Large Scale ◽  
Positive Impact ◽  
Young Infant ◽  
Critical Factor ◽  
Neonatal Morbidity ◽  
Qualitative Studies ◽  
Current Evidence ◽  
Cochrane Library ◽  
Quantitative Studies ◽  
Life Threatening

Abstract Poor infection control practices during childbirth are recognised as a critical factor leading to life-threatening maternal and newborn sepsis. Therefore, this paper assesses the effectiveness of clean birth kits (CBKs) to ensure a safe birthing environment. We searched PubMed, Cochrane Library and CINAHL, as well as Google Scholar, to identify both qualitative and quantitative studies on CBKs published in English up to November 2018. Studies were included if the pregnant women or women giving birth intended to use or used a CBK. The methodological quality of included papers was assessed. A total of 37 studies, 26 quantitative and 11 qualitative studies, were included. Quantitative studies showed a positive impact of CBKs on reducing the incidence of puerperal sepsis and neonatal tetanus. The review also identified CBK use to be associated with a reduction in perinatal, neonatal and young infant mortality. Qualitative studies suggested that a lack of awareness of the importance of CBKs and clean delivery practices, unavailability of CBKs and financial constraints to purchase CBKs were the potential barriers. CBKs appear to be a promising strategy to reduce maternal and neonatal morbidity and mortality. However, the current evidence is limited and further large-scale trials are required.

scholarly journals Cardiac sarcoidosis: systematic review of literature on corticosteroid and immunosuppressive therapies

2021 ◽  
pp. 2100449
Author(s):  
Julien Stievenart ◽  
Guillaume Le Guenno ◽  
Marc Ruivard ◽  
Virginie Rieu ◽  
Marc André ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cardiac Sarcoidosis ◽  
Positive Impact ◽  
Immunosuppressive Agents ◽  
Left Ventricular ◽  
Randomised Control Trial ◽  
Cochrane Library ◽  
Prisma Statement ◽  
Threatening Condition ◽  
Life Threatening

BackgroundCardiac sarcoidosis (CS) is a life-threatening condition in which clear recommendations are lacking. We aimed to review systematically the literature on cardiac sarcoidosis treated by corticosteroids and/or immunosuppressive agents in order to update the management of CS.MethodsUsing Pubmed, Embase and Cochrane Library databases, we found original articles on corticosteroid and/or standard immunosuppressive therapies for CS which provided at least fair SIGN overall assessment of quality and analyse the relapse rate, major cardiac adverse events (MACEs) and adverse events. We base our methods on Prisma statement and checklist.ResultsWe retrieved 21 studies. Mean quality provided by SIGN assessment was 6.8/14 (range 5–9). Corticosteroids appeared to have a positive impact on left ventricular function, atrioventricular block, and ventricular arrhythmias. For corticosteroids alone, nine (45%) studies (n=351) provided data on relapses, representing an incidence of 34% (n=119). Three studies (14%, n=73) provided data on MACEs (n=33), representing 45% of MACEs in patients treated by corticosteroid alone. Nine studies provided data on adjunctive immunosuppressive therapy in which four studies (n=78) provided data on CS relapse, representing an incidence of 33% (n=26). Limitations consisted in no randomised control trial retrieved and unclear data on MACEs in patients treated by combined immunosuppressive agents and corticosteroids.ConclusionsCorticosteroids should be started early after diagnosis but the exact scheme is still unclear. Studies concerning adjunctive conventional immunosuppressive therapies are lacking and benefits of adjunctive immunosuppressive therapies are unclear. Homogenous data on CS long-term outcomes under corticosteroids, immunosuppressive therapies and other adjunctive therapies are lacking.

Anti-Fibrinolytics (lysine analogues) for the Prevention of Bleeding in Patients with Hematological Disorders: A Systematic Review

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3427-3427
Author(s):  
Douglas Wardrop ◽  
Lise Estcourt ◽  
Susan J Brunskill ◽  
Carolyn Doree ◽  
Marialena Trivella ◽  
...  
Keyword(s):  
At Risk ◽  
Adverse Events ◽  
Qualitative Analysis ◽  
Bone Marrow Failure ◽  
Current Evidence ◽  
Cochrane Library ◽  
Consolidation Chemotherapy ◽  
Hematological Disorders ◽  
Final Study ◽  
Life Threatening

Abstract Abstract 3427 Introduction: Patients with hematological disorders are frequently at risk of severe or life-threatening bleeding as a result of thrombocytopenia. This is despite the routine use of prophylactic platelet transfusions (PlTx) to prevent bleeding once the platelet count falls below a certain threshold. PlTx are not without risk and adverse events may be life threatening. A possible adjunct to prophylactic PlTxs is the use of anti-fibrinolytics, specifically the lysine analogues tranexamic acid (TXA) and epsilon aminocaproic acid (EACA). The objective of this review was to establish the current evidence for the safety and efficacy of these agents in thrombocytopenic patients with hematological disorders who would routinely receive PlTx. Methods: The protocol was pre-specified and published in the Cochrane Database of Systematic Reviews (CD009733). We searched (in full) MEDLINE (1948–2011); EMBASE (1980–2011); CENTRAL (The Cochrane Library Issue 4, 2011); CINAHL (1982–2011); LILACS; Transfusion Evidence Library: WHO ICTRP; ISRCTN ClinicalTrials.gov; EU Clinical Trials Register; and 4 other electronic databases up to 31st October 2011 as well as additional records from hand-searching articles. There were no restrictions on language or publication period. Eligible studies were randomized-controlled trials (RCTs) involving patients (of all ages) with a hematological disorder who were severely thrombocytopenic due to bone marrow failure, who required PlTxs, and who received TXA or EACA (any dose, via any route). Trials of patients with immune thrombocytopenia were excluded. Two authors extracted data independently. Study and participant characteristics, details of the intervention and comparator, and key outcomes were recorded. Primary outcomes were bleeding and thromboembolism. Secondary outcomes included mortality, laboratory measures of fibrinolysis, number of platelet (plt) and red blood cell (RBC) transfusions (Tx), and adverse events of anti-fibrinolytic agents or transfusions. Risk of study bias was assessed using the Cochrane Collaboration criteria. Results: Of 446 initially identified, 415 articles were excluded on the basis of the title and abstract. Thirty-one full text articles were reviewed from which, 4 studies reported in 5 articles were eligible for inclusion. One TXA study (8 patients (pts)) was excluded from the qualitative analysis due to poor study design. Three studies (2 TXA (12 to 56pts), 1 EACA (18pts)) reported in 4 articles (published 1983 to 1995) were included in the qualitative analysis. No quantitative analysis was performed due to differences in the way outcomes were reported and the paucity of data available. All studies reported bleeding, but it was reported in different ways. All 3 studies suggested anti-fibrinolytics reduced the risk of bleeding. The first study showed a difference in average bleeding score of 42 in placebo (P) vs. 3 (TXA). The second study only showed a difference in bleeding episodes during consolidation chemotherapy, mean 2.6 episodes/pt (SD 2.2) (P) vs. mean 1.1 episodes/pt (SD 1.4) (TXA). The final study reported bleeding on 50% of days at risk (P) vs. bleeding on 31% of days at risk (EACA). Two studies reported thromboembolism and no events occurred. All 3 studies reported a reduction in PlTx usage. The first study reported a difference of 222 plt units (P) vs. 69 plt units (TXA). The second study only showed a difference in total plt usage during consolidation chemotherapy, mean 9.3 units (SD 3.3) (P) vs 3.7 (SD 4.1) (TXA). The final study reported 1 PlTx every 10.5 days at risk (P) vs. 1 PlTx every 13.3 days at risk (EACA). One of the 2 studies that reported RBCTx usage found a reduction in use. None of the studies reported overall mortality. One study reported death due to bleeding, and none occurred. Only 1 study reported adverse events of TXA and none occurred. Conclusions: Our results indicate that the evidence base for the use of anti-fibrinolytics in this patient group is poor. TXA and EACA may be useful adjuncts to PlTx in order to minimize their use and any associated complications because all of the studies showed the same direction of effect. They appear to be well tolerated although the data are sparse. Larger RCTs are required to evaluate the use of anti-fibrinolytics before they can be widely adopted in clinical hematology practice. Disclosures: No relevant conflicts of interest to declare.

Are decisions by purchasers in an English health district evidence-based?

2002 ◽  
Vol 7 (3) ◽  
pp. 166-169 ◽  
Author(s):  
Paul Johnstone ◽  
Prabha Lacey
Keyword(s):  
Expert Panel ◽  
Qualitative Studies ◽  
Cochrane Library ◽  
Economic Evaluations ◽  
District Health ◽  
Organisation Of Care ◽  
Quantitative Studies ◽  
Independent Expert ◽  
Randomised Controlled ◽  
The Cochrane Library

Objectives: First, to investigate how many decisions by one commissioning body (district health authority) were based on evidence of effectiveness from randomised controlled trials (RCTs) and systematic reviews of RCTs. Second, to investigate whether other types of quantitative studies and qualitative studies could be used as evidence to support commissioning decisions. Method: From three planning documents (for 1997-1998), all statements were identified. Effectiveness questions were constructed from each and used to search for evidence from trials and reviews in the Cochrane Library (Issue 4, 1998). Further searches for other studies (all methodologies) were performed on a subset of decisions and appraised by an independent expert panel. Results: A total of 124 decisions were identified of which two-thirds concerned organisation of care. Evidence existed for less than half (48.4%) the decisions, with 33.9% favouring the decision and 14.5% where evidence was either equivocal or unfavourable. From a random subset of ten decisions, relevant non-randomised quantitative studies and qualitative studies were identified for half the decisions. Evidence from economic evaluations was identified for only one decision. Conclusions: Large gaps in knowledge exist if health care purchasers are to base their decisions on evidence of effectiveness from RCTs. However, other types of evidence can be used to support such decisions. Summaries of research should be published in a format that is accessible to purchasers.

scholarly journals Against method: Exploding the boundary between qualitative and quantitative studies of science

2020 ◽  
Vol 1 (3) ◽  
pp. 930-944 ◽  
Author(s):  
Donghyun Kang ◽  
James Evans
Keyword(s):  
Text Analysis ◽  
Large Scale ◽  
Theory Development ◽  
Qualitative Studies ◽  
Digital Data ◽  
Policy Makers ◽  
New Era ◽  
Qualitative And Quantitative ◽  
Quantitative Studies ◽  
Scientific Institutions

Quantitative and qualitative studies of science have historically played radically different roles with opposing epistemological commitments. Using large-scale text analysis, we see that qualitative studies generate and value new theory, especially regarding the complex social and political contexts of scientific action, while quantitative approaches confirm existing theory and evaluate the performance of scientific institutions. Large-scale digital data and emerging computational methods could allow us to refigure these positions, turning qualitative artifacts into quantitative patterns into qualitative insights across many scales, heralding a new era of theory development, engagement, and relevance for scientists, policy-makers, and society.

scholarly journals The Relationship between Branched-Chain Amino Acid Related Metabolomic Signature and Insulin Resistance: A Systematic Review

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Xue Zhao ◽  
Qing Han ◽  
Yujia Liu ◽  
Chenglin Sun ◽  
Xiaokun Gang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Insulin Resistance ◽  
Large Scale ◽  
Positive Association ◽  
Current Evidence ◽  
Cochrane Library ◽  
Diabetic Patients ◽  
Factors Influencing ◽  
Branched Chain ◽  
The Relationship

Recent studies have shown the positive association between increased circulating BCAAs (valine, leucine, and isoleucine) and insulin resistance (IR) in obese or diabetic patients. However, results seem to be controversial in different races, diets, and distinct tissues. Our aims were to evaluate the relationship between BCAA and IR as well as later diabetes risk and explore the phenotypic and genetic factors influencing BCAA level based on available studies. We performed systematic review, searching MEDLINE, EMASE, ClinicalTrials.gov, the Cochrane Library, and Web of Science from inception to March 2016. After selection, 23 studies including 20,091 participants were included. Based on current evidence, we found that BCAA is a useful biomarker for early detection of IR and later diabetic risk. Factors influencing BCAA level can be divided into four parts: race, gender, dietary patterns, and gene variants. These factors might not only contribute to the elevated BCAA level but also show obvious associations with insulin resistance. Genes related to BCAA catabolism might serve as potential targets for the treatment of IR associated metabolic disorders. Moreover, these factors should be controlled properly during study design and data analysis. In the future, more large-scale studies with elaborate design addressing BCAA and IR are required.

scholarly journals The Efficacy and Safety of Esmolol for Septic Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Po Huang ◽  
Xiangchun Zheng ◽  
Zhi Liu ◽  
Xiaolei Fang
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Septic Shock ◽  
Large Scale ◽  
Positive Impact ◽  
Meta Analysis ◽  
Heart Rate Change ◽  
Cochrane Library ◽  
Randomized Controlled ◽  
Further Development

Purpose: The meta-analysis aims to identify whether septic shock patients can benefit from esmolol.Materials and Methods: The relevant studies from MEDLINE, Cochrane Library, Embase were searched by two independent investigators using a variety of keywords. Stata software (version 12.0, Stata Corp LP, College Station, TX, United States)was used for statistical analysis.Results: A total of 14 studies were identified and incorporated into the meta-analysis. For overall analysis, the treatment of esmolol was associated with decreased 28-day mortality (RR = 0.66, 95% CI = 0.56–0.77, p < 0.001). Meanwhile, our analysis found that, esmolol could decrease HR (SMD: −1.70; 95% CI: [−2.24−(−1.17)], cTnI (SMD: −1.61; 95% CI: [−2.06−(−1.16)] compared with standard treatment. No significant differences between the two groups were found in MAP, Lac, CI, and SVI.Conclusion: The findings of this meta-analysis intend to demonstrate that septic shock patients with high heart beats rate might be benefit from esmolol treatment despite enough fluid resuscitation. While, dependent on the study published, with the further development of septic shock, the positive impact of esmolol varies. The appropriate heart rate change interval cannot be confirmed, further high-quality and large-scale RCTs should be performed to verify it and screening more suitable heart rate levels.Systematic Review Registration: CRD42021239513

scholarly journals A systematic review of the evidence for deprescribing interventions among older people living with frailty

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kinda Ibrahim ◽  
Natalie J. Cox ◽  
Jennifer M. Stevenson ◽  
Stephen Lim ◽  
Simon D. S. Fraser ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Current Evidence ◽  
Cochrane Library ◽  
Potentially Inappropriate Medications ◽  
Frailty Status ◽  
Randomised Controlled ◽  
The Impact

Abstract Background Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty. Methods The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Interventional studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists. Results Two thousand three hundred twenty-two articles were identified and six (two randomised controlled trials) were included with 657 participants in total (mean age range 79–87 years). Studies were heterogeneous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n = 3) or multidisciplinary team-led (n = 3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72–91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving. Conclusion There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations. Trial registration The review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367.

The Role of Gut Hormones in Diet-Induced Weight Change: A Systematic Review

2017 ◽  
Vol 49 (11) ◽  
pp. 816-825 ◽  
Author(s):  
Xue Zhao ◽  
Qing Han ◽  
Xiaokun Gang ◽  
You Lv ◽  
Yujia Liu ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Large Scale ◽  
Weight Regain ◽  
Dietary Intervention ◽  
Gut Hormones ◽  
Current Evidence ◽  
Cochrane Library ◽  
Weight Changes ◽  
Gut Hormone

AbstractGut hormones are known to play an important role in long-term weight loss maintenance after bariatric surgery. However, the interplay between gut hormones and diet-induced weight changes remains unclear. Our aims were to evaluate the alterations of gut hormones in diet-induced weight loss, weight maintenance, and weight regain periods. Available studies were searched on MEDLINE, EMASE, ClinicalTrials.gov, the Cochrane Library, and Web of science from inception to October 2016. After selection, 16 studies with 656 participants were included. Based on current evidence, we found significant alterations of gut hormones induced by different diets. In weight-loss diets, decreased fasting total PYY, GLP-1, CCK, GIP, PP, and amylin along with increased ghrelin levels were observed in most studies. After weight loss, the persistent decreases of fasting total PYY and GLP-1 levels as well as increased appetite were reported, suggesting the profound impact of altered gut hormones on later weight regain after dietary intervention. The differences between diet-induced changes in gut hormones and other treatments such as bariatric surgery and exercise are also discussed in this review. Although significant alterations of gut hormones were found during weight changes, huge heterogeneity exists in methods and populations. More large-scale studies with elaborate design addressing the gut hormone alterations in dietary weight regulation are required in the future.

scholarly journals A Systematic Review of the Evidence for Deprescribing Interventions Among Older People Living With Frailty

2020 ◽  
Author(s):  
Kinda Ibrahim ◽  
Natalie Cox ◽  
Jennifer M Stevenson ◽  
Stephen Lim ◽  
Simon Fraser ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Current Evidence ◽  
Cochrane Library ◽  
Potentially Inappropriate Medications ◽  
Frailty Status ◽  
Randomised Controlled ◽  
The Impact

Abstract Background: Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty.Methods: The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists.Results: 2322 articles were identified and six (two randomised controlled trials) were included with 53 participants in total (mean age range 79–87 years). Studies were heterogenous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n=3) or multidisciplinary team-led (n=3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72-91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving. Conclusion: There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations. Trial registration: the review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367.

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