scholarly journals Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Janislei Gislei Dorociaki Stocco ◽  
Hellen Hoers ◽  
Franciele Soares Pott ◽  
Karla Crozeta ◽  
Dulce Aparecida Barbosa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sensitivity Analysis ◽  
Clinical Trials ◽  
Relative Risk ◽  
Confidence Interval ◽  
Bloodstream Infection ◽  
Second Generation ◽  
Statistical Significance ◽  
Number Needed To Treat ◽  
Central Venous

Abstract Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials. Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5. Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects.

Effects of electromyographic biofeedback interventions for shoulder pain and function: Systematic review and meta-analysis

2021 ◽  
pp. 026921552199095
Author(s):  
Danilo Harudy Kamonseki ◽  
Letícia Bojikian Calixtre ◽  
Rodrigo Py Gonçalves Barreto ◽  
Paula Rezende Camargo
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Confidence Interval ◽  
Shoulder Pain ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Electromyographic Biofeedback ◽  
Mean Differences ◽  
And Function

Objective: To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain. Design: Systematic review of controlled clinical trials. Literature search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020. Study selection criteria: Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized. Data synthesis: The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis. Results: Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48). Conclusion: Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.

scholarly journals Systematic Review and Meta-Analysis of Linezolid and Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bloodstream Infections

2013 ◽  
Vol 57 (10) ◽  
pp. 5013-5018 ◽  
Author(s):  
Donald W. Whang ◽  
Loren G. Miller ◽  
Neil M. Partain ◽  
James A. McKinnell
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Fixed Effects ◽  
Randomized Clinical Trials ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Bloodstream Infections ◽  
Small Sample ◽  
Antibiotic Selection ◽  
Vancomycin Resistant

ABSTRACTBloodstream infections due to vancomycin-resistant enterococci (VRE-BSI) result in substantial patient mortality and cost. Daptomycin and linezolid are commonly prescribed for VRE-BSI, but there are no clinical trials to determine optimal antibiotic selection. We conducted a systematic review for investigations that compared daptomycin and linezolid for VRE-BSI. We searched Medline from 1966 through 2012 for comparisons of linezolid and daptomycin for VRE-BSI. We included searches of EMBASE, clinicaltrials.gov, and national meetings. Data were extracted using a standardized instrument. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using a fixed-effects model. Our search yielded 4,243 publications, of which 482 contained data on VRE treatment. Most studies (452/482) did not present data on BSI or did not provide information on linezolid or daptomycin. Among the remaining 30 studies, 9 offered comparative data between the two agents. None were randomized clinical trials. There was no difference in microbiologic (n= 5 studies, 517 patients; OR, 1.0; 95% CI, 0.4 to 1.7;P= 0.95) and clinical (n= 3 studies, 357 patients; OR, 1.2; 95% CI, 0.7 to 2.0;P= 0.7) cures between the two antibiotics. There was a trend toward increased survival with linezolid compared to daptomycin treatment (n= 9 studies, 1,074 patients; OR, 1.3; 95% CI, 1.1 to 1.8;I2= 0 [whereI2is a measure of inconsistency]), but this did not reach statistical significance (P= 0.054). There are limited data to inform clinicians on optimal antibiotic selection for VRE-BSI. Available studies are limited by small sample size, lack of patient-level data, and inconsistent outcome definitions. Additional research, including randomized clinical trials, is needed before conclusions can be drawn about treatment options for VRE therapy.

Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients

2008 ◽  
Vol 29 (9) ◽  
pp. 847-853 ◽  
Author(s):  
J. Vallés ◽  
I. Fernández ◽  
D. Alcaraz ◽  
E. Chacón ◽  
A. Cazorla ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Relative Risk ◽  
Confidence Interval ◽  
Chlorhexidine Gluconate ◽  
Catheter Colonization ◽  
Central Venous ◽  
Gram Positive Bacteria ◽  
Skin Antisepsis ◽  
Antiseptic Solutions

Objective.To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).Design.Prospective, randomized controlled trial.Setting.Intensive care unit in a teaching hospital.Methods.Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.Results.A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1 % vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.Conclusions.The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.

Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): a randomized trial

2012 ◽  
Vol 42 (11) ◽  
pp. 2265-2273 ◽  
Author(s):  
G. Huf ◽  
E. S. F. Coutinho ◽  
C. E. Adams ◽  
Keyword(s):  
Health Care ◽  
Relative Risk ◽  
Confidence Interval ◽  
Care Pathway ◽  
Statistical Significance ◽  
The Other ◽  
Physical Restraints ◽  
Psychotic Illness ◽  
The People ◽  
Mean Time

BackgroundAfter de-escalation techniques have failed, restraints, seclusion and/or rapid tranquillization may be used for people whose aggression is due to psychosis. Most coercive acts of health care have not been evaluated in trials.MethodPeople admitted to the emergency room of Instituto Philippe Pinel, Rio de Janeiro, Brazil, whose aggression/agitation was thought due to psychosis and for whom staff were unsure if best to restrict using physical restraints or a seclusion room, were randomly allocated to one or the other and followed up to 14 days. The primary outcomes were ‘no need to change intervention early – within 1 h’ and ‘not restricted by 4 h’.ResultsA total of 105 people were randomized. Two-thirds of the people secluded were able to be fully managed in this way. Even taking into account the move out of seclusion into restraints, this study provides evidence that embarking on the less restrictive care pathway (seclusion) does not increase overall time in restriction of some sort [not restricted by 4 h: relative risk 1.09, 95% confidence interval 0.75–1.58; mean time to release: restraints 337.6 (s.d.=298.2) min, seclusion room 316.3 (s.d.=264.5) min, p=0.48]. Participants tended to be more satisfied with their care in the seclusion group (17.0% v. 11.1%) but this did not reach conventional levels of statistical significance (p=0.42).ConclusionsThis study should be replicated, but suggests that opting for the least restrictive option in circumstances where there is clinical doubt does not harm or prolong coercion.

Statistical basis of clinical trials

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Clinical Trials ◽  
Statistical Analysis ◽  
Observational Study ◽  
Odds Ratio ◽  
Binary Data ◽  
Statistical Significance ◽  
Sample Size Calculation ◽  
Number Needed To Treat ◽  
Drug Trials ◽  
Research Types

This chapter summarizes some aspects of study design and statistical analysis to allow the anaesthetist to appraise research. Types of observational study are described and aspects of interventional studies such as sample size calculation and power are explained. Research governance, phases of drug trials and levels of evidence are described. A section on statistical analysis includes expression of proportion for binary data (odds ratio, number needed to treat) and use of probability and confidence intervals to measure statistical significance.

scholarly journals Quilting Sutures in Rhytidectomy: A Systematic Review of the Literature

2019 ◽  
Vol 40 (11) ◽  
pp. 1157-1164 ◽  
Author(s):  
Anthony Ballan ◽  
Samer Jabbour ◽  
Youssef El Rayess ◽  
Khalil Jabbour ◽  
Lena El Hachem ◽  
...  
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Postoperative Complications ◽  
Confidence Interval ◽  
Meta Analysis ◽  
Control Group ◽  
Published Data ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Safety And Efficacy

Abstract Background Different technical variations exist for the utilization of quilting sutures (QS) in rhytidectomy. No systematic review or meta-analysis of the studies describing the use of QS in facelifts has been published to date to the authors’ knowledge. Objectives The objective of this study was to summarize all the published data regarding the utilization of QS in rhytidectomy, compare QS techniques, and evaluate their effect on postoperative complications. Methods On April 1, 2019, a systematic search of the Medline, Embase, and Cochrane databases was conducted. All the studies describing the usage of QS in facelifts were included in this review. Studies reporting hematoma rate in a QS group and a control group were included in the meta-analysis part of this study. Results The initial search of the databases yielded 93 results. Four trials were included in the systematic review and 2 were included in the meta-analysis. The total number of included patients with QS was 527. Two studies employed internal QS and the remaining studies utilized external QS. The meta-analysis found a lower rate of hematoma in the QS group (relative risk, 0.02; 95% confidence interval = 0.00-0.13; P &lt; 0.0001). Conclusions QS can be applied either internally or externally and are very effective in reducing hematomas after facelifts. QS could be a great asset in facelifts but should be utilized with caution because additional work is needed to confirm their safety and efficacy. Level of Evidence: 2

scholarly journals Carica papaya extract in dengue: a systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Senaka Rajapakse ◽  
Nipun Lakshitha de Silva ◽  
Praveen Weeratunga ◽  
Chaturaka Rodrigo ◽  
Chathurani Sigera ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Confidence Interval ◽  
Carica Papaya ◽  
Meta Analysis ◽  
Dengue Infection ◽  
Platelet Counts ◽  
Duration Of Hospital Stay ◽  
Plasma Leakage ◽  
Quality Evidence

Abstract Background Carica papaya (CP) extract is becoming popular as an unlicensed herbal remedy purported to hasten recovery in dengue infection, mostly based on observations that it may increase platelet counts. This systematic review and meta-analysis aims to critically analyze the evidence from controlled clinical trials on the efficacy and safety of CP extract in the treatment of dengue infection. Methods PubMed, LILACS and Google Scholar were searched for randomized or non-randomized trials enrolling patients with suspected or confirmed dengue where CP extract was compared, as a treatment measure, against standard treatment. Recovery of platelet counts as well as other clinical indicators of favourable outcome (duration of hospital stay, prevention of plasma leakage, life threatening complications, and mortality) were assessed. Results Nine studies (India-6, Pakistan-1, Indonesia-1, Malaysia-1) met the inclusion criteria. Seven studies showed an increase in platelet counts in patients receiving CP extract, while one study showed no significant difference between the two groups, and direct comparison was not possible in the remaining study. Serious adverse events were not reported. CP extract may reduce the duration of hospital stay (mean difference − 1.98 days, 95% confidence interval − 1.83 to − 2.12, 3 studies, 580 participants, low quality evidence), and cause improvement in mean platelet counts between the first and fifth day of treatment (mean difference 35.45, 95% confidence interval 23.74 to 47.15, 3 studies, 129 participants, low quality evidence). No evidence was available regarding other clinical outcomes. Conclusions The clinical value of improvement in platelet count or early discharge is unclear in the absence of more robust indicators of favourable clinical outcome. Current evidence is insufficient to comment on the role of CP extract in dengue. There is a need for further well designed clinical trials examining the effect of CP on platelet counts, plasma leakage, other serious manifestations of dengue, and mortality, with clearly defined outcome measures.

Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

2008 ◽  
Vol 29 (10) ◽  
pp. 947-950 ◽  
Author(s):  
Duk-hee Lee ◽  
Koo Young Jung ◽  
Yoon-Hee Choi
Keyword(s):  
Multivariate Analysis ◽  
Mortality Rate ◽  
Central Venous Catheter ◽  
Confidence Interval ◽  
Bloodstream Infection ◽  
Odds Ratio ◽  
Venous Catheter ◽  
Central Venous ◽  
Factors Associated ◽  
Catheter Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

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