The Evidence Base for Interventions Targeting Individuals With Work-Related PTSD: A Systematic Review and Recommendations

The purpose of this study was to summarize the evidence base for interventions targeting individuals with work-related posttraumatic stress disorder (PTSD), to make recommendations for clinicians and administrative decision makers involved in their rehabilitation, and to guide future research in this area. Particular attention was given to studies that were conducted in naturalistic clinical settings or in a workers’ compensation claim context. Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, PsycINFO, CINAHL, PILOTS, and EMBASE identified 11 articles. Study populations included railroad personnel, police officers, disaster workers, and individuals with industrial injuries. Interventions included trauma-focused cognitive-behavioral therapy and eye movement desensitization and reprocessing. Several studies specifically targeted workers who had failed to return to work (RTW) after standard PTSD treatment. The results suggest that psychotherapy interventions are beneficial for helping clients recover from PTSD symptoms and RTW. In studies that reported on work status, RTW rates increased over time and generally lay between 58% and 80% across follow-up time points. Narrative impressions were supplemented by calculation of Risk Differences for individuals working at pretreatment versus posttreatment. Clinical consideration, methodological issues limiting the current body of work, and recommendations for future research are discussed.

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Azithromycin in patients with Covid-19; a systematic review and metanalysis

10.1101/2021.08.03.21261414 ◽

2021 ◽

Author(s):

Luis Ayerbe ◽

Ivo Forgnone ◽

Carlos Risco-Risco ◽

Maria Perez-Pinar ◽

Salma Ayis

Keyword(s):

Systematic Review ◽

Clinical Severity ◽

Future Research ◽

Controlled Trials ◽

Clinical Settings ◽

Cochrane Central Register ◽

Random Effects Models ◽

Central Register ◽

Significant Difference ◽

Observational Design

Background: Azithromycin (AZM) has been widely used in the management of Covid-19. However, the evidence on its actual effects remains disperse and difficult to apply in clinical settings. This systematic review and metanalysis summarizes the studies on the beneficial and adverse effect of AZM in patients with Covid-19. Methods: The PRISMA 2020 statement criteria were followed. Randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of patients treated, and not treated, with AZM, indexed until the 5th of July 2021, were searched in PubMed, Embase, The Web of Science, Scopus, The Cochrane Central Register of Controlled Trials, and MedRXivs. We used Random-effects models to estimate pooled effect size from aggregate data. Results: The initial search produced 4950 results. Finally, 16 studies, five RCTs and 11 with an observational design, with a total of 22984 patients, were included. The metanalysis showed no difference in mortality for those treated, or not, with AZM, OR: 0.95 (0.79-1.13). There was also no significant difference for those treated, and not, with AZM in need for hospital admission or time to admission from ambulatory settings, clinical severity, need for intensive care, or adverse effects. Conclusions: These results presented in this review do not support the use of AZM in the management of Covid-19. They also show that any harm caused to the patient who received it is unlikely. Future research on treatment for patients with Covid-19 may need to focus on other drugs

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Digital Interventions for Problematic Cannabis Users in Non-Clinical Settings: Findings from a Systematic Review and Meta-Analysis

European Addiction Research ◽

10.1159/000445716 ◽

2016 ◽

Vol 22 (5) ◽

pp. 233-242 ◽

Cited By ~ 33

Author(s):

Eva Hoch ◽

Ulrich W. Preuss ◽

Marica Ferri ◽

Roland Simon

Keyword(s):

Systematic Review ◽

Behavioral Therapy ◽

Meta Analysis ◽

Cannabis Use ◽

Treatment Programs ◽

Controlled Trials ◽

Clinical Settings ◽

Cochrane Central Register ◽

Digital Interventions ◽

Central Register

Background: Existing cannabis treatment programs reach only a very limited proportion of people with cannabis-related problems. The aim of this systematic review and meta-analysis was to assess the effectiveness of digital interventions applied outside the health care system in reducing problematic cannabis use. Methods: We systematically searched the Cochrane Central Register of Controlled Trials (2015), PubMed (2009-2015), Medline (2009-2015), Google Scholar (2015) and article reference lists for potentially eligible studies. Randomized controlled trials examining the effects of internet- or computer-based interventions were assessed. Study effects were estimated by calculating effect sizes (ESs) using Cohen's d and Hedges' g bias-corrected ES. The primary outcome assessed was self-reported cannabis use, measured by a questionnaire. Results: Fifty-two studies were identified. Four studies (including 1,928 participants) met inclusion criteria. They combined brief motivational interventions and cognitive behavioral therapy delivered online. All studies were of good quality. The pooled mean difference (Δ = 4.07) and overall ES (0.11) give evidence of small effects at 3-month follow-up in favor of digital interventions. Conclusions: Digital interventions can help to successfully reduce problematic cannabis use outside clinical settings. They have some potential to overcome treatment barriers and increase accessibility for at-risk cannabis users.

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Systematic review and meta-analysis of outcomes in patients with suspected pulmonary embolism

Blood Advances ◽

10.1182/bloodadvances.2020002398 ◽

2021 ◽

Vol 5 (8) ◽

pp. 2237-2244

Author(s):

Parth Patel ◽

Payal Patel ◽

Meha Bhatt ◽

Cody Braun ◽

Housne Begum ◽

...

Keyword(s):

Pulmonary Embolism ◽

Ct Scan ◽

Major Bleeding ◽

Meta Analysis ◽

Cochrane Central Register ◽

Suspected Pulmonary Embolism ◽

Central Register ◽

Mortality Incidence ◽

D Dimer

Abstract Prompt evaluation and therapeutic intervention of suspected pulmonary embolism (PE) are of paramount importance for improvement in outcomes. We systematically reviewed outcomes in patients with suspected PE, including mortality, incidence of recurrent PE, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included 22 studies with 15 865 patients. Among patients who were diagnosed with PE and discharged with anticoagulation, 3-month follow-up revealed that all-cause mortality was 5.69% (91/1599; 95% confidence interval [CI], 4.56-6.83), mortality from PE was 1.19% (19/1597; 95% CI, 0.66-1.72), recurrent venous thromboembolism (VTE) occurred in 1.38% (22/1597; 95% CI: 0.81-1.95), and major bleeding occurred in 0.90% (2/221%; 95% CI, 0-2.15). In patients with a low pretest probability (PTP) and negative D-dimer, 3-month follow-up revealed mortality from PE was 0% (0/808) and incidence of VTE was 0.37% (4/1094; 95% CI: 0.007-0.72). In patients with intermediate PTP and negative D-dimer, 3-month follow-up revealed that mortality from PE was 0% (0/2747) and incidence of VTE was 0.46% (14/3015; 95% CI: 0.22-0.71). In patients with high PTP and negative computed tomography (CT) scan, 3-month follow-up revealed mortality from PE was 0% (0/651) and incidence of VTE was 0.84% (11/1302; 95% CI: 0.35-1.34). We further summarize outcomes evaluated by various diagnostic tests and diagnostic pathways (ie, D-dimer followed by CT scan).

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Cognitive Behavioral Therapy combined with physical exercise for depression, anxiety, fatigue and pain in adults with chronic diseases: systematic review and meta-analysis

10.31236/osf.io/as6c7 ◽

2018 ◽

Author(s):

Paquito Bernard ◽

Romain Ahmed Jérôme ◽

Johan Caudroit ◽

Guillaume Chevance ◽

Carayol Marion ◽

...

Keyword(s):

Physical Exercise ◽

Methodological Quality ◽

Randomized Clinical Trials ◽

Behavioral Therapy ◽

Meta Analysis ◽

Effect Sizes ◽

Cognitive Behavior ◽

Cochrane Central Register ◽

Depression And Anxiety ◽

Central Register

Objective. The present meta-analysis aimed to determine the overall effect of cognitive behavior therapy combined with physical exercise (CBTEx) interventions on depression, anxiety, fatigue, and pain in adults with chronic illness; to identify the potential moderators of efficacy; and to compare the efficacy of CBTEx versus each condition alone (CBT and physical exercise). Methods. Relevant randomized clinical trials, published before July 2017, were identified through database searches in Pubmed, PsycArticles, CINAHL, SportDiscus and the Cochrane Central Register for Controlled Trials.Results. A total of 30 studies were identified. CBTEx interventions yielded small-to-large effect sizes for depression (SMC = -0.34, 95% CI [-0.53; -0.14]), anxiety (SMC = -0.18, 95% CI [-0.34; -0.03]) and fatigue (SMC = -0.96, 95% CI [-1.43; -0.49]). Moderation analyses revealed that longer intervention was associated with greater effect sizes for depression and anxiety outcomes. Low methodological quality was also associated with increased CBTEx efficacy for depression. When compared directly, CBTEx interventions did not show greater efficacy than CBT alone or physical exercise alone for any of the outcomes. Conclusion. The current literature suggests that CBTEx interventions are effective for decreasing depression, anxiety, and fatigue symptoms, but not pain. However, the findings do not support an additive effect of CBT and exercise on any of the four outcomes compared to each condition alone.

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“Take home” naloxone: what does the evidence base tell us?

Drugs and Alcohol Today ◽

10.1108/dat-03-2015-0017 ◽

2015 ◽

Vol 15 (2) ◽

pp. 67-75 ◽

Cited By ~ 1

Author(s):

Josefien J. F. Breedvelt ◽

Derek K. Tracy ◽

Emily C. Dickenson ◽

Lucy V. Dean

Keyword(s):

Evidence Base ◽

Future Research ◽

Opioid Overdose ◽

Pilot Studies ◽

Content Type ◽

Practical Concern ◽

Drug Overdoses ◽

Associated Risk Factors ◽

The Uk

Purpose – Opiod users are at high risk of suffering from drug overdoses. Naloxone has been used for decades in emergency treatment settings to reverse the symptoms of opioid overdose. Pilot studies and regional programmes have been rolled out to make naloxone more widely available. This review of user/carer administration of naloxone – so-called “take home naloxone” – aims to provide health professionals and interested readers with an up-to-date evidence base, clinical implications and practical concern considerations for such community management. The paper aims to discuss these issues. Design/methodology/approach – A review and analysis of the recent literature on naloxone. Findings – The evidence base suggests training and education is effective in preparing users for wider naloxone distribution. Furthermore, studies of varying quality indicate that naloxone may prove useful in reducing overdose-related deaths. However, even after implementation ineffective response techniques continued to be used at times and there remained a heistance to call medical services post overdose. Intranasal naloxone may reduce some of the risks associated with intramuscular naloxone. Ethical considerations, including provision of a needle and syringe kit to the community, should be considered. Studies suffered from a lack of follow-up data and methodological difficulties are associated with establishing opioid-related deaths post implementation. Two running trials in the UK might mitigate these concerns. Research limitations/implications – Future research is needed to address wider context of an overdose and targeting associated risk factors. Originality/value – Clinicians and other professionals will be informed on the most up-to-date evidence base and which areas are improtant to consider when take-home naloxone is introduced in their services.

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An evaluation of group cognitive behaviour therapy for low self-esteem in primary care

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x14000051 ◽

2014 ◽

Vol 7 ◽

Cited By ~ 4

Author(s):

Stuart Pack ◽

Emma Condren

Keyword(s):

Cognitive Behaviour Therapy ◽

Self Esteem ◽

Evidence Base ◽

Future Research ◽

Depression And Anxiety ◽

Behaviour Therapy ◽

Psychological Therapies ◽

Cognitive Behaviour ◽

Group Programme

AbstractLow self-esteem is widely acknowledged to be associated with the phenomenology of a number of mental health diagnoses, including those which are treated under the umbrella of Improving Access to Psychological Therapies (IAPT) services. To evaluate the effectiveness of group Cognitive Behaviour Therapy (CBT) based on the work of Fennell in treating low self-esteem 50 participants attended a 10-week group programme. Pre- and post-group measures of depression, anxiety and self-esteem were compared using Mann–Whitney U tests. The results indicated that there was a statistically significant and clinically meaningful change across all pre- and post-group measures. Mean post-group measures indicated levels of depression and anxiety which were below caseness and a healthy level of self-esteem. Results indicated that gains were well maintained at 3-month follow-up. The results from this study highlight the effectiveness of group CBT for low self-esteem and thus contribute to the limited evidence base in this area. Results are discussed with consideration of the existing evidence base, implications for clinical practice, and future research.

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Pharmacologic interventions for fatigue in cancer and transplantation: a meta-analysis

Current Oncology ◽

10.3747/co.25.3883 ◽

2018 ◽

Vol 25 (2) ◽

pp. 152 ◽

Cited By ~ 19

Author(s):

D. Tomlinson ◽

P. D. Robinson ◽

S. Oberoi ◽

D. Cataudella ◽

N. Culos-Reed ◽

...

Keyword(s):

Meta Analysis ◽

Future Research ◽

Cochrane Central Register ◽

Hematopoietic Stem ◽

Patients With Cancer ◽

Effective Interventions ◽

Methodologic Quality ◽

Central Register ◽

Fatigue Severity ◽

Pharmacologic Agents

Background Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (hsct).Methods For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, cinahl, and Psychinfo for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of hsct. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models.Results In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), l-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (smd): –0.52; 95% confidence interval (ci): –0.89 to –0.14] and with methylphenidate (smd: –0.36; 95% ci: –0.56 to –0.15); modafinil (or armodafinil) and corticosteroids were not effective.Conclusions Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of hsct. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.

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Effectiveness of rigorously evaluated behavior change interventions delivered via mobile application: Systematic review and meta-analysis (Preprint)

10.2196/preprints.21563 ◽

2020 ◽

Author(s):

Sarah J Iribarren ◽

Tokunbo O Akande ◽

Kendra J Kamp ◽

Dwight Barry ◽

Yazan G Kader ◽

...

Keyword(s):

Behavior Change ◽

Health Outcomes ◽

Meta Analysis ◽

Outcome Data ◽

Cochrane Central Register ◽

Pilot Studies ◽

Behavior Change Interventions ◽

Cochrane Database ◽

Central Register

BACKGROUND Background: Mobile applications can deliver more efficiently behavior change interventions that are traditionally resource-intensive and difficult to scale. OBJECTIVE Objectives: To summarize the evidence of app-driven behavior change interventions on health outcomes and identify whether certain features contribute to improved outcomes. METHODS Methods: We conducted a literature search in seven databases (MEDLINE; Scopus; PsycINFO, CINAHL, Global Index Medicus; Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews). Five reviewers independently screened and extracted sample characteristics. We used a random-effects model to calculate pooled effect size estimates for meta-analysis. Sensitivity analysis was conducted based on follow-up time, stand-alone app interventions, level of personalization, and pilot studies. Logistic regression was used to examine the structure of app features. RESULTS Results: From the database searches, 8230 records were initially identified. Of these, 172 met inclusion criteria. Studies were predominantly conducted in high-income countries (164, 94.3%). The majority had follow-up periods of six months or less (143, 83.1%). Over half of the interventions were delivered by a standalone app (106, 61.6%). Static/one size fits all (97,56. 4.0%) was the most common level of personalization. Intervention frequency was mostly at least daily (123, 71.5%). A total of 156 studies involving 21,422 participants reported continuous health outcome data. The use of a behavior change app (either as a stand-alone or as part of a larger intervention) confers a slight/weak advantage over standard care in health interventions [standardized mean difference = 0.38 (95% CI: 0.31-0.45), I2 = 80%] though heterogeneity is high. CONCLUSIONS Conclusion: Rigorous evaluation of behavior-change related intervention apps is increasing substantially. The evidence that behavior change apps improve health outcomes is weak, which may reflect the need for improved methodological and evaluative approaches to assessment of healthcare improvement apps. CLINICALTRIAL PROSPERO, CRD42018106868

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Conjoined versus separate technique: a meta-analysis of anastomosis techniques for urinary diversion after bladder cancer

10.21203/rs.2.11111/v1 ◽

2019 ◽

Author(s):

Liu Daqian ◽

Wang Yonghua ◽

Zhao Yang ◽

Yang Xuecheng ◽

wang xinsheng ◽

...

Keyword(s):

Bladder Cancer ◽

Urinary Diversion ◽

Odds Ratio ◽

Meta Analysis ◽

Anastomosis Group ◽

Separate Group ◽

Cochrane Central Register ◽

Central Register ◽

The Difference

Abstract Introduction: This was a meta-analysis of studies on conjoined and separate anastomosis for urinary diversion after radical cystectomy due to bladder cancer. Methods: We searched databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials) for studies regarding anastomosis for urinary diversion due to bladder cancer. The meta-analysis was designed to determine the difference between conjoined and separate anastomosis. Six studies including 1601 patients were considered in the meta-analysis (654 in the separate group and 947 in the conjoined group). Results: There were no significant differences with respect to age, gender or duration of follow-up. There were seven studies that compared the rate of stricture and the rate of hydronephrosis. For overall stricture, there were 186 of 1163 ureters in the separate group and 64 of 1718 ureters in the conjoined group (odds ratio, 4.53; 95% CI, 2.01-10.22; P = 0.0003). For overall hydronephrosis patients, there were 55 of 205 ureters in the separate group and 51 of 254 ureters in the conjoined group (odds ratio, 1.48; 95% CI, 0.95-2.29; P = 0.08). Conclusion: The separate anastomosis had a higher ratio of strictures than did the conjoined group. The separate anastomosis group experienced hydronephrosis more often than did the conjoined anastomosis group. The separate anastomosis is the better choice for surgery during the operation.

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Effects of an Internet-Based Cognitive Behavioral Therapy for Insomnia Program on Work Productivity: A Secondary Analysis

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa085 ◽

2020 ◽

Author(s):

Kelly M Shaffer ◽

Eric A Finkelstein ◽

Fabian Camacho ◽

Karen S Ingersoll ◽

Frances Thorndike ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Secondary Analysis ◽

Work Productivity ◽

Cognitive Behavioral ◽

Activity Impairment ◽

Work Related ◽

Post Assessment

Abstract Background Cognitive-behavioral therapy for insomnia (CBT-I) may improve productivity along with insomnia symptoms, but the long-term duration of productivity gains is unknown. Purpose In this secondary analysis, effects of Internet-delivered CBT-I on work-related and daily activity productivity were examined through 1 year post-treatment. Methods Adults with chronic insomnia (N = 303) were randomized to Internet-delivered CBT-I (Sleep Healthy Using the Internet [SHUTi]) or to patient education (PE). Participants reported interference with attendance (absenteeism) and productivity (presenteeism) at paid employment and in daily activities outside work on the Work Productivity Activity Impairment scale at baseline, 9 weeks later for postintervention assessment (post-assessment), and 6- and 12-month follow-ups. Results Participants randomized to SHUTi were about 50% less likely than those in the PE condition to report any absenteeism (logistic regression odds ratio [OR] = 0.48 [95% confidence intervals {CI} = 0.24,0.96]), total impairment (OR = 0.52 [95% CI = 0.29,0.93]), or activity impairment (OR = 0.50 [95% CI = 0.30,0.85]) at post-assessment; however, differences were not detected at 6- or 12-month follow-ups. SHUTi participants also reported lower overall levels of presenteeism (constrained longitudinal data analysis MDiff = −6.84 [95% CI = −11.53, −2.15]), total impairment (MDiff = −7.62 [95% CI = −12.50, −2.73]), and activity impairment (MDiff = −7.47 [95% CI = −12.68, −2.26]) at post-assessment relative to PE participants. Differences were sustained at 6-month follow-up for presenteeism (MDiff = −5.02 [95% CI = −9.94, −0.10]) and total impairment (MDiff = −5.78 [95% CI = −10.91, −0.65]). No differences were detected by 12-month follow-up. Conclusions Findings suggest that Internet-based CBT-I may help accelerate improvement in work-related and daily activity impairment corroborating prior research, but did not find that CBT-I has persistent, long-term benefits in productivity relative to basic insomnia education. Trial Registration NCT00328250 “Effectiveness of Internet Cognitive Behavioral Therapy Intervention for Treating Insomnia” (https://clinicaltrials.gov/ct2/show/NCT00328250).

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