Reduction of ileocolic intussusception under sedation or anaesthesia: a systematic review of complications

2021 ◽  
pp. archdischild-2021-322706
Author(s):  
Moran Gal ◽  
Shirly Gamsu ◽  
Ron Jacob ◽  
Daniel M Cohen ◽  
Itai Shavit
Keyword(s):  
Systematic Review ◽  
Intestinal Perforation ◽  
English Language ◽  
Data Extraction ◽  
Current Data ◽  
Pulmonary Aspiration ◽  
Ileocolic Intussusception ◽  
Newcastle Ottawa Scale ◽  
Permanent Neurological Deficit ◽  
Ottawa Scale

BackgroundDespite the increased use of sedation in children undergoing stressful procedures, reduction of ileocolic intussusception (RII) is usually performed on awake children without any form of sedation.ObjectiveTo evaluate the incidence of severe complications of RII under sedation or anaesthesia.DesignA systematic review including English language original articles of any date.PatientsChildren undergoing RII (pneumatic or hydrostatic) under sedation or anaesthesia.Data sourcesOvid Embase, Scopus, PubMed, the Cochrane Database of Systematic Reviews and the internet search engine Google Scholar.Data extractionThree authors independently reviewed each article for eligibility. The Newcastle-Ottawa Scale was used to assess the quality of included studies.Main outcome measuresThe primary outcome was the incidence of intestinal perforation during RII. The secondary outcomes were the incidence of sentinel adverse events defined as death, cardiopulmonary resuscitation, permanent neurological deficit and pulmonary aspiration syndrome.ResultsThe search yielded 368 articles. Nine studies with 1391 cases were included in the analysis. Of the nine studies, six had a score of ≤6 stars in the Newcastle-Ottawa Scale assessment, indicating low-to-moderate quality. Propofol-based sedation was used in 849 (59.2%) cases; 5 (0.6%) had intestinal perforation. Intestinal perforation was not reported in patients who were sedated with other sedatives. One patient had pulmonary aspiration syndrome.ConclusionsAlthough caution remains warranted, current data suggest that the incidence of severe complications due to RII under sedation or anaesthesia is low. Due to the lack of prospective data, it is difficult to ascertain the exact incidence of severe complications.

scholarly journals Epidemiology of placenta previa accreta: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031193 ◽  
Author(s):  
Eric Jauniaux ◽  
Lene Grønbeck ◽  
Catey Bunce ◽  
Jens Langhoff-Roos ◽  
Sally L Collins
Keyword(s):  
Systematic Review ◽  
Placenta Previa ◽  
Data Extraction ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Registration Number ◽  
Newcastle Ottawa Scale ◽  
Placenta Accreta Spectrum ◽  
Obstetric Population ◽  
Ottawa Scale

ObjectiveTo estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis.DesignSystematic review and meta-analysis.Data sourcesPubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between August 1982 and September 2018.Eligibility criteriaStudies reporting on placenta previa complicated by PAS diagnosed in a defined obstetric population.Data extraction and synthesisTwo independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with difference agreed by consensus. The primary outcomes were overall prevalence of placenta previa, incidence of PAS according to the type of placenta previa and the reported clinical outcomes, including the number of peripartum hysterectomies and direct maternal mortality. The secondary outcomes included the criteria used for the prenatal ultrasound diagnosis of placenta previa and the criteria used to diagnose and grade PAS at birth.ResultsA total of 258 articles were reviewed and 13 retrospective and 7 prospective studies were included in the analysis, which reported on 587 women with placenta previa and PAS. The meta-analysis indicated a significant (p<0.001) heterogeneity between study estimates for the prevalence of placenta previa, the prevalence of placenta previa with PAS and the incidence of PAS in the placenta previa cohort. The median prevalence of placenta previa was 0.56% (IQR 0.39–1.24) whereas the median prevalence of placenta previa with PAS was 0.07% (IQR 0.05–0.16). The incidence of PAS in women with a placenta previa was 11.10% (IQR 7.65–17.35).ConclusionsThe high heterogeneity in qualitative and diagnostic data between studies emphasises the need to implement standardised protocols for the diagnoses of both placenta previa and PAS, including the type of placenta previa and grade of villous invasiveness.PROSPERO registration numberCRD42017068589

scholarly journals Prevalence of retinopathy in prediabetes: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040997
Author(s):  
Varo Kirthi ◽  
Paul Nderitu ◽  
Uazman Alam ◽  
Jennifer Evans ◽  
Sarah Nevitt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diabetic Retinopathy ◽  
Data Extraction ◽  
Meta Analysis ◽  
International Diabetes Federation ◽  
Current Data ◽  
Risk Of Bias ◽  
Fundus Photography ◽  
Primary Data ◽  
Cochrane Library

IntroductionThere is growing evidence of a higher than expected prevalence of retinopathy in prediabetes. This paper presents the protocol of a systematic review and meta-analysis of retinopathy in prediabetes. The aim of the review is to estimate the prevalence of retinopathy in prediabetes and to summarise the current data.Methods and analysisThis protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. A comprehensive electronic bibliographic search will be conducted in MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar and the Cochrane Library. Eligible studies will report prevalence data for retinopathy on fundus photography in adults with prediabetes. No time restrictions will be placed on the date of publication. Screening for eligible studies and data extraction will be conducted by two reviewers independently, using predefined inclusion criteria and prepiloted data extraction forms. Disagreements between the reviewers will be resolved by discussion, and if required, a third (senior) reviewer will arbitrate.The primary outcome is the prevalence of any standard features of diabetic retinopathy (DR) on fundus photography, as per International Clinical Diabetic Retinopathy Severity Scale (ICDRSS) classification. Secondary outcomes are the prevalence of (1) any retinal microvascular abnormalities on fundus photography that are not standard features of DR as per ICDRSS classification and (2) any macular microvascular abnormalities on fundus photography, including but not limited to the presence of macular exudates, microaneurysms and haemorrhages. Risk of bias for included studies will be assessed using a validated risk of bias tool for prevalence studies. Pooled estimates for the prespecified outcomes of interest will be calculated using random effects meta-analytic techniques. Heterogeneity will be assessed using the I2 statistic.Ethics and disseminationEthical approval is not required as this is a protocol for a systematic review and no primary data are to be collected. Findings will be disseminated through peer-reviewed publications and presentations at national and international meetings including Diabetes UK, European Association for the Study of Diabetes, American Diabetes Association and International Diabetes Federation conferences.PROSPERO registration numberCRD42020184820.

Hydroxychloroquine prophylaxis for preeclampsia, hypertension and prematurity in pregnant patients with systemic lupus erythematosus: A meta-analysis

Lupus ◽  
2021 ◽  
pp. 096120332110071
Author(s):  
Jiaoniu Duan ◽  
Dan Ma ◽  
Xiaoting Wen ◽  
Qianyu Guo ◽  
Jinfang Gao ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
English Language ◽  
Gestational Hypertension ◽  
Meta Analysis ◽  
Fetal Outcomes ◽  
Pregnancy Hypertension ◽  
Cochrane Database ◽  
Newcastle Ottawa Scale ◽  
Prospective Cohorts ◽  
Ottawa Scale

Objectives This meta-analysis aimed to evaluate the effectiveness of HCQ in improving the maternal and fetal outcomes in pregnancies with SLE. Methods A literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane database for relevant English language articles, and Wanfang, CNKI and VIP for Chinese articles, from the databases’ inception to April 30, 2020. These studies compared the maternal and/or fetal outcomes between pregnant patients with SLE who were administered HCQ during pregnancy (HCQ+ group) and those who were not administered HCQ (HCQ− group). Two investigators extracted the data and assessed the quality using the Newcastle-Ottawa Scale (NOS) and GRADE criteria independently. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. All statistical analyses were conducted using the Stata 12.0 software. Results Nine studies involving 1132 pregnancies were included in the study (3 case controls, 2 prospective cohorts, 4 retrospective cohorts). Preeclampsia, gestational hypertension, and prematurity were significantly lower in the HCQ+ group than in the HCQ− group (OR 0.35, 95% CI 0.21–0.59), (OR 0.41, 95% CI 0.19–0.89) and (OR 0.55, 95% CI 0.36–0.86), respectively. There were no significant differences in the rates of HELLP Syndrome (OR 0.88, 95% CI 0.19–3.96), gestational diabetes (OR 2.3, 95% CI 0.44–12.12), thrombotic events (OR 0.26, 95% CI 0.05–1.51), spontaneous abortion (OR 1.77, 95% CI 0.96–3.26), premature rupture of membranes (OR 0.58, 95% CI 0.24–1.39), oligohydramnios (OR 0.90, 95% CI 0.38–2.14), live birth (OR 1.22, 95% CI 0.60–2.47), stillbirth (OR 1.00, 95% CI 0.50–2.00), congenital malformation (OR 0.53, 95% CI 0.14–2.04), low birth weight (OR 0.77, 95% CI 0.43–1.39), intrauterine distress (OR 1.07, 95% CI 0.41–2.76,), intrauterine growth restriction (OR 0.57, 95% CI 0.06–5.43), or five-minute APGAR score <7 (OR 0.72, 95% CI 0.20–2.58) between the two groups. Conclusions HCQ treatment during pregnancy could reduce the risk of preeclampsia, pregnancy hypertension and prematurity in SLE patients. The certainty of evidence is high but majority of the studies included are retrospective studies and not randomized controlled trials. Therefore, the multidisciplinary management of pregnant patients with SLE should promote HCQ use, irrespective of disease activity or severity.

scholarly journals Safety of Systemic Medications Among Older Adults With Psoriasis and Atopic Dermatitis: A Systematic Review of Observational Studies

2021 ◽  
pp. 120347542199377
Author(s):  
Evan Tang ◽  
Talha Maqbool ◽  
Megan Lam ◽  
Gaelen P. Adam ◽  
Mina Tadrous ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Atopic Dermatitis ◽  
Observational Studies ◽  
Relative Effect ◽  
Emergency Department Visits ◽  
Major Cardiovascular Events ◽  
Quantitative Synthesis ◽  
Newcastle Ottawa Scale ◽  
Ottawa Scale

Background Psoriasis and atopic dermatitis are common among older adults (≥65 years old), but clinical trials often exclude that population. Objective To synthesize evidence from observational studies on the safety of systemic therapies (conventional or biologic) for psoriasis and atopic dermatitis among older adults in a systematic review. Methods We searched MEDLINE and EMBASE (inception to October 31, 2019) and included observational studies reporting adverse events among older people treated with systemic therapy for psoriasis or atopic dermatitis. Outcomes were death, hospitalization, emergency department visits, infections, major cardiovascular events, renal toxicity, hepatotoxicity, and cytopenias. We assessed study quality using the Newcastle-Ottawa Scale. Results We included 22 studies on treatment for psoriasis and 2 for atopic dermatitis. Most studies were small and non-comparative and 20 of 24 were low quality. Studies comparing safety between medications or medication classes or between older and younger adults did not show apparent differences but had wide confidence intervals around relative effect estimates. Heterogeneity of study design and reporting precluded quantitative synthesis. Conclusions There is scant evidence on the safety of conventional systemic and biologic medications for older adults with psoriasis or atopic dermatitis; older adults and their clinicians should be aware of this evidence gap.

Role of Topical Oxymetazoline for Management of Erythematotelangiectatic Rosacea

2017 ◽  
Vol 52 (3) ◽  
pp. 263-267 ◽  
Author(s):  
Rebecca M. Hoover ◽  
John Erramouspe
Keyword(s):  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Drug Approval ◽  
Current Data ◽  
Patient Response ◽  
Study Selection ◽  
Cochrane Database ◽  
Drug Approval Process ◽  
Individual Patient Response

Objective: To review and summarize topical oxymetazoline’s pharmacology, pharmacokinetics, efficacy, safety, cost, and place in therapy for persistent redness associated with erythematotelangiectatic rosacea. Data Sources: Literature searches of MEDLINE (1975 to September 2017), International Pharmaceutical Abstracts (1975 to September 2017), and Cochrane Database (publications through September 2017) using the terms rosacea, persistent redness, α -agonist, and oxymetazoline. Study Selection and Data Extraction: Results were limited to studies of human subjects, English-language publications, and topical use of oxymetazoline. Relevant materials from government sources, industry, and reviews were also included. Data Synthesis: Data support the efficacy of oxymetazoline for persistent facial redness. Little study beyond clinical trials cited in the drug approval process has been conducted. Current data suggest that oxymetazoline is similar in safety and efficacy to brimonidine. Head-to-head comparisons of topical α-agonists for erythema caused by rosacea are needed. Conclusion: The topical α-agonist, oxymetazoline, is safe and effective for reducing persistent facial redness associated with erythematotelangiectatic subtype of rosacea. Health care practitioners selecting among treatments should consider not only the subtype of rosacea but also individual patient response, preference, and cost.

scholarly journals What does my neighbourhood have to do with my weight? A protocol for systematic review and meta-analysis of the association between neighbourhood socioeconomic status and body weight

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017567
Author(s):  
Shimels Hussien Mohammed ◽  
Mulugeta Molla Birhanu ◽  
Tesfamichael Awoke Sissay ◽  
Tesfa Dejenie Habtewold ◽  
Balewgizie Sileshi Tegegn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Socioeconomic Status ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cross Sectional ◽  
Registration Number ◽  
Newcastle Ottawa Scale ◽  
Neighbourhood Socioeconomic Status ◽  
Using Data

IntroductionIndividuals living in poor neighbourhoods are at a higher risk of overweight/obesity. There is no systematic review and meta-analysis study on the association of neighbourhood socioeconomic status (NSES) with overweight/obesity. We aimed to systematically review and meta-analyse the existing evidence on the association of NSES with overweight/obesity.Methods and analysisCross-sectional, case–control and cohort studies published in English from inception to 15 May 2017 will be systematically searched using the following databases: PubMed, EMBASE, Web of Sciences and Google Scholar. Selection, screening, reviewing and data extraction will be done by two reviewers, independently and in duplicate. The Newcastle–Ottawa Scale (NOS) will be used to assess the quality of evidence. Publication bias will be checked by visual inspection of funnel plots and Egger’s regression test. Heterogeneity will be checked by Higgins’s method (I2statistics). Meta-analysis will be done to estimate the pooled OR. Narrative synthesis will be performed if meta-analysis is not feasible due to high heterogeneity of studies.Ethics and disseminationEthical clearance is not required as we will be using data from published articles. Findings will be communicated through a publication in a peer-reviewed journal and presentations at professional conferences.PROSPERO registration numberCRD42017063889.

Systematic review of interventions to improve gender equity in graduate medicine

2021 ◽  
pp. postgradmedj-2020-138864
Author(s):  
Sinéad Lydon ◽  
Emily O'Dowd ◽  
Chloe Walsh ◽  
Angela O'Dea ◽  
Dara Byrne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gender Equity ◽  
English Language ◽  
Clinical Medicine ◽  
Data Extraction ◽  
Self Report ◽  
Clinical Settings ◽  
Reference List ◽  
High Quality Research ◽  
Work Settings

Women are substantially underrepresented in senior and leadership positions in medicine and experience gendered challenges in their work settings. This systematic review aimed to synthesise research that has evaluated interventions for improving gender equity in medicine. English language electronic searches were conducted across MEDLINE, CINAHL, Academic Search Complete, PsycINFO and Web of Science. Reference list screening was also undertaken. Peer-reviewed studies published between 2000 and March 2020 that evaluated interventions to improve gender equity, or the experiences of women, in academic or clinical medicine were reviewed. Dual reviewer data extraction on setting, participants, type of intervention, measurement and outcomes was completed. Methodological rigour and strength of findings were evaluated. In total, 34 studies were included. Interventions were typically focused on equipping the woman (82.4%), that is, delivering professional development activities for women. Fewer focused on changing cultures (20.6%), ensuring equal opportunities (23.5%) or increasing the visibility or valuing of women (23.5%). Outcomes were largely positive (87.3%) but measurement typically relied on subjective, self-report data (69.1%). Few interventions were implemented in clinical settings (17.6%). Weak methodological rigour and a low strength of findings was observed. There has been a focus to-date on interventions which Equip the Woman. Interventions addressing systems and culture change require further research consideration. However, institutions cannot wait on high quality research evidence to emerge to take action on gender equity. Data collated suggest a number of recommendations pertaining to research on, and the implementation of, interventions to improve gender equity in academic and clinical settings.

The promise of Telemedicine in Pakistan: A Systematic Review (Preprint)

2021 ◽  
Author(s):  
Syed Sarosh Mahdi ◽  
Franceso Amenta ◽  
Raheel Allana ◽  
Gopi Battineni 3rd ◽  
Tamsal Khalid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rural Areas ◽  
Urban Region ◽  
Middle Income ◽  
Web Based ◽  
Study Characteristics ◽  
Implementation Costs ◽  
Newcastle Ottawa Scale ◽  
Good Support ◽  
Ottawa Scale

BACKGROUND Telemedicine is a medical practice of assisting remote patients and it has great potential in developing countries like Pakistan. Telemedicine solves the logistical barriers, deliver good support to weak health systems and unite worldwide networks of healthcare personals. Because of high implementation costs, yet it is not possible to adopt telehealth systems for low and middle-income nations. OBJECTIVE In this systematic review, we aim to present an update revision of region-based telemedical services in Pakistan. METHODS Libraries such as PubMed (Medline), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus (EMBASE) and Google Scholar were used for document search. Newcastle Ottawa Scale (NOS) is adopted to conduct study quality. Majority of the studies (n-8) included in the review were of high quality as assessed through the Newcastle Ottawa scale. Selected study characteristics further analyzed based on different parameters such as publication year, sample size, study design, methods, motivation and outcomes. RESULTS Search produced 955 articles and 11 items were ultimately selected to conduct the review. These studies further characterized as region-based telemedicine implementation. Out of 11, eight studies were conducted in the urban region and three studies were conducted in the rural areas of Pakistan. Majority of studies produced evidence on telehealth interventions by smartphone services like SMS, apps and web-based telemedicine. CONCLUSIONS Telehealth interventions like mHealth, eHealth, telemedicine, and telepharmacy are starting to evaluate for the last two decades but certainly needs to become an integral part of Pakistan's current health infrastructure.

scholarly journals Sleep in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies

2018 ◽  
Vol 21 (4) ◽  
pp. 146-154 ◽  
Author(s):  
Amparo Díaz-Román ◽  
Junhua Zhang ◽  
Richard Delorme ◽  
Anita Beggiato ◽  
Samuele Cortese
Keyword(s):  
Systematic Review ◽  
Autism Spectrum Disorders ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Newcastle Ottawa Scale ◽  
Spectrum Disorders ◽  
Sleep Alterations ◽  
The Impact ◽  
Ottawa Scale

BackgroundSleep problems are common and impairing in individuals with autism spectrum disorders (ASD). Evidence synthesis including both subjective (ie, measured with questionnaires) and objective (ie, quantified with neurophysiological tools) sleep alterations in youth with ASD is currently lacking.ObjectiveWe conducted a systematic review and meta-analysis of subjective and objective studies sleep studies in youth with ASD.MethodsWe searched the following electronic databases with no language, date or type of document restriction up to 23 May 2018: PubMed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge. Random-effects models were used. Heterogeneity was assessed with Cochran’s Q and I2 statistics. Publication (small studies) bias was assessed with final plots and the Egger’s test. Study quality was evaluated with the Newcastle Ottawa Scale. Analyses were conducted using Review Manager and Comprehensive Meta-Analysis.FindingsFrom a pool of 3359 non-duplicate potentially relevant references, 47 datasets were included in the meta-analyses. Subjective and objective sleep outcome measures were extracted from 37 and 15 studies, respectively. Only five studies were based on comorbidity free, medication-naïve participants. Compared with typically developing controls, youth with ASD significantly differed in 10/14 subjective parameters and in 7/14 objective sleep parameters. The average quality score in the Newcastle-Ottawa Scale was 5.9/9.Discussion and clinical implicationsA number of subjective and, to a less extent, objective sleep alterations might characterise youth with ASD, but future studies should assess the impact of pharmacological treatment and psychiatric comorbidities.

scholarly journals Factors Associated with Disease Severity and Mortality among Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Vignesh Chidambaram ◽  
Nyan Lynn Tun ◽  
Waqas Haque ◽  
Marie Gilbert Majella ◽  
Ranjith Kumar Sivakumar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
English Language ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Data Extraction ◽  
Meta Analysis ◽  
Severe Disease ◽  
Factors Associated ◽  
Risk Of Mortality

Background: Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. Methods: We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. Results: Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45; 95%CI 1.23,1.71), dyspnea (RR 2.55; 95%CI 1.88,2.46), diabetes (RR 1.59; 95%CI 1.41,1.78), hypertension (RR 1.90; 95%CI 1.69,2.15). Congestive heart failure (OR 4.76; 95%CI 1.34,16.97), hilar lymphadenopathy (OR 8.34; 95%CI 2.57,27.08), bilateral lung involvement (OR 4.86; 95%CI 3.19,7.39) and reticular pattern (OR 5.54; 95%CI 1.24,24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. Conclusion: Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

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