Prealbumin: The clinical utility and analytical methodologies

2020 ◽  
pp. 000456322093188
Author(s):  
Ruvini NK Ranasinghe ◽  
Milly Biswas ◽  
Royce P Vincent
Keyword(s):  
Clinical Practice ◽  
Prognostic Marker ◽  
Clinical Utility ◽  
High Sensitivity ◽  
Clinical History ◽  
Short Review ◽  
Cochrane Library ◽  
Search Terms ◽  
General Search ◽  
The Cochrane Library

Prealbumin is a small protein which has been widely evaluated as a nutritional and a prognostic marker. The small size and concentration of prealbumin in blood proposes challenges on measuring it with high sensitivity and specificity. Over the years, a number of analytical methodologies have been developed, which may help establish prealbumin as a useful biomarker in routine clinical practice. The aim of the short review was to explore the current literature on the clinical utility of prealbumin and the advances made in the analytical methodologies of prealbumin. We searched MEDLINE, EMBASE and the Cochrane Library for articles published between January 1980 and July 2019, with the general search terms of ‘prealbumin’, ‘prognostic marker’, ‘nutritional marker’, ‘analytical methodologies’ and ‘malnutrition’. Additionally, we selected relevant articles and comprehensive overviews from reference lists of identified studies. The routine use of prealbumin in clinical practice remains debatable; however; it can complement clinical history, anthropometric assessment and physical examination to assess malnutrition with more certainty. Consensus on the clinical applications of prealbumin in the management of malnutrition is warranted.

scholarly journals Scoping review protocol: the use of telemedicine in providing opioid agonist treatment and related psychosocial supports

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040556
Author(s):  
Des Crowley ◽  
Robyn Homeniuk ◽  
Ide Delargy
Keyword(s):  
Scoping Review ◽  
Psychosocial Support ◽  
Descriptive Analysis ◽  
Cochrane Library ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Search Terms ◽  
Medical Librarian ◽  
The Cochrane Library

IntroductionThe global opioid-related disease burden is significant. Opioid agonist treatment (OAT) can be effective in reducing illicit opioid use and fatal overdose, and improving multiple health and social outcomes. Despite evidence for its effectiveness, there are significant deficits in OAT globally. COVID-19 has required rapid adaptation of remote models of healthcare. Telemedicine is not used routinely in OAT, and little is known about the current levels of use and effectiveness. The objective of this review is to describe models of telemedicine and their efficacy.Methods and analysisThis scoping review uses the review methodology described by Arksey and O’Malley and adapted by Levac et al. The search strategy developed by the medical librarian at the Irish College of General Practitioners in conjunction with the research team will involve five databases (PubMed, EMBASE, the Cochrane Library, PsycInfo and OpenGrey) and the hand searching of reference lists. A limited initial search of two databases will be completed to refine search terms, followed by a second comprehensive search using newly refined search terms of all databases and finally hand searching references of included studies. To be included, studies must report on remote ways of providing OAT (including assessment, induction and monitoring) or related psychosocial support; be published in English after 2010. Two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Data will be extracted onto an agreed template and will undergo a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics.Ethics and disseminationResearch ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a national remote model of OAT. The results will be published in peer-reviewed journals and presented at relevant conferences.

The metabolic syndrome in pediatrics: Do we have a reliable definition? A systemic review.

2021 ◽  
Author(s):  
Angelo Tropeano ◽  
Domenico Corica ◽  
Alessandra Li Pomi ◽  
Giorgia Pepe ◽  
Letteria Anna Morabito ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Clinical Practice ◽  
Pediatric Population ◽  
High Sensitivity ◽  
Systemic Review ◽  
Cochrane Library ◽  
Sample Population ◽  
Cross Sectional ◽  
The Metabolic Syndrome ◽  
Increased Risk

Objective: Metabolic syndrome is a cluster of cardio-metabolic risk factors associated with an increased risk of cardiovascular disease and type 2 diabetes. In the last two decades, several definitions of metabolic syndrome have been proposed for the pediatric population; all of them agree on the defining components but differ in the suggested criteria for diagnosis. This review aims to analyze the current diagnostic criteria of metabolic syndrome in pediatrics with a reference to their feasibility and reliability in clinical practice. Methods: The systemic research was conducted from January 2003 to June 2020 through MEDLINE via PubMed, Cochrane Library and EMBASE databases. Results: After the selection phase, a total of 15 studies (182 screened) met the inclusion and exclusion criteria and hence they were reported in the present review. Twelve studies were cross-sectional, 2 were longitudinal and 1 was a consensus report. The sample population consisted of multiethnic group or single ethnic group including Turkish, European, Asian and Hispanic subjects. Conclusions: To date, there is not a univocal, internationally accepted pediatric definition of metabolic syndrome, which guarantees a high sensitivity and stability of the diagnosis. The definition proposed by IDF results the most straightforward and easy to use in clinical practice, having the unquestionable advantage of requiring measurements quickly accessible in clinical practice, without the adoption of multiple reference tables. Further research is needed to validate a new version of such definition which includes the diagnostic cut-off points recently suggested by published guidelines.

scholarly journals A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery

2014 ◽  
Vol 96 (2) ◽  
pp. 89-94 ◽  
Author(s):  
EL Jones ◽  
TW Wainwright ◽  
JD Foster ◽  
JRA Smith ◽  
RG Middleton ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Length Of Stay ◽  
Patient Experience ◽  
Enhanced Recovery ◽  
Cochrane Library ◽  
Search Terms ◽  
Included Patient ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty ◽  
The Cochrane Library

Introduction Orthopaedic enhanced recovery after surgery (ERAS) providers are encouraged to estimate the actual benefit of ERAS according to the patient’s opinion by using patient generated data alongside traditional measures such as length of stay. The aim of this paper was to systemically review the literature on the use of patient generated information in orthopaedic ERAS across the whole perioperative pathway. Methods Publications were identified using Embase™, MEDLINE®, AMED, CINAHL® (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the British Nursing Index. Search terms related to experiences, acceptance, satisfaction or perception of ERAS and quality of life (QoL). Findings Of the 596 abstracts found, 8 papers were identified that met the inclusion criteria. A total of 2,208 patients undergoing elective hip and knee arthroplasty were included. Patient satisfaction was reported in 6 papers. Scores were high in all patients and not adversely affected by length of stay. QoL was reported in 2 papers and showed that QoL scores continued to increase up to 12 months following ERAS. Qualitative methods were used in one study, which highlighted problems with support following discharge. There is a paucity of data reporting on patient experience in orthopaedic ERAS. However, ERAS does not compromise patient satisfaction or QoL after elective hip or knee surgery. The measurement of patient experience should be standardised with further research.

scholarly journals COVID-19 Pandemic and Clinical Oncology Concerns

2020 ◽  
Vol 8 (6) ◽  
pp. 442-454
Author(s):  
Hyunjo Kim ◽  
Jae-Hoon Song
Keyword(s):  
Cancer Patients ◽  
Clinical Oncology ◽  
Ground Glass Opacity ◽  
Cochrane Library ◽  
Tumor Treatment ◽  
Search Terms ◽  
Information Status ◽  
The Common ◽  
Novel Coronavirus ◽  
The Cochrane Library

Purpose: The purpose of this review article is concerns on thatcancer patients are regarded as a highly vulnerable group in the currentCoronavirus Disease 2019 (COVID-19) pandemic.Methods: A literature search was performed using the PubMeddatabase and the Cochrane library. Search terms included ”novel coronavirus”or “2019-nCoV” and “clinical oncology”. Authors re- viewedcancer registry information, status, and treatments.Results: COVID-19-infected cancer patients were included and the lastanti-tumor treatment was within 14 days, it significantly increased therisk of developing severe events. Lung cancer was the most frequentcancer type. The common chest computed tomography (CT) findingswere ground- glass opacity and patchy consolidation. A total of patientshad severe events and the mortality rate was high. Furthermore, patchyconsolidation on CT on admission was associated with a higher risk ofdeveloping severe events.Conclusions: Cancer patients show deteriorating conditions and pooroutcomes from the COVID-19 infection. It is recommended that cancerpatients receiving anti-tumor treatments should have vigorous screeningfor COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19infection.

scholarly journals Expression of PD-L1 for predicting response to immune checkpoint inhibitors in metastatic urothelial carcinoma: a systematic review and meta-analysis

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
J. Huang ◽  
X. Teng
Keyword(s):  
Urothelial Cancer ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Objective Response ◽  
High Sensitivity ◽  
Cochrane Library ◽  
Significant Difference ◽  
Metastatic Urothelial Carcinoma ◽  
The Cochrane Library ◽  
Expression Status

Background We conducted this meta-analysis and systematic literature review to study the ability of PD-L1 to predict objective response in patients with urothelial cancer treated with PD-1/PD-L1 inhibitors. Methods Relevant studies of PD-1 or PD-L1 inhibitors in urothelial cancer that reported objective response rate (orr) based on PD-L1 expression status in PubMed, embase, and the Cochrane Library were retrieved. Efficacy of PD-L1 expression status in predicting orr and the efficacy, safety of PD-1 and PD-L1 drugs were analyzed. Results Studies were divided into ≥1%, ≥5%, and ≥25% based on PD-L1 positivity threshold, and the patients were grouped into PD-L1 positive and negative. In all 3 expression thresholds, patients with positive PD-L1 expression were more likely to experience an objective response [≥1% threshold odds ratio (or): 1.74; 95% confidence interval (ci): 1.20 to 2.53; ≥5% threshold or: 2.74; 95% ci: 2.01 to 3.724; ≥25% threshold or: 7.13; 95% ci: 2.38 to 21.40] in compar­ison with patients with negative PD-L1 expression. Of the 3 thresholds, the ≥25% threshold was better in predicting orr (1.74 vs. 2.93 vs. 7.13; p < 0.0001). The ≥1% PD-L1 threshold had a relatively high sensitivity in predicting orr; the ≥5% PD-L1 threshold was better for specificity. Sensitivity was higher at the ≥25% threshold than at the other two thresholds, but specificity was lower. Further, we found that there is no statistically significant difference in efficacy between PD-1 and PD-L1 drugs. Conclusions Urothelial cancer patients with PD-L1 positive expression responded better than PD-L1 negative patients did, and a threshold of ≥5% or greater for PD-L1 expression might predict positive clinical response.

Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review

2016 ◽  
Vol 10 (3) ◽  
pp. 252-257 ◽  
Author(s):  
Kempland C. Walley ◽  
Kurt J. Hofmann ◽  
Brian T. Velasco ◽  
John Y. Kwon
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Cochrane Library ◽  
Management Options ◽  
Radiographic Outcomes ◽  
Search Terms ◽  
Syndesmotic Screw ◽  
Retrospective Cohort Studies ◽  
Removal Of Hardware ◽  
The Cochrane Library

Background. While trans-syndesmotic fixation with metal screws is considered the gold standard in treating syndesmotic injuries, controversy exists regarding the need and timing of postoperative screw removal. Formal recommendations have not been well established in the literature and clinical practice is highly variable in this regard. The purpose of this systematic review is to critically examine the most recent literature regarding syndesmotic screw removal in order to provide surgeons an evidence-based approach to management of these injuries. Methods. The Cochrane Library and PubMed Medline databases were explored using search terms for syndesmosis and screw removal between October 1, 2010 and June 1, 2016. Results. A total of 9 studies (1 randomized controlled trial and 8 retrospective cohort studies) were found that described the outcomes of either retained or removed syndesmotic screws. Overall, there was no difference in functional, clinical or radiographic outcomes in patients who had their syndesmotic screw removed. There was a higher likelihood of recurrent syndesmotic diastasis when screws were removed between 6 and 8 weeks. There was a higher rate of postoperative infections when syndesmotic screws were removed without administering preoperative antibiotics. Conclusion. Removal of syndesmotic screws is advisable mainly in cases of patient complaints related to the other implanted perimalleolar hardware or malreduction of the syndesmosis after at least 8 weeks postoperatively. Broken or loose screws should not be removed routinely unless causing symptoms. Antibiotic prophylaxis is recommended on removal. Radiographs should be routinely obtained immediately prior to removal and formal discussions should be had with patients prior to surgery to discuss management options if a broken screw is unexpectedly encountered intraoperatively. Radiographs and/or computed tomography imaging should be obtained after syndesmotic screw removal when indicated for known syndesmotic malreduction. Levels of Evidence: Level IV: Systematic review

scholarly journals LO072: Fever in the returning traveller: a systematic review and critical appraisal of existing clinical practice guidelines and approaches to returning travellers presenting with fever

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S54-S55
Author(s):  
A. Collier ◽  
J.J. Perry ◽  
A. Nath
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Practice Guideline ◽  
Critical Appraisal ◽  
Clinical Information ◽  
Final Analysis ◽  
Cochrane Library ◽  
The Cochrane Library

Introduction: Fever in the returning traveller is a common ED presentation; however approaches and level of comfort with tropical diseases vary widely. This project aimed to conduct a systematic review and critical appraisal of existing clinical practice guidelines and approaches, to guide an ED approach, in Canada, to fever in the returning traveller. Methods: A literature review was conducted of peer reviewed papers, national and international practice guidelines, and practice statements presenting approaches to fever in the returning traveller. A literature search was conducted using MEDLINE and Embase (1947-Dec 2014), with librarian assistance to optimize strategy. The databases of guideline clearing houses, CMA, PHAC, WHO, CDC, and the Cochrane library were searched, along with a google scholar search. References of included articles were hand searched. Article titles and abstracts were reviewed by the author for inclusion. Key elements of the guidelines and approaches were identified and grouped by theme and where appropriate, the quality of guidelines were assessed by two reviewers using the AGREEII tool. Results: The search returned 1598 titles. 72 full manuscripts were reviewed based on inclusion from title and abstract, with 24 manuscripts included for final analysis. Common elements suggested by the guidelines or approaches were identified and grouped within three themes (key historical features, physical exam findings, investigations). Most manuscripts presented tables of important clinical information, but limited guidance on how to approach diagnosis in a focused manner. When evaluated by AGREEII, only one guideline (D’Acremont et al) scored > 50% overall quality rating. Unlike other approaches, this guideline proposes a stepwise approach to diagnosis and treatment based on the presence of key exposures, signs/symptoms, and eosinophilia. Conclusion: The guideline by D’Acremont et al was identified as the most rigorous existing practice guideline. This guideline, combined with other elements identified by thematic review, forms the basis of a suggested ED approach to fever in the returning traveller, which will be further refined using the AGREEII model to propose a practice guideline for Canadian EDs.

Is the exposure to antidepressant drugs in early pregnancy a risk factor for spontaneous abortion? A review of available evidences

2009 ◽  
Vol 18 (3) ◽  
pp. 240-247 ◽  
Author(s):  
Giovanni Santone ◽  
Gianmatteo Ricchi ◽  
David Rocchetti ◽  
Stefania Tofani ◽  
Cesario Bellantuono
Keyword(s):  
Risk Factor ◽  
Spontaneous Abortion ◽  
Early Pregnancy ◽  
Antidepressant Drugs ◽  
First Trimester ◽  
Cochrane Library ◽  
Control Group ◽  
Search Terms ◽  
First Trimester Of Pregnancy ◽  
The Cochrane Library

SUMMARYAim– To review studies conducted to establish the risk of spontaneous abortion (SA) in women exposed to anti-depressant drugs (ADs) during early pregnancy.Methods– By using different search terms, PubMed, Toxline, EMBASE, PsychINFO, and the Cochrane library databases were searched from January 1980 to March 2008, to identify studies assessing the risk of SA in women exposed to different classes of ADs during the first trimester of pregnancy.Results– Ten studies over 21 identified were selected for the analysis. All were performed prospectively and included as control group unexposed women, or exposed to non-teratogenic drugs or to placebo. In seven studies a depressive episode was specified as the reason for which the drug was prescribed, while the time of exposure was in nine.Conclusions– Only three studies over ten selected reported a significant association between an increased rate of SAs and early pregnancy exposure to some ADs. Many methodological flaws in the study design were found in all studies considered. Given this background and a lack of strong evidence on this issue, further prospective and better designed studies are needed to assess the risk of SA in pregnant women exposed to ADs against the risk of an untreated maternal depression.Declaration of Interest:None.

Cervical Ripening Using Foley Balloon with or without Oxytocin: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 36 (04) ◽  
pp. 406-421 ◽  
Author(s):  
Lauren Gallagher ◽  
Benjamin Gardner ◽  
Mahbubur Rahman ◽  
Corina Schoen ◽  
Katherine Connolly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cervical Ripening ◽  
Cochrane Library ◽  
Search Terms ◽  
Vaginal Deliveries ◽  
Mechanical Methods ◽  
Multiparous Women ◽  
The Cochrane Library

Objective To assess available evidence regarding the use of oxytocin in conjunction with Foley balloon (FB) for cervical ripening. Methods Databases from MEDLINE (U.S. National Library of Medicine, 1980—May 12, 2017), MEDLINE (Ovid, 1980—June 30, 2017), the Cochrane Library Controlled Trials Register, ClinicalTrials.gov, and Web of Science were queried for studies on FB cervical ripening with or without oxytocin in pregnant women. Search terms included: “balloon dilatation” OR “mechanical methods” OR “mechanical method” OR “mechanical dilation” OR “mechanical dilatation” OR “mechanical dilations” OR “mechanical dilatations” OR “balloon” OR “Foley” AND “Pitocin” OR “oxytocin.” All relevant references were reviewed. Literature for inclusion and methodological quality were reviewed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Results Out of 344 citations, six randomized clinical trials (1,133 patients) fulfilled our inclusion criteria. The pooled estimate showed that the cesarean delivery (CD) rate did not differ (relative risk [RR]: 0.91 (95% confidence interval [CI] [0.76–1.10]; p = 0.23) between patients who underwent preinduction cervical ripening with FB alone versus those who received oxytocin in addition to FB. Heterogeneity was not significant among studies (I 2 0.0%; p = 0.64). Furthermore, no differences in other outcomes such as composite and maternal outcomes were detected between these two groups. Compared with simultaneous use of oxytocin with FB, the Foley alone cervical ripening group had a longer induction to delivery time, and lower deliveries within 12 and 24 hours. Subgroup analysis showed that only multiparous women in the Foley alone group had lower rate of vaginal delivery within 24 hours (RR: 0.74, 95% CI [0.61–0.89], p = 0.002) along with a trend toward higher CD rates. Conclusion Adding oxytocin to FB at the time of preinduction cervical ripening does not reduce cesarean rates nor improve maternal or neonatal outcomes. Multiparous women who received FB alone seem to have lower rates of vaginal deliveries within 24 hours, but these results should be interpreted with caution.

scholarly journals Evidence-based Recommendations for the Management of Comorbidities in Rheumatoid Arthritis, Psoriasis, and Psoriatic Arthritis: Expert Opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative

2015 ◽  
Vol 42 (10) ◽  
pp. 1767-1780 ◽  
Author(s):  
Camille Roubille ◽  
Vincent Richer ◽  
Tara Starnino ◽  
Collette McCourt ◽  
Alexandra McFarlane ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Potential Effect ◽  
Cochrane Library ◽  
Evidence Based ◽  
Grade Of Recommendation ◽  
The Cochrane Library ◽  
Based Medicine ◽  
Level Of Agreement

Objective.Comorbidities such as cardiovascular diseases (CVD), cancer, osteoporosis, and depression are often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO). Recommendations may improve identification and treatment of comorbidities. The Canadian Dermatology-Rheumatology Comorbidity Initiative reviewed the literature to develop practical evidence-based recommendations for management of comorbidities in patients with RA, PsA, and PsO.Methods.Eight main topics regarding comorbidities in RA, PsA, and PsO were developed. MEDLINE, EMBASE, and the Cochrane Library (1960–12/2012), together with abstracts from major rheumatology and dermatology congresses (2010–2012), were searched for relevant publications. Selected articles were analyzed and metaanalyses performed whenever possible. A meeting including rheumatologists, dermatologists, trainees/fellows, and invited experts was held to develop consensus-based recommendations using a Delphi process with prespecified cutoff agreement. Level of agreement was measured using a 10-point Likert scale (1 = no agreement, 10 = full agreement) and the potential effect of recommendations on daily clinical practice was considered. Grade of recommendation (ranging from A to D) was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.Results.A total of 17,575 articles were identified, of which 407 were reviewed. Recommendations were synthesized into 19 final recommendations ranging mainly from grade C to D, and relating to a large spectrum of comorbidities observed in clinical practice: CVD, obesity, osteoporosis, depression, infections, and cancer. Level of agreement ranged from 80.9% to 95.8%.Conclusion.These practical evidence-based recommendations can guide management of comorbidities in patients with RA, PsA, and PsO and optimize outcomes.

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