scholarly journals New Hope for Behavioural and Psychological Symptoms in Dementia (BPSD): A Narrative Review of Clinical Studies Conducted in the Symptomatic Treatments for Agitation and Psychosis Episodes in Alzheimer’s Disease/Dementia

2022 ◽  
Author(s):  
Haider Saddam Qasim ◽  
Maree Donna Donna
Keyword(s):  
Systematic Reviews ◽  
English Language ◽  
Psychological Symptoms ◽  
Aged Care ◽  
Narrative Review ◽  
Psychomotor Agitation ◽  
Choice Of Treatment ◽  
Aged Care Facilities ◽  
Meta Analyses

Background: The psychomotor agitation of the BPSD is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferable choice of treatment. But which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from RCTs and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who had taken agitation treatments. Assessing the efficacy of antidepressants and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This narrative review includes RCTs and retrospective studies that were comparing one or more active ingredient medications with another or with a placebo, along with sys-tematic reviews comparing antidepressants with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies extracted by searching accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Quality of evidence: The quality of systematic reviews was judged against AMSTAR score, and RCTs were judged according to CONSORT checklist for RCT protocols. Conclusion: There are still few studies of serotonin targeting treatment of agitation in BPSD. The SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. This review also illustrates brexpiprazole as a target of multimodal neurotransmitters such as dopamine, serotonin, and norepinephrine; and dextromethorphan, OR dextromethorphan associated with bupropion or quinidine as a blockade of NMDA receptors. The outcome of this review suggests that further studies involving more dementia/Alzheimer’s participants should be conducted. Future studies are required also to assess the long-term safety and efficacy of SSRI, brexpiprazole, dextromethorphan treatments for agitation in BPSD.

scholarly journals Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in patients with BPSD

2022 ◽  
Author(s):  
Haider Qasim
Keyword(s):  
Systematic Reviews ◽  
English Language ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Psychological Symptoms ◽  
Aged Care ◽  
Psychomotor Agitation ◽  
Choice Of Treatment ◽  
Randomised Control Trials ◽  
Aged Care Facilities ◽  
Meta Analyses

Background: The psychomotor agitation of the behavioural and psychological symptoms of dementia (BPSD) is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferred choice of treatment, but which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from Randomised Control Trials (RCTs) and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who have taken agitation treatments. Assessing the efficacy of selective serotonin reuptake inhibitors (SSRI) and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This review includes RCT that compared one or more active ingredient medications with another medication or with a placebo, along with systematic reviews comparing citalopram (SSRI) with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies were extracted by searching and accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Conclusion: There is still limited studies of SSRIs for the treatment of agitation in BPSD. SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. Future studies are required to assess the long-term safety and efficacy of SSRI treatments for agitation in BPSD.

scholarly journals Barriers and facilitators to implementing Clinical Imaging Referral Guidelines among medical professionals: Protocol for a systematic mixed studies review

2020 ◽  
Author(s):  
Harriet Nalubega Kisembo ◽  
Alison Annet Kinengyere ◽  
Abdirahaman Omar Sahal ◽  
Richard Malumba ◽  
Dina Husseiny Salaama ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
English Language ◽  
Barriers And Facilitators ◽  
Systematic Review Protocol ◽  
Increased Risk ◽  
Review Protocol ◽  
Medical Professions ◽  
Meta Analyses

Abstract Background The past two decades have seen increasingly rapid advances in the field of diagnostic imaging technology. This has significantly contributed to the quality of medical care outcomes. However, a number of studies have found that 20%-50% of imaging requisitions are inappropriate and unjustified. This wastes the already meager resources and exposes patients to unnecessary radiation with increased risk of radiation induced cancers.Clinical Imaging Guidelines (CIGs) are evidence-based tools developed to support the imaging referrer’s decision-making process by choosing the most appropriate imaging investigation for a particular patient with a specific set of symptoms and signs. However, implementing CIGs has not been effective in several settings. Identifying factors that influence CIGs implementation could give an insight into the type of strategies to put in place before implementing CIGs This systematic review protocol is aimed at understanding barriers and facilitators that influence implementation of CIGs among medical professions. Review Methods The development of the systematic review protocol will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P) (additional file 1) Key databases Pubmed (Medline) and Embase will be searched using relevant terms. The, experts in the field will be contacted for their opinion and references from included studies will also be searched Only literature written in the English language will be reviewed. All study designs will be included, and there will be no limit set by the year of publication. The criteria for inclusion will be those studies which document and discuss barriers and facilitators to implementing CIGs among medical professions. All identified studies will be screened by a single reviewer but Quality of the studies to be included and extraction of data will be independently performed by two reviewers. Any discrepancies will be resolved by consensus through discussion, with a 3rd reviewer as a tie breaker Pre-established categories of barriers and facilitators to implementing CIGs in practice from literature, will be used to assess content analysis Discussion The findings from this review will provide an insight and direction to the “champions” implementing adoption or adaption of CIGs, especially in Africa of what is ahead of them for proper planning The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020136372.

scholarly journals How are meta-analyses being conducted and reported in dentistry?

2021 ◽  
Vol 20 ◽  
pp. e211701
Author(s):  
Leticia Tainá de Oliveira Lemes ◽  
Lara Dotto ◽  
Bernardo Antonio Agostini ◽  
Gabriel Kalil Rocha Pereira ◽  
Rafael Sarkis-Onofre
Keyword(s):  
Systematic Reviews ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Great Part ◽  
Analysis Model ◽  
Study Selection ◽  
Statistical Heterogeneity ◽  
Meta Analyses

Aim: This study aimed to evaluate how meta-analyses are conducted and reported in dentistry. Methods: We conducted a search to identify dentistry-related Systematic Reviews (SRs) indexed in PubMed in 2017 (from January 01 until December 31) and published in the English language. We included only SRs reporting at least one meta-analysis. The study selection followed the 4-phase flow set forth in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), and it was independently conducted by two researchers. Data extraction was performed by one of three reviewers, and data related to conducting and reporting of the meta-analysis were collected. Descriptive data analysis was performed summarizing frequencies for categorical items or median and interquartile range for continuous data. Results: We included 214 SRs with meta-analyses. Most of the studies reported in the title that a meta-analysis was conducted. We identified three critical flaws in the included studies: Ninety (90) meta-analyses (43.1%) did not specify the primary outcome; most of the meta-analyses reported that a measure of statistical heterogeneity was used to justify the use of a fixed-effect or random-effects meta-analysis model (n=114, 58.5%); and a great part did not assess publication bias (n=106, 49.5%). Conclusion: We identified deficiencies in the reporting and conduct of meta-analysis in dentistry, suggesting that there is room for improvement. Educational approaches are necessary to improve the quality of such analyses and to avoid biased and imprecise results.

scholarly journals Digital health interventions in palliative care: a systematic meta-review

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Hannah O’Donnell ◽  
Jean Lugton ◽  
Tilly Gibson-Watt ◽  
Connie Swenson ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Systematic Reviews ◽  
Psychological Symptoms ◽  
Digital Health ◽  
Evidence Synthesis ◽  
Information Provision ◽  
Health Interventions ◽  
Meta Review

AbstractDigital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.

scholarly journals Concordance between systematic reviews of randomized controlled trials in assisted reproduction: an overview

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Mariano Mascarenhas ◽  
Theodoros Kalampokas ◽  
Sesh Kamal Sunkara ◽  
Mohan S Kamath
Keyword(s):  
Assisted Reproduction ◽  
Systematic Reviews ◽  
Selective Reporting ◽  
Methodological Issues ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Cochrane Reviews ◽  
Secondary Outcomes ◽  
Meta Analyses

Abstract STUDY QUESTION Are systematic reviews published within a 3-year period on interventions in ART concordant in their conclusions? SUMMARY ANSWER The majority of the systematic reviews published within a 3-year period in the field of assisted reproduction on the same topic had discordant conclusions. WHAT IS KNOWN ALREADY Systematic reviews and meta-analyses have now replaced individual randomized controlled trials (RCTs) at the top of the evidence pyramid. There has been a proliferation of systematic reviews and meta-analyses, many of which suffer from methodological issues and provide varying conclusions. STUDY DESIGN, SIZE, DURATION We assessed nine interventions in women undergoing ART with at least three systematic reviews each, published from January 2015 to December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS The systematic reviews which included RCTs were considered eligible for inclusion. The primary outcome was extent of concordance between systematic reviews on the same topic. Secondary outcomes included assessment of quality of systematic reviews, differences in included studies in meta-analyses covering the same search period, selective reporting and reporting the quality of evidence. MAIN RESULTS AND THE ROLE OF CHANCE Concordant results and conclusions were found in only one topic, with reviews in the remaining eight topics displaying partial discordance. The AMSTAR grading for the majority of the non-Cochrane reviews was critically low whilst it was categorized as high for all of the Cochrane reviews. For three of the nine topics, none of the included systematic reviews assessed the quality of evidence. We were unable to assess selective reporting as most of the reviews did not have a pre-specified published protocol. LIMITATIONS, REASONS FOR CAUTION We were limited by the high proportion of reviews lacking a pre-specified protocol, which made it impossible to assess for selective reporting. Furthermore, many reviews did not specify primary and secondary outcomes which made it difficult to assess reporting bias. All the authors of this review were Cochrane review authors which may introduce some assessment bias. The categorization of the review’s conclusions as beneficial, harmful or neutral was subjective, depending on the tone and wording of the conclusion section of the review. WIDER IMPLICATIONS OF THE FINDINGS The majority of the systematic reviews published within a 3-year period on the same topic in the field of assisted reproduction revealed discordant conclusions and suffered from serious methodological issues, hindering the process of informed healthcare decision-making. STUDY FUNDING/COMPETING INTEREST(S) All the authors are Cochrane authors. M.S.K. is an editorial board member of Cochrane Gynaecology and Fertility group. No grant from funding agencies in the public, commercial or not-for-profit sectors was obtained.

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