scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W. M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Care ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Gynecological Cancer ◽  
Tertiary Care ◽  
System Level ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care

Abstract Background Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify and synthesize existing literature on the effects of pathways in oncological care. Methods All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals, and system level were extracted from each study. Results Out of 13,847 search results, we selected 158 articles eligible for full text assessment. One hundred fifty studies were excluded and the remaining eight studies represented 4786 patients. Most studies were conducted in secondary/tertiary care. Length of stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (weighted mean difference (WMD)): − 2.75, CI: − 4.67 to − 0.83) and gynecological cancer (WMD: − 1.58, CI: − 2.10 to − 1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favor of cancer care pathways. Systematic review registration PROSPERO CRD42017057592.

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W.M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Care ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Tertiary Care ◽  
Evidence Base ◽  
System Level ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care

Abstract Background: Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods: All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals and system level were extracted from each study. Results: Out of 13,847 search results, we selected 158 articles eligible for full text assessment. 150 studies were excluded and the remaining eight studies represented 4,786 patients. Most studies were conducted in secondary/tertiary care. Length of Stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (Weighted Mean Difference (WMD)): -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions: Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favour of cancer care pathways. Systematic review registration: PROSPERO CRD42017057592

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W.M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Care ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Tertiary Care ◽  
Evidence Base ◽  
System Level ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care

Abstract Background: Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods: All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals and system level were extracted from each study. Results: Out of 13,847 search results, we selected 158 articles eligible for full text assessment. 150 studies were excluded and the remaining eight studies represented 4,786 patients. Most studies were conducted in secondary/tertiary care. LOS was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter Length of Stay (LOS) regarding gastric cancer (Weighted Mean Difference (WMD)): -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions: Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favour of cancer care pathways. Systematic review registration: PROSPERO CRD42017057592

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W.M. Vernooij ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
Sabine Siesling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Cancer Care ◽  
Secondary Care ◽  
Meta Analysis ◽  
Evidence Base ◽  
Care Pathways ◽  
Positive Effects ◽  
Oncological Care ◽  
Study Results

Abstract Background Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods All patients diagnosed with cancer in primary and secondary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding “patient outcomes” and “costs” were extracted from each study. Results Out of 12,689 search results, we selected 158 articles eligible for full text assessment. The remaining 10 studies represented 4,786 patients. Most studies were conducted in secondary care. LOS was the most common used indicator for patients outcomes, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (WMD: -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary care regarding the positive effects of LOS in favour of cancer care pathways.

scholarly journals Effects of oncological care pathways in primary and secondary care on patient, professional, and health systems outcomes: protocol for a systematic review and meta-analysis

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Jolanda C. van Hoeve ◽  
Robin W. M. Vernooij ◽  
Adegboyega K. Lawal ◽  
Michelle Fiander ◽  
Peter Nieboer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Secondary Care ◽  
Meta Analysis ◽  
Care Pathways ◽  
Oncological Care

The association between dietary inflammatory index and risk of central obesity in adults: An updated systematic review and meta-analysis

2020 ◽  
Vol 90 (5-6) ◽  
pp. 535-552 ◽  
Author(s):  
Mahdieh Abbasalizad Farhangi ◽  
Mahdi Vajdi
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Central Obesity ◽  
Assessment Tool ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Dietary Factors ◽  
Cross Sectional ◽  
Inflammatory Status ◽  
Obesity Indices

Abstract. Backgrounds: Central obesity, as a pivotal component of metabolic syndrome is associated with numerous co-morbidities. Dietary factors influence central obesity by increased inflammatory status. However, recent studies didn’t evaluate the association between central obesity and dietary inflammation index (DII®) that give score to dietary factors according to their inflammatory potential. In the current systematic review and meta-analysis, we summarized the studies that investigated the association between DII® with central obesity indices in the general populations. Methods: In a systematic search from PubMed, SCOPUS, Web of Sciences and Cochrane electronic databases, we collected relevant studies written in English and published until 30 October 2019. The population of included studies were apparently healthy subjects or individuals with obesity or obesity-related diseases. Observational studies that evaluated the association between DII® and indices of central obesity including WC or WHR were included. Results: Totally thirty-two studies were included; thirty studies were cross-sectional and two were cohort studies with 103071 participants. Meta-analysis of observational studies showed that higher DII® scores were associated with 1.81 cm increase in WC (Pooled weighted mean difference (WMD) = 1.813; CI: 0.785–2.841; p = 0.001). Also, a non-significant increase in the odds of having higher WC (OR = 1.162; CI: 0.95–1.43; p = 0.154) in the highest DII category was also observed. In subgroup analysis, the continent, dietary assessment tool and gender were the heterogeneity sources. Conclusion: The findings proposed that adherence to diets with high DII® scores was associated with increased WC. Further studies with interventional designs are necessary to elucidate the causality inference between DII® and central obesity indices.

Puerarin for OVX-Induced Postmenopausal Osteoporosis in Murine Model: Systematic Review and Meta-Analysis

2020 ◽  
Vol 15 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Xiaobin Yang ◽  
Haishi Zheng ◽  
Yuan Liu ◽  
Dingjun Hao ◽  
Baorong He ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Mass ◽  
Postmenopausal Osteoporosis ◽  
Murine Model ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Weighted Mean ◽  
Enhancing Effect ◽  
Searching Strategy

Aims/Background: Ovariectomy (OVX)-induced murine model is widely used for postmenopausal osteoporosis study. Our current study was conducted to systematically review and essentially quantified the bone mass enhancing effect of puerarin on treating OVX-induced postmenopausal osteoporosis in murine model. Methods: Literatures from PUBMED, EMBASE, and CNKI were involved in our searching strategy by limited the inception date to January 9th, 2019. Moreover, the enhancing effect of puerarin on bone mass compared to OVX-induced rats is evaluated by four independent reviewers. Finally, all the data were extracted, quantified and analyzed via RevMan, besides that in our current review study, we assessed the methodological quality for each involved study. Results: Based on the searching strategy, eight randomization studies were finally included in current meta-analysis and systematic review. According to the data analysis by RevMan, puerarin could improve bone mineral density (BMD); (eight studies, n=203; weighted mean difference, 0.05; 95% CI, 0.03-0.07; P<0.0001) using a random-effects model. There is no significant difference between puerarin and estrogen (seven studies, n=184; weighted mean difference, 0.00; 95% CI, -0.01 to 0.00; P=0.30). Conclusions: Puerarin showed upregulating effects on bone mass in OVX-induced postmenopausal osteoporosis in murine model. More studies of the effect of puerarin on bone density in OVX animals are needed.

scholarly journals The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sharare Taheri Moghadam ◽  
Farahnaz Sadoughi ◽  
Farnia Velayati ◽  
Seyed Jafar Ehsanzadeh ◽  
Shayan Poursharif
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Cochrane Library ◽  
Physician Practice ◽  
Positive Effects ◽  
Practice Performance

Abstract Background Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes. Methods This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity. Results On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.

scholarly journals Sulforaphane ameliorates lipid profile in rodents: an updated systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kaili Du ◽  
Yuxin Fan ◽  
Dan Li
Keyword(s):  
Systematic Review ◽  
Weight Control ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Low Density Lipoprotein ◽  
Disease Model ◽  
Density Lipoprotein ◽  
Liver Weight ◽  
Lipoprotein Cholesterol ◽  
Alcoholic Fatty Liver

AbstractSulforaphane (SFN), a naturally-occurring isothiocyanate enriched in cabbage and broccoli, has been provided as food supplements to improve weight management and reduce lipid levels. However, its effects on serum lipid profiles are contradictory. In this review, a meta-analysis and systematic review of SFN on lipid reduction and weight control is assessed with mice and rats fed on high-fat diet. The effects of SFN supplementation were evaluated by weighted mean difference (WMD) in body weight (BW), liver weight (LW) and also by its effect on serum lipids. A random-effects model was applied to estimate the overall summary effect. SFN reduced BW (WMD: − 2.76 g, 95% CI: − 4.19, − 1.34) and LW (WMD: − 0.93 g, 95% CI: − 1.63, − 0.23) significantly in our ten trials. Its effects on serum total cholesterol (TC) (WMD: − 15.62 mg/dL, 95% CI: − 24.07, − 7.18), low-density lipoprotein cholesterol (LDL-C) (WMD: − 8.35 mg/dL, 95% CI: − 15.47, − 1.24) and triglyceride (TG) (WMD: − 40.85 mg/dL, 95% CI: − 67.46, − 14.24) were significant except for high-density lipoprotein cholesterol (HDL-C) component (WMD: 1.05 mg/dL, 95% CI: − 3.44, 5.54). However, species, disease model, duration, SFN dosage as well as route of administration did not explain the heterogeneity among studies. In summary, these findings provide new insights concerning preclinical strategies for treating diseases including obesity, diabetes, hypertension, non-alcoholic fatty liver disease as well as cardiovascular disease with SFN supplements.

scholarly journals Efficacy and safety of anti-epidermal growth factor receptor agents for the treatment of oesophageal cancer: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046352
Author(s):  
Lijuan Zhang ◽  
Yanli Song ◽  
Nan Jiang ◽  
Yaqi Huang ◽  
Bo Dong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Growth Factor ◽  
Outcome Measures ◽  
Oesophageal Cancer ◽  
Meta Analysis ◽  
Growth Factor Receptor ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Positive Effects

ObjectivesDespite remarkable advances in the treatment of oesophageal cancer (OC), the role of antiepidermal growth factor receptor (anti-EGFR) agents in treating OC remains controversial. Herein, a systematic review and meta-analysis were conducted to elucidate the efficacy and safety of anti-EGFR agents in patients with OC.DesignMeta-analysis of randomised controlled trials (RCTs) identified by searching the PubMed, Embase, Web of Science, ClinicalTrials.gov, Cochrane Library, Chinese Biology Medicine, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform databases from inception to December 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.SettingRCTs from any country and healthcare setting.ParticipantsPatients with OC.InterventionsCombination therapy with anti-EGFR agents and conventional treatments versus conventional treatments alone in patients with OC.Primary and secondary outcome measuresOverall survival (OS) and progression-free survival (PFS) were primary outcome measures, and objective response rate (ORR), disease control rate (DCR) and treatment toxicities were secondary outcome measures.ResultsIn total, 25 RCTs comprising 3406 patients with OC were included. Overall, anti-EGFR treatment significantly improved the OS (HR: 0.81, 95% CI 0.74 to 0.89, p<0.00001), ORR (relative risk (RR): 1.33, 95% CI 1.16 to 1.52, p<0.0001) and DCR (RR: 1.22, 95% CI 1.11 to 1.34, p<0.0001) but not PFS (HR: 0.91, 95% CI 0.76 to 1.08, p=0.26). Anti-EGFR treatment was significantly associated with higher incidences of myelosuppression, diarrhoea, acne-like rash and hypomagnesaemia.ConclusionsOverall, anti-EGFR agents have positive effects on OS, the ORR and DCR in OC. However, considering the high incidence of adverse effects, such as myelosuppression, diarrhoea, acne-like rashes and hypomagnesaemia, careful monitoring of patients with OC is recommended during anti-EGFR treatment.Trial registration numberCRD42020169230.

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