scholarly journals Relationship between hospital or surgeon volume and outcomes in joint arthroplasty: protocol for a suite of systematic reviews and dose–response meta-analyses

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022797 ◽  
Author(s):  
Xiang-Dong Wu ◽  
Meng-Meng Liu ◽  
Ya-Ying Sun ◽  
Zhi-Hu Zhao ◽  
Quan Zhou ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Dose Response ◽  
Data Extraction ◽  
Meta Analysis ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Surgeon Volume ◽  
Published Data ◽  
Records Management ◽  
Meta Analyses

IntroductionJoint arthroplasty is a particularly complex orthopaedic surgical procedure performed on joints, including the hip, knee, shoulder, ankle, elbow, wrist and even digit joints. Increasing evidence from volume–outcomes research supports the finding that patients undergoing joint arthroplasty in high-volume hospitals or by high-volume surgeons achieve better outcomes, and minimum case load requirements have been established in some areas. However, the relationships between hospital/surgeon volume and outcomes in patients undergoing arthroplasty are not fully understood. Furthermore, whether elective arthroplasty should be restricted to high-volume hospitals or surgeons remains in dispute, and little is known regarding where the thresholds should be set for different types of joint arthroplasties.Methods and analysesThis is a protocol for a suite of systematic reviews and dose–response meta-analyses, which will be amended and updated in conjunction with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Electronic databases, including PubMed and Embase, will be searched for observational studies examining the relationship between the hospital or surgeon volume and clinical outcomes in adult patients undergoing primary or revision of joint arthroplasty. We will use records management software for study selection and a predefined standardised file for data extraction and management. Quality will be assessed using the Newcastle-Ottawa Scale, and the meta-analysis, subgroup analysis and sensitivity analysis will be performed using Stata statistical software. Once the volume–outcome relationships are established, we will examine the potential non-linear relationships between hospital/surgeon volume and outcomes and detect whether thresholds or turning points exist.Ethics and disseminationEthical approval is not required, because these studies are based on aggregated published data. The results of this suite of systematic reviews and meta-analyses will be submitted to peer-reviewed journals for publication.PROSPERO registration numberCRD42017056639.

scholarly journals Global, regional and national estimates ofToxoplasma gondiiseroprevalence in pregnant women: a protocol for a systematic review and modelling analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030472 ◽  
Author(s):  
Jean Joel Bigna ◽  
Joel Noutakdie Tochie ◽  
Dahlia Noelle Tounouga ◽  
Anne Olive Bekolo ◽  
Nadia S Ymele ◽  
...  
Keyword(s):  
Public Health ◽  
Toxoplasma Gondii ◽  
Pregnant Women ◽  
Data Extraction ◽  
Meta Analysis ◽  
Empirical Studies ◽  
Published Data ◽  
Representative Study ◽  
Nationally Representative ◽  
Meta Analyses

IntroductionTo set priorities for public health policy, funding for public health interventions, and healthcare planning which will ultimately contribute in bending the burden of toxoplasmosis towards maternal and neonatal health, it is necessary to have accurate data on the prevalence of toxoplasmosis in pregnancy. Therefore, we aimed to estimate the seroprevalence ofToxoplasma gondiiinfection in pregnant women by countries, WHO regions and globally.Methods and analysisWe will search multiple databases to identify studies that reported the prevalence (or enough data to compute this estimate) ofToxoplasma gondiiin the global population of pregnant women up till December 31, 2018 without any language restrictions. Study selection, data extraction and risk of bias assessment will be conducted independently by three pairs of investigators. For each country, we will estimate the prevalence based on empirical studies if there is either one nationally representative study, or two or more not nationally representative studies. Then, we will perform a country-specific random-effects meta-analyses. The heterogeneity will be evaluated using the χ² test on Cochrane’s Q statistic and quantified with H and I² statistics. For countries with one or no empirical studies or where the meta-analysis will result in a wide CI of 0%–100%, we will predict the country’s prevalence by using a Bayesian generalised non-linear multilevel model. The model will have a hierarchical structure in which estimates for each country will be informed by its own data, if available, or by data from other countries in the same WHO region.Ethics and disseminationSince this study will be based on published data, it does not require any ethical approval. Its findings will be published in a scientific peer-reviewed journal. They will also be presented at scientific conferences and to relevant public health sectors.PROSPERO registration numberCRD42019125572.

Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis

2020 ◽  
pp. 106002802094912
Author(s):  
Anum Saqib Zaidi ◽  
Gregory M. Peterson ◽  
Luke R.E. Bereznicki ◽  
Colin M. Curtain ◽  
Mohammed Salahudeen
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Adverse Drug Events ◽  
Data Extraction ◽  
Meta Analysis ◽  
Published Data ◽  
Potentially Inappropriate Medications ◽  
Cochrane Central Register ◽  
Increased Risk ◽  
Meta Analyses

Objective: To investigate mortality and hospitalization outcomes associated with medication misadventure (including medication errors [MEs], such as the use of potentially inappropriate medications [PIMs], and adverse drug events [ADEs]) among people with cognitive impairment or dementia. Data Sources: Ovid MEDLINE, Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception to December 2019. Study Selection and Data Extraction: Relevant studies using any study design were included. Reviewers independently performed critical appraisal and extracted relevant data. Data Synthesis: The systematic review included 10 studies that reported the outcomes of mortality or hospitalization associated with medication misadventure, including PIMs (n=5), ADEs (n=2), a combination of MEs and ADEs (n=2), and drug interactions (n=1). Five studies examining the association between PIMs and mortality/hospitalization were included in the meta-analyses. Exposure to PIMs was not associated with either mortality (odds ratio [OR]=1.36; 95%CI=0.79-2.35) or hospitalization (OR=1.02; 95%CI=0.83-1.26). In contrast, single studies indicated that ADEs with cholinesterase inhibitors were associated with mortality and hospitalization. Relevance to Patient Care and Clinical Practice: Individuals with cognitive impairment or dementia are at increased risk of medication misadventure; based on relatively limited published data, this does not necessarily translate to increased mortality and hospitalization. Conclusions: Overall, medication misadventure was not associated with mortality or hospitalization in people with cognitive impairment or dementia, noting the limited number of studies, difficulty in controlling potential confounding variables, and that most studies focus on PIMs.

scholarly journals Methods used to meta-analyse results from interrupted time series studies: A methodological systematic review protocol

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 110
Author(s):  
Elizabeth Korevaar ◽  
Amalia Karahalios ◽  
Andrew B. Forbes ◽  
Simon L. Turner ◽  
Steve McDonald ◽  
...  
Keyword(s):  
Public Health ◽  
Time Series ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Meta Analysis ◽  
Interrupted Time Series ◽  
Analysis Methods ◽  
Study Selection ◽  
The Individual ◽  
Meta Analyses

Background: Systematic reviews are used to inform healthcare decision making. In reviews that aim to examine the effects of organisational, policy change or public health interventions, or exposures, evidence from interrupted time series (ITS) studies may be included. A core component of many systematic reviews is meta-analysis, which is the statistical synthesis of results across studies. There is currently a lack of guidance informing the choice of meta-analysis methods for combining results from ITS studies, and there have been no studies examining the meta-analysis methods used in practice. This study therefore aims to describe current meta-analysis methods used in a cohort of reviews of ITS studies. Methods: We will identify the 100 most recent reviews (published between 1 January 2000 and 11 October 2019) that include meta-analyses of ITS studies from a search of eight electronic databases covering several disciplines (public health, psychology, education, economics). Study selection will be undertaken independently by two authors. Data extraction will be undertaken by one author, and for a random sample of the reviews, two authors. From eligible reviews we will extract details at the review level including discipline, type of interruption and any tools used to assess the risk of bias / methodological quality of included ITS studies; at the meta-analytic level we will extract type of outcome, effect measure(s), meta-analytic methods, and any methods used to re-analyse the individual ITS studies. Descriptive statistics will be used to summarise the data. Conclusions: This review will describe the methods used to meta-analyse results from ITS studies. Results from this review will inform future methods research examining how different meta-analysis methods perform, and ultimately, the development of guidance.

Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

2019 ◽  
Vol 32 (10) ◽  
pp. 1-8
Author(s):  
P Prasad ◽  
M Navidi ◽  
A Immanuel ◽  
S M Griffin OBE ◽  
A W Phillips
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Cochrane Library ◽  
Published Data ◽  
Meta Analyses ◽  
The Impact

SUMMARY Changes in the structure of surgical training have affected trainees’ operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)—this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11–15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

scholarly journals Association between vision impairment and mortality: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037556
Author(s):  
Joshua R Ehrlich ◽  
Jacqueline Ramke ◽  
David Macleod ◽  
Bonnielin K Swenor ◽  
Helen Burn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Global Health ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Vision Impairment ◽  
Published Data ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Meta Analyses

IntroductionDue to growth and ageing of the world’s population, the number of individuals worldwide with vision impairment (VI) and blindness is projected to increase rapidly over the coming decades. VI and blindness are an important cause of years lived with disability. However, the association of VI and blindness with mortality, including the risk of bias in published studies and certainty of the evidence, has not been adequately studied in an up-to-date systematic review and meta-analysis.Methods and analysisThe planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases, including MEDLINE Ovid, Embase Ovid and Global Health, will be searched for relevant studies. Two reviewers will then screen studies and review full texts to identify studies for inclusion. Data extraction will be performed, and for included studies, the risk of bias and certainty of the evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. The prognostic factor in this study is visual function, which must have been measured using a standard objective ophthalmic clinical or research instrument. We will use standard criteria from WHO to categorise VI and blindness. All-cause mortality may be assessed by any method one or more years after baseline assessment of vision. Results from included studies will be meta-analysed according to relevant sections of the Meta-analysis Of Observational Studies in Epidemiology checklist.Ethics and disseminationThis review will only include published data; therefore, ethics approval will not be sought. The findings of this review and meta-analysis will be published in an open-access, peer-reviewed journal and will be included in the ongoing Lancet Global Health Commission on Global Eye Health.

scholarly journals Impact and use of reviews and ‘overviews of reviews’ to inform clinical practice guideline recommendations: protocol for a methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031442
Author(s):  
Carole Lunny ◽  
Cynthia Ramasubbu ◽  
Savannah Gerrish ◽  
Tracy Liu ◽  
Douglas M Salzwedel ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Systematic Reviews ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Data Extraction ◽  
Meta Analysis ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Meta Analyses ◽  
The Impact

IntroductionGuidelines are systematically developed recommendations to assist practitioner and patient decisions about treatments for clinical conditions. High quality and comprehensive systematic reviews and ‘overviews of systematic reviews’ (overviews) represent the best available evidence. Many guideline developers, such as the WHO and the Australian National Health and Medical Research Council, recommend the use of these research syntheses to underpin guideline recommendations. We aim to evaluate the impact and use of systematic reviews with and without pairwise meta-analysis or network meta-analyses (NMAs) and overviews in clinical practice guideline (CPG) recommendations.Methods and analysisCPGs will be retrieved from Turning Research Into Practice and Epistemonikos (2017–2018). The retrieved citations will be sorted randomly and then screened sequentially by two independent reviewers until 50 CPGs have been identified. We will include CPGs that provide at least two explicit recommendations for the management of any clinical condition. We will assess whether reviews or overviews were cited in a recommendation as part of the development process for guidelines. Data extraction will be done independently by two authors and compared. We will assess the risk of bias by examining how each guideline developed clinical recommendations. We will calculate the number and frequency of citations of reviews with or without pairwise meta-analysis, reviews with NMAs and overviews, and whether they were systematically or non-systematically developed. Results will be described, tabulated and categorised based on review type (reviews or overviews). CPGs reporting the use of the Grading of Recommendations, Assessment, Development and Evaluation approach will be compared with those using a different system, and pharmacological versus non-pharmacological CPGs will be compared.Ethics and disseminationNo ethics approval is required. We will present at the Cochrane Colloquium and the Guidelines International Network conference.

Quality of meta-analyses of non-opioid, pharmacological, perioperative interventions for chronic postsurgical pain: a systematic review

2022 ◽  
pp. rapm-2021-102981
Author(s):  
Rachel H McGregor ◽  
Freda M Warner ◽  
Lukas D Linde ◽  
Jacquelyn J Cragg ◽  
Jill A Osborn ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Data Extraction ◽  
Meta Analysis ◽  
Measurement Tool ◽  
Critical Element ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Registration Number ◽  
Meta Analyses

BackgroundIn an attempt to aggregate observations from clinical trials, several meta-analyses have been published examining the effectiveness of systemic, non-opioid, pharmacological interventions to reduce the incidence of chronic postsurgical pain.ObjectiveTo inform the design and reporting of future studies, the purpose of our study was to examine the quality of these meta-analyses.Evidence reviewWe conducted an electronic literature search in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews. Published meta-analyses, from the years 2010 to 2020, examining the effect of perioperative, systemic, non-opioid pharmacological treatments on the incidence of chronic postsurgical pain in adult patients were identified. Data extraction focused on methodological details. Meta-analysis quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) critical appraisal tool.FindingsOur search yielded 17 published studies conducting 58 meta-analyses for gabapentinoids (gabapentin and pregabalin), ketamine, lidocaine, non-steroidal anti-inflammatory drugs, and mexiletine. According to AMSTAR 2, 88.2% of studies (or 15/17) were low or critically low in quality. The most common critical element missing was an analysis of publication bias. Trends indicated an improvement in quality over time and association with journal impact factor.ConclusionsWith few individual trials adequately powered to detect treatment effects, meta-analyses play a crucial role in informing the perioperative management of chronic postsurgical pain. In light of this inherent value and despite a number of attempts, high-quality meta-analyses are still needed.PROSPERO registration numberCRD42021230941.

scholarly journals Prior surgical uterine evacuation of pregnancy and infertility: protocol for systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034837
Author(s):  
Pengcheng Tu ◽  
Kaiyan Pei
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Published Data ◽  
Inverse Variance ◽  
Increased Risk ◽  
Registration Number ◽  
Meta Analyses ◽  
Classification Tool ◽  
Dissemination Of Results

IntroductionPrior surgical uterine evacuation is associated with an increased risk of infertility. However, findings are inconsistent, highlighting the need for a clear consensus on the effect of prior surgical uterine evacuation on the risk of infertility. Therefore, the aim of this systematic review and meta-analysis is to summarise the available evidence examining the association between prior surgical uterine evacuation and the risk of infertility.Methods and analysisA systematic search of electronic databases (ie, PubMed, Scopus, ClinicalTrials.gov, EMBASE and ScienceDirect) will be conducted since their inception until October 2019 with no limit for language using a detailed prespecified search strategy. Both the authors will independently screen titles and abstracts and select full-text articles, perform data extraction and appraise the quality of included studies using a bias classification tool. Meta-analyses will be performed to calculate the overall pooled estimates using the generic inverse variance method. This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines.Ethics and disseminationGiven that this is a protocol based on published data, there is no requirement for ethics approval. It is anticipated that the dissemination of results will be reported according to the PRISMA statement. The results will be published in peer-reviewed journals and presented at scientific conferences.PROSPERO registration numberCRD42019117266.

scholarly journals Methods used to meta-analyse results from interrupted time series studies: A methodological systematic review protocol

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 110
Author(s):  
Elizabeth Korevaar ◽  
Amalia Karahalios ◽  
Andrew B. Forbes ◽  
Simon L. Turner ◽  
Steve McDonald ◽  
...  
Keyword(s):  
Public Health ◽  
Time Series ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Meta Analysis ◽  
Interrupted Time Series ◽  
Analysis Methods ◽  
Study Selection ◽  
The Individual ◽  
Meta Analyses

Background: Systematic reviews are used to inform healthcare decision making. In reviews that aim to examine the effects of organisational, policy change or public health interventions, or exposures, evidence from interrupted time series (ITS) studies may be included. A core component of many systematic reviews is meta-analysis, which is the statistical synthesis of results across studies. There is currently a lack of guidance informing the choice of meta-analysis methods for combining results from ITS studies, and there have been no studies examining the meta-analysis methods used in practice. This study therefore aims to describe current meta-analysis methods used in a cohort of reviews of ITS studies. Methods: We will identify the 100 most recent reviews (published between 1 January 2000 and 11 October 2019) that include meta-analyses of ITS studies from a search of eight electronic databases covering several disciplines (public health, psychology, education, economics). Study selection will be undertaken independently by two authors. Data extraction will be undertaken by one author, and for a random sample of the reviews, two authors. From eligible reviews we will extract details at the review level including discipline, type of interruption and any tools used to assess the risk of bias / methodological quality of included ITS studies; at the meta-analytic level we will extract type of outcome, effect measure(s), meta-analytic methods, and any methods used to re-analyse the individual ITS studies. Descriptive statistics will be used to summarise the data. Conclusions: This review will describe the methods used to meta-analyse results from ITS studies. Results from this review will inform future methods research examining how different meta-analysis methods perform, and ultimately, the development of guidance.

scholarly journals Effectiveness of direct oral anticoagulants in obese adults with atrial fibrillation: an overview examining the evidence from international systematic reviews and meta-analyses

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Shaikh ◽  
R Wynne ◽  
R L Castelino ◽  
S C Inglis ◽  
C Ferguson
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Reviews ◽  
Research Training ◽  
Data Extraction ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Obese Adults ◽  
Significant Difference ◽  
Meta Analyses

Abstract Background Obesity may influence the pharmacology of direct oral anticoagulants (DOAC) that are recommended by all international guidelines for stroke prevention in adults with atrial fibrillation (AF). Purpose To evaluate the safety and efficacy of DOACs in obese adults with AF. Methods Medline, CINAHL, Scopus, Web of Science, Cochrane Database, Johanna Briggs Institute, Embase, Psych Info and ProQuest were searched till April 2020. Only systematic reviews with meta-analyses, that were published after 2005 and were in the English language were included. Articles were screened by title and abstract, followed by full text assessment using the Covidence systematic review software. Data was extracted using a standardised extraction tool. AMSTAR-2® and ROBIS® tools were used for quality and risk of bias assessment. The entire process was undertaken by two investigators at each stage of the study selection, appraisal, and data extraction. Disagreements were resolved through consensus discussion with a third arbitrary investigator. Statistical analyses were performed using the DerSimonian and Laird method for random effects. Meta-analysis was performed using only randomised controlled trials from eligible systematic reviews at both 12 months and across the entire trial. Primary outcomes assessed was stroke (ischemic or haemorrhagic) or systemic or pulmonary embolism. Secondary outcomes assessed included all-cause mortality, transient ischemic attack, myocardial infarction, major bleed, all cause-hospitalisation, and cardiovascular mortality. Results Of the 8162 articles screened, a total of five systematic reviews were included in this overview. There was disagreement within the published reviews on the effect of DOAC in obesity. Four of the five reviews were of either “low” or “critically low” quality, with inconsistencies in data extraction and appropriateness of the included studies and statistical methods used in analysis. Data from only the RE-LY, AVERROES and ENGAGE AF-TIMI 48 trials, were available for the meta-analysis, which did not find any significant difference between all BMI groups for all outcomes, at both time points. However, analysis of the different weight groups versus normal weight, highlighted non-significant differences between the different DOACs. Conclusion There was no difference between the BMI classes in any of the outcomes assessed. However, the non-significant trends that were seen, suggests individual superiority of DOACs may exist within the obese adult populations. There is a need for prospective trials to evaluate which DOACs are safe and efficacious in the obese class III adults and at which dose. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Australian Government Research Training Program (RTP) Heart Foundation of AustraliaNational Health and Medical Research Council (NHMRC)

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