scholarly journals The role of corticosteroids in the management of critically ill patients with coronavirus disease 2019 (COVID-19): A meta-analysis

2020 ◽  
Author(s):  
Kalyan Kumar Gangopadhyay ◽  
Jagat J Mukherjee ◽  
Binayak Sinha ◽  
Samit Ghosal
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Data Synthesis ◽  
Systemic Corticosteroids ◽  
Study Selection ◽  
Coronavirus Infection

AbstractObjectiveThere are no controlled studies on the role of systemic corticosteroids (CS) in patients with coronavirus disease 2019 (COVID-19). In the absence of high-quality evidence, understandably the recommendations from various organizations are cautious. Several randomized controlled trials are underway but shall take time to conclude. We therefore undertook a meta-analysis to ascertain the role of CS in the management of critically ill patients with COVID-19.Data SourcesElectronic databases, including Pubmed, Cochrane library and Embase, were searched, using the keywords of interest and the PICO search technique, from inception to 12th April 2020.Study SelectionStudies highlighting the use of CS in coronavirus infection with severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS) and COVID-19 were selected based on pre-determined inclusion criteria.Data extractionData was extracted into an excel sheet and transferred to comprehensive meta-analysis software version 3, Biostat Inc., Englewood, NJ, USA, for analysis.Data synthesisFive studies with SARS-CoV-2 infection were included in the meta-analysis. The rate ratio (RR) for mortality in patients with SARS-CoV-2 infection was 1.26 (95% CI: 0.96-1.65, I2: 74.46), indicating lack of benefit of CS therapy on mortality in critically ill patients with COVID-19. The RR for mortality on analysis of the three studies that particularly reported on patients with significant pulmonary compromise secondary to SARS-CoV-2 infection was neutral (RR: 0.91, 95% CI: 0.63-1.33, I2: 63.38).ConclusionsThe use of CS in critically ill patients with COVID-19 did not improve or worsen mortality. Pending further information from controlled studies, CS can be used in critically ill patients with COVID-19 with ‘critical illness related corticosteroid insufficiency’ and moderate to severe ARDS without the risk of increased mortality.

scholarly journals Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

2020 ◽  
Vol 30 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Jasmine N Khouja ◽  
Steph F Suddell ◽  
Sarah E Peters ◽  
Amy E Taylor ◽  
Marcus R Munafò
Keyword(s):  
Animal Studies ◽  
Data Extraction ◽  
Meta Analysis ◽  
Self Report ◽  
Smoking History ◽  
Cochrane Library ◽  
Cigarette Use ◽  
Data Synthesis ◽  
Study Selection ◽  
Negative Controls

ObjectiveThe aim of this review was to investigate whether e-cigarette use compared with non-use in young non-smokers is associated with subsequent cigarette smoking.Data sourcesPubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts.Study selectionAll studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an OR could be calculated were included (excluding reviews and animal studies).Data extractionIndependent extraction was completed by multiple authors using a preprepared extraction form.Data synthesisOf 9199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR: 4.59, 95% CI: 3.60 to 5.85) when the results were meta-analysed in a random-effects model. However, there was high heterogeneity (I2=88%).ConclusionsAlthough the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.

scholarly journals Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

2019 ◽  
Author(s):  
Jasmine N Khouja ◽  
Steph F Suddell ◽  
Sarah Peters ◽  
Amy E Taylor ◽  
Marcus R Munafò
Keyword(s):  
Animal Studies ◽  
Data Extraction ◽  
Meta Analysis ◽  
Self Report ◽  
Smoking History ◽  
Cochrane Library ◽  
Cigarette Use ◽  
Data Synthesis ◽  
Study Selection ◽  
Negative Controls

AbstractObjectiveThe aim of this review was to investigate whether e-cigarette use compared to non-use in young non-smokers is associated with subsequent cigarette smoking.Data sourcesPubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts.Study selectionAll studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an odds ratio could be calculated were included (excluding reviews and animal studies).Data ExtractionIndependent extraction was completed by multiple authors using a pre-prepared extraction form.Data synthesisOf 9,199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR 4.59, 95% CI 3.60 to 5.85) when the results were meta-analysed in a random effects model. However, there was high heterogeneity (I2 = 88%).ConclusionsWhilst the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.

scholarly journals Prioritising recommendations following analyses of adverse events in healthcare: a systematic review

2020 ◽  
Vol 9 (4) ◽  
pp. e000843
Author(s):  
Kelly Bos ◽  
Maarten J van der Laan ◽  
Dave A Dongelmans
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Data Extraction ◽  
Data Sources ◽  
Cochrane Library ◽  
High Quality ◽  
Data Synthesis ◽  
Study Selection ◽  
Personal Opinion ◽  
User Friendly

PurposeThe purpose of this systematic review was to identify an appropriate method—a user-friendly and validated method—that prioritises recommendations following analyses of adverse events (AEs) based on objective features.Data sourcesThe electronic databases PubMed/MEDLINE, Embase (Ovid), Cochrane Library, PsycINFO (Ovid) and ERIC (Ovid) were searched.Study selectionStudies were considered eligible when reporting on methods to prioritise recommendations.Data extractionTwo teams of reviewers performed the data extraction which was defined prior to this phase.Results of data synthesisEleven methods were identified that are designed to prioritise recommendations. After completing the data extraction, none of the methods met all the predefined criteria. Nine methods were considered user-friendly. One study validated the developed method. Five methods prioritised recommendations based on objective features, not affected by personal opinion or knowledge and expected to be reproducible by different users.ConclusionThere are several methods available to prioritise recommendations following analyses of AEs. All these methods can be used to discuss and select recommendations for implementation. None of the methods is a user-friendly and validated method that prioritises recommendations based on objective features. Although there are possibilities to further improve their features, the ‘Typology of safety functions’ by de Dianous and Fiévez, and the ‘Hierarchy of hazard controls’ by McCaughan have the most potential to select high-quality recommendations as they have only a few clearly defined categories in a well-arranged ordinal sequence.

Risk of Gastrointestinal Bleeding on Treatment With Statin Alone or With Concomitant Administration of Warfarin: A Systematic Review and Meta-analysis of 5.3 Million Participants

2021 ◽  
pp. 106002802110497
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Kota Vidyasaga ◽  
Eyob Alemayehu Gebreyohannes ◽  
Wubshet Tesfaye
Keyword(s):  
Gastrointestinal Bleeding ◽  
Observational Studies ◽  
Data Extraction ◽  
Meta Analysis ◽  
Concomitant Administration ◽  
Pooled Analysis ◽  
Data Synthesis ◽  
Study Selection ◽  
Statin Monotherapy ◽  
Statin Use

Objective: This study aimed to comprehensively evaluate the risk of gastrointestinal bleeding (GIB) with statin monotherapy or with concomitant warfarin use. Data Sources: PubMed, Web of Science, and EMBASE (via Scopus) were searched for observational studies that reported the risk of GIB in adults on statin therapy or with concomitant warfarin use until August 28, 2021. Study Selection and Data Extraction: Observational studies evaluating the risk of GIB in adults (age >18 years) on statin medication or concomitant use with warfarin were included. Data Synthesis: In all, 14 studies with a total of 5 235 123 participants, reporting 48 677 GIB events (43 734 from statin users and 4943 from users of statin combined with warfarin), were included in the analyses. The pooled analysis revealed no difference in the risk of GIB with statin monotherapy (relative risk [RR]: 0.65; 95% CI: 0.42-1.02) or concomitant statin + warfarin use (RR: 0.97; 95% CI: 0.91-1.02). Prior use of statin was not associated with GIB risk (RR: 0.88; 95% CI: 0.63-1.22), whereas a shorter duration of statin use (<5 years) was associated with a lower risk of GIB (RR: 0.42; 95% CI: 0.18-0.97). Relevance to Patient Care and Clinical Practice: This analysis provides strong evidence on the association between statin use (with/without warfarin) and risk of GIB. Conclusion: Statin alone or combined with warfarin was not significantly associated with either an increased or decreased risk of GIB. The GIB risk was significantly lower when statins were used for a short duration (<5 years). The putative relationship between statins and GIB in warfarin users warrant further investigation.

Intravenous Zanamivir: A Viable Option for Critically Ill Patients With Influenza

2020 ◽  
pp. 106002802096361
Author(s):  
Douglas Slain
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Data Extraction ◽  
Clinical Trial Data ◽  
Neuraminidase Inhibitor ◽  
European Medicines Agency ◽  
Oseltamivir Resistance ◽  
Study Selection ◽  
Available Information ◽  
Intravenous Formulation

Objective: To review the pharmacology, clinical trial data, and clinical implications for the intravenous formulation of zanamivir. Data Sources: MEDLINE, PubMed, EMBASE, and Google Scholar were searched during November 2019 to July 2020. Search terms zanamivir and neuraminidase inhibitor were used. Study Selection and Data Extraction: All human trials and major reports from compassionate use programs with the intravenous zanamivir (IVZ) formulation were assessed and reviewed here. Data Synthesis: IVZ was found to be similar but not superior to oral oseltamivir in hospitalized patients when studied in populations with very low baseline oseltamivir resistance. IVZ provides an effective alternative for critically ill patients when oral antiviral therapy is not preferred or when oseltamivir resistance is increased. Relevance to Patient Care and Clinical Practice: IVZ was recently authorized for use by the European Medicines Agency, and it is eligible for consideration in emergency use protocols and US stockpile inclusion. It will be of particular interest in critically ill patients especially during influenza seasons with appreciable oseltamivir and peramivir resistance. Conclusions: The available information suggests that the intravenous formulation of zanamivir offers a viable alternative treatment for critically ill patients with influenza, especially when resistance to other agents is present.

Blinding Strategies in Dry Needling Trials: Systematic Review and Meta-Analysis

2019 ◽  
Vol 99 (11) ◽  
pp. 1461-1480 ◽  
Author(s):  
Felicity A Braithwaite ◽  
Julie L Walters ◽  
Lok Sze Katrina Li ◽  
G Lorimer Moseley ◽  
Marie T Williams ◽  
...  
Keyword(s):  
Data Extraction ◽  
Meta Analysis ◽  
Cognitive Strategies ◽  
Evidence Based ◽  
Dry Needling ◽  
Data Synthesis ◽  
Study Selection ◽  
Methodological Bias ◽  
Tactile Sensations ◽  
Effectiveness Data

Abstract Background Blinding of participants and therapists in trials of physical interventions is a significant and ongoing challenge. There is no widely accepted sham protocol for dry needling. Purpose The purpose of this review was to summarize the effectiveness and limitations of blinding strategies and types of shams that have been used in dry needling trials. Data Sources Twelve databases were searched from inception to February 2016. Study Selection Trials that compared active dry needling with a sham that simulated dry needling were included. Data Extraction The main domains of data extraction were participant/therapist details, intervention details, blinding strategies, blinding assessment outcomes, and key conclusions of authors. Reported blinding strategies and sham types were synthesized descriptively, with available blinding effectiveness data synthesized using a chance-corrected measurement of blinding (blinding index). Data Synthesis The search identified 4894 individual publications with 27 trials eligible for inclusion. In 22 trials, risk of methodological bias was high or unclear. Across trials, blinding strategies and sham types were heterogeneous. Notably, no trials attempted therapist blinding. Sham protocols have focused on participant blinding using strategies related to group standardization and simulation of tactile sensations. There has been little attention given to the other senses or cognitive strategies to enhance intervention credibility. Nonpenetrating sham types may provide effective participant blinding. Limitations Trials were clinically and methodologically diverse, which limited the comparability of blinding effectiveness across trials. Reported blinding evaluations had a high risk of chance findings with power clearly achieved in only 1 trial. Conclusions Evidence-based consensus on a sham protocol for dry needling is required. Recommendations provided in this review may be used to develop sham protocols so that future protocols are more consistent and potentially more effective.

Changing Perspectives of Stress Gastritis Prophylaxis

1994 ◽  
Vol 28 (9) ◽  
pp. 1073-1085 ◽  
Author(s):  
Maureen A. Smythe ◽  
Barbara J. Zarowitz
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Data Extraction ◽  
Care Patient ◽  
Receptor Antagonists ◽  
Data Synthesis ◽  
Medline Search ◽  
Prophylactic Agent ◽  
Study Selection ◽  
Meta Analyses

OBJECTIVE: To present recent advances in stress gastritis prophylaxis in the critically ill and review considerations in selection of a prophylactic agent. DATA SOURCES: Information was obtained from MEDLINE search, reference lists from articles identified in search, and from review articles. STUDY SELECTION: Emphasis was placed on controlled trials conducted within the last 5 years. DATA EXTRACTION: All literature was assessed for methodology, results, and conclusions. Results of prospective, randomized trials, and meta-analyses are summarized. DATA SYNTHESIS: Histamine2-receptor antagonists, antacids, and sucralfate appear equally effective in preventing stress gastritis in the critically ill. A definitive cause–effect relationship between histamine2-receptor antagonists and increased incidence of nosocomial pneumonia has not yet been established. The indications for using a prophylactic agent and consideration in selecting an agent should include an evaluation of the following: Risk factors for gastritis including the type of intensive care patient, comparative efficacy, adverse effects, drug interactions, cost, and ease of administration. The least expensive, safest agent requiring minimal monitoring is sucralfate. Prevention of stress gastritis has never been shown to reduce morbidity or mortality significantly. CONCLUSIONS: Controversies still exist regarding the need to provide prophylaxis, the choice of an agent, and the relative importance of previously identified risk factors. Further well-designed studies are needed before consensus can be reached.

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 088506662094027
Author(s):  
Jeremy Cheuk Kin Sin ◽  
Lillian King ◽  
Emma Ballard ◽  
Stacey Llewellyn ◽  
Kevin B. Laupland ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Icu Length Of Stay ◽  
Newcastle Ottawa Scale

Purpose: Hypophosphatemia is reported in up to 5% of hospitalized patients and ranges from 20% to 80% in critically ill patients. The consequences of hypophosphatemia for critically ill patients remain controversial. We evaluated the effect of hypophosphatemia on mortality and length of stay in intensive care unit (ICU) patients. Methods: MEDLINE, EMBASE, Cochrane Library (Reviews and Trials), and PubMed were searched for articles in English. The primary outcome was mortality and secondary outcome was length of stay. The quality of evidence was graded using a modified Newcastle-Ottawa Scale. Results: Our search yielded 828 articles and ultimately included 12 studies with 7626 participants in the analysis. Hypophosphatemia was associated with increased hospital length of stay (2.19 days [95% CI, 1.74-2.64]) and ICU length of stay (2.22 days [95% CI, 1.00-3.44]) but not mortality (risk ratio: 1.13 [95% CI, 0.98-1.31]; P = .09). Conclusions: Hypophosphatemia in ICU was associated with increased hospital and ICU length of stay but not all-cause mortality. Hypophosphatemia appears to be a marker of disease severity. Limited number of available studies and varied study designs did not allow for the ascertainment of the effect of severe hypophosphatemia on patient mortality.

scholarly journals Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Ka Man Fong ◽  
Shek Yin Au ◽  
George Wing Yiu Ng
Keyword(s):  
Respiratory Failure ◽  
Data Extraction ◽  
Meta Analysis ◽  
Adult Patients ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Study Selection ◽  
Screening Study

Abstract Background Patients with acute hypoxemic respiratory failure are at risk for life-threatening complications during endotracheal intubation. Preoxygenation might help reduce the risk of hypoxemia and intubation-related complications. This network meta-analysis summarizes the efficacy and safety of preoxygenation methods in adult patients with acute hypoxemic respiratory failure. Methods We searched PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials through April 2019 for randomized controlled trials (RCT) that studied the use of conventional oxygen therapy (COT), high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and HFNC and NIV as preoxygenation before intubation in patients with acute hypoxemic respiratory failure. Citations’ screening, study selection, data extraction, and risk of bias assessment were independently performed by two authors. The primary outcome was the lowest SpO2 during the intubation procedure. Results We included 7 RCTs (959 patients). Patients preoxygenated with NIV had significantly less desaturation than patients treated with COT (mean difference, MD 5.53, 95% CI 2.71, 8.34) and HFNC (MD 3.58, 95% CI 0.59, 6.57). Both NIV (odds ratio, OR 0.43, 95% CI 0.21, 0.87) and HFNC (OR 0.49, 95% CI 0.28, 0.88) resulted in a lower risk of intubation-related complications than COT. There were no significant mortality differences among the use of NIV, HFNC, COT, and HFNC and NIV during preoxygenation. Conclusions In adult patients with acute hypoxemic respiratory failure, NIV is a safe and probably the most effective preoxygenation method.

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