scholarly journals Anticoagulation Therapy for Thrombotic Events in Paediatric Cancer Patients with Low Platelet Counts

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2625-2625
Author(s):  
Abha Athale ◽  
Uma H. Athale ◽  
Leonardo R. Brandão
Keyword(s):  
Systematic Review ◽  
Cancer Patients ◽  
Full Text ◽  
Platelet Transfusion ◽  
Anticoagulation Therapy ◽  
Secondary Outcome ◽  
Evidence Based ◽  
Paediatric Cancer ◽  
Platelet Counts ◽  
Anticoagulation Intensity

Background Thrombocytopenia is common in children receiving cancer chemotherapy. In addition, children with cancer are also at increased risk of acute thrombotic events (TE). When these two complications occur simultaneously, TE management with anticoagulants (ACT) poses a unique challenge, as ACT use in thrombocytopenic patients increases their bleeding risk. Current guidelines provide only best practice recommendations on how to manage this treatment conundrum, and even these recommendations vary on optimal management due to the lack of evidence to guide treatment. To date, no systematic literature review summarizing the available paediatric data on treatment of TE in the presence of thrombocytopenia has been conducted. The aim of our systematic review was to summarize the data available to evaluate the safety of ACT for management of TE in paediatric oncology patients during periods of thrombocytopenia. Methods We systematically searched MEDLINE and EMBASE from the OVID platform from inception to April 15th 2016 for studies that included children aged less than 18 years with diagnosis of cancer complicated by an objectively confirmed TE, whose anticoagulation therapy was complicated by a period of thrombocytopenia (as defined by the study author). We included all study designs. Two authors (LB and AA) screened the data at title then full-text level to select eligible studies. Disputes were arbitrated by a third author (UA) until a consensus was reached. Our primary outcome was haemorrhagic complications, categorized as minor or major according to paediatric ISTH criteria. Bleeding episodes were divided according to anticoagulation intensity (age-appropriate, agent-specific full dose vs. half-dose, as per CHEST guidelines) and degree of thrombocytopenia (i.e. severe </=50 x109/L, moderate 51-99 x109/L, mild >/=100 x109/L). Our secondary outcome was the identification of platelet transfusion triggers according to degree of anticoagulation intensity. Results Our search yielded 244 articles, of which 13 were screened at a full text level. Four manuscripts were selected for inclusion, as follows: case report (n=1), case series (n=2), and prospective cohort study (n=1). Details of included studies are described inTable 1 and patient information in table 2. The studies included 39 patients with malignancies, of which the most common were acute lymphoblastic leukaemia (n=13), CNS malignancies (n=6), non-hodgkinlymphoma(n=4). All patients had venous TE. Type and regimen of ACT, and author definitions of thrombocytopenia and bleeding were variable. Thirty-five patients received low-molecular weight heparin (LMWH), of whom 33 received therapeutic dose, and no dose was recorded for two. Three patients received unfractionated heparin (UFH) with antithrombin(AT) supplementation; however, UFH wasstopped in periods of low platelet counts, and one received a reduced dose UFH. According to our definition, 36/39 (92.3%) experienced severe thrombocytopenia, 1 (2.6%) developed moderate thrombocytopenia, platelet count was not stated in 2(5.1%). Using the ISTH bleeding criteria, one patient (2.6%) developed major bleeding, and seven (17.9%) developed minor bleeding (n=2 intestinal bleeding, n=5 injection site/port bleeding). Only one study reported our secondary outcome, which used a platelet transfusion trigger of <40x109/L if receiving therapeutic LMWH and <20x109/L if receiving prophylactic LMWH. Given the heterogeneity, we were unable to statistically aggregate any data. Discussion The results of this systematic review highlight the paucity of high-quality data to assess the use and safety of ACT for TE in paediatric cancer patients during periods of thrombocytopenia. We identified only observational studies- one prospective and three retrospective in design. These studies included very few patients (total n=39), and had variable patients, disease and treatment-related factors. Evidence-based recommendations cannot be generated to guide an optimal ACT management in such situations. Further research using standardized definitions is needed to identify optimal strategies for treating thrombotic events during periods of thrombocytopenia. Such research will help on the development of evidence-based clinical practice guidelines to improve patient care. Disclosures Brandão: Boehringer Ingelheim: Consultancy.

scholarly journals Comparison of the clinical effectiveness of treatments for aromatase inhibitor-induced arthralgia in breast cancer patients: a protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033461
Author(s):  
Kyeore Bae ◽  
Si Yeon Song
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Pain Intensity ◽  
Aromatase Inhibitor ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Secondary Outcome ◽  
Breast Cancer Patients ◽  
Patient Reported

IntroductionAromatase inhibitor-induced arthralgia (AIA) is a major adverse event of aromatase inhibitors (AIs) and leads to premature discontinuation of AI therapy in breast cancer patients. The objective of this protocol for a systematic review and network meta-analysis (NMA) is to provide the methodology to compare the change in pain intensity between different AIA treatments and demonstrate the rank probabilities for different treatments by combining all available direct and indirect evidence.Methods and analysisPubMed, the Cochrane Controlled Register of Trials (CENTRAL), EMBASE, Web of Science and ClinicalTrials.gov will be searched to identify publications in English from inception to November 2019. We will include randomised controlled trials (RCTs) assessing the effects of different treatments for AIA in postmenopausal women with stage 0–III hormone receptor-positive breast cancer. The primary endpoints will be the change in patient-reported pain intensity from baseline to post-treatment. The number of adverse events will be presented as a secondary outcome.Both pairwise meta-analysis and NMA with the Frequentist approach will be conducted. We will demonstrate summary estimates with forest plots in meta-analysis and direct and mixed evidence with a ranking of the treatments as the P-score in NMA. The revised Cochrane risk-of-bias tool for randomised trials will be used to assess the methodological quality within individual RCTs. The quality of evidence will be assessed.Ethics and disseminationAs this review does not involve individual patients, ethical approval is not required. The results of this systematic review and NMA will be published in a peer-reviewed journal. This review will provide valuable information on AIA therapeutic options for clinicians, health practitioners and breast cancer survivors.PROSPERO registration numberCRD42019136967.

scholarly journals Terapi Non Farmakalogis untuk Mengurangi Kecemasan pada Pasien Kanker dengan Kemoterapi: A Systematic Review

2020 ◽  
Vol 11 (4) ◽  
pp. 334
Author(s):  
Andrik Hermanto ◽  
Tintin Sukartini ◽  
Esti Yunitasari
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Cancer Patients ◽  
Full Text ◽  
Guided Imagery ◽  
Subcutaneous Tissue ◽  
Full Text Article ◽  
Inclusion Criteria ◽  
Tissue Necrosis ◽  
Keywords Cancer

Background: Anxiety will affect the cancer patient's physiology and decrease the body's immune system, so that intervention is needed to alleviate anxiety. Objective: To find out various non-pharmacalogical therapies to reduce anxiety in cancer patients with chemotherapy. Method: The database used in this study was scopus, proquest and pubmed were limited to the last 5 years of publication from 2016 to 2020, full-text article and in english. The keywords used were "cancer" and "anxiety". This systematic review uses 10 articles that fit the inclusion criteria. Results: nonpharmacological management of cancer patients to reduce anxiety includes music therapy, autogenic training, mindfulness programs, virtual reality, guided imagery and progressive muscle training. Non-pharmacalogical therapy functions to reduce anxiety in cancer patients with chemotherapy and reduce various kinds of side effects such as anaemia, thrombocytopenia, leucopenia, nausea and vomiting, alopecia (hair loss), stomatitis, allergic reactions, neurotoxic, and extravasation (discharge of vesicle or irritant drugs to the patient) subcutaneous tissue resulting in pain, tissue necrosis, and tissue ulceration). Keywords: cancer; anxiety; nonpharmacologic therapy ABSTRAK Latar belakang: Cemas akan mempengaruhi psikologis pasien kanker dan menurunkan sistem imun tubuh, sehingga dibutuhkan intervensi yang dapat meringankan kecemasan. Tujuan: Untuk mengetahui berbagai macam terapi non farmakalogis untuk mengurangi kecemasan pada pasien kanker dengan kemoterapi. Metode: Database yang digunakan dalam studi ini adalah Scopus, Proquest dan Pubmed terbatas untuk publikasi 5 tahun terakhir dari 2016 hingga 2020, full text article dan berbahasa Inggris. Kata kunci yang digunakan adalah “cancer” AND “anxiety”. Systematic review ini menggunakan 10 artikel yang sesuai dengan kriteria inklusi Hasil: Tatalaksana nonfarmakologi pada pasien kanker untuk mengurangi cemas antara lain meliputi terapi musik, latihan autogenik, minfullnes program, virtual reality, guided imagery dan latihan otot progresif. Terapi non farmakalogis berfungsi untuk mengurangi kecemasan pada pasien kanker dengan kemoterapi dan mengurangi berbagai macam efek samping seperti anemia, trombositopenia, leucopenia, mual dan muntah, alopesia (rambut rontok), stomatitis, reaksialergi, neurotoksik, dan ekstravasasi (keluarnya obat vesikan atau iritan ke jaringan subkutan yang berakibat timbulnya rasa nyeri, nekrosis jaringan, dan ulserasi jaringan). Kata kunci: kanker; kecemasan; terapi nonfarmakologi

scholarly journals Estimating the incubation period of acute Q fever, a systematic review

2018 ◽  
Vol 146 (6) ◽  
pp. 665-672 ◽  
Author(s):  
D. Todkill ◽  
T. Fowler ◽  
J.I. Hawker
Keyword(s):  
Systematic Review ◽  
Incubation Period ◽  
Full Text ◽  
English Language ◽  
Q Fever ◽  
Expert Advice ◽  
Evidence Based ◽  
Individual Level ◽  
Level Data ◽  
Acute Q Fever

AbstractEstimates of the incubation period for Q fever vary substantially between different reviews and expert advice documents. We systematically reviewed and quality appraised the literature to provide an evidence-based estimate of the incubation period of the Q fever by the aerosolised infection route. Medline (OVIDSP) and EMBASE were searched with the search limited to human studies and English language. Eligible studies included persons with symptomatic, acute Q fever, and defined exposure toCoxiella burnetti. After review of 7115 titles and abstracts, 320 records were screened at full-text level. Of these, 23 studies contained potentially useful data and were quality assessed, with eight studies (with 403 individual cases where the derivation of incubation period was possible) being of sufficient quality and providing individual-level data to produce a pooled summary. We found a median incubation period of 18 days, with 95% of cases expected to occur between 7 and 32 days after exposure.

scholarly journals Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients with Positional Plagiocephaly

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. E625-E626 ◽  
Author(s):  
Catherine Mazzola ◽  
Lissa C. Baird ◽  
David F. Bauer ◽  
Alexandra Beier ◽  
Susan Durham ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Clinical Examination ◽  
Full Text ◽  
Evidence Based ◽  
X Rays ◽  
Class Iii ◽  
Positional Plagiocephaly ◽  
Evidence Based Guideline

Abstract BACKGROUND: No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly. OBJECTIVE: The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis. METHODS: The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated. CONCLUSION: Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_2.

Systematic review and meta-analysis of definitions and reported incidences of anthracycline cardiotoxicity.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23081-e23081
Author(s):  
Sae Jang ◽  
Kathryn Jean Ruddy ◽  
Charles L. Loprinzi ◽  
Saro Armenian ◽  
Daniel John Lenihan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Cancer Patients ◽  
Full Text ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Anthracycline Cardiotoxicity ◽  
Ventricular Ejection Fraction

e23081 Background: Anthracycline-induced cardiotoxicity (AIC) is a well-known phenomenon, but the true incidence is poorly defined, and definitions of AIC in the literature are variable. We performed a systematic review and meta-analysis to elucidate AIC definitions and the incidence of clinical heart failure (HF) and subclinical AIC reported in adult breast cancer and lymphoma patients after anthracycline (AC) therapy. Methods: 3,428 abstract and titles were identified via PubMed search. Inclusion criteria for full text review included minimum of 100 adult patients receiving ACs; median/mean follow up of at least 12 months; and specified evaluation of left ventricular ejection fraction. Outcomes were divided into clinical HF and subclinical AIC. Meta-analysis was performed with MedCalc software with random effects model. Results: 366 full text articles were reviewed. 24 studies, including a total of 11,065 patients, reported clinical HF findings; 21 studies, including a total of 8,098 patients, reported subclinical AIC findings. Meta-analysis showed an overall incidence of clinical HF of 3.1% (range 0 to 29%, CI 1.9 to 4.6%, I2= 93.9%); an incidence of 2.0% (CI 0.9 to 3.6%, I2 = 91.6%) in breast cancer patients receiving AC; and 4.8% in lymphoma patients receiving AC (CI 2.1 to 8.6%, I2 = 93.6%). Subclinical AIC was seen in 13.8% overall patients (range 2 to 45%, CI 10.4 to 17.7%, I2= 95.3%); 10.3% of breast cancer patients (CI 7.0 to 14.3%, I2= 95.0%); and 19.8% of lymphoma patients (CI 12.3 to 28.6%, I2= 94.4%). Incidence of HF correlated with increasing age (r = 0.51, p = 0.06) and cumulative dose (r = 0.51 , p = 0.19). There was notable heterogeneity of AIC definitions between studies (Table). Conclusions: Cardiotoxicity is not uncommon among patients who receive AC, particularly at doses given for the treatment of lymphoma. However, there was considerable heterogeneity in HF incidences. More uniform criteria and precise estimates are needed to inform clinical practice and trials. [Table: see text]

scholarly journals Low Level Evidence Suggests That Librarian-Led Instruction in Evidence Based Practice is Effective Regardless of Instructional Model

2017 ◽  
Vol 12 (2) ◽  
pp. 163
Author(s):  
Lindsay J. Alcock
Keyword(s):  
Systematic Review ◽  
Teaching Methods ◽  
Full Text ◽  
Literature Search ◽  
Critical Appraisal ◽  
Evidence Based Practice ◽  
Instructional Methods ◽  
Health Sciences ◽  
Google Scholar ◽  
Evidence Based

A Review of: Swanberg, S. M., Dennison, C. C., Farrell, A., Machel, V., Marton, C., O'Brien, K. K., … & Holyoke, A. N. (2016). Instructional methods used by health sciences librarians to teach evidence-based practice (EBP): a systematic review. Journal of the Medical Library Association: JMLA, 104(3), 197-208. http://dx.doi.org/10.3163/1536-5050.104.3.004 Abstract Objective – To determine both the instructional methods and their effectiveness in teaching evidence based practice (EBP) by librarians in health sciences curricula. Design – Systematic review. Setting – A total of 16 databases, Google Scholar, and MLA Annual Meeting abstracts. Subjects – There were 27 studies identified through a systematic literature search. Methods – An exhaustive list of potential articles was gathered through searching 16 online databases, Google Scholar, and MLA Annual Conference abstracts. Inclusion and exclusion criteria were identified to inform the literature search and determine article eligibility. Duplicates were removed and the remaining search results were divided into sets and assigned to two reviewers who screened first by title/abstract and then by full-text. A third reviewer addressed disagreement in article inclusion. Data extraction, using a validated method described by Koufogiannakis and Wiebe (2006), and critical appraisal, using the Glasgow checklist (1999), were performed concurrently. Main Results – After removal of duplicates 30,043 articles were identified for initial title/abstract screening. Of the 637 articles assessed for full-text screening 26 articles and 1 conference proceeding ultimately met all eligibility criteria. There was no meta-analysis included in the synthesis. There were 16 articles published in library and information science journals and 10 in health sciences journals. Of those studies, 22 were conducted in the United States. A wide range of user groups was identified as participants in the studies with medical students and residents representing the highest percentage and nursing and other allied health professional programs also included. While there was variation in sample size and group allocation, the authors estimate an average of 50 participants per instructional session. Included studies represented research undertaken since the 1990s. All studies addressed at least one of the standard EBP steps including obtaining the best evidence through a literature search (27 studies), developing a clinical question (22 studies), and critical appraisal (12 studies). There were 11 studies which addressed applying evidence to clinical scenarios, and 1 study which addressed the efficacy and efficiency of the EBP process. The majority of studies indicated that literature searching was the primary focus of EBP instruction with MEDLINE being the most utilized database and Cochrane second. Other resources include databases and clinical decision support tools. Teaching methods, including lecture, small group, computer lab, and online instruction, varied amongst the studies. There were 7 studies which employed 1 instructional method while 20 employed a combination of teaching methods. Only one study compared instructional methods and found that students obtained better scores when they received online instruction as compared with face-to-face instruction. The difference, however, was not statistically significant. Skills assessments were conducted in most of the studies utilizing various measurements both validated and not validated. Given the variation in measurement tools a cross-study analysis was not possible. The most common assessment methods included self-reporting and pre- and post-surveys of participants’ attitudes and confidence in EBP skills. Randomization was utilized in 10 studies, and an additional 3 studies had a “clearly defined intervention group.” There were 10 blinded studies and 15 studies utilized cohorts with pre- and post- intervention assessments. There were 25 studies which included descriptive statistics and many also included inferential statistics intended to show significance. Differences between groups were assessed with parametric measures in 9 studies and non-parametric measures in 15 studies. Good to high statistical significance on at least 1 measurement was achieved in 23 studies. Given the absence of effect sizes, the level of differences between study groups could not be determined. Conclusion – Numerous pedagogical methods are used in librarian-led instruction in evidence based practice. However, there is a paucity of high level evidence and the literature suggests that no instructional method is demonstrated to be more effective than another.

Quality of evidence‐based guidelines for platelet transfusion and use: A systematic review

Transfusion ◽  
2021 ◽  
Author(s):  
Arwa Z. Al‐Riyami ◽  
Rachel Jug ◽  
Ursula La Rocca ◽  
Homa Keshavarz ◽  
Denise Landry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Platelet Transfusion ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Evidence Based Guidelines
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