The magnitude and severity of abortion-related morbidity in settings with limited access to abortion services: a systematic review and meta-regression

IntroductionDefining and accurately measuring abortion-related morbidity is important for understanding the spectrum of risk associated with unsafe abortion and for assessing the impact of changes in abortion-related policy and practices. This systematic review aims to estimate the magnitude and severity of complications associated with abortion in areas where access to abortion is limited, with a particular focus on potentially life-threatening complications.MethodsA previous systematic review covering the literature up to 2010 was updated with studies identified through a systematic search of Medline, Embase, Popline and two WHO regional databases until July 2016. Studies from settings where access to abortion is limited were included if they quantified the percentage of abortion-related hospital admissions that had any of the following complications: mortality, a near-miss event, haemorrhage, sepsis, injury and anaemia. We calculated summary measures of the percentage of abortion-related hospital admissions with each complication by conducting meta-analysis and explored whether these have changed over time.ResultsBased on data collected between 1988 and 2014 from 70 studies from 28 countries, we estimate that at least 9% of abortion-related hospital admissions have a near-miss event and approximately 1.5% ends in a death. Haemorrhage was the most common complication reported; the pooled percentage of abortion-related hospital admissions with severe haemorrhage was 23%, with around 9% having near-miss haemorrhage reported. There was strong evidence for between-study heterogeneity across most outcomes.ConclusionsIn spite of the challenges on how near miss morbidity has been defined and measured in the included studies, our results suggest that a substantial percentage of abortion-related hospital admissions have potentially life-threatening complications. Estimates that are more reliable will only be obtained with increased use of standard definitions such as the WHO near-miss criteria and/or better reporting of clinical criteria applied in studies.

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The impact of antenatal care on maternal near-miss events in Ethiopia: A systematic review and meta-analysis

International Journal of Africa Nursing Sciences ◽

10.1016/j.ijans.2020.100246 ◽

2020 ◽

Vol 13 ◽

pp. 100246

Author(s):

Ebisa Turi ◽

Ginenus Fekadu ◽

Bedasa Taye ◽

Gemechu Kejela ◽

Markos Desalegn ◽

...

Keyword(s):

Systematic Review ◽

Antenatal Care ◽

Meta Analysis ◽

Near Miss ◽

Maternal Near Miss ◽

The Impact

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Gastric ischemic preconditioning may reduce the incidence and severity of anastomotic leakage after οesophagectomy: a systematic review and meta-analysis

Diseases of the Esophagus ◽

10.1093/dote/doaa010 ◽

2020 ◽

Vol 33 (10) ◽

Author(s):

Adamantios Michalinos ◽

Stavros A Antoniou ◽

Dimitrios Ntourakis ◽

Dimitrios Schizas ◽

Konstantinos Ekmektzoglou ◽

...

Keyword(s):

Systematic Review ◽

Anastomotic Leakage ◽

Ischemic Preconditioning ◽

Postoperative Morbidity ◽

Anastomotic Stricture ◽

Meta Analysis ◽

Subgroup Analyses ◽

Preconditioning Technique ◽

Life Threatening ◽

The Impact

Summary Anastomotic leakage after esophagectomy is a severe and life-threatening complication. Gastric ischemic preconditioning is a strategy for the improvement of anastomotic healing. Aim of this systematic review and meta-analysis is to investigate the impact of gastric ischemic preconditioning on postoperative morbidity. A systematic literature search was performed to identify studies comparing patients undergoing gastric ischemic preconditioning before esophagectomy with nonpreconditioned patients. Meta-analysis was conducted for the overall incidence of anastomotic leakage, severe anastomotic leakage, anastomotic stricture, postoperative morbidity, and mortality. Mantel–Haenszel odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed concerning preconditioning technique, the interval between preconditioning and surgery and the extent of preconditioning. Fifteen cohort studies were identified. Gastric preconditioning was associated with reduced overall incidence of anastomotic leakage (OR 0.73; 95% CI, 0.53–1.0; P = 0.050) and severe anastomotic leakage (OR 0.27; 95% CI, 0.14–0.50; P < 0.010), but not with anastomotic stricture (OR 1.18; 95% CI 0.38 to 3.66; P = 0.780), major postoperative morbidity (OR 1.03; 95% CI 0.45 to 2.36; P = 0.940) or mortality (OR 0.69; 95% CI 0.39 to 1,23; P = 0.210). Subgroup analyses did not identify any differences between embolization and ligation while increasing the interval between preconditioning and esophagectomy as well as the extent of preconditioning might be beneficial. Gastric ischemic preconditioning may be associated with a reduced incidence of overall and severe anastomotic leakage. Randomized studies are necessary to further evaluate its impact on leakage, refine the technique and define patient populations that will benefit the most.

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Norovirus gastroenteritis outbreaks in military units: a systematic review

BMJ Military Health ◽

10.1136/bmjmilitary-2019-001341 ◽

2020 ◽

pp. jramc-2019-001341

Author(s):

Luis Queiros-Reis ◽

A Lopes-João ◽

J R Mesquita ◽

C Penha-Gonçalves ◽

M S J Nascimento

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Armed Forces ◽

Operational Effectiveness ◽

Military Forces ◽

Norovirus Gastroenteritis ◽

Life Threatening ◽

The Military ◽

The Impact ◽

Military Units

IntroductionNorovirus gastroenteritis is one of the most frequent causes of personnel unavailability in military units, being associated with significant morbidity and degradation of their operational effectiveness. The disease is usually mild but can be severe and life-threatening in young and healthy soldiers, who are prone to dehydration due to intensive daily activity. Despite its impact, the full extent of the norovirus gastroenteritis burden in military forces remains unclear. This systematic review aims to evaluate the impact and ascertain clinical and epidemiological features of norovirus outbreaks that have occurred in the military forces.MethodsThe systematic review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines and used three databases: PubMed, Scopus, and LILACs. Papers published up to 1 September 2019 were included without restrictions if they reported one or more outbreaks in the military forces on active duty, either on national territories or deployed overseas.ResultsA total of 343 papers were retrieved from the literature search. After inclusion/exclusion criteria a total of 39 eligible papers were considered. From 1988 (first reported outbreak in the military) to 2018 more than 101 norovirus outbreaks have been reported in the military, accounting for at least 24 332 cases. Secondary transmission was emphasised as the main route of norovirus transmission in the military forces, with eating outside the military setting an important route for the primary cases.ConclusionsThe present review highlights that norovirus gastroenteritis has been a burden to military troops both in combat and on peacekeeping operations. Norovirus disease has been shown to exact a substantial toll on mission readiness and operational effectiveness. It is noteworthy that the impact of norovirus outbreaks among military units is underestimated because the literature review retrieved information from the armed forces from only nine countries.

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Diagnostic accuracy and clinical impact of natriuretic peptide screening for the detection of heart failure in the community: a protocol for systematic review and meta-analysis

Wellcome Open Research ◽

10.12688/wellcomeopenres.15536.1 ◽

2019 ◽

Vol 4 ◽

pp. 169

Author(s):

C. R. Goyder ◽

A. K. Roalfe ◽

N. R. Jones ◽

K. S. Taylor ◽

C. D. Plumptre ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Impact Analysis ◽

Hospital Admissions ◽

Alternative Pathway ◽

Meta Analysis ◽

Clinical Impact ◽

Cochrane Central Register ◽

Optimal Thresholds ◽

The Impact

Introduction: Patients diagnosed with heart failure in primary care have a better prognosis than those diagnosed in hospital. However, most cases are missed in the community. Recent attention has focussed on the potential of early detection through screening. Natriuretic peptides (NPs) are tested by GPs and used to rule out heart failure in patients presenting with symptoms. Evidence is now emerging that they may also have a role in screening but their accuracy in this context and the associated optimal thresholds, have not been established. The impact that NP screening would have on patients and health care systems also remains unclear. Methods: We aim to undertake a systematic search of the following sources: Ovid Medline, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Screening, data extraction and critical appraisal will be carried out independently and in duplicate by two reviewers. We will include studies based in the community with >100 participants that recruited a screened population. We will not add a study design filter and there will be no language restriction. The primary outcome will be the sensitivity and the specificity of NP screening and optimal thresholds for screening will be explored. Outcomes of interest for the impact analysis will include mortality, hospital admissions and cost effectiveness. This protocol has been developed in accordance with guidelines from the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). Discussion: This systematic review will identify how accurately NP screen for heart failure in the community and explore where NP screening thresholds should be set. It also aims to summarise the clinical impact of this strategy. Together, these results should inform future interventions that may provide an alternative pathway to facilitate improved detection of heart failure in the community. Registration: PROSPERO CRD42018087498; registered on 11 May 2018.

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Diagnostic accuracy and clinical impact of natriuretic peptide screening for the detection of heart failure in the community: a protocol for systematic review and meta-analysis

Wellcome Open Research ◽

10.12688/wellcomeopenres.15536.2 ◽

2019 ◽

Vol 4 ◽

pp. 169

Author(s):

C. R. Goyder ◽

A. K. Roalfe ◽

N. R. Jones ◽

K. S. Taylor ◽

C. D. Plumptre ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Impact Analysis ◽

Hospital Admissions ◽

Alternative Pathway ◽

Meta Analysis ◽

Clinical Impact ◽

Cochrane Central Register ◽

Optimal Thresholds ◽

The Impact

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Acute cardiac injury in patients with COVID-19

10.1101/2020.05.18.20105866 ◽

2020 ◽

Author(s):

Andrea De Lorenzo ◽

Daniel Kasal ◽

Bernardo Tura ◽

Cristiane Lamas ◽

Helena Rey

Keyword(s):

Systematic Review ◽

Myocardial Injury ◽

Meta Analysis ◽

Cardiac Injury ◽

Risk Of Bias ◽

Cardiac Complications ◽

Troponin Elevation ◽

Study Heterogeneity ◽

Life Threatening

Introduction: Cardiac complications of COVID-19 are potentially life-threatening. The occurrence of myocardial injury in the context of COVID-19 is multifactorial and has generated increasing interest. Methods: A systematic review with meta-analysis of the literature was performed. MEDLINE and EMBASE were searched. Two independente reviewers evaluated the selected manuscripts for the outcome myocardial injury, defined by troponin elevation above the 99th percentile. Study heterogeneity and risk of bias were evaluated. Results: Eight studies, with a total of 1229 patients, were included. The frequency of myocardial injury was 16% (95% CI: 9% - 27%). The heterogeneity among studies was high (93%). Conclusions: Myocardial injury may occur in patients with COVID-19, with a frequency of 16% among current studies. Continuous research is needed to update these findings, as the pandemic evolves, and to define the implications of myocardial injury in the context of this infection.

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Impact of BMI on Growth Hormone Stimulation Tests in Children and Adolescents: A Systematic Review and Meta-Analysis

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1382 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A678-A678

Author(s):

Ozair Abawi ◽

Dieuwertje Augustijn ◽

Sanne Hoeks ◽

Yolanda B de Rijke ◽

Erica L T van den Akker

Keyword(s):

Systematic Review ◽

Growth Hormone ◽

Short Stature ◽

Meta Analysis ◽

Overweight And Obesity ◽

Individual Participant Data ◽

Study Heterogeneity ◽

Individual Participant ◽

Stimulation Tests ◽

The Impact

Abstract Background: Peak stimulated growth hormone (GH) levels are known to decrease with increasing BMI, possibly leading to overdiagnosis of GH deficiency (GHD) in children with overweight and obesity. However, current guidelines do not provide guidance how to interpret peak GH values of these children, nor has this been assessed systematically. The aim of this systematic review and meta-analysis was to study the effect of BMI on stimulated peak GH values in children, and to quantify to which extent peak GH values in children with obesity are decreased. Methods: We searched the Medline, Embase, Cochrane, Web of Science, and Google Scholar databases (13 July 2020) for studies reporting impact of BMI on peak GH in children. Where possible, individual participant data was extracted and/or obtained from the authors. Primary outcome was the association between peak GH values and BMI standard deviation score (SDS). Pooled correlation coefficients were calculated under a random effects model, and exploratory moderator analyses and meta-regression were performed. Study heterogeneity was assessed using the I2 statistic. For studies with available individual participant data, linear mixed-models regression analysis was performed with BMI SDS as predictor and ln(peak GH) as outcome, accounting for used GH stimulation agent (fixed effect) and study (random effect). This systematic review was performed in accordance to the PRISMA guidelines. Results: In total, 56 studies were included, providing data on n=5100 children (1346 with individual participant data). Across all studies, a pooled r of -0.37 (95% CI -0.44 to -0.31, n=2785) was found. Study heterogeneity was large (I2=58%). Pubertal status, sex, presence of syndromic obesity, and mean age and BMI SDS of the population did not significantly moderate the pooled r (all p>0.05). Individual participant data analysis revealed a beta of -0.11 (95% CI -0.08 to -0.15, p<0.001), i.e., per 1 point increase in BMI SDS, peak GH decreases by 11% (95% CI 7 to 14%). In the 8 studies performed in children referred for short stature, obesity was present in 27/893 (3.02%) children without GHD and in 36/615 (5.85%) children with GHD (p=0.0069). This corresponds to a RR of 1.43 (95% CI 1.14 to 1.78, p=0.002) for a diagnosis of GHD in children with short stature with obesity compared to children without obesity. Discussion: To our knowledge, this is the first systematic review and meta-analysis to investigate the impact of BMI on peak GH values in children, showing a significant negative correlation and risk of overdiagnosis of GHD in children with obesity. All in all, with ever-rising prevalence of pediatric obesity, our study highlights the urgent need for BMI (SDS)-specific cut-off values for GH stimulation tests in children.

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