scholarly journals Impact of cardiac rehabilitation on mortality and morbidity in diabetic versus non-diabetic patients: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047134
Author(s):  
Emad Hanna Dababneh ◽  
Sumanta Saha ◽  
Linda Östlundh ◽  
Rami H Al-Rifai ◽  
Abderrahim Oulhaj
Keyword(s):  
Systematic Review ◽  
Cardiac Rehabilitation ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
P Value ◽  
Diabetic Patients ◽  
Cardiac Diseases ◽  
Mortality And Morbidity ◽  
Randomised Controlled ◽  
The Impact

BackgroundCardiac rehabilitation (CR) decreases the morbidity and mortality risk among patients with cardiac diseases; however, the impact of CR on patients with diabetes remains underexplored. This is a protocol for a systematic review and meta-analysis methodology to explore if the effect of CR on mortality and morbidity is the same in patients with type 2 diabetes compared with patients without diabetes.Methods and analysisInterventional and non-interventional studies comparing the effect of CR, for at least 1 month, on all-cause mortality and cardiovascular outcomes including fatal and non-fatal myocardial infarction, revascularisation and rehospitalisation in adults with cardiac diseases will be deemed eligible for inclusion. Studies published between 1990 and 2020 will be searched in PubMed, Embase, Cochrane, CINAHL, Scopus and in registries for randomised controlled trials. Eligible studies will be selected using the Covidence software, and their salient details regarding the design, population, tested interventions and outcomes of interest will be gathered. The quality of studies to be deemed eligible and reviewed will be assessed using the Cochrane Collaboration and National Heart, Lung, and Blood Institute’s tools. The appraisal process will be based on the study design (interventional and non-interventional). In the meta-analysis step, the pooled effect of CR on the outcomes will be estimated. All meta-analyses will be done using the random-effects model approach (inverse-variance method). I2 and p value of χ2 statistics will guide the heterogeneity assessment. Subgroup analyses will also be performed. The small study effect will be investigated by generating the funnel plots. The symmetry of the latter will be tested by performing Egger’s test.Ethics and disseminationThe systematic review will use data from published literature; hence, no ethical approval will be required. Findings of the systematic review and meta-analysis will be published in peer-reviewed international journals and will be disseminated in local and international scientific meetings.PROSPERO registration numberCRD42020148832.

scholarly journals Cardiac rehabilitation and physical activity: systematic review and meta-analysis

Heart ◽  
2018 ◽  
Vol 104 (17) ◽  
pp. 1394-1402 ◽  
Author(s):  
Grace Olivia Dibben ◽  
Hasnain M Dalal ◽  
Rod S Taylor ◽  
Patrick Doherty ◽  
Lars Hermann Tang ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Meta Analysis ◽  
Physically Active ◽  
Language Restriction ◽  
Randomised Controlled ◽  
The Impact

ObjectiveTo undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies.MethodsDatabases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis.ResultsForty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor.ConclusionOverall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

scholarly journals Heroin on trial: Systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction

2015 ◽  
Vol 207 (1) ◽  
pp. 5-14 ◽  
Author(s):  
John Strang ◽  
Teodora Groshkova ◽  
Ambros Uchtenhagen ◽  
Wim van den Brink ◽  
Christian Haasen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Methadone Maintenance ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Heroin Dependence ◽  
Heroin Addiction ◽  
Healthcare Provision ◽  
Safety Issues ◽  
Randomised Controlled ◽  
The Impact

BackgroundSupervised injectable heroin (SIH) treatment has emerged over the past 15 years as an intensive treatment for entrenched heroin users who have not responded to standard treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation.AimsTo synthesise published findings for treatment with SIH for refractory heroin-dependence through systematic review and meta-analysis, and to examine the political and scientific response to these findings.MethodRandomised controlled trials (RCTs) of SIH treatment were identified through database searching, and random effects pooled efficacy was estimated for SIH treatment. Methodological quality was assessed according to criteria set out by the Cochrane Collaboration.ResultsSix RCTs met the inclusion criteria for analysis. Across the trials, SIH treatment improved treatment outcome, i.e. greater reduction in the use of illicit ‘street’ heroin in patients receiving SIH treatment compared with control groups (most often receiving MMT).ConclusionsSIH is found to be an effective way of treating heroin dependence refractory to standard treatment. SIH may be less safe than MMT and therefore requires more clinical attention to manage greater safety issues. This intensive intervention is for a patient population previously considered unresponsive to treatment. Inclusion of this low-volume, high-intensity treatment can now improve the impact of comprehensive healthcare provision.

scholarly journals Pharmacological interventions for drug-using offenders: an update to a systematic review and meta-analysis

2021 ◽  
Author(s):  
J. M. Glanville ◽  
A. E. Perry ◽  
M. Martyn-St James ◽  
C. Hewitt ◽  
S. Swami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Drug Use ◽  
Meta Analysis ◽  
Treatment Options ◽  
Criminal Activity ◽  
Cochrane Collaboration ◽  
Pharmacological Interventions ◽  
Serious Adverse Events ◽  
Male Adult ◽  
The Impact

Abstract This updated systematic review assesses the effects of pharmacological interventions for drug-using offenders. Methods Systematic review protocols and conventions of the Cochrane Collaboration were followed to identify eligible studies. Studies were pooled in a meta-analysis to assess the impact of pharmacological interventions on drug use and criminal activity. An economic appraisal was conducted. Results The search strategies identified 22 studies containing 4372 participants. Meta-analyses revealed a small statistically significant mean difference favouring pharmacological interventions relative to psychological interventions in reducing drug use and criminal activity. When comparing the drugs to one another there were no significant differences between those included (methadone versus buprenorphine, naltrexone and cyclazocine). Conclusion Overall, the findings of this review suggest that methadone and naltrexone may have some impact on reducing drug use and reincarceration. Individual pharmacological drugs had differing (generally non-significant) effects. One study identified serious adverse events. Three studies reported cost and consequences information sufficient to conduct a full economic analysis but this was not comprehensive enough to be able to make judgements across all treatment options. Full economic analyses should be encouraged. The study findings were limited mainly to male adult offenders.

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

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.

Surgical or medical abortion of pregnancies between 13+0 and 23+6 weeks’ gestation? A systematic review and new NICE national guidelines

2020 ◽  
pp. bmjsrh-2019-200460
Author(s):  
Mia Schmidt-Hansen ◽  
Patricia A Lohr ◽  
Sharon Cameron ◽  
Elise Hasler
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Medical Abortion ◽  
Cochrane Library ◽  
National Guidelines ◽  
Cervical Injury ◽  
Surgical Methods ◽  
Randomised Controlled

BackgroundAbortion in the second trimester may be performed surgically or medically. The objective of this systematic review was to examine the effectiveness, safety and acceptability/satisfaction of surgical compared with medical abortion of pregnancy between 13+0 and 23+6 weeks’ gestation for a new national guideline.MethodsWe searched Embase, Medline and the Cochrane Library on 4 March 2019. We included randomised controlled trials (RCTs; any size) and non-randomised comparative studies with n≥100 in each arm, published in English from 1985. Risk-of-bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs)used the Mantel-Haenszel method. The quality of the evidence was assessed using GRADE.ResultsTwo RCTs (n=140) were included. ‘Incomplete abortion requiring surgical intervention’ was clinically significantly higher with medical than surgical methods (RR=4.58, 95% CI 1.07 to 19.64). ‘Abortion completed by the intended method’ was statistically, but not clinically, significantly lower after medical than surgical methods, but was marked by high between-study heterogeneity (RR=0.88, 95% CI 0.79 to 0.98). To the extent that ‘haemorrhage requiring transfusion/≥500 mL blood loss’, ‘uterine injury’, ‘cervical injury requiring repair’ and ‘infection reported within 1 month of abortion’ were reported, they did not differ significantly between methods. Depending on measurement method, ‘patient satisfaction/acceptability’ was either clinically significantly higher or comparable after surgical than medical methods. The quality of this evidence was limited by low event rates and attrition bias.ConclusionBased on this evidence and consensus, women should be offered the choice of medical or surgical methods of abortion between 13+0 and 23+6 weeks’ gestation, unless not clinically appropriate.

scholarly journals Dissertation about Cardiac Rehabilitation

2020 ◽  
Author(s):  
Zuhair Rushdi Mustafa
Keyword(s):  
Systematic Review ◽  
Observational Study ◽  
Cardiac Rehabilitation ◽  
Relevant Information ◽  
Mortality And Morbidity ◽  
Secondary Prevention Programme ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
Randomised Controlled

Abstract BackgroundMyocardial infarction (MI) is a major cause of death and disability worldwide. Many MI survivors potentially experience poor health-related quality of life (HRQOL). Outpatient cardiac rehabilitation (CR) programmes are widely accepted as beneficial for reducing mortality and morbidity among MI survivors. However, their effect on HRQOL has not been clearly identified. This systematic review aims to investigate the effectiveness of such a programme on HRQOL for post MI patients.MethodsThe following databases were searched for relevant information: MIDLINE, CINAHAL, EMBASE, AMED, Web of Science, and PsycINFO. They were searched from 1970 to July, 2012, for studies that investigated the effectiveness of outpatient cardiac rehabilitation in improving HRQOL for patients with MI. Studies were excluded if they did not separate MI patients from other cardiac conditions; included other CR modalities; and reported on just a component of HRQOL. ResultsOut of the 848 citations identified, only 11 studies were agreed upon by the reviewers and considered relevant for inclusion in this systematic review. The designs of included studies were non-controlled, non-randomised observational study; controlled, non-randomised observational study; and randomised controlled trials. Instruments used to assess HRQOL included SIP, SF-36, WHOQOL-BREF; QOLMI, MacNew and QOL- Cardiac Version III. All eleven studies confirmed that the HRQOL score of MI patients who participated in outpatient CR improved significantly compared to those who did not participate. In terms of the CR design, it is seems that the length between MI and CR initiation, CR duration, and intensity and frequency do not always affect improvements in HRQOL among participants. However, component of CR may have variable impacts in improving HRQOL. ConclusionOutpatient CR, regardless of its design and components, improves HRQOL of MI patients immediately following the programme. This implies that CR is the best secondary prevention programme and that all post MI patients should be considered as candidates for participation in CR.

scholarly journals Impact of social distancing measures for preventing coronavirus disease 2019 [COVID-19]: A systematic review and meta-analysis protocol

2020 ◽  
Author(s):  
Krishna Regmi ◽  
Cho Mar Lwin
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
List Type ◽  
Social Distancing ◽  
Randomised Controlled ◽  
The Impact

AbstractIntroductionSocial distancing measures (SDMs) protect public health from the outbreak of coronavirus disease 2019 (COVID-19). However, the impact of SDMs has been inconsistent and unclear. This study aims to assess the effects of SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19.Methods and analysisWe will conduct a systematic review meta-analysis research of both randomised controlled trials and non-randomised controlled trials. We will search MEDLINE, EMBASE, Allied & Complementary Medicine, COVID-19 Research and WHO database on COVID-19 for primary studies assessing the effects of SDMs (e.g. isolation, quarantine) for reducing the transmission of COVID-19, and will be reported in accordance with PRISMA statement. The PRISMA-P checklist will be used while preparing this protocol. We will use Joanna Briggs Institute guidelines (JBI Critical Appraisal Checklists) to assess the methodological qualities and synthesised performing thematic analysis. Two reviewers will independently screen the papers and extracted data. If sufficient data are available, the random-effects model for meta-analysis will be performed to measure the effect size of SDMs or the strengths of relationships. To assess the heterogeneity of effects, I2 together with the observed effects (Q-value, with degrees of freedom) will be used to provide the true effects in the analysis.Ethics and disseminationEthics approval and consent will not be required for this systematic review of the literature as it does not involve human participation. We will be able to disseminate the study findings using the following strategies: we will be publishing at least one paper in peer-reviewed journals, and an abstract will be presented at suitable national/international conferences or workshops. We will also share important information with public health authorities as well as with the World Health Organization. In addition, we may post the submitted manuscript under review to bioRxiv, medRxiv, or other relevant pre-print servers.Strengths and limitations of this studyTo our knowledge, this study will be the first systematic review to examine the impact of social distancing measures to reduce transmission of COVID-19.This study will offer highest level of evidence for informed decisions, drawing a broader framework.This protocol reduces the possibility of duplication, provides transparency to the methods and procedures that will be used, minimise potential biases and allows peer-review.This research is not externally funded, and therefore time and resource will be constrained.If included studies will be variable in sample size, quality and population, which may open to bias, and the heterogeneity of data will preclude a meaningful meta-analysis to measure the impact of specific SDMs

Impact of anthocyanin-rich whole fruit consumption on exercise-induced oxidative stress and inflammation: a systematic review and meta-analysis

2019 ◽  
Vol 77 (9) ◽  
pp. 630-645 ◽  
Author(s):  
Taylor K Bloedon ◽  
Rock E Braithwaite ◽  
Imogene A Carson ◽  
Dorothy Klimis-Zacas ◽  
Robert A Lehnhard
Keyword(s):  
Oxidative Stress ◽  
Systematic Review ◽  
Inflammatory Marker ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Oxidative Stress Marker ◽  
Exercise Induced ◽  
The Impact ◽  
And Oxidative Stress

Abstract Context Supplementing with fruits high in anthocyanins to reduce exercise-induced oxidative stress and inflammation has produced mixed results. Objective This systematic review and meta-analysis aims to discuss the impact of whole fruits high in anthocyanins, including processing methods and the type and amount of fruit, on inflammation and oxidative stress. Data Sources PICOS reporting guidelines and a customized coding scheme were used to search 5 databases (SPORTDiscus, Science Direct, Web of Science [BIOSIS], Medline [Pubmed], and the Cochrane Collaboration) with additional cross-referencing selection. Data Extraction A random-effects meta-analysis was used to measure effects of the fruit supplements with 3 statistics; the QTotal value based on a χ2 distribution, τ2 value, and I2 value were used to determine homogeneity of variances on 22 studies (out of 807). Outliers were identified using a relative residual value. Results A small significant negative summary effect across the sum of all inflammatory marker outcomes (P < 0.001) and a moderate negative effect for the sum of all oxidative stress marker outcomes (P = 0.036) were found. Moderator analyses did not reveal significant (P > 0.05) differences between subgrouping variables. Conclusions Results indicate that consumption of whole fruit high in anthocyanins can be beneficial for reducing inflammation and oxidative stress.

Systematic review of histamine type 2 receptor antagonists as an adjunct to curative surgical resection in gastrointestinal malignancies

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15085-e15085
Author(s):  
S. Deva ◽  
M. B. Jameson
Keyword(s):  
Systematic Review ◽  
Cancer Patients ◽  
Surgical Resection ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Tumor Infiltrating Lymphocytes ◽  
Cochrane Collaboration ◽  
Curative Intent ◽  
Gastrointestinal Malignancies ◽  
The Impact

e15085 Background: H2RAs have induced regression in a number of malignancies. The mechanisms that may contribute to this effect include inhibition of T-suppressor lymphocytes, increased tumor infiltrating lymphocytes and blockade of histamine-induced tumor proliferation and angiogenesis. Unique to cimetidine is its ability to inhibit vascular endothelial expression of the cell adhesion molecule E-selectin, to which many GI tumor cells adhere via carbohydrate antigen ligands. The optimal use of H2RAs in cancer patients could therefore be as adjuvant therapy rather than for metastatic disease. Methods: This systematic review examines the impact of H2RAs on the overall survival of patients when used as an adjunct to curative surgical resection for a GI malignancy. Using a sensitive search strategy, randomized controlled trials were identified in relevant databases. Criteria for study selection included: patients with colorectal or gastric cancer surgically resected with curative intent; H2RAs used i) at any dose, ii) for any length of time, iii) with any other treatment modality and iv) in the pre-, peri- or post-operative period. The results were stratified for both the type of malignancy and the H2RA used and analyzed by meta-analysis using Cochrane Collaboration software. Results: Of 350 trials identified, 8 were eligible for inclusion and had sufficient data for analysis, including a total of 1461 patients. Meta-analysis revealed a risk ratio for mortality of 0.86 (95% CI 0.76–0.99, p = 0.03) for patients randomised to H2RAs. Trials of colorectal cancer patients where cimetidine was the H2RA being evaluated demonstrated a significant survival advantage, risk ratio 0.53 (95% CI 0.33–0.84, p = 0.007). All other subgroups demonstrated a non-significant trend favouring H2RAs. Conclusions: H2RAs, and cimetidine in particular, appear to confer a survival benefit when given as an adjunct to curative surgical resection of GI cancers. The trial designs were heterogeneous and further large studies are warranted. No significant financial relationships to disclose.

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