Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta-analyses

(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: “caesarean section”, “cesarean section”, “wound complication”, “wound morbidity”, and “wound infection”. A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64–2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85–3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking.

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Experiences of children who have been separated from a parent due to military deployment:a systematic review of reviews

BJPsych Open ◽

10.1192/bjo.2021.702 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S263-S263

Author(s):

Jennifer Kent ◽

Pamela Taylor ◽

Sarah Argent ◽

Narasha Kalebic

Keyword(s):

Systematic Review ◽

English Language ◽

Child Outcomes ◽

Physical Symptoms ◽

Mental Illnesses ◽

Military Deployment ◽

Parental Relationships ◽

Negative Effect ◽

Review Of Reviews ◽

Meta Analyses

AimsTo conduct a systematic review of reviews to investigate how military deployment of a parent affects his/her child, and the extent to which the child's own perspectives have been documented.BackgroundLengthy but finite disruptions to parenting in any form may affect child development and mental and physical health.Military deployment means weeks or months of separation from one parent.2016 figures for the U.S. military showed that 40.5% of military personnel have children, and of these 1.7 million children the largest percentage are aged between 0–5 years (37.8%).MethodSeven databases were searched: AMED, Web of Science, Scopus, EMBASE 1947, Joanna Briggs Institute EMP database, Ovid MEDLINE 1946 and PsycINFO 1806 from the inception of each electronic database until 31st March 2018.Inclusion criteria:Child and young adults aged 0–24 yearsEnglish language papers onlyAll papers being systematic reviews or meta-analysesA focus on documenting the effects on child outcomesData extracted included the review methods and child outcomes reported, including educational attainment; physical symptoms; mental illnesses or disorders; changes to behaviours, and effects on peer and parental relationships.ResultThe eight reviews identified included 32 common and relevant studies.Across the various studies, only about 20% of data came directly from children.Five papers extracted from the reviews identified parental deployment as having a negative effect on school attainment.Nine studies extracted from the review papers found a positive correlation between having a deployed parent and a greater chance of experiencing depressive symptoms and feelings of anxiety.Strong correlations of increased prevalence of both externalising & internalising behaviours were conclusively found in 7 of the reviews.Increased resilience was detailed in only one study featured in multiple reviews.Just one study featured across the reviews reported on physiological measures - adolescents with deployed parents had higher blood pressures and significantly higher heart rates and stress scores than civilian children.ConclusionMore research obtaining the viewpoint of the child directly and observation of such children is required to properly understand the effects on children with a deployed parent, without the interference of parent or teacher reporting bias. Additionally, with only one study reporting on increased offspring resilience there has been limited exploration of potential positive correlates, so further research regarding these is important.

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Remote Care Technology: A Systematic Review of Reviews and Meta-Analyses

Technologies ◽

10.3390/technologies6010022 ◽

2018 ◽

Vol 6 (1) ◽

pp. 22 ◽

Cited By ~ 7

Author(s):

Alexandra Queirós ◽

Joaquim Alvarelhão ◽

Margarida Cerqueira ◽

Anabela Silva ◽

Milton Santos ◽

...

Keyword(s):

Systematic Review ◽

Review Of Reviews ◽

Remote Care ◽

Care Technology ◽

Meta Analyses

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A Review of Strategies to Improve Biomechanical Fixation in the Cervical Spine

Global Spine Journal ◽

10.1177/21925682211063855 ◽

2022 ◽

pp. 219256822110638

Author(s):

Colby Oitment ◽

Patrick Thornley ◽

Frank Koziarz ◽

Thorsten Jentzsch ◽

Kunal Bhanot

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Surgical Techniques ◽

Cochrane Library ◽

Rigid Fixation ◽

Poor Bone Quality ◽

Bone Implant ◽

Meta Analyses ◽

Key Techniques ◽

Biomechanical Strength

Study Design Systematic review. Objectives Review the surgical techniques and construct options aimed at improving the biomechanical strength of cervical constructs. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify all studies examining biomechanical strategies utilized in the osteoporotic cervical spine. Screening was performed in duplicate for all stages of the review process. Results An initial search returned 3887 articles. After deletion of duplications and review of abstracts and full text, 39 articles met inclusion criteria. Overall, the surgical techniques reviewed aimed at obtaining rigid fixation in the setting of poor bone quality, or dispersing the forces at the bone-implant interface. We identified 6 key techniques to improve biomechanical fixation. These include bicortical fixation, appropriate screw selection (size and trajectory), PMMA augmentation, load sharing techniques, consideration of ancillary fixation around the occipitocervical junction, and supplementing the construct with post-operative collar or halo. Conclusion The summation of the literature highlights a framework of modalities available to surgeons to improve biomechanical fixation in the cervical spine. While these may improve construct strength in the setting of osteoporosis, there is a paucity of evidence available to make recommendations in this patient population.

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Consequences of physical inactivity in older adults: A systematic review of reviews and meta‐analyses

Scandinavian Journal of Medicine and Science in Sports ◽

10.1111/sms.13616 ◽

2020 ◽

Vol 30 (5) ◽

pp. 816-827 ◽

Cited By ~ 20

Author(s):

Conor Cunningham ◽

Roger O' Sullivan ◽

Paolo Caserotti ◽

Mark A. Tully

Keyword(s):

Systematic Review ◽

Older Adults ◽

Physical Inactivity ◽

Review Of Reviews ◽

Meta Analyses

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Technologies for Ageing in Place: A Systematic Review of Reviews and Meta-analyses

Biomedical Engineering Systems and Technologies - Communications in Computer and Information Science ◽

10.1007/978-3-319-94806-5_18 ◽

2018 ◽

pp. 331-353

Author(s):

Luís Pereira ◽

Ana Dias ◽

Alexandra Queirós ◽

Nelson Pacheco Rocha

Keyword(s):

Systematic Review ◽

Ageing In Place ◽

Review Of Reviews ◽

Meta Analyses

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A Systematic Review of Treatment Interventions for Metacarpal Shaft Fractures in Adults

Hand ◽

10.1177/1558944720974363 ◽

2020 ◽

pp. 155894472097436

Author(s):

Rowa H. M. Taha ◽

Douglas Grindlay ◽

Sandeep Deshmukh ◽

Alan Montgomery ◽

Tim R. C. Davis ◽

...

Keyword(s):

Systematic Review ◽

Best Practice ◽

Treatment Modalities ◽

Eligibility Criteria ◽

Efficient Treatment ◽

Shaft Fractures ◽

Metacarpal Shaft ◽

Wide Variability ◽

Cost Efficient ◽

Meta Analyses

Metacarpal shaft fractures are common hand injuries that predominantly affect younger patients. There is wide variability in their treatment with no consensus on best practice. We performed a systematic review to assess the breadth and quality of available evidence supporting different treatment modalities for metacarpal shaft fractures of the finger digits in adults. A comprehensive search was conducted across multiple databases, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1600 records were identified; 7 studies fulfilled eligibility criteria and were included. No randomized controlled trials directly comparing surgery with nonsurgical treatment were found. One retrospective study compared nonsurgical with surgical treatment, whereas 6 compared surgical or nonsurgical treatments. Considerable heterogeneity between studies along with a high or critical risk of bias restricts direct comparison and conclusions. There is a lack of high-quality evidence to guide treatment, supporting the need for well-designed, multicenter trials to identify the most effective and cost-efficient treatment for metacarpal shaft fractures in adults.

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The Effect of Laboratory Test–Based Clinical Decision Support Tools on Medication Errors and Adverse Drug Events: A Laboratory Medicine Best Practices Systematic Review

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.028019 ◽

2019 ◽

Vol 3 (6) ◽

pp. 1035-1048

Author(s):

Nedra S Whitehead ◽

Laurina Williams ◽

Sreelatha Meleth ◽

Sara Kennedy ◽

Nneka Ubaka-Blackmoore ◽

...

Keyword(s):

Systematic Review ◽

Decision Support ◽

Clinical Decision Support ◽

Best Practice ◽

Adverse Drug Events ◽

Clinical Decision ◽

Laboratory Medicine ◽

Bibliographic Databases ◽

Laboratory Monitoring ◽

Meta Analyses

Abstract Background Laboratory and medication data in electronic health records create opportunities for clinical decision support (CDS) tools to improve medication dosing, laboratory monitoring, and detection of side effects. This systematic review evaluates the effectiveness of such tools in preventing medication-related harm. Methods We followed the Laboratory Medicine Best Practice (LMBP) initiative's A-6 methodology. Searches of 6 bibliographic databases retrieved 8508 abstracts. Fifteen articles examined the effect of CDS tools on (a) appropriate dose or medication (n = 5), (b) laboratory monitoring (n = 4), (c) compliance with guidelines (n = 2), and (d) adverse drug events (n = 5). We conducted meta-analyses by using random-effects modeling. Results We found moderate and consistent evidence that CDS tools applied at medication ordering or dispensing can increase prescriptions of appropriate medications or dosages [6 results, pooled risk ratio (RR), 1.48; 95% CI, 1.27–1.74]. CDS tools also improve receipt of recommended laboratory monitoring and appropriate treatment in response to abnormal test results (6 results, pooled RR, 1.40; 95% CI, 1.05–1.87). The evidence that CDS tools reduced adverse drug events was inconsistent (5 results, pooled RR, 0.69; 95% CI, 0.46–1.03). Conclusions The findings support the practice of healthcare systems with the technological capability incorporating test-based CDS tools into their computerized physician ordering systems to (a) identify and flag prescription orders of inappropriate dose or medications at the time of ordering or dispensing and (b) alert providers to missing laboratory tests for medication monitoring or results that warrant a change in treatment. More research is needed to determine the ability of these tools to prevent adverse drug events.

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Triclosan-Coated Sutures Reduce the Risk of Surgical Site Infections: A Systematic Review and Meta-analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2014.22 ◽

2015 ◽

Vol 36 (2) ◽

pp. 169-179 ◽

Cited By ~ 24

Author(s):

Anucha Apisarnthanarak ◽

Nalini Singh ◽

Aila Nica Bandong ◽

Gilbert Madriaga

Keyword(s):

Systematic Review ◽

Abdominal Surgery ◽

Random Effects ◽

Meta Analysis ◽

Surgical Site Infections ◽

Sensitivity Analyses ◽

Publication Type ◽

Random Effects Models ◽

Meta Regression ◽

Meta Analyses

OBJECTIVETo analyze available evidence on the effectiveness of triclosan-coated sutures (TCSs) in reducing the risk of surgical site infection (SSI).DESIGNSystematic review and meta-analysis.METHODSA systematic search of both randomized (RCTs) and nonrandomized (non-RCT) studies was performed on PubMed Medline, OVID, EMBASE, and SCOPUS, without restrictions in language and publication type. Random-effects models were utilized and pooled estimates were reported as the relative risk (RR) ratio with 95% confidence interval (CI). Tests for heterogeneity as well as meta-regression, subgroup, and sensitivity analyses were performed.RESULTSA total of 29 studies (22 RCTs, 7 non-RCTs) were included in the meta-analysis. The overall RR of acquiring an SSI was 0.65 (95% CI: 0.55–0.77; I2=42.4%, P=.01) in favor of TCS use. The pooled RR was particularly lower for the abdominal surgery group (RR: 0.56; 95% CI: 0.41–0.77) and was robust to sensitivity analysis. Meta-regression analysis revealed that study design, in part, may explain heterogeneity (P=.03). The pooled RR subgroup meta-analyses for randomized controlled trials (RCTs) and non-RCTs were 0.74 (95% CI: 0.61–0.89) and 0.53 (95% CI: 0.42–0.66), respectively, both of which favored the use of TCSs.CONCLUSIONThe random-effects meta-analysis based on RCTs suggests that TCSs reduced the risk of SSI by 26% among patients undergoing surgery. This effect was particularly evident among those who underwent abdominal surgery.Infect Control Hosp Epidemiol 2015;36(2): 1–11

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