scholarly journals Etiology of community-acquired pneumonia in adults: a systematic review

Pneumonia ◽  
2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Saeed Shoar ◽  
Daniel M. Musher
Keyword(s):  
Systematic Review ◽  
Antibiotic Stewardship ◽  
English Language ◽  
Community Acquired Pneumonia ◽  
Common Cause ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Bacterial Coinfection ◽  
The One ◽  
Meta Analyses

Abstract Background The etiology of community-acquired pneumonia (CAP) has evolved since the beginning of the antibiotic era. Recent guidelines encourage immediate empiric antibiotic treatment once a diagnosis of CAP is made. Concerns about treatment recommendations, on the one hand, and antibiotic stewardship, on the other, motivated this review of the medical literature on the etiology of CAP. Methods We conducted a systematic review of English-language literature on the etiology of CAP using methods defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed using a combination of the keywords ‘pneumonia’, ‘CAP’, ‘etiology’, ‘microbiology’, ‘bacteriology’, and ‘pathogen’. We examined articles on antibiotics that were develop to treat pneumonia. We reviewed all ‘related articles’ as well as studies referenced by those that came up in the search. After we excluded articles that did not give sufficient microbiological data or failed to meet other predetermined criteria, 146 studies remained. Data were stratified into diagnostic categories according to the microbiologic studies that were done; results are presented as the percentage in each category of all cases in which an etiology was established. Results Streptococcus pneumoniae remains the most common cause of CAP although declining in incidence; this decline has been greater in the US than elsewhere. Haemophilus influenzae is the second most common cause of CAP, followed by Staphylococcus aureus and Gram negative bacilli. The incidence of all bacteria as causes of CAP has declined because, with routine use of PCR for viruses, the denominator, cases with an established etiology, has increased. Viruses were reported on average in about 10% of cases, but recent PCR-based studies identified a respiratory virus in about 30% of cases of CAP, with substantial rates of viral/bacterial coinfection. Conclusion The results of this study justify current guidelines for initial empiric treatment of CAP. With pneumococcus and Haemophilus continuing to predominate, efforts at antibiotic stewardship might be enhanced by greater attention to the routine use of sputum Gram stain and culture. Because viral/bacterial coinfection is relatively common, the identification of a virus by PCR does not, by itself, allow for discontinuation of the antibiotic therapy.

scholarly journals 1498. Etiology of Community-acquired Pneumonia in Adults: A Systematic Review

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S751-S751
Author(s):  
Saeed Shoar ◽  
Daniel Musher
Keyword(s):  
Literature Review ◽  
Antibiotic Treatment ◽  
Systematic Literature Review ◽  
Antibiotic Stewardship ◽  
Community Acquired Pneumonia ◽  
Influenza Viruses ◽  
Common Cause ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Bacterial Coinfection

Abstract Background Background: Recent guidelines recommend immediate empiric antibiotic treatment for patients (pts) with community-acquired pneumonia (CAP). Concerns about treatment recommendations and antibiotic stewardship motivated a systematic literature review of the etiology of CAP. Methods We reviewed English-language literature using PRISMA guidelines. Data were stratified into diagnostic categories according to the microbiologic studies that were done (Table1). Fig.1. Flowchart of systematic literature review and study selection Table 1. Characteristics of studies reporting the etiology of community-acquired pneumonia Results 146 articles with 82,674 CAP pts met criteria for inclusion; 63,938 (77.3%) were inpatients, 16,532 (20.0%) were in- or outpatients, and 2,204 (2.7%) were outpatients. Pneumococcus was the most common cause of CAP without regard to which microbiological techniques were used (33-50% of all cases). The proportion due to this organism declined with time, much more strikingly in the US than in Europe. Haemophilus influenzae was the second most common cause (7-16% of cases), followed by Staphylococcus aureus and Enterobacteriaceae each in 4–10%. Pseudomonas (0.8-4.5%) and Moraxella (1.2-3.5%) were less common; all other bacteria were isolated far less frequently. Mycoplasma caused 4-11% of CAP, Legionella 3-8%, Chlamydophila 2-7%, and Coxiella < 2%; some studies showed a much higher frequency of Mycoplasma. With routine use of viral PCR, a virus was identified in 30-40% of pts; bacterial/viral coinfection was found in 25-35% of these cases. In a separate study of CAP pts in whom viral PCR was positive, 40% had bacterial coinfection. Influenza viruses were identified in 6.2-13.7% of cases and rhinoviruses in 4.1-11.5%. RSV and human metapneumovirus were less common (0.4-4.7%), followed more distantly by other viruses. Even with the use of the most sophisticated diagnostic techniques, no etiologic agent for CAP was identified in > 50% of cases. Trends of identification of S. pneumoniae and H. influenzae as the etiology of CAP (above); and the proportion of S. pneumoniae as the causes of CAP in different geographic regions (below). Conclusion Our results justify current guidelines for initial empiric antibiotic treatment of all pts with CAP. With pneumococcus and Haemophilus continuing to predominate, efforts at antibiotic stewardship might be enhanced by greater attention to routine use of sputum Gram stain and culture. Because viral/bacterial coinfection is relatively common, the identification of a virus by PCR does not, by itself, permit the non-use of an antibiotic. Disclosures All Authors: No reported disclosures

Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 073346482110182
Author(s):  
Sainfer Aliyu ◽  
Jasmine L. Travers ◽  
S. Layla Heimlich ◽  
Joanne Ifill ◽  
Arlene Smaldone
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Antibiotic Stewardship ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Meta Analyses

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

scholarly journals Emotional Eating and Weight Status in Adolescents: A Systematic Review

2021 ◽  
Vol 18 (3) ◽  
pp. 991
Author(s):  
Christine A. Limbers ◽  
Emma Summers
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Emotional Eating ◽  
Weight Status ◽  
English Language ◽  
Gastric Bypass Surgery ◽  
Study Results ◽  
Weight Outcomes ◽  
Prospective Association ◽  
The One

Background: Despite evidence that emotional eating is associated with weight gain in adults, less is known about this association in adolescents. The purpose of the current study was to conduct a systematic review to assess the association between emotional eating and weight status in adolescents. This study also sought to describe existing measures of emotional eating in adolescents and explore weight-loss interventions that assessed emotional eating in relation to weight status in this population. Methods: Two independent reviewers searched the database PubMed for published or in press peer-reviewed studies that assessed the association between emotional eating and weight status in adolescents aged 12 to 19 years. Studies were excluded from this review if they were not written in the English language, did not include a measure of emotional eating, or were a dissertation study. Results: A total of 13 studies met full inclusion criteria and were included in the systematic review. Of the six longitudinal studies in the review, only one found a prospective association between emotional eating and weight status. The Dutch Eating Behavior Questionnaire was the most widely used measure of emotional eating in the systematic review (n = 6; 46.2%). The one intervention study included in this review found that baseline emotional eating was not associated with weight outcomes 2 years following gastric bypass surgery in obese Swedish adolescents (13–18 years). Conclusions: While there were some inconsistent findings across the studies included in this review, taken as a whole, the results largely do not support an association between emotional eating and elevated weight status or reduced weight loss in adolescents.

scholarly journals Experiences of children who have been separated from a parent due to military deployment:a systematic review of reviews

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S263-S263
Author(s):  
Jennifer Kent ◽  
Pamela Taylor ◽  
Sarah Argent ◽  
Narasha Kalebic
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Child Outcomes ◽  
Physical Symptoms ◽  
Mental Illnesses ◽  
Military Deployment ◽  
Parental Relationships ◽  
Negative Effect ◽  
Review Of Reviews ◽  
Meta Analyses

AimsTo conduct a systematic review of reviews to investigate how military deployment of a parent affects his/her child, and the extent to which the child's own perspectives have been documented.BackgroundLengthy but finite disruptions to parenting in any form may affect child development and mental and physical health.Military deployment means weeks or months of separation from one parent.2016 figures for the U.S. military showed that 40.5% of military personnel have children, and of these 1.7 million children the largest percentage are aged between 0–5 years (37.8%).MethodSeven databases were searched: AMED, Web of Science, Scopus, EMBASE 1947, Joanna Briggs Institute EMP database, Ovid MEDLINE 1946 and PsycINFO 1806 from the inception of each electronic database until 31st March 2018.Inclusion criteria:Child and young adults aged 0–24 yearsEnglish language papers onlyAll papers being systematic reviews or meta-analysesA focus on documenting the effects on child outcomesData extracted included the review methods and child outcomes reported, including educational attainment; physical symptoms; mental illnesses or disorders; changes to behaviours, and effects on peer and parental relationships.ResultThe eight reviews identified included 32 common and relevant studies.Across the various studies, only about 20% of data came directly from children.Five papers extracted from the reviews identified parental deployment as having a negative effect on school attainment.Nine studies extracted from the review papers found a positive correlation between having a deployed parent and a greater chance of experiencing depressive symptoms and feelings of anxiety.Strong correlations of increased prevalence of both externalising & internalising behaviours were conclusively found in 7 of the reviews.Increased resilience was detailed in only one study featured in multiple reviews.Just one study featured across the reviews reported on physiological measures - adolescents with deployed parents had higher blood pressures and significantly higher heart rates and stress scores than civilian children.ConclusionMore research obtaining the viewpoint of the child directly and observation of such children is required to properly understand the effects on children with a deployed parent, without the interference of parent or teacher reporting bias. Additionally, with only one study reporting on increased offspring resilience there has been limited exploration of potential positive correlates, so further research regarding these is important.

scholarly journals New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1252
Author(s):  
Henry H. L. Wu ◽  
Philip A. Kalra ◽  
Rajkumar Chinnadurai
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Published Data ◽  
Scleroderma Renal Crisis ◽  
Qualitative Synthesis ◽  
Vaccination Programs ◽  
Relapsed Disease ◽  
Meta Analyses ◽  
New Onset

Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selected for review. Results: Forty-eight cases from thirty-six articles were included in the qualitative synthesis of this systematic review. Minimal change disease (19 cases) was the most frequent pathology observed, followed by IgA nephropathy (14 cases) and vasculitis (10 cases). Other cases include relapse of membranous nephropathy, acute rejection of kidney transplant, relapse of IgG4 nephritis, new-onset renal thrombotic microangiopathy, and scleroderma renal crisis following COVID-19 vaccination. There was no mortality reported in any of the included cases. Patients in all but one case largely recovered and did not require long-term renal replacement therapy. Conclusion: This systematic review provides insight into the relationship between various kidney pathologies that may have followed COVID-19 vaccination. Despite these reported cases, the protective benefits offered by COVID-19 vaccination far outweigh its risks. It would be recommended to consider early biopsy to identify histopathology amongst patients presenting with symptoms relating to new-onset kidney disease following vaccination and to monitor symptoms for those with potential relapsed disease.

scholarly journals A Systematic Review of Social Media Integration to Teach Speaking

2021 ◽  
Vol 13 (16) ◽  
pp. 9047
Author(s):  
Emily John ◽  
Melor Md Yunus
Keyword(s):  
Systematic Review ◽  
Social Media ◽  
Teaching And Learning ◽  
English Language ◽  
Selection Process ◽  
Systematic Analysis ◽  
Social Media Platforms ◽  
Use Of Social Media ◽  
Meta Analyses ◽  
Speaking Skills

The ubiquitous nature of social media (SM) makes it a very essential tool to use in the world of education, especially with the advent of the COVID-19 pandemic which has led to a paradigm shift in the approaches used in the teaching and learning of English language skills. This review focuses on the use of social media as a medium of instruction to aid the acquisition of speaking skills, which many learners find extremely challenging and inhibiting. Thus, this systematic review investigates the integration of social media in the teaching and learning of speaking skills. To ensure the systematic analysis of the selected articles, Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) 2020 guidelines were utilized. A total of 36 peer-reviewed journal articles from the year 2016 to 2021 were accessed from two databases: ERIC and Google Scholar. Prior to the start of the review, an inclusion and exclusion criteria selection process was conducted to ensure the focus of the review. Overall, the articles reviewed presented the claim that the integration of social media is seen as a positive inclusion for the teaching of speaking skills using various social media applications. Findings reveal that there are improvements in speaking skills, as well as confidence to speak and a decline in speaking anxiety. Teachers and educators can now make use of the various social media platforms such as Telegram, Facebook, WhatsApp, and others to provide learners with more practice that is not only restricted to the classroom but has moved beyond it.

scholarly journals Passive Sensing of Health Outcomes Through Smartphones: Systematic Review of Current Solutions and Possible Limitations (Preprint)

2018 ◽  
Author(s):  
Alina Trifan ◽  
Maryse Oliveira ◽  
José Luís Oliveira
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Well Being ◽  
Monitoring Systems ◽  
User Engagement ◽  
Positioning Systems ◽  
Health Related ◽  
Being There ◽  
Meta Analyses ◽  
Health And Well Being

BACKGROUND Technological advancements, together with the decrease in both price and size of a large variety of sensors, has expanded the role and capabilities of regular mobile phones, turning them into powerful yet ubiquitous monitoring systems. At present, smartphones have the potential to continuously collect information about the users, monitor their activities and behaviors in real time, and provide them with feedback and recommendations. OBJECTIVE This systematic review aimed to identify recent scientific studies that explored the passive use of smartphones for generating health- and well-being–related outcomes. In addition, it explores users’ engagement and possible challenges in using such self-monitoring systems. METHODS A systematic review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to identify recent publications that explore the use of smartphones as ubiquitous health monitoring systems. We ran reproducible search queries on PubMed, IEEE Xplore, ACM Digital Library, and Scopus online databases and aimed to find answers to the following questions: (1) What is the study focus of the selected papers? (2) What smartphone sensing technologies and data are used to gather health-related input? (3) How are the developed systems validated? and (4) What are the limitations and challenges when using such sensing systems? RESULTS Our bibliographic research returned 7404 unique publications. Of these, 118 met the predefined inclusion criteria, which considered publication dates from 2014 onward, English language, and relevance for the topic of this review. The selected papers highlight that smartphones are already being used in multiple health-related scenarios. Of those, physical activity (29.6%; 35/118) and mental health (27.9; 33/118) are 2 of the most studied applications. Accelerometers (57.7%; 67/118) and global positioning systems (GPS; 40.6%; 48/118) are 2 of the most used sensors in smartphones for collecting data from which the health status or well-being of its users can be inferred. CONCLUSIONS One relevant outcome of this systematic review is that although smartphones present many advantages for the passive monitoring of users’ health and well-being, there is a lack of correlation between smartphone-generated outcomes and clinical knowledge. Moreover, user engagement and motivation are not always modeled as prerequisites, which directly affects user adherence and full validation of such systems.

scholarly journals Relationship of prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e050376
Author(s):  
Pranav Satish ◽  
Alex Freeman ◽  
Daniel Kelly ◽  
Alex Kirkham ◽  
Clement Orczyk ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Systematic Review ◽  
Magnetic Resonance ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Resonance Imaging ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Meta Analyses

IntroductionMultiparametric magnetic resonance imaging (mpMRI) has improved the triage of men with suspected prostate cancer, through precision prebiopsy identification of clinically significant disease. While multiple important characteristics, including tumour grade and size have been shown to affect conspicuity on mpMRI, tumour location and association with mpMRI visibility is an underexplored facet of this field. Therefore, the objective of this systematic review and meta-analysis is to collate the extant evidence comparing MRI performance between different locations within the prostate in men with existing or suspected prostate cancer. This review will help clarify mechanisms that underpin whether a tumour is visible, and the prognostic implications of our findings.Methods and analysisThe databases MEDLINE, PubMed, Embase and Cochrane will be systematically searched for relevant studies. Eligible studies will be full-text English-language articles that examine the effect of zonal location on mpMRI conspicuity. Two reviewers will perform study selection, data extraction and quality assessment. A third reviewer will be involved if consensus is not achieved. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will inform the methodology and reporting of the review. Study bias will be assessed using a modified Newcastle-Ottawa scale. A thematic approach will be used to synthesise key location-based factors associated with mpMRI conspicuity. A meta-analysis will be conducted to form a pooled value of the sensitivity and specificity of mpMRI at different tumour locations.Ethics and disseminationEthical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42021228087.

scholarly journals Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027049 ◽  
Author(s):  
F Fatoye ◽  
P Smith ◽  
T Gebrye ◽  
G Yeowell
Keyword(s):  
Systematic Review ◽  
Real World ◽  
English Language ◽  
Patient Adherence ◽  
Medication Possession Ratio ◽  
Educational Status ◽  
Oral Bisphosphonates ◽  
Oral Bisphosphonate ◽  
The Mean ◽  
Meta Analyses

ObjectivesThis study examined patient adherence and persistence to oral bisphosphonates for the treatment of osteoporosis in real-world settings.MethodsA systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database NHS EED) databases were searched for studies published in English language up to April 2018. Prospective and retrospective observational studies that used prescription claim databases or hospital medical records to examine patient adherence and persistence to oral bisphosphonate treatment among adults with osteoporosis were included. The Newcastle–Ottawa quality assessment scale (NOS) was used to assess the quality of included studies.ResultsThe search yielded 540 published studies, of which 89 were deemed relevant and were included in this review. The mean age of patients included within the studies ranged between 53 to 80.8 years, and the follow-up varied from 3 months to 14 years. The mean persistence of oral bisphosphonates for 6 months, 1 year and 2 years ranged from 34.8% to 71.3%, 17.7% to 74.8% and 12.9% to 72.0%, respectively. The mean medication possession ratio ranged from 28.2% to 84.5%, 23% to 50%, 27.2% to 46% over 1 year, 2 years and 3 years, respectively. All studies included scored between 6 to 8 out of 9 on the NOS. The determinants of adherence and persistence to oral bisphosphonates included geographic residence, marital status, tobacco use, educational status, income, hospitalisation, medication type and dosing frequency.ConclusionsWhile a number of studies reported high levels of persistence and adherence, the findings of this review suggest that patient persistence and adherence with oral bisphosphonates medications was poor and reduced notably over time. Overall, adherence was suboptimal. To maximise adherence and persistence to oral bisphosphonates, it is important to consider possible determinants, including characteristics of the patients.

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