Global epidemiology ofNeisseria gonorrhoeaein infertile populations: protocol for a systematic review

IntroductionA key target of the WHO’s ‘Global Health Sector Strategy on sexually transmitted infections, 2016–2021’ is achieving 90% reduction inNeisseria gonorrhoeae(gonorrhoea for short) incidence globally by 2030. Though untreated, gonorrhoea has been linked to infertility, the epidemiology of this infection in infertile populations remains poorly understood and somewhat a neglected area of reproductive health. Our proposed systematic review aims to fill this gap by characterising comprehensively gonorrhoea infection in infertile populations globally.Methods and analysisAll available studies of gonorrhoea infection in infertile populations, including infertility clinic attendees, will be systematically reviewed informed by Cochrane Collaboration guidelines. Findings will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources will be searched using broad index terms exploded to cover all subheadings and free text terms with no language or year restriction. Any epidemiological measure in infertile populations based on primary data will be eligible for inclusion. Measures based on different assay types will be extracted as separate studies for different analyses. Only one biospecimen type per assay type will be considered based on a predefined priority order. Samples including fewer than 10 participants or assessing infection in the upper genital tract will be excluded. Quality assessments will be conducted for all measures included in the review. Meta-analyses will be implemented using DerSimonian-Laird random effect models to estimate the mean prevalence of gonorrhoea in infertile populations globally, and stratified by WHO region, assay type, sex, infertility type, infertility diagnosis, among other factors. Detailed heterogeneity assessment will be performed, and potential sources of between-study heterogeneity will be explored using meta-regression. Review will be conducted from 26 March 2018 to 28 July 2019.Ethics and disseminationAn institutional review board clearance is not required as all data are publicly available. The findings will be disseminated through a peer-reviewed publication and international scientific meetings/workshops with key stakeholders.PROSPERO registration numberCRD42018102934

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Diet quality during preconception or pregnancy and gestational weight gain: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-033130 ◽

2020 ◽

Vol 10 (2) ◽

pp. e033130

Author(s):

Yamei Yu ◽

Isabelle Hardy ◽

Wenguang Sun ◽

Dean A Fergusson ◽

William Fraser ◽

...

Keyword(s):

Systematic Review ◽

Weight Gain ◽

Gestational Weight Gain ◽

Diet Quality ◽

Meta Analysis ◽

Random Effect ◽

Primary Data ◽

Gestational Weight ◽

Newcastle Ottawa Scale ◽

Scientific Meetings

IntroductionInappropriate gestational weight gain (GWG), including inadequate and excessive GWG, has become pandemic across nations and continents. This review aims to synthesise the evidence on the correlation between diet quality and GWG. If this association is confirmed, improving diet quality could become an intervention target in the efforts to reduce inappropriate GWG.Methods and analysisWe will conduct a systematic review of all prospective cohort studies on diet quality in preconception or pregnancy and GWG. Our secondary outcomes include gestational diabetes, pre-eclampsia and birth weight. A comprehensive search of all published articles in MEDLINE ALL (Ovid), Embase (Ovid), Food Science and Technology Abstracts (Ovid) and CINAHL (EBSCOHost), from database creation to 20 April 2019, will be conducted. Studies will be screened for eligibility by title, abstract and full text in duplicate by two independent reviewers. Study quality and risk of bias will be assessed using the adapted Newcastle–Ottawa Scale. Results will be reported following the meta-analysis of observational studies in epidemiology guidelines. If sufficient data are available, a meta-analysis will be conducted to synthesise the effect size reported as OR with 95% CI using both fixed-effect and random-effect models. I2 statistics and visual inspection of the forest plots will be used to assess heterogeneity and identify the potential sources of heterogeneity. Publication bias will be assessed by visual inspections of funnel plots and Egger’s test.Ethics and disseminationFormal ethical approval is not required as no primary data will be collected. We aim to publish the results of this study in a peer-reviewed journal and present them at conferences and scientific meetings to promote knowledge transfer.PROSPERO registration numberCRD42019128732

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Effectiveness of Hydrocolloid Dressings for Treating Pressure Ulcers in Adult Patients: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17217881 ◽

2020 ◽

Vol 17 (21) ◽

pp. 7881

Author(s):

Magdalena Sylwia Kamińska ◽

Anna Maria Cybulska ◽

Karolina Skonieczna-Żydecka ◽

Katarzyna Augustyniuk ◽

Elżbieta Grochans ◽

...

Keyword(s):

Systematic Review ◽

Pressure Ulcers ◽

Meta Analysis ◽

Random Effect ◽

Cochrane Collaboration ◽

Adult Patients ◽

Therapeutic Effects ◽

Study Selection ◽

Meta Analyses ◽

The Cochrane Collaboration

The aim of this study was to assess the effectiveness of hydrocolloid dressings in the treatment of grade I, II, III, and IV pressure ulcers in adult patients. We compared the therapeutic effects of hydrocolloids and alternative dressings in pressure ulcer treatment. We conducted a systematic review, using a literature search only in English, from database inception until 20 April 2020, to identify randomized trials comparing various types of dressings applied in the healing of pressure ulcers. The databases were PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The study selection was performed independently by two reviewers. Data were extracted based on the guidelines included in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The risk of bias in the included studies was assessed using a standardized critical appraisal instrument developed by the Cochrane Collaboration. Random-effect meta-analysis of data from three or more studies was performed using meta-analysis software (Comprehensive Meta-Analysis V3, Biostat, New Jersey, USA). A total of 1145 records were identified, of which 223 were qualified after further verification, of which eight were finally included in further analysis. Hydrocolloid dressings were not superior to control therapeutics (p = 0.839; Z = 0.203; CI 95%: 0.791–1.334). They were not associated with higher healing rates (p = 0.718; Z = 0.361; OR: 0.067; CI 95%: 0.297–0.431), nor did they decrease the incidence of adverse events compared with control therapeutics (p = 0.300; Z = −1.036; OR: 0.067; CI 95%: 0.394–1.333). In the above cases, Egger’s test also did not indicate publication bias (t value = 0.779, p = 0.465; t value = 1.198, p = 0.442; t value = 0.834, p = 0.465, respectively). The present meta-analysis shows that hydrocolloid dressings are not significantly better than alternative ones in the healing of pressure ulcers in adult patients.

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User involvement in adolescents’ mental healthcare: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-018800 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018800

Author(s):

Petter Viksveen ◽

Stig Erlend Bjønness ◽

Siv Hilde Berg ◽

Nicole Elizabeth Cardenas ◽

Julia Rose Game ◽

...

Keyword(s):

Systematic Review ◽

Critical Appraisal ◽

Research Evidence ◽

Data Extraction ◽

Mental Healthcare ◽

User Involvement ◽

Cochrane Collaboration ◽

Research Literature ◽

Primary Data ◽

Evaluation Approach

IntroductionUser involvement has become a growing importance in healthcare. The United Nations state that adolescents have a right to be heard, and user involvement in healthcare is a legal right in many countries. Some research provides an insight into the field of user involvement in somatic and mental healthcare for adults, but little is known about user involvement in adolescents’ mental healthcare, and no overview of the existing research evidence exists.Methods and analysisThe aim of this systematic review is to provide an overview of existing research reporting on experiences with and the effectiveness and safety issues associated with user involvement for adolescents’ mental healthcare at the individual and organisational level. A systematic literature search and assessment of published research in the field of user involvement in adolescents’ mental healthcare will be carried out. Established guidelines will be used for data extraction (Cochrane Collaboration guidelines, Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisal Skills Programme (CASP)), critical appraisal (Cochrane Collaboration guidelines and Pragmatic-Explanatory Continuum Indicator Summary) and reporting of results (Preferred Reporting Items for Systematic reviews and Meta-Analyses, Consolidated Standards of Reporting Trials and CASP). Confidence in the research evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Adolescents are included as coresearchers for the planning and carrying out of this systematic review. This systematic review will provide an overview of the existing research literature and thereby fill a knowledge gap. It may provide various stakeholders, including decision-makers, professionals, individuals and their families, with an overview of existing knowledge in an underexplored field of research.Ethics and disseminationEthics approval is not required for this systematic review as we are not collecting primary data. The results will be published in a peer-reviewed journal and at conference presentations and will be shared with stakeholder groups.

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Mindfulness- and Acceptance-Based Interventions for Stroke Survivors: A Systematic Review and Meta-Analysis

Rehabilitation Counseling Bulletin ◽

10.1177/00343552211043257 ◽

2021 ◽

pp. 003435522110432

Author(s):

Areum Han

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Mental Fatigue ◽

Stroke Survivors ◽

Positive Effects ◽

Meta Analyses

Objective: Mindfulness- and acceptance-based intervention (MABI) is an emerging evidenced-based practice, but no systematic review incorporating meta-analyses for MABIs in stroke survivors has been conducted. The objective of this systematic review was to measure the effectiveness of MABIs on outcomes in people with stroke. Method: Three electronic databases, including PubMed, CINAHL, and PsycINFO, were searched to identify relevant studies published in peer-reviewed journals. The methodological quality of the included studies was assessed. Data were extracted and combined in a meta-analysis with a random-effect model to compute the size of the intervention effect. Results: A total of 11 studies met the eligibility criteria. Meta-analyses found a small-to-moderate effect of MABIs on depressive symptoms (standardized mean difference [SMD] = 0.39, 95% confidence interval [CI] = [0.12, 0.66]) and a large effect on mental fatigue (SMD = 1.22, 95% CI = [0.57, 1.87]). No statistically significant effect of MABIs on anxiety, quality of life, and mindfulness was found, but there was a trend in favor of MABIs overall. Conclusions: This meta-analysis found positive effects of MABIs on depressive symptoms and mental fatigue in stroke survivors, but future high-quality studies are needed to guarantee treatment effects of MABIs on varied outcomes in stroke survivors.

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Manifestações orais da sífilis: revisão sistematizada de literatura

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v8i8.3330 ◽

2019 ◽

Vol 8 (8) ◽

Author(s):

Erison Santana Santos ◽

Jamile de Oliveira Sá ◽

Rachel Lamarck

Keyword(s):

Congenital Syphilis ◽

Health Sector ◽

Secondary Syphilis ◽

World Health ◽

Oral Manifestations ◽

Oral Diseases ◽

Probable Case ◽

Sexually Transmitted ◽

Global Epidemiology ◽

Head Neck

A sífilis é uma infecção bacteriana exclusiva de seres humanos que é transmitida principalmente através de relações sexuais sem o uso de preservativos. Embora seja mais comum em regiões genitais, pode manifestar sinais e sintomas na cavidade oral e mimetizar lesões potencialmente malignas e, dependendo do seu estágio, pode levar ao óbito. O objetivo desse estudo foi realizar uma revisão de literatura a fim de conhecer as principais manifestações orais da sífilis. Foi realizado um levantamento bibliográfico na base de dados PubMed e SciELO. A busca foi realizada durante o mês de agosto e setembro de 2018. No PubMed, foram utilizados os termos “syphilis oral”, “manifestations of syphilis”, “syphilis in oral cavity”, “syphilis in buccal cavity”, “syphilis in mouth”. Na SciELO, foram usadas os descritores: “oral manifestations of syphilis”, “manifestações orais AND sífilis”. As manifestações orais da sífilis embora sejam raras, são importantes para o cirurgiã-dentista diagnosticar a infecção em estágios menos agressivos da doença. Pode manifestar-se de diversas formas, dependendo do período de evolução da infecção. Sua incidência vem aumentando devido às mudanças de hábitos na população, principalmente nos grupos de risco. Sendo assim, conhecer as principais manifestações orais da sífilis é importante para intervir em estágios menos avançados, visto que é uma infecção que pode se disseminar rapidamente e levar o paciente a óbito se não tratada. Descritores: Sífilis; Manifestações Bucais; Cancro; Treponema pallidum.ReferênciasLeuci S, Martina S, Adamo D, Ruoppo E, Santarelli A, Sorrentino R et al. Oral Syphilis: a retrospective analysis of 12 cases and a review of literature. Oral diseases. 2013;19(8):738-46.Leão JC, Gueiros LAM, Porter SR. Oral manifestations of syphilis. Clinics. 2006;61(2):161-66.Bruce AJ, Rogers RS 3rd. Oral manifestations of sexually transmitted diseases. Clin Dermatol. 2004;22(6):520-27.Neville BW, Damm DD, Allan CM, Chi AC. Patologia Oral e Maxilofacial. 4.ed. Elsevier: Rio de Janeiro; 2016.Kojima N, Klausner JD. An update on the global epidemiology of syphilis. Curr Epidemiol Rep. 2018;5(1):24-38.World Health Organization. Global health sector strategy on sexually transmitted infections 2016-2021. 2016. The WHO's strategy for STI treatment.Carbone PN, Capra GG, Nelson BL. Oral Secondary Syphilis. Head Neck Pathol. 2016; 10(2):206-8.Dickenson AJ, Currie WJ, Avery BS. Screening for syphilis in patients with carcinoma of the tongue. Br J Oral Maxillofac Surg. 1995;33(5):319-20.Ficarra G, Carlos R. Syphilis: the renaissance of a old disease with oral implications. Head Neck Pathol. 2009;3(3):195-206.Gaul JS, Grossschimdt K, Gusenbauer C, Kanz F. A probable case of congenital syphilis from pre-Columbian Austria. Anthropol Anz. 2015; 72(4):451-72.Jones L, Ong ELC, Okpokman A, Sloan P, Macleod I, Staines KS. Three cases of oral syphilis - an overview. Br Dental J. 2012; 212(10):477-80.Little JW. Syphilis: a update. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(1):3-9.Minicucci EM, Vieira RA, Oliveira DT, Marques SA. Oral manifestations of secondary syphilis in the elderly – a timely reminder for dentists. Aust Dent J. 2013;58(3):368-70.Paulo LF, Servato JP, Oliveira MT, Duriguetto AF Jr, Zanetta-Barbosa D. Oral manifestations of oral syphilis. Int J Infect Dis. 2015;35:40-2.Scott CM, Flint SR. Oral syphilis—re-emergence of an old disease with oral manifestations. Int J Oral Maxillofac Surg. 2005;34(1):58-63.Siqueira CS, Saturno JL, Sousa SCO, Silveira FR. Diagnostic approaches in unsuspected oral lesions of syphilis. Int J Oral Maxillofac Surg. 2014; 43(12):1436-40.Strieder LR, Léon JE, Carvalho YR, Kaminagakura E. Oral syphilis: report of three cases and characterization of the inflammatory cells. Annals of Diagnostic Pathology. 2015;19:76-80.

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A systematic review of the effects of nicotine replacement therapy on agitation among nicotine-dependent psychiatric inpatients

BJPsych Open ◽

10.1192/bjo.2021.785 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S296-S296

Author(s):

Joseph Toms ◽

Jacob King

Keyword(s):

Systematic Review ◽

English Language ◽

Controlled Trial ◽

Psychiatric Inpatients ◽

Cochrane Collaboration ◽

Search Strategies ◽

Primary Data ◽

Psychiatric Admission ◽

Cross Sectional ◽

Nicotine Replacement

AimsThis systematic review aims to evaluate the effect of nicotine replacement therapies (NRTs) on measures of agitation amongst nicotine-dependent adult psychiatric inpatients.BackgroundSince the introduction of the smoke-free policy for all psychiatric facilities, a psychiatric admission is likely to upset a nicotine-dependent individual's normal routine of nicotine consumption. In addition to the physiological effects of nicotine withdrawal (NW), the interpersonal dynamic which nurse-led guardianship of nicotine products constructs presents stressors to the nicotine dependent patient.Several systematic reviews evaluating changes in objective measures of agitation amongst smoking patients in medical critical care units have found varied results, with some demonstrating worsening agitation with NRT use. We therefore believe that there is sufficient equipoise in the use of NRT to prompt a review of studies amongst psychiatric inpatients.MethodThis review identified English language studies through developed search strategies in PubMed/MEDLINE, EMBASE, PyschINFO, PSYCHLit, Cochrane databases, and Google scholar. The bibliographies of notable papers were explored. Hand searches of five major psychiatric journals were conducted. Peer reviewed studies of any study design were included if they reported primary data of adult psychiatric inpatients. Studies were extracted from 1990 – present, this was felt appropriate as nicotine replacement patches became available in 1992.Search strategies were informed by MeSH search terms and included multiple conceptions of “agitation”, including variations on; agitation, irritability, and arousal to capture the concept from broad academic constructions. The quality of studies was assessed with the Newcastle-Ottawa and Cochrane Collaboration tools.This review follows PRISMA guidelines, and an application for PROSPERO registration has been submitted pending acceptance.ResultTwo studies were identified which matched inclusion criteria. A double-blinded randomised placebo-controlled trial of 40 nicotine-dependent inpatients from Allen et al. reported a significant 23% reduction in Agitated Behaviour Scores at 24 hours following NRT administration on admission compared to their matched placebo controls. Yet a retrospective cross-sectional analysis from Okoli using scores for NW identified more severe withdrawal symptoms including “restlessness” and “anger/irritability” than nicotine-dependent patients not provided with NRT.ConclusionDespite considerable commentary within literature there is presently only one study providing moderate evidence of a positive benefit to measures of agitated behaviour from the use of NRT amongst nicotine-dependent psychiatric inpatients. There is currently very low evidence whether NRT improves or exacerbates the agitation associated with NW amongst nicotine-dependent psychiatric inpatients.

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Developing, Implementing, and Applying Novel Techniques During Systematic Reviews of Primary Space Medicine Data

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5803.2021 ◽

2021 ◽

Vol 92 (8) ◽

pp. 681-688

Author(s):

Andrew Winnard ◽

Nick Caplan ◽

Claire Bruce-Martin ◽

Patrick Swain ◽

Rochelle Velho ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Quantitative Methods ◽

Primary Data ◽

Controlled Trials ◽

Synthesis Methods ◽

Space Medicine ◽

Systematic Review Methods ◽

Meta Analyses ◽

Primary Space

BACKGROUND: The Aerospace Medicine Systematic Review Group was set up in 2016 to facilitate high quality and transparent synthesis of primary data to enable evidence-based practice. The group identified many research methods specific to space medicine that need consideration for systematic review methods. The group has developed space medicine specific methods to address this and trialed usage of these methods across seven published systematic reviews. This paper outlines evolution of space medicine synthesis methods and discussion of their initial application.METHODS: Space medicine systematic review guidance has been developed for protocol planning, quantitative and qualitative synthesis, sourcing gray data, and assessing quality and transferability of space medicine human spaceflight simulation study environments.RESULTS: Decision algorithms for guidance and tool usage were created based on usage. Six reviews used quantitative methods in which no meta-analyses were possible due to lack of controlled trials or reporting issues. All reviews scored the quality and transferability of space simulation environments. One review was qualitative. Several research gaps were identified.CONCLUSION: Successful use of the developed methods demonstrates usability and initial validity. The current space medicine evidence base resulting in no meta-analyses being possible shows the need for standardized guidance on how to synthesize data in this field. It also provides evidence to call for increasing use of controlled trials, standardizing outcome measures, and improving minimum reporting standards. Space medicine is a unique field of medical research that requires specific systematic review methods.Winnard A, Caplan N, Bruce-Martin C, Swain P, Velho R, Meroni R, Wotring V, Damann V, Weber T, Evetts S, Laws J. Developing, implementing, and applying novel techniques during systematic reviews of primary space medicine data. Aerosp Med Hum Perform. 2021; 92(8):681688.

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Antisocial Disorders in Adolescence and Youth, According to Structural, Emotional, and Cognitive Transdiagnostic Variables: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093036 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3036 ◽

Cited By ~ 1

Author(s):

Ronald Toro ◽

Juan García-García ◽

Flor Zaldívar-Basurto

Keyword(s):

Systematic Review ◽

Experiential Avoidance ◽

Cochrane Collaboration ◽

Explanatory Models ◽

Emotional Dysregulation ◽

Structural Level ◽

Explanatory Variables ◽

Meta Analyses ◽

The Cochrane Collaboration ◽

Violent Ideation

Transdiagnostic causal variables have been identified that have allowed understanding the origin and maintenance of psychopathologies in parsimonious explanatory models of antisocial disorders. However, it is necessary to systematize the information published in the last decade. The aim of the study was to identify through a systematic review, the structural, emotional and cognitive transdiagnostic variables in antisocial disorders of adolescence and youth. Recommendations for systematic reviews and meta-extraction and analysis of information according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), the Cochrane Collaboration and Campbell were followed. We found 19 articles from 110 reviewed documents. The results indicated that at a structural level there is a general psychopathological factor (psychopathy or externalizing), non-emotional callousness and impulsivity from behavioral inhibition and activation systems, and negative affect traits as base structures. In the emotional level, the study found a risk component from emotional dysregulation and experiential avoidance. In the cognitive level, a key role of anger-rumination and violent ideation as explanatory variables of antisocial disorders. We concluded that the interaction of these identified variables makes it possible to generate an evidence-based transdiagnostic model.

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Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1675214 ◽

2018 ◽

Vol 40 (11) ◽

pp. 713-721 ◽

Cited By ~ 7

Author(s):

Iramar Nascimento ◽

Guilherme Dienstmann ◽

Matheus de Souza ◽

Raquel Fleig ◽

Carla Hoffmann ◽

...

Keyword(s):

Systematic Review ◽

Treatment Time ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Eligibility Criteria ◽

Time Segment ◽

Meta Analyses ◽

The Cochrane Collaboration ◽

Lower Correlation

Objective Does the use of metformin have an influence on the outcomes of preeclampsia (PE)? Sources of Data The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study. Selection of Studies Total number of journals in the initial search (n = 824); exclusions from repeated articles on different search engines (n = 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n = 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n = 185), exclusion of articles with lower correlation with the objective of the present study (n = 187); and final bibliographic selection (n = 35). Data Collection At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region. Synthesis of Data The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE. Conclusion Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.

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Simultaneous compared to interval administration of mifepristone and misoprostol for medical abortion up to 10+0 weeks' gestation: a systematic review with meta-analyses

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2019-200448 ◽

2020 ◽

pp. bmjsrh-2019-200448

Author(s):

Mia Schmidt-Hansen ◽

Jonathan Lord ◽

Elise Hasler ◽

Sharon Cameron

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Medical Abortion ◽

Cochrane Library ◽

Published Data ◽

Study Results ◽

Randomised Controlled ◽

Meta Analyses

BackgroundMedical abortion with mifepristone and misoprostol usually involves an interval of 36–48 hours between administering these drugs; however, it is possible that the clinical efficacy at early gestations may be maintained when the drugs are taken simultaneously. The objective of this systematic review was to determine the safety and effectiveness of simultaneous compared with interval administration of mifepristone and misoprostol for abortion up to 10+0 weeks’ gestation.MethodsWe searched Embase Classic, Embase; Ovid MEDLINE(R) including Daily, and Epub Ahead-of-Print, In-Process & Other Non-Indexed Citations; and Cochrane Library on 11 December 2019. We included randomised controlled trials (RCTs), published in English from 1985, comparing simultaneous to interval administration of mifepristone and misoprostol for early abortion. Risk of bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs) using the Mantel-Haenszel method were performed. The quality of the evidence was assessed using GRADE.ResultsMeta-analyses of three RCTs (n=1280) showed no differences in ‘ongoing pregnancy’ (RR 1.78, 95% CI 0.38 to 8.36), ‘haemorrhage requiring transfusion or ≥500 mL blood loss’ (RR 0.11, 95% CI 0.01 to 2.03) and ‘incomplete abortion with the need for surgical intervention’ (RR 1.30, 95% CI 0.76 to 2.25) between the interventions. Individual study results showed no difference in patient satisfaction, or ‘need for repeat misoprostol’, although ‘time to onset of bleeding or cramping’ was longer after simultaneous than interval administration. The quality of evidence was very low to moderate.ConclusionThe published data support the use of simultaneous mifepristone and misoprostol for medical abortion up to 9+0 weeks in women who prefer this method of administration.

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