Anti-D prophylaxis for rhesus D (RhD)-negative women having an abortion of a pregnancy up to 13+6 weeks’ gestation: a systematic review and new NICE consensus guidelines

2020 ◽  
pp. bmjsrh-2019-200536 ◽  
Author(s):  
Mia Schmidt-Hansen ◽  
Jonathan Lord ◽  
James Hawkins ◽  
Sharon Cameron ◽  
Anuja Pandey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effect ◽  
Random Effect Model ◽  
Medical Abortion ◽  
Cochrane Library ◽  
Clinical Expertise ◽  
Effect Model ◽  
Randomised Controlled ◽  
The Cochrane Library ◽  
Surgical Abortion

BackgroundIn order to develop the 2019 National Institute for Health and Care Excellence (NICE) national guideline on abortion care for the National Health Service1 we undertook a systematic review comparing anti-D prophylaxis to no prophylaxis in rhesus D (RhD)-negative women undergoing medical or surgical abortion of pregnancy at ≤13+6 weeks’ gestationMethodsWe searched Embase, Medline and the Cochrane Library on 19 October 2018. We also consulted experts and checked reference lists for any missed trials. Eligible studies were randomised controlled trials and non-randomised comparative studies, published in English from 1985 onwards, comparing anti-D prophylaxis to no anti-D prophylaxis in RhD-negative women undergoing medical or surgical abortion at ≤13+6 weeks’ gestation, and reporting subsequent anti-D isoimmunisation/sensitisation or subsequent affected pregnancy. These outcomes were to be analysed as risk ratios in Review Manager 5.3 using the Mantel-Haenszel statistical method and a fixed or random effect model. The overall quality of the evidence was planned to be assessed using GRADE.ResultsThe search identified 426 potentially relevant studies of which none met the inclusion criteria. Recommendations for practice were therefore based on the clinical expertise of the guideline committee.Conclusions(1) Offer anti-D prophylaxis to women who are Rhesus D negative who are having an abortion after 10+0 weeks’ gestation. (2) Do not offer anti-D prophylaxis to women who are having a medical abortion up to and including 10+0 weeks’ gestation. (3) Consider anti-D prophylaxis for women who are rhesus D negative and are having a surgical abortion up to and including 10+0 weeks’ gestation.

scholarly journals Do Corticosteroids Affect Prenatal Biophysical Parameters? A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (3) ◽  
pp. 259-264
Author(s):  
Sanaz Musavi ◽  
Leila Nikniaz ◽  
Hosein Hoseinifard ◽  
Arezou Hamzehzadeh ◽  
Shabnam Vazifekhah
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Effect Model ◽  
Biophysical Profile ◽  
Betamethasone And Dexamethasone

This systematic review and meta-analysis aimed to evaluate the effect of betamethasone and dexamethasone on biophysical profile (BPP) parameters. In addition, it was performed in 2017, using several databases such as PubMed/MEDLINE, Scopus, EMBASE, Cochrane library, ISI Web of science, Proquest, and Google scholar, along with Magiran SID and IranMedex. Eligible studies were selected by two reviewers and the outcomes of interest were extracted as well. Meta-analysis was done using the random effect model. Further, I-square statistic test was used for heterogeneity analysis and the presence of publication bias was also checked. At last, 12 studies were included and a random and fixed effect model was used for analysis. The pooled event rates were 4.5% (95% CI = 0.01-64.3, P=0.1), 76.8% (% 95 CI=33.5-95.6, P=0.21), 71.8% (% 95 CI=38.8-91.1, P=0.18), 70.9% (%95 CI=38.4-90.5, P=0.20), and 92.3% (%95 CI=76.0-97.8, P<0.001) for the reduced amniotic fluid volume, baseline fetal heart rate reactivity, fetal breathing, fetal movement, and heart rate variability, respectively. In summary, a significant decrease was observed in heart rate variability following betamethasone and dexamethasone administration. However, further systematic reviews are necessary to differentiate steroid induced changes in the fetal BPP from those due to fetal compromise

scholarly journals The Effect of Deworming School Children on Anemia Prevalence: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 12 (1) ◽  
pp. 155-161 ◽  
Author(s):  
Tadele Girum ◽  
Abebaw Wasie
Keyword(s):  
Systematic Review ◽  
School Children ◽  
Fixed Effects ◽  
Random Effect ◽  
Random Effect Model ◽  
Hemoglobin Level ◽  
Cochrane Library ◽  
Bibliographic Databases ◽  
Effect Model ◽  
Prevalence Of Anemia

Introduction: High prevalence of anemia attributable to intestinal parasite infection occurs among children in developing countries. As a result mass treatment of all children with anti-helminthic drugs particularly in school setting is being implemented. There are few studies conducted to assess impact of deworming on anemia prevalence among school children with inconclusive finding. Therefore we aimed to conduct a systematic review on impact assessment of deworming on anemia prevalence or hemoglobin level of school children so that policy makers and other stalk holders could have pooled evidence on the direction to make decision. Methods: The review was conducted through a systematic literature search of articles published between 1998 and 2015. Five bibliographic databases and libraries: PubMed/Medline, Global Health Database, Embase, the Cochrane Library, and African Index Medicus were used. After cleaning and sorting, analysis was performed using STATA version 11. The pooled estimate was through a fixed-effects model. Heterogeneity was assessed by the I2 and publication bias through funnel plot. Results: Eight studies were retained for final analysis which enrolled a total of 1,005,239 school children. The overall change in the hemoglobin level after deworming was 1.62(95%CI=1.01-2.25) gram/deciliter. There was no difference between the random effect model and the fixed effect model. The prevalence of anemia was markedly changed after the program, particularly in the studies which implemented deworming with hygiene program, co-administration of iron and retinol. Conclusion and Recommendation: School based deworming program decreases prevalence of anemia and will contribute to reduction of anemia in the community. Therefore the program should be expanded in all areas and integrated with other child care programs.

scholarly journals Effectiveness of blended learning in pharmacy education: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252461
Author(s):  
Athira Balakrishnan ◽  
Sandra Puthean ◽  
Gautam Satheesh ◽  
Unnikrishnan M. K. ◽  
Muhammed Rashid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blended Learning ◽  
Effect Size ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Pharmacy Education ◽  
Cochrane Library ◽  
Control Group ◽  
Effect Model

Background & objective Though blended learning (BL), is widely adopted in higher education, evaluating effectiveness of BL is difficult because the components of BL can be extremely heterogeneous. Purpose of this study was to evaluate the effectiveness of BL in improving knowledge and skill in pharmacy education. Methods PubMed/MEDLINE, Scopus and the Cochrane Library were searched to identify published literature. The retrieved studies from databases were screened for its title and abstracts followed by the full-text in accordance with the pre-defined inclusion and exclusion criteria. Methodological quality was appraised by modified Ottawa scale. Random effect model used for statistical modelling. Key findings A total of 26 studies were included for systematic review. Out of which 20 studies with 4525 participants for meta-analysis which employed traditional teaching in control group. Results showed a statistically significant positive effect size on knowledge (standardized mean difference [SMD]: 1.35, 95% confidence interval [CI]: 0.91 to 1.78, p<0.00001) and skill (SMD: 0.68; 95% CI: 0.19 to 1.16; p = 0.006) using a random effect model. Subgroup analysis of cohort studies showed, studies from developed countries had a larger effect size (SMD: 1.54, 95% CI: 1.01 to 2.06), than studies from developing countries(SMD: 0.44, 95% CI: 0.23 to 0.65, studies with MCQ pattern as outcome assessment had larger effect size (SMD: 2.81, 95% CI: 1.76 to 3.85) than non-MCQs (SMD 0.53, 95% CI 0.33 to 0.74), and BL with case studies (SMD 2.72, 95% CI 1.86–3.59) showed better effect size than non-case-based studies (SMD: 0.22, CI: 0.02 to 0.41). Conclusion BL is associated with better academic performance and achievement than didactic teaching in pharmacy education.

scholarly journals Comparison of the therapeutic methods (pharmacologic and nonpharmacologic) on prevention of post-ERCP pancreatitis: A systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 17-17
Author(s):  
Masood Shirmohammadi ◽  
Mohammad Hossein Somi ◽  
Morteza Ghojazadeh ◽  
Hossein Hosseinfard ◽  
Fatemeh Tahmasebi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
P Value ◽  
Effect Model ◽  
Rectal Indomethacin ◽  
Accurate Reporting

Background: Pancreatitis is considered as the most prevalent serious disorders of endoscopic retrograde cholangiopancreatography (ERCP). Different approaches have been suggested to prevent or reduce this complication. Therefore we aim to investigate them in the current study. This systematic review was performed in 2019 using Pubmed, Embase, google scholar and Cochrane library. Two reviewers selected eligible studies and outcomes of interest were extracted. Meta-analysis was done by using the random or fixed-effect models. I-square statistic test was used for heterogeneity analysis. Material and Methods: Totally, 2758 articles were searched. Thereafter duplicated and irrelevant articles were excluded, and six articles were entered to the present study. Six RCTs were considered eligible with a total participants of 1685. Results: The relative risk of PEP was not significantly different in NSAID and hydration groups (Pooled RR=1.19, 95%CI: 0.40 to 3.50, P-value=0.74). The random effect model indicated no significant differences between NSAID and NSAID+hydration groups regarding the incidence of PEP (Pooled RR=2.19, 95%CI: 0.70 to 6.88, P-value=0.17). Conclusion: Additionally, the results of one study showed that rectal indomethacin alone appeared to be more effective for preventing PEP than no prophylaxis, PSP alone, and the combination of indomethacin and PSP. Using NSAIDs alone or the combination of NSAIDs and hydration can reduce the risk of post-ERCP pancreatitis. Lack of studies comparing different approaches of prophylaxis in post-ERCP patient or the reporting of different parameters among the existing studies seriously limited the possibility and quality of meta-analysis. Further well-designed studies with accurate reporting of data is necessary to provide more reliable conclusion.

scholarly journals The Most Psychological Impacts of Coronavirus Epidemics: A Protocol for Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Parandis Pourdehghan ◽  
Seyed-Ali Mostafavi
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Psychological Problems ◽  
Cochrane Library ◽  
Prevalence Rates ◽  
Study Selection ◽  
Psychological Stressor ◽  
The Cochrane Library

Objective: The Coronavirus disease 2019 (COVID-19) is a considerable psychological stressor that has a significant impact on every facet of people’s life. Since 2002 that the first Coronavirus epidemic has emerged, many pieces of researches have indicated several psychological problems during this period. In circumstances such as COVID-19, researchers could deploy previous resources to identify the most prevalent psychological effects of Coronavirus diseases. We aim to systematically review and quantitatively assess the psychological problems during Coronavirus epidemics to identify the most prevalent psychological problems. Method: A systematic review of the literature will be conducted on psychological problems during previous and the new Coronavirus epidemics. Electronic databases, including PubMed/MEDLINE, Web of Science, Cochrane Library, PsycINFO/ProQuest, Scopus, and Google Scholar will be systematically searched using predefined search terms to identify relevant articles published from January 1, 2002 to June 20, 2020. Two authors independently identify papers that reported the prevalence rates of the psychological problems during Coronavirus outbreaks. The outcomes will include the most prevalent psychological problems during Coronavirus outbreaks. To ensure we have gathered all the evidence, we will conduct another search on the specific psychological problems revealed in the previous search. Study selection will follow the Cochrane library guideline. Afterward, data synthesis will be performed via the meta-analysis of the prevalence rates using the random effect model. Conclusion: The findings can allow identifying the most prevalent psychological problems since the first Coronavirus epidemic in 2002. This can help health policymakers and clinicians to be informed of the priorities of the psychological problems related to COVID-19.

scholarly journals Alteration of Postural Balance in Patients with Fibromyalgia Syndrome—A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 127
Author(s):  
David Núñez-Fuentes ◽  
Esteban Obrero-Gaitán ◽  
Noelia Zagalaz-Anula ◽  
Alfonso Javier Ibáñez-Vera ◽  
Alexander Achalandabaso-Ochoa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postural Balance ◽  
Fibromyalgia Syndrome ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Healthy Controls ◽  
Functional Balance ◽  
Sensory Organization ◽  
Effect Model

Balance problems are one of the most frequent symptoms in patients with Fibromyalgia Syndrome (FMS). However, the extent and nature of this balance disorder are not known. The objective of this work was to determine the best evidence for the alteration of postural balance in patients with FMS and analyze differences with healthy controls. To meet this objective, a systematic review with meta-analysis was performed. A bibliographical search was carried out in PubMed Medline, Scopus, Web of Science, CINAHL and SciELO. Observational studies that assessed postural balance in patients with FMS compared to healthy subjects in baseline conditions, were selected. In a random-effect model, the pooled effect was calculated with the Standardized Mean Difference (SMD) and its 95% confidence interval (CI). Nineteen studies reporting data of 2347 participants (95% female) were included. FMS patients showed poor balance with a large effect on static (SMD = 1.578; 95% CI = 1.164, 1.992), dynamic (SMD = 0.946; 95% CI = 0.598, 1.294), functional balance (SMD = 1.138; 95% CI = 0.689, 1.588) and on balance confidence (SMD = 1.194; 95% CI = 0.914, 1.473). Analysis of the Sensory Organization Test showed large alteration of vestibular (SMD = 1.631; 95% CI = 0.467, 2.795) and visual scores (SMD = 1.317; 95% CI = 0.153, 2.481) compared to healthy controls. Patients with FMS showed worse scores for different measures of postural balance compared to healthy controls. Concretely, FMS patients appear to have poor vestibular and visual scores with a possible somatosensory dependence.

scholarly journals Magnitude and determinants of neural tube defect in Africa: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Atlaw ◽  
Yohannes Tekalegn ◽  
Biniyam Sahiledengle ◽  
Kenbon Seyoum ◽  
Damtew Solomon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neural Tube ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Folic Acid Supplementation ◽  
Maternal Exposure ◽  
X Ray ◽  
Effect Model ◽  
Pooled Prevalence

Abstract Background Neural tube defects (NTDs) are a group of disorders that arise from the failure of the neural tube close between 21 and 28 days after conception. About 90% of neural tube defects and 95% of death due to these defects occurs in low-income countries. Since these NTDs cause considerable morbidity and mortality, this study aimed to determine the prevalence and associated factors of NTDs in Africa. Methods The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO number: CRD42020149356). All major databases such as PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, African Journals Online (AJOL), and Google Scholar search engine were systematically searched. A random-effect model was used to estimate the pooled prevalence of NTDs in Africa, and Cochran’s Q-statistics and I2 tests were used to assess heterogeneity between included studies. Publication bias was assessed using Begg ’s tests, and the association between determinant factors and NTDs was estimated using a random-effect model. Results Of the total 2679 articles, 37 articles fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. The pooled prevalence of NTDs in Africa was 50.71 per 10,000 births (95% CI: 48.03, 53.44). Folic acid supplementation (AOR: 0.40; 95% CI: 0.19–0.85), maternal exposure to pesticide (AOR: 3.29; 95% CI: 1.04–10.39), mothers with a previous history of stillbirth (AOR: 3.35, 95% CI: 1.99–5.65) and maternal exposure to x-ray radiation (AOR 2.34; 95% CI: 1.27–4.31) were found to be determinants of NTDs. Conclusions The pooled prevalence of NTDs in Africa was found to be high. Maternal exposure to pesticides and x-ray radiation were significantly associated with NTDs. Folic acid supplementation before and within the first month of pregnancy was found to be a protective factor for NTDs.

scholarly journals Assessment of the Antihyperlipidemic Effect of Garlic Vs Pitavastatin in Patients with Moderate Hyperlipidemia: A Metanalysis of Randomized Controlled Trials

2021 ◽  
Vol 20 (4) ◽  
Author(s):  
Muhammad Waqas Saeed ◽  
◽  
Syed Wasif Gillani ◽  
Rana Kamran Mahmood ◽  
Muhammad Usman ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Low Density Lipoprotein ◽  
Random Effect ◽  
Random Effect Model ◽  
Density Lipoprotein ◽  
Mean Difference ◽  
Controlled Trials ◽  
Effect Model ◽  
Randomised Controlled ◽  
Level Reduction

Abstract To assess the efficacy of garlic in comparison with pitavastatin in reducing hypercholesteremia. Databases that include PubMed/Medline, Cochrane, TRIP and SCOPUS were searched. All randomised controlled trials selected for the study. Studies comparing garlic with placebo and pitavastatin with either placebo or other drugs were selected to treat hypercholesteremia. Statistical analysis done using a random-effect model, and results expressed in Mean difference and variance for continuous data with 95% confidence intervals (CI). Twelve studies analysed the efficacy of garlic compared to pitavastatin. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides assessed for garlic and pitavastatin's comparative efficacy. Mean difference noticed in total cholesterol in garlic arm was -13.604 with 95% CI = -22.246, -4.962 while in pitavastatin group was -28.205 (95% CI = -29.016,-27.394). The LDL-c reduction not recorded in the garlic arm where the mean increase was recorded of 0.309 (95% CI = -12.502, 13.120) while in the pitavastatin group was -35.538 (95% CI = -39.992, -31.084). Similarly, the increase in HDL was more in the pitavastatin group 5.308 (95% CI = 0.906, 9.710 compared to garlic (2.754 with 95% CI = 1.069, 4.440). Triglycerides level reduction was also low in whereas pitavastatin was -24.210 with 95% CI = -29.249, -19.171.The analysis showed that garlic has a significant effect on lipid profile. The comparison profile of garlic with pitavastatin showed clinical application in the treatment of mild-moderate hypercholesteremia—further studies required the investigator to use the combination therapy in controlled trials. Keywords: Allicin, Allium sativum, Dyslipidemia, Garlic, Hypercholesteremia, Hyperlipidemia Pitavastatin

Systematic Review and Meta-analysis of Pirfenidone, Nintedanib, and Pamrevlumab for the Treatment of Idiopathic Pulmonary Fibrosis

2020 ◽  
pp. 106002802096445
Author(s):  
Enrica Di Martino ◽  
Alessio Provenzani ◽  
Patrizio Vitulo ◽  
Piera Polidori
Keyword(s):  
Systematic Review ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
World Health ◽  
Effect Model ◽  
All Cause Mortality ◽  
Positive Effect

Background: The comparative efficacy of pirfenidone, nintedanib, and pamrevlumab in slowing the rate of forced vital capacity (FVC) decline and mortality in patients with idiopathic pulmonary fibrosis (IPF) is unknown. Objective: To perform a systematic review and meta-analysis (MA) of these drugs for IPF. Methods: We searched CENTRAL, PubMed, EMBASE, ClincalTrials.gov, and the World Health Organization’s registry databases up to March 2020. Phase II/III randomized controlled trials in adults with IPF were eligible. The random-effect model was implemented calculating the effect size and respective 95% CI as Cohen’s d for change from baseline FVC (in percentage predicted and liters) and odds ratio (OR) for 10% reduction in FVC and all-cause mortality (ACM). Results: Six studies were included in the MA. For change from baseline in percentage predicted FVC, the MA indicated that the 3 drugs were more effective than placebo (pirfenidone: d=3.30%, 95% CI=2.15-4.45; nintedanib: d=3.15%, 95% CI=2.35-3.95; pamrevlumab: d=4.30%, 95% CI=0.45-8.15). These results are superimposable to those relating to change from baseline FVC in liters (pirfenidone: d=0.09L, 95% CI=0.04-0.14; nintedanib: d=0.13L, 95% CI=0.10-0.16; pamrevlumab: d=0.20L, 95% CI=0.05-0.35). Each drug had a positive effect on 10% reduction in FVC (pirfenidone: OR=0.57, 95% CI=0.45-0.74; nintedanib: OR=0.66, 95% CI=0.51-0.85; pamrevlumab: OR=0.24, 95% CI=0.08-0.73), but only pirfenidone showed an effect on ACM (OR=0.50; 95% CI=0.31-0.83). Conclusion and Relevance: This MA provided encouraging results on pamrevlumab efficacy in slowing the decline in FVC compared with pirfenidone and nintedanib. Actually, in phase 3, it could become a potential IPF treatment.

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.

Sign in / Sign up

Export Citation Format

Share Document