scholarly journals Non-pharmacological interventions to improve the patient experience of colonoscopy under moderate or no sedation: a systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038621
Author(s):  
Colin Sue-Chue-Lam ◽  
Matthew Castelo ◽  
Jill Tinmouth ◽  
Diego Llovet ◽  
Teruko Kishibe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Experience ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Critical Dimension ◽  
Study Data ◽  
Pharmacological Interventions ◽  
Screening Process ◽  
Moderate Sedation ◽  
Randomised Controlled

IntroductionThe patient experience is a critical dimension of colonoscopy quality. Sedative and analgesic drugs are commonly used to improve the patient experience of colonoscopy, with predominant regimens being deep sedation, typically achieved with propofol, and moderate sedation, typically achieved with an opioid and a benzodiazepine. However, non-pharmacological interventions exist that may be used to improve patient experience. Furthermore, by identifying non-pharmacological interventions to increase the quality of patient experience under moderate sedation, jurisdictions facing rising use of deep sedation for colonoscopy and its significant associated costs may be better able to encourage patients and clinicians to adopt moderate sedation. Advancing either of these aims requires synthesising the evidence and raising awareness around these non-pharmacological interventions to improve the patient experience of colonoscopy.Methods and analysisA systematic review will be conducted that searches multiple electronic databases from inception until 2020 to identify randomised controlled trials evaluating what, if any, non-pharmacological interventions are effective compared with placebo or usual care for improving the patient experience of routine colonoscopy under moderate or no sedation. Two reviewers will independently perform a three-stage screening process and extract all study data using piloted forms. Study quality will be assessed using the Cochrane Risk of Bias Tool V.2.0. Where multiple studies evaluate a single intervention, evidence will be quantitatively synthesised using pairwise meta-analysis, otherwise narrative syntheses will be undertaken.Ethics and disseminationThis is a review of existing literature not requiring ethics approval. The review findings will be included in future efforts to develop an implementation strategy to reduce the use of deep sedation for routine colonoscopy. They will also be published in a peer-reviewed journal, presented at conferences and contribute to a doctoral thesis.PROSPERO registration numberCRD42020173906.

scholarly journals Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011155
Author(s):  
Ka Hou Christien Li ◽  
Tian Sang ◽  
Cheng Chan ◽  
Mengqi Gong ◽  
Yingzhi Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Observational Studies ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Recurrence Risk ◽  
Moderate Sedation ◽  
Significant Difference ◽  
Randomised Controlled

ObjectivesThis meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of atrial fibrillation (AF) catheter ablation in patients under general anaesthesia (GA)/deep sedation and mild/moderate sedation.BackgroundCatheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to GA.MethodsPubMed and Embase were searched up to July 2018 for randomised controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. Nine studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger’s regression, respectively.ResultsOur meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI 0.56 to 1.13, p=0.20) and complications (RR: 0.95, 95% CI 0.64 to 1.42, p=0.82), though statistically insignificant. In terms of procedural parameters, there was no significant difference between the two groups for both procedural time (SMD: −0.13, 95% CI −0.90 to 0.63, p=0.74) and fluoroscopy time (SMD: −0.41, 95% CI −1.40 to 0.58, p=0.41). Univariate meta-regression did not reveal any covariates as a moderating factor for complication and recurrence risk.ConclusionApart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.

scholarly journals Role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025145
Author(s):  
Bianca E Kavanagh ◽  
Sharon Lee Brennan-Olsen ◽  
Alyna Turner ◽  
Olivia M Dean ◽  
Michael Berk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Personality Disorder ◽  
Mood Disorders ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Pharmacological Interventions ◽  
Randomised Controlled

IntroductionRemission rates for mood disorders, including depressive and bipolar disorders, remain relatively low despite available treatments, and many patients fail to respond adequately to these interventions. Evidence suggests that personality disorder may play a role in poor outcomes. Although personality disorders are common in patients with mood disorders, it remains unknown whether personality disorder affects treatment outcomes in mood disorders. We aim to review currently available evidence regarding the role of personality disorder on pharmacological interventions in randomised controlled trials for adults with mood disorders.Methods and analysisA systematic search of Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com, PubMed via PubMed, EMBASE via embase.com, PsycINFO via Ebsco and CINAHL Complete via Ebsco databases will be conducted to identify randomised controlled trials that have investigated pharmacological interventions in participants aged 18 years or older for mood disorders (ie, depressive disorders and bipolar spectrum disorders) and have also included assessment of personality disorder. One reviewer will screen studies against the predetermined eligibility criteria, and a second reviewer will confirm eligible studies. Data will be extracted by two independent reviewers. Methodological quality and risk of bias will be assessed using the Cochrane Risk of Bias tool. A systematic review, and if sufficient evidence is identified, a meta-analysis will be completed. Meta-analysis will be conducted using the standardised mean difference approach and reported with 95% CIs. A random effects model will be employed and statistical heterogeneity will be evaluated using the I2 statistic. Prespecified subgroup analyses will be completed.Ethics and disseminationAs this systematic review will use published data, ethics permission will not be required. The outcomes of this systematic review will be published in a relevant scientific journal and presented at a research conference.Trial registration numberCRD42018089279.

scholarly journals Non-pharmacological management of antipsychotic-induced weight gain: Systematic review and meta-analysis of randomised controlled trials

2008 ◽  
Vol 193 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Mario Álvarez-Jiménez ◽  
Sarah E. Hetrick ◽  
César González-Blanch ◽  
John F. Gleeson ◽  
Patrick D. McGorry
Keyword(s):  
Systematic Review ◽  
Weight Gain ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Specific Treatment ◽  
Antipsychotic Treatment ◽  
Controlled Trials ◽  
Pharmacological Interventions ◽  
Management Interventions ◽  
Randomised Controlled

BackgroundAntipsychotic-induced weight gain is a major concern in the treatment of psychosis. The efficacy of non-pharmacological interventions as well as the optimal intervention approach for this side-effect remain unclear.AimsTo determine the effectiveness of non-pharmacological interventions and specific treatment approaches to control antipsychotic-induced weight gain in patients with firstepisode or chronic schizophrenia.MethodSystematic review and meta-analysis of randomised controlled trials.ResultsTen trials were included in the meta-analysis. Adjunctive non-pharmacological interventions, either individual or group interventions, or cognitive-behavioural therapy as well as nutritional counselling were effective in reducing or attenuating antipsychotic-induced weight gain compared with treatment as usual, with treatment effects maintained over follow-up.ConclusionsNon-pharmacological weight-management interventions should be a priority, particularly during the early stages of antipsychotic treatment. Preventive approaches have the potential to be more effective, acceptable, cost-efficient and beneficial.

P2838The impact of anesthesia depth on catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K H Li ◽  
T Sang ◽  
C P Chan ◽  
M Gong ◽  
G Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Catheter Ablation ◽  
Observational Studies ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Moderate Sedation ◽  
Complication Risk ◽  
Significant Difference ◽  
Procedural Success ◽  
Procedural Outcomes

Abstract Objectives This meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of catheter ablation in patients under GA/deep sedation and mild/moderate sedation. Background Catheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to general anesthesia. Methods PubMed and Embase were searched up to July 2018 for randomized controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. 12 studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Results Our meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI: 0.56 to 1.13, P=0.20) and complications (RR: 0.95, 95% CI: 0.64 to 1.42, P=0.82), though statistically insignificant. In terms of procedural parameters, there was non-significant difference between the two groups when both procedural time (SMD: −0.13, 95% CI: −0.90 to 0.63, P=0.74) and fluoroscopy time (SMD: −0.41, 95% CI: −1.40 to 0.58, P=0.41) were considered. Multivariate meta-regression demonstrated hypertension as an independent moderating factor for complication risk. Complications Comparison Conclusion Apart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.

scholarly journals Comparative Effectiveness of Pharmacological Interventions for Covid-19: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Franco De Crescenzo ◽  
Laura Amato ◽  
Fabio Cruciani ◽  
Luke P Moynihan ◽  
Gian Loreto D’Alò ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions ◽  
Serious Adverse Events ◽  
All Cause Mortality ◽  
Randomised Controlled

Background: Several pharmacological interventions are now under investigation for the treatment of Covid-19, and the evidence is evolving rapidly. Our aim is to assess the comparative efficacy and safety of these drugs.Methods and Findings: We performed a systematic review and network meta-analysis searching Medline, Pubmed, Embase, Cochrane Covid-19 register, international trial registers, medRxiv, bioRxiv, and arXiv up to December 10, 2020. We included all randomised controlled trials (RCTs) comparing any pharmacological intervention for Covid-19 against any drugs, placebo or standard care (SC). Data extracted from published reports were assessed for risk of bias in accordance with the Cochrane tool, and using the GRADE framework. Primary outcomes were all-cause mortality, adverse events (AEs) and serious adverse events (SAEs). We estimated summary risk ratio (RR) using pairwise and network meta-analysis with random effects (Prospero, number CRD42020176914). We performed a systematic review and network meta-analysis searching Medline, Pubmed, Embase, Cochrane Covid-19 register, international trial registers, medRxiv, bioRxiv, and arXiv up to December 10, 2020. We included all randomised controlled trials (RCTs) comparing any pharmacological intervention for Covid-19 against any drugs, placebo or standard care (SC). Data extracted from published reports were assessed for risk of bias in accordance with the Cochrane tool, and using the GRADE framework. Primary outcomes were all-cause mortality, adverse events (AEs) and serious adverse events (SAEs). We estimated summary risk ratio (RR) using pairwise and network meta-analysis with random effects (Prospero, number CRD42020176914). We included 96 RCTs, comprising of 34,501 patients. The network meta-analysis showed in terms of all-cause mortality, when compared to SC or placebo, only corticosteroids significantly reduced the mortality rate (RR 0.90, 95%CI 0.83, 0.97; moderate certainty of evidence). Corticosteroids significantly reduced the mortality rate also when compared to hydroxychloroquine (RR 0.83, 95%CI 0.74, 0.94; moderate certainty of evidence). Remdesivir proved to be better in terms of SAEs when compared to SC or placebo (RR 0.75, 95%CI 0.63, 0.89; high certainty of evidence) and plasma (RR 0.57, 95%CI 0.34, 0.94; high certainty of evidence). The combination of lopinavir and ritonavir proved to reduce SAEs when compared to plasma (RR 0.49, 95%CI 0.25, 0.95; high certainty of evidence). Most of the RCTs were at unclear risk of bias (42 of 96), one third were at high risk of bias (34 of 96) and 20 were at low risk of bias. Certainty of evidence ranged from high to very low.Conclusion: At present, corticosteroids reduced all-cause mortality in patients with Covid-19, with a moderate certainty of evidence. Remdesivir appeared to be a safer option than SC or placebo, while plasma was associated with safety concerns. These preliminary evidence-based observations should guide clinical practice until more data are made public.

scholarly journals M89. PHARMACOLOGICAL INTERVENTIONS FOR SMOKING CESSATION AMONG PEOPLE WITH SCHIZOPHRENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S168-S168
Author(s):  
Dan Siskind ◽  
Brian Wu ◽  
Tommy Wong ◽  
Steve Kisely
Keyword(s):  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Evidence Based ◽  
Smoking Abstinence ◽  
Pharmacological Interventions ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract Background People living with schizophrenia are 3 times more likely to smoke than the general population, and have fewer and less successful quitting attempts. In concert with psychosocial quit interventions, there is a need for evidence based pharmacological interventions to assist people living with schizophrenia achieve smoking abstinence. Methods We systematically searched PubMed, PsycInfo, EMBASE and Cochrane for randomised controlled trials of pharmacological interventions for reducing smoking among people living with schizophrenia. We conducted pairwise and network meta-analyses of effectiveness of interventions for achieving abstinence and reduction in smoking. We also examined psychiatric and physical adverse events of interventions. Results Nineteen studies were included in the systematic review. Data was available for buproprion, varenicline and nicotine replacement therapy (NRT). Buproprion (RR 3.4, 95%CI 1.6–7.3, p=0.002), varenicline (RR 3.8, 95%CI 2.0–7.2, p<0.001) and NRT (RR 4.3, 95%CI 1.7–10.7, p=0.002) were all associated with increased rates of abstinence in pairwise meta-analyses. In a network meta-analysis varenicline was superior to buproprion (RR 2.0, 95%CI 1.0–3.9), however there was no statistically significant difference between varenicline and NRT or buproprion and NRT. Varenicline was associated with higher rates of nausea than placebo. Discussion Buproprion, varenicline and NRT were all superior to placebo for achieving abstinence. Varenicline appears to be superior to buproprion for achieving abstinence, however varenicline is associated with higher rates of nausea.

scholarly journals Exploratory Research on the Effectiveness of Lannea coromandelica in Streptozotocin Induced Diabetic Model: A Protocol for Systematic Review

2021 ◽  
Author(s):  
Jacques Britto ◽  
Kesavi Durairaj ◽  
Sandhya Sundram ◽  
Usha Kumary ◽  
Uppu Praveen
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Meta Analysis ◽  
Exploratory Research ◽  
Screening Process ◽  
Glucose Levels ◽  
Lannea Coromandelica ◽  
Cochrane Database ◽  
Diabetic Model ◽  
Randomised Controlled

Introduction: Diabetes mellitus is a metabolic disorder affecting human population since many centuries ago. To contend this disorder, effective alternative use of non-pharmacological approaches, particularly natural herbal plants, has become a subject of interest since the last decade. Aim: To evaluate the safety and effectiveness of Lannea coromandelica in the management of diabetes mellitus. Materials and Methods: A systematic review on randomised controlled trials will be carried out. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines will be followed. The search strategies will be conducted in PubMed/MEDLINE, J-Gate, EMBASE, COCHRANE database and Google Scholar. The search period will be included from 1968 to December 2020. The screening process will be initiated by two authors for title and abstract followed by four authors for full-text articles. The extraction will be performed by using the following characteristics-Study design, Animal model, Intervention of interest. Conclusion: This current review will provide evidence based on the available literature either to accept or reject the hypothesis that efficacy of Lannea coromandelica herbal plant may be beneficial for controlling glucose levels in diabetic model.

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