Association between increased antenatal vaginal pH and preterm birth rate: a systematic review

Abstract Background Worldwide, 14.9 million infants (11%) are born preterm each year. Up to 40% of preterm births (PTBs) are associated with genital tract infections. The vaginal pH can reflect changes in the vaginal milieu and, if elevated, indicates an abnormal flora or infection. Objective The aim of the study was to investigate whether an increased antenatal vaginal pH >4.5 in pre-labour pregnant women is associated with an increased PTB rate <37 completed weeks gestation. Search strategy Key databases included SCOPUS, EMBASE, MEDLINE, PsycInfo and the Cochrane Central Register of Controlled Trials, complemented by hand search, up to January 2017. Selection criteria Primary research reporting vaginal pH assessment in pre-labour pregnant women and PTB rate. Data collection and analysis Data extraction and appraisal were carried out in a pre-defined standardised manner, applying the Newcastle-Ottawa scale (NOS) and Cochrane risk of bias tool. Analysis included calculation of risk difference (RD) and narrative synthesis. It was decided to abstain from pooling of the studies due to missing information in important moderators. Main results Of 986 identified records, 30 were included in the systematic review. The risk of bias was considered mostly high (40%) or moderate (37%). Fifteen studies permitted a calculation of RD. Of these, 14 (93%) indicated a positive association between increased antenatal vaginal pH and PTB (RD range: 0.02–0.75). Conclusion An increased antenatal vaginal pH >4.5 may be associated with a higher risk for PTB. It is recommended to conduct a randomised controlled trial (RCT) to investigate the effectiveness of antenatal pH screening to prevent PTB. Tweetable abstract Pregnant women with an increased vaginal pH >4.5 may be at higher risk to experience preterm birth.

Download Full-text

Oral Clindamycin to prevent Preterm Birth: A Randomized Placebo Controlled Trial in South India

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1354 ◽

2015 ◽

Vol 7 (3) ◽

pp. 191-196 ◽

Cited By ~ 2

Author(s):

MB Bellad ◽

Pallavi Chalasani ◽

Madiwalayya S Ganachari ◽

Shivaprasad S Goudar ◽

Nancy L Sloan ◽

...

Keyword(s):

Preterm Birth ◽

South India ◽

Controlled Trial ◽

Preterm Births ◽

Multiple Gestation ◽

Chi Square ◽

Double Blind ◽

Study Objective ◽

Vaginal Ph ◽

Student’S T

ABSTRACT Objectives Clindamycin is the only antibiotic shown effective, in a single study conducted in the United Kingdom, to prevent preterm birth, the leading cause of neonatal mortality. The study objective was to confirm whether oral clindamycin reduces preterm birth by two-thirds in women with vaginal pH > five in a developing country. Materials and Methods All women presenting to antenatal care were screened for study eligibility. Two hundred and ten consenting women were randomized at 13 to 17 weeks gestation in this double-blind randomized trial to 300 mg oral clindamycin twice daily for 5 days or an identical placebo at Jawaharlal Nehru Medical College, Belgaum, India. Outcomes were assessed using Chi-square and Student's t-tests. Results Twelve women lost to follow-up and three women with unexpected multiple gestation were excluded from analysis. The study group characteristics (n = 100 clindamycin, n = 95 placebo) were similar. The incidence of birth <37 and <34 weeks were 12.0 and 6.0% in the clindamycin compared with 24.2 and 14.7% in the placebo groups (p = 0.026 and p = 0.044, respectively). Conclusion Gestational infection accounts for ~40% of preterm births. This is the first confirmation of the only published trial demonstrating that oral clindamycin provided to women with vaginal pH > 5.0 early in gestation substantially reduces preterm birth. How to cite this article Bellad MB, Chalasani P, Ganachari MS, Goudar SS, Sloan NL, Hoffman MK, Derman RJ. Oral Clindamycin to prevent Preterm Birth: A Randomized Placebo Controlled Trial in South India. J South Asian Feder Obst Gynae 2015;7(3):191-196.

Download Full-text

Impact of point-of-care tests in community pharmacies: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-034298 ◽

2020 ◽

Vol 10 (5) ◽

pp. e034298 ◽

Cited By ~ 1

Author(s):

Ali Albasri ◽

Ann Van den Bruel ◽

Gail Hayward ◽

Richard J McManus ◽

James Peter Sheppard ◽

...

Keyword(s):

Systematic Review ◽

Point Of Care ◽

Controlled Trial ◽

Meta Analysis ◽

Clinical Care ◽

Cochrane Central Register ◽

Upper Respiratory Tract ◽

Review Team ◽

Tract Infections ◽

The Impact

ObjectivesTo summarise the literature regarding the use of point-of-care test (POCT) in pharmacies versus control/usual care.Design and settingSystematic review and random-effects meta-analysis in community pharmacy.Data sourcesMEDLINE, Cochrane Central Register of Controlled Trials, Embase, ClinicalTrial.gov and Web of Science databases were searched.Eligibility criteriaArticles were included if they: involved a POCT conducted by a community pharmacist, member of pharmacy staff or local equivalent; measured a clinically relevant outcome for example, clinical parameter monitoring. No clinical condition or language limits were set.Patient and public involvementNo patient involvement.Data extraction and synthesisData were independently extracted by two members of the review team to capture changes in clinical care that resulted from the use of the POCTs. The methodological quality of included studies was assessed, using the Cochrane Risk of Bias tool and Newcastle-Ottawa scale.ResultsThirteen of the 1584 articles found were included in the meta-analyses. Studies covered four therapeutic areas: targeted anti-malarial therapy (n=3 studies), glycated haemoglobin (HbA1c) in diabetes (n=2 studies), lipid control (n=3 studies) and international normalised ratio (INR) control in patients taking warfarin (n=5 studies). POCT in pharmacies reduced the risk of receiving antimalarial treatment when not clinically indicated (risk ratio 0.34, 95% CI 0.31 to 0.37). Lipid and HbA1c control appeared largely unaffected by pharmacy POCTs, and the impact on INR time-in-therapeutic-range was inconclusive.ConclusionsOnly 4 out of 13 included studies used a gold-standard randomised controlled trial (RCT) design, limiting our ability to conclusively determine the clinical utility of POCT conducted in pharmacies. Further RCTs are needed, particularly in areas such as upper respiratory tract infections, which have gathered momentum among service commissioners in recent years.PROSPERO registration numberCRD42017048578.

Download Full-text

Adverse events associated with administration of vasopressor medications through a peripheral intravenous catheter: a systematic review and meta-analysis

Critical Care ◽

10.1186/s13054-021-03553-1 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Victoria S. Owen ◽

Brianna K. Rosgen ◽

Stephana J. Cherak ◽

Andre Ferland ◽

Henry T. Stelfox ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Controlled Trial ◽

Meta Analysis ◽

Patient Characteristics ◽

Risk Of Bias ◽

Cochrane Central Register ◽

Prevalence Studies ◽

Incidence Proportion ◽

Subgroup Analyses

Abstract Background It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine the incidence of local anatomic adverse events associated with PIV vasopressor administration in patients of any age cared for in any acute care environment. Methods MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of controlled trials, and the Database of Abstracts of Reviews of Effects were searched without restriction from inception to October 2019. References of included studies and related reviews, as well as relevant conference proceedings were also searched. Studies were included if they were: (1) cohort, quasi-experimental, or randomized controlled trial study design; (2) conducted in humans of any age or clinical setting; and (3) reported on local anatomic adverse events associated with PIV vasopressor administration. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or the Joanna Briggs Institute checklist for prevalence studies where appropriate. Incidence estimates were pooled using random effects meta-analysis. Subgroup analyses were used to explore sources of heterogeneity. Results Twenty-three studies were included in the systematic review, of which 16 and 7 described adults and children, respectively. Meta-analysis from 11 adult studies including 16,055 patients demonstrated a pooled incidence proportion of adverse events associated with PIV vasopressor administration as 1.8% (95% CI 0.1–4.8%, I2 = 93.7%). In children, meta-analysis from four studies and 388 patients demonstrated a pooled incidence proportion of adverse events as 3.3% (95% CI 0.0–10.1%, I2 = 82.4%). Subgroup analyses did not detect any statistically significant effects associated with stratification based on differences in clinical location, risk of bias or design between studies, PIV location and size, or vasopressor type or duration. Most studies had high or some concern for risk of bias. Conclusion The incidence of adverse events associated with PIV vasopressor administration is low. Additional research is required to examine the effects of PIV location and size, vasopressor type and dose, and patient characteristics on the safety of PIV vasopressor administration.

Download Full-text

Are the Subgroup Analyses in Stroke Clinical Trials Credible? – Protocol for a Systematic Review

10.21203/rs.3.rs-137730/v1 ◽

2021 ◽

Author(s):

Ayoola Ademola ◽

Kevin A Hildebrand ◽

Samuel Babatunde ◽

Darren Mazzei ◽

Michael D Hill ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Trials ◽

Controlled Trial ◽

Reporting Quality ◽

Risk Of Bias ◽

Cochrane Central Register ◽

Negative Consequences ◽

Medical Subject Headings ◽

Subgroup Analyses

Abstract Background: Clinicians and decision-makers are mostly interested in how the overall effect in a randomized controlled trial impact patient differently due to differential treatment effects. Subgroup analyses of randomized trials examine if the overall treatment effect is consistent among the subgroup or to identify groups that modify the intervention effects. Well defined and performed subgroup analyses led to critical policy decisions; however, inappropriately performed subgroup analyses had resulted in incorrect decisions with negative consequences. This systematic review examines the reporting quality and the subgroup analyses’ credibility in stroke clinical trials. Methods and analysis: We will extract relevant studies from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science using three concepts in the Medical Subject Headings (MESH) heading. Two reviewers will independently screen the title, abstract, and full text of relevant studies. We will examine the risk of bias and the credibility of reported subgroup analyses using two validated instruments, i.e., Cochrane Risk-of-Bias tool for randomized trials version 2 (RoB 2) and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN), respectively. Random effects regression will be used to evaluate study characteristics associated with the credibility of subgroup analyses in the included studies.Expected outcomes: This research aims to review the quality of subgroup analyses’ results and reporting. The research’s results will also provide critical methodological contributions to the statistical literature of clinical trials. Ethics and dissemination: This systematic review does not require primary patient data and does not require ethical approval. The review’s results will be published in a peer-review and scientific conferences.Trial registration number: CRD42020223133

Download Full-text

Effectiveness of Nutritional Education for Obese Older Adults With Frailty: A Systematic Review and Meta-Analysis

Innovation in Aging ◽

10.1093/geroni/igaa057.1291 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 401-401

Author(s):

Yue-Heng Yin ◽

Liu Yat Justina

Keyword(s):

Systematic Review ◽

Physical Function ◽

Meta Analysis ◽

Experimental Studies ◽

Well Being ◽

Risk Of Bias ◽

Cochrane Library ◽

Nutritional Education ◽

Hand Search ◽

Education Interventions

Abstract Obesity has been shown to intensify the decline of physical function and lead to frailty. Nutrition is an important method in managing obesity and frailty, while seldom reviews have ever explored the effects of nutritional education interventions. We conducted a systematic review (PROSPERO: CRD42019142403) to explore the effectiveness of nutritional education interventions in managing body composition and physio-psychosocial parameters related to frailty. Randomized controlled trials and quasi-experimental studies were searched in CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed and Scopus from 2001 to 2019. Hand search for the reference lists of included papers was conducted as well. We assessed the quality of included studies by Cochrane risk of bias tool. Meta-analyses and narrative synthesis were used to analyse the data. Two studies with low risk of bias were screened from 180 articles, which involved 177 older people with an average age of 69.69±4.08 years old. The results showed that nutritional education was significantly effective in reducing body weight and fat mass than exercises, and it was beneficial to enhancing physical function and psychosocial well-being. But the effects of nutritional education in increasing muscle strength were not better than exercises. The combined effects of nutritional education and exercises were superior than either exercises or nutritional education interventions solely in preventing the loss of lean mass and bone marrow density, and in improving physical function. Due to limited numbers of relevant studies, the strong evidence of effectiveness of nutritional education interventions on reversing frailty is still lacking.

Download Full-text

Risk of colectomy after conservative treatment of diverticulitis of the left hemicolon complicated by abdominal or pelvic abscess: protocol of a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-042350 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042350

Author(s):

Maximilian Sohn ◽

Ayman Agha ◽

Igors Iesalnieks ◽

Anna Tiefes ◽

Alfred Hochrein ◽

...

Keyword(s):

Systematic Review ◽

Emergency Surgery ◽

Case Reports ◽

Acute Diverticulitis ◽

Meta Analysis ◽

Case Series ◽

Pelvic Abscess ◽

Risk Of Bias ◽

Cochrane Central Register ◽

Review Manager

IntroductionAcute diverticulitis of the sigmoid colon is increasingly treated by a non-operative approach. The need for colectomy after recovery from a flare of acute diverticulitis of the left colon, complicated diverticular abscess is still controversial. The primary aim of this study is to assess the risk of interval emergency surgery by systematic review and meta-analysis.Methods and analysisThe systematic review and meta-analysis will be conducted in accordance to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE will be screened for the predefined searching term: (Diverticulitis OR Diverticulum) AND (Abscess OR pelvic abscess OR pericolic abscess OR intraabdominal abscess) AND (surgery OR operation OR sigmoidectomy OR drainage OR percutaneous drainage OR conservative therapy OR watchful waiting). All studies published in an English or German-speaking peer-reviewed journal will be suitable for this analysis. Case reports, case series of less than five patients, studies without follow-up information, systematic and non-systematic reviews and meta-analyses will be excluded. Primary endpoint is the rate of interval emergency surgery. Using the Review Manager Software (Review Manager/RevMan, V.5.3, Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2012) meta-analysis will be pooled using the Mantel-Haenszel method for random effects. The Risk of Bias in Non-randomized Studies of Interventions tool will be used to assess methodological quality of non-randomised studies. Risk of bias in randomised studies will be assessed using the Cochrane developed RoB 2-tool.Ethics and disseminationAs no new data are being collected, ethical approval is exempt for this study. This systematic review is to provide a new insight on the need for surgical treatment after a first attack of acute diverticulitis, complicated by intra-abdominal or pelvic abscesses. The results of this study will be presented at national and international meetings and published in a peer-reviewed journal.PROSPERO registration numberCRD42020164813.

Download Full-text

Interventions to reduce preterm birth in pregnant women with psychosocial vulnerability factors - a systematic review.

Midwifery ◽

10.1016/j.midw.2021.103018 ◽

2021 ◽

pp. 103018

Author(s):

Johanne Frøsig Pedersen ◽

Sarah Boutrup Kallesøe ◽

Sofie Langergaard ◽

Charlotte Overgaard

Keyword(s):

Systematic Review ◽

Preterm Birth ◽

Pregnant Women ◽

Vulnerability Factors ◽

Psychosocial Vulnerability

Download Full-text

Comparison of effects of different dietary interventions on cognitive function in Alzheimer’s disease: protocol for systematic review and network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-042997 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042997

Author(s):

Lili Chen ◽

Xinhua Xu ◽

Huizhen Cao ◽

Hong Li

Keyword(s):

Systematic Review ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Function ◽

Risk Of Bias ◽

Evaluation Framework ◽

Controlled Trials ◽

Cochrane Central Register ◽

Dietary Interventions ◽

Meta Analyses

IntroductionAlzheimer’s disease (AD) is the most common neurodegenerative disease and is characterised by cognitive impairment. Non-pharmacological treatments such as diet therapy have been widely investigated in studies on AD. Given the synergistic effects of nutrients present in foods, considering overall dietary composition rather than focusing on a single nutrient may be more useful for evaluating the relationship between diet and AD cognition. The present study aimed to assess the efficacy of different dietary interventions (eg, ketogenic and Mediterranean diets) on cognitive function in patients with AD in a systematic review and pairwise and network meta-analyses of randomised controlled trials or clinical trials.Methods and analysisTwo reviewers will independently conduct searches of PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL, PsycINFO and China National Knowledge Infrastructure databases. Data will be extracted from selected studies and risk of bias will be assessed using the revised Cochrane risk-of-bias tool, and evidence quality will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluation framework. The primary outcome of interest is cognitive function in patients with AD; secondary outcomes include biochemical biomarkers of AD and oxidative stress and/or inﬂammatory biomarkers in cerebrospinal fluid or plasma. For each outcome, random-effects pairwise and network meta-analyses will be carried out to determine the pooled relative effect of each intervention relative to every other intervention.Ethics and disseminationAs this study is based solely on published literature, no ethics approval is required. The research will be published in a peer-reviewed journal.

Download Full-text

DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis

Acta Endocrinologica ◽

10.1530/eje-16-0297 ◽

2016 ◽

Vol 175 (2) ◽

pp. R65-R80 ◽

Cited By ~ 40

Author(s):

Irina Bancos ◽

Shrikant Tamhane ◽

Muhammad Shah ◽

Danae A Delivanis ◽

Fares Alahdab ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Performance ◽

Small Sample Size ◽

Controlled Trial ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Central Register ◽

Moderate Risk ◽

Adrenal Biopsy ◽

Adrenocortical Carcinomas

ObjectiveTo perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy.MethodsMedline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate.ResultsWe included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6–11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5–3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively.ConclusionsEvidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.

Download Full-text

Abstract 20: The Effect of Resistance Training on Survival and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.20 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Farzane Saeidifard ◽

Jose R Medina Inojosa ◽

Colin P West ◽

Thomas P Olson ◽

Virend K Somers ◽

...

Keyword(s):

Systematic Review ◽

Heart Disease ◽

Resistance Training ◽

Subgroup Analysis ◽

Cancer Mortality ◽

Meta Analysis ◽

Cardiovascular Outcomes ◽

Risk Of Bias ◽

Cochrane Central Register ◽

All Cause Mortality

Background: This is the first systematic review and meta-analysis to investigate the effect of resistance training (RT) on survival and other cardiovascular outcomes including ischemic heart disease events and stroke. Methods: An experienced librarian searched databases up to September 25 th , 2017, for randomized trials and cohort studies that evaluated the effect of RT on survival and cardiovascular events in the general population. The databases included Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Two investigators conducted the screening process independently and in duplicate. Cochrane tools were used to assess the risk of bias in clinical trials and observational studies. We calculated hazard ratios and 95% confidence intervals using RevMan and fixed and random effect models and had a subgroup analysis based on doses of RT and for the combination of RT and aerobic exercise (AE) vs no exercise. Results: The search identified 1429 studies from which 10 (one randomized trial) met the inclusion criteria, including 338,254 participants with a mean follow up of 8.14 years. The meta-analysis showed that RT, in comparison with no exercises, is associated with 24% lower all-cause mortality and 48% lower mortality when combined with AE. Based on subgroup analysis, performing 1-2 sessions of RT/week is associated with lower all-cause mortality by 28% (HR 0.72, 95% CI 0.66-0.78) whereas > 5 sessions of RT/week has no association with all-cause mortality (HR 0.99, 95% CI 0.76-1.31). Further, RT alone or combined with AE is associated with lower CV mortality compared to no exercise (Figures). Finally, RT alone also showed a borderline association with lower all-cancer mortality. Heterogeneity was present for several comparisons, and subsequent analysis will explore sources of this variability. Using study design-specific Cochrane risk of bias tools, no major sources of bias were identified in the included studies. One cohort study looked at the effect of RT on coronary heart disease events and found 23% risk reduction in men, while no study specifically assessed the effect of RT on cerebrovascular outcomes. Conclusion: RT is associated with lower all-cause, CV and all-cancer mortality. RT appears to have an additive effect when combined with AE.

Download Full-text