Interventions to Address Potentially Inappropriate Prescriptions and Over-The-Counter Medication Use Among Adults 65 Years and Older in Primary Care Settings: Protocol for a Systematic Review

Abstract Purpose: To inform recommendations by the Canadian Task Force on Preventive Health Care on potentially inappropriate prescribing and over-the-counter (OTC) medication use among adults aged 65 years and older in primary care settings. This protocol outlines the planned scope and methods for a systematic review of the benefits and harms and acceptability of interventions to reduce potentially inappropriate prescriptions and OTC medication use.Methods: De novo systematic reviews will be conducted to synthesize the available evidence on (a) the benefits and harms of interventions to reduce potentially inappropriate prescriptions and OTC medications compared to no intervention, usual care, or non- or minimally-active intervention among adults aged 65 years and older and (b) the acceptability of these interventions or attributes among patients. Outcomes of interest for the benefits and harms review are all-cause mortality, hospitalization, non-serious adverse drug reactions, quality of life, emergency department visits, injurious falls, medical visits, and the number of medications (and number of pills). Outcomes for the acceptability review are the preference for and relative importance of different interventions or their attributes. For the benefits and harms review, we will search MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials. For the acceptability review, we will search MEDLINE, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database for experimental and observational studies with a comparator. Websites of relevant organizations, other grey literature sources, and reference lists of included studies and reviews will be searched. Title and abstract screening will be completed by two independent reviewers using the liberal accelerated approach. Full-text review, data extraction, risk of bias assessments, and GRADE (Grading of Recommendations Assessment, Development andEvaluation) will be completed independently by two reviewers, with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE approach will be used to assess the certainty of the evidence for outcomes.Discussion: The results of this systematic review will be used by the Canadian Task Force on Preventive Health Care to inform their recommendation on potentially inappropriate prescribing and OTC medication use among adults aged 65 years and older.Systematic review registration: PROSPERO (KQ1: CRD [tbd]; KQ2: CRD [tbd]); Open Science Framework (link TBD).

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Functional cortical changes associated with shoulder instability – a systematic review

Shoulder & Elbow ◽

10.1177/17585732211019016 ◽

2021 ◽

pp. 175857322110190

Author(s):

Morissa F Livett ◽

Deborah Williams ◽

Hayley Potter ◽

Melinda Cairns

Keyword(s):

Systematic Review ◽

Joint Instability ◽

Glenohumeral Joint ◽

Controlled Trials ◽

Cochrane Central Register ◽

Cortical Function ◽

High Quality Research ◽

Central Register ◽

Rehabilitative Measures ◽

Randomised Controlled

Background Glenohumeral joint instability is associated with structural deficits and/or alterations in sensory and motor processing; however, a proportion of patients with glenohumeral joint instability fail to respond to surgical and rehabilitative measures. This systematic review aimed to establish if functional cortical changes occur in patients with glenohumeral joint instability. Methods AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, PEDro, Pubmed, PsychINFO and Scopus were searched from inception to 17 March 2021. Randomised controlled trials and non-randomised trials were included and quality was appraised using the Downs and Black tool. Results One thousand two hundred seventy-nine records were identified of which five were included in the review. All studies showed altered cortical function when comparing instability patients with healthy controls and included areas associated with higher cortical functions. Discussion The findings of this systematic review offer some insight as to why interventions addressing peripheral pathoanatomical factors in patients with glenohumeral joint instability may fail in some cases due to functional cortical changes. However, data are of moderate to high risk of bias. Further high-quality research is required to ascertain the degree of functional cortical changes associated with the type and duration of glenohumeral joint instability.

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Azithromycin in patients with Covid-19; a systematic review and metanalysis

10.1101/2021.08.03.21261414 ◽

2021 ◽

Author(s):

Luis Ayerbe ◽

Ivo Forgnone ◽

Carlos Risco-Risco ◽

Maria Perez-Pinar ◽

Salma Ayis

Keyword(s):

Systematic Review ◽

Clinical Severity ◽

Future Research ◽

Controlled Trials ◽

Clinical Settings ◽

Cochrane Central Register ◽

Random Effects Models ◽

Central Register ◽

Significant Difference ◽

Observational Design

Background: Azithromycin (AZM) has been widely used in the management of Covid-19. However, the evidence on its actual effects remains disperse and difficult to apply in clinical settings. This systematic review and metanalysis summarizes the studies on the beneficial and adverse effect of AZM in patients with Covid-19. Methods: The PRISMA 2020 statement criteria were followed. Randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of patients treated, and not treated, with AZM, indexed until the 5th of July 2021, were searched in PubMed, Embase, The Web of Science, Scopus, The Cochrane Central Register of Controlled Trials, and MedRXivs. We used Random-effects models to estimate pooled effect size from aggregate data. Results: The initial search produced 4950 results. Finally, 16 studies, five RCTs and 11 with an observational design, with a total of 22984 patients, were included. The metanalysis showed no difference in mortality for those treated, or not, with AZM, OR: 0.95 (0.79-1.13). There was also no significant difference for those treated, and not, with AZM in need for hospital admission or time to admission from ambulatory settings, clinical severity, need for intensive care, or adverse effects. Conclusions: These results presented in this review do not support the use of AZM in the management of Covid-19. They also show that any harm caused to the patient who received it is unlikely. Future research on treatment for patients with Covid-19 may need to focus on other drugs

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Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314504 ◽

2018 ◽

Vol 104 (3) ◽

pp. 280-285 ◽

Cited By ~ 3

Author(s):

Christopher Stutchfield ◽

Anna Davies ◽

Amber Young

Keyword(s):

Systematic Review ◽

Fluid Resuscitation ◽

Primary Data ◽

Controlled Trials ◽

Burn Shock ◽

Cochrane Central Register ◽

Study Protocols ◽

Central Register ◽

Affect Patient Outcome ◽

Randomised Controlled

BackgroundOptimal fluid resuscitation in children with major burns is crucial to prevent or minimise burn shock and prevent complications of over-resuscitation.ObjectivesTo identify studies using endpoints to guide fluid resuscitation in children with burns, review the range of reported endpoint targets and assess whether there is evidence that targeted endpoints impact on outcome.DesignSystematic review.MethodsMedline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials databases were searched with no restrictions on study design or date. Search terms combined burns, fluid resuscitation, endpoints, goal-directed therapy and related synonyms. Studies reporting primary data regarding children with burns (<16 years) and targeting fluid resuscitation endpoints were included. Data were extracted using a proforma and the results were narratively reviewed.ResultsFollowing screening of 777 unique references, 7 studies fulfilled the inclusion criteria. Four studies were exclusively paediatric. Six studies used urine output (UO) as the primary endpoint. Of these, one set a minimum UO threshold, while the remainder targeted a range from 0.5–1.0 mL/kg/hour to 2–3 mL/kg/hour. No studies compared different UO targets. Heterogeneous study protocols and outcomes precluded comparison between the UO targets. One study targeted invasive haemodynamic variables, but this did not significantly affect patient outcome.ConclusionsFew studies have researched resuscitation endpoints for children with burns. Those that have done so have investigated heterogeneous endpoints and endpoint targets. There is a need for future randomised controlled trials to identify optimal endpoints with which to target fluid resuscitation in children with burns.

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Systematic Review of Randomized Clinical Trials of Acupressure Therapy for Primary Dysmenorrhea

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/169692 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Hui-ru Jiang ◽

Shuang Ni ◽

Jin-long Li ◽

Miao-miao Liu ◽

Ji Li ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Statistical Analysis ◽

Adverse Events ◽

Randomized Clinical Trials ◽

Controlled Trials ◽

Cochrane Central Register ◽

Primary Dysmenorrhea ◽

Randomized Controlled ◽

Central Register

The evidence of acupressure is limited in the management of dysmenorrhea. To evaluate the efficacy of acupressure in the treatment of primary dysmenorrhea based on randomized controlled trials (RCTs), we searched MEDLINE, the Chinese Biomedical Database (CBM), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception until March 2012. Two reviewers independently selected articles and extracted data. Statistical analysis was performed with RevMan 5.1 software. Eight RCTs were identified from the retrieved 224 relevant records. Acupressure improved pain measured with VAS (−1.41 cm 95% CI [−1.61, −1.21]), SF-MPQ at the 3-month followup (WMD −2.33, 95% CI [−4.11, −0.54]) and 6-month followup (WMD −4.67, 95% CI [−7.30, −2.04]), and MDQ at the 3-month followup (WMD −2.31, 95% CI [−3.74, −0.87]) and 6-month followup (WMD −4.67, 95% CI [−7.30, −2.04]). All trials did not report adverse events. These results were limited by the methodological flaws of trials.

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Effect of Rapid Maxillary Expansion on Mandibular Rotation—A Systematic Review

The Journal of Indian Orthodontic Society ◽

10.1177/0301574219897318 ◽

2020 ◽

Vol 54 (1) ◽

pp. 5-13

Author(s):

Priyanka Chhutani ◽

Sonali Deshmukh ◽

Sandeep Jethe ◽

Sanket Agarkar ◽

Sujata Yerawadekar ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Rapid Maxillary Expansion ◽

Controlled Trials ◽

Cochrane Central Register ◽

Maxillary Expansion ◽

Eligibility Criteria ◽

Maxillary Molars ◽

Central Register ◽

Clinical Trials Registry

Objective: To evaluate the effect of rapid maxillary expansion (RME) on mandibular rotation. Materials and Method: A systematic review of articles selected from 4 electronic databases—PUBMED, Cochrane Central Register of Controlled Trials, Clinical Trials Registry, and Google Scholar—was carried out. Additional studies were hand-searched and retrieved from the reference lists of relevant articles. Studies published till August, 2019, were included in this study. Results: A total of 28 articles were identified through electronic database searching. 16 articles were obtained after elimination of duplicates which were then screened. Full-text articles were assessed according to the eligibility criteria. 2 randomized controlled trials (RCTs) and 14 clinical trials (CTs) were identified for inclusion in the review. These studies effectively highlighted the effect of RME on mandibular rotation, primarily in the clockwise direction. Conclusion: There is a moderate sum of evidence to illustrate the effect of RME on mandibular rotation. It can be concluded that RME brings about clockwise rotation of the mandible, ie in downward and backward directions, thereby increasing the lower anterior facial height. This effect could be attributed to the vertical maxillary movement and the extrusion of the maxillary molars.

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Right versus left thoracic approach oesophagectomy for oesophageal cancer: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2019-030157 ◽

2019 ◽

Vol 9 (7) ◽

pp. e030157

Author(s):

Tianci Chai ◽

Zhimin Shen ◽

Sui Chen ◽

Yuhan Lin ◽

Zhenyang Zhang ◽

...

Keyword(s):

Systematic Review ◽

Oesophageal Cancer ◽

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Malignant Tumours ◽

Central Register ◽

Registration Number ◽

Thoracic Approach ◽

Randomised Controlled

IntroductionOesophageal cancer is one of the most common malignant tumours and has been identified as one of the leading causes of cancer death worldwide. Surgery is considered to be the optimal treatment for patients with resectable oesophageal cancer. Oesophagectomy for oesophageal cancer can significantly extend the survival period of patients and provide a potential opportunity for a cure. However, there is still controversy regarding which thoracic approach (right or left) during oesophagectomy for oesophageal cancer can lead to better surgical outcomes globally. This systematic review and meta-analysis will be performed to determine which thoracic approach during oesophagectomy will achieve longer patient survival and will be more beneficial for patients.Methods and analysisWe will search PubMed, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials and Google Scholar databases for relevant clinical trials published in any language before 1 October 2019. Randomised controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, tumour pathological stage and ethnicity will be performed.PROSPERO registration numberCRD42019124133.Ethics and disseminationBecause this study will be based on published or unpublished records and studies, there is no need for ethics approval. The results of the study will be published in a peer-reviewed journal.

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Pharmacological prevention of fractures in patients undergoing glucocorticoid therapies: a systematic review and network meta-analysis

Rheumatology ◽

10.1093/rheumatology/keaa228 ◽

2020 ◽

Cited By ~ 3

Author(s):

Jiawen Deng ◽

Zachary Silver ◽

Emma Huang ◽

Elena Zheng ◽

Kyra Kavanagh ◽

...

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Vertebral Fractures ◽

Meta Analysis ◽

Adult Patients ◽

Controlled Trials ◽

Cochrane Central Register ◽

Vitamin D Metabolites ◽

Pharmacological Prevention ◽

Central Register

Abstract Objective To perform a network meta-analysis (NMA) on the efficacy of antiosteoporotic interventions in the prevention of vertebral and non-vertebral fractures in adult patients taking glucocorticoids (GCs). Methods We performed NMAs based on a prospectively developed protocol. A librarian-assisted database search of MEDLINE, EMBASE, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL) and Chinese databases was conducted for randomized controlled trials (RCTs) comparing antiosteoporotic interventions in adult patients taking GCs. Outcomes were vertebral and non-vertebral fracture incidences. Results We included 56 RCTs containing 6479 eligible patients in our analysis. We found that alendronate and teriparatide were associated with decreased odds of both vertebral and non-vertebral fractures. Denosumab and risedronate were associated with decreased odds of vertebral fractures, while etidronate, ibandronate and alfacalcidol were associated with decreased odds of non-vertebral fractures. We observed low network heterogeneity as indicated by the I2 statistic, and we did not detect evidence of publication bias. All outcomes were based on a moderate quality of evidence according to GRADE. Conclusion Bisphosphonates, teriparatide and denosumab are associated with decreased odds of fracture in patients undergoing GC therapy. Vitamin D metabolites and analogues (e.g. alfacalcidol) may have greater anti-fracture efficacy compared with plain vitamin D. Systematic Review Registration The International Prospective Register of Systematic Reviews (PROSPERO)—CRD42019127073

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Evaluation of the Effect of Limosilactobacillus fermentum CECT5716 on Gastrointestinal Infections in Infants: A Systematic Review and Meta-Analysis

Microorganisms ◽

10.3390/microorganisms9071412 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1412

Author(s):

Belén Pastor-Villaescusa ◽

Ruth Blanco-Rojo ◽

Mónica Olivares

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Well Being ◽

Preventive Therapy ◽

Controlled Trials ◽

Cochrane Central Register ◽

Gastrointestinal Infections ◽

Early Stages ◽

Central Register ◽

Present Systematic Review

Reducing the incidence of gastrointestinal infections (GIs) that occur at early stages to mitigate hospitalizations and treatments with adverse effects is a promising strategy for providing well-being to infants and their families. This systematic review and meta-analysis explores whether the early administration of Limosilactobacillus fermentum CECT5716 might be effective as a preventive therapy for GIs. We reviewed the literature to identify randomized controlled trials (RCTs) investigating the effectiveness of milk formulas supplemented with L. fermentum CECT5716 administered to infants at early stages to reduce the incidence of GIs. The MEDLINE (via PubMed), Web of Science (WoS), and Cochrane Central Register of Controlled Trials (via CENTRAL) databases were searched up to 15 June 2021. GI data from the included studies were synthesized in a random-effects model. Three RCTs were finally selected including 435 infants. There was a significant reduction in the incidence rate of GIs for those receiving L. fermentum CECT5716 compared with those receiving placebo (IRR: 0.52, 95% CI: 0.36–0.74, p = 0.0004). Heterogeneity between studies was moderate (I2 = 54.5%). Based on the present systematic review and meta-analysis, the administration of L. fermentum CECT5716 at doses from 1 × 109 to 8.4 × 108 cfu/day in milk formulas may prevent GIs in infants up to 12 months old. Longer-term studies including a higher number of infants are needed to determine whether the use of this probiotic during the early stages of life is an efficient way to reduce the incidence of GIs.

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IgM ELISA for leptospirosis diagnosis: a systematic review and meta-analysis

Ciência & Saúde Coletiva ◽

10.1590/1413-812320172212.14112016 ◽

2017 ◽

Vol 22 (12) ◽

pp. 4001-4012 ◽

Cited By ~ 5

Author(s):

Maria Ines Rosa ◽

Maria Fernandes dos Reis ◽

Carla Simon ◽

Eduardo Dondossola ◽

Maria Cecília Alexandre ◽

...

Keyword(s):

Systematic Review ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Grey Literature ◽

British Library ◽

Controlled Trials ◽

Cochrane Central Register ◽

Medical Subject Headings ◽

Igm Elisa ◽

Central Register

Abstract A systematic review with meta-analysis was performed to estimate the accuracy of IgM ELISA for Leptospirosis diagnosis. A search of Medline, Lilacs, Embase, Cochrane Central Register of Controlled Trials and Grey literature (Google Scholar and British Library) was conducted. The medical subject headings (MeSHs) and the words “leptospirosis”, “human leptospirosis” and “IgM ELISA” were used. Fifty-two studies were analyzed, which included 10,775 samples. The pooled sensitivity of all the studies was 86% (CI 95%, 85%-87%) and specificity was 90% (CI 95%, 89%-91%). In studies of the acute phase, the sensitivity and specificity were 84% (CI 95%, 82%-85%) and 91% (CI 95%, 90%-91%), respectively. In conclusion, IgM ELISA is sensitive for use as an initial screen for leptospiral infections.

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Prevalence and Possible Role of Candida Species in Patients with Psoriasis: A Systematic Review and Meta-Analysis

Mediators of Inflammation ◽

10.1155/2018/9602362 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Aldona Pietrzak ◽

Ewelina Grywalska ◽

Mateusz Socha ◽

Jacek Roliński ◽

Kinga Franciszkiewicz-Pietrzak ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Fungal Colonization ◽

Controlled Trials ◽

Cochrane Central Register ◽

Cross Sectional ◽

Detection Rates ◽

Central Register ◽

Cross Sectional Studies

Although fungal colonization is implicated in the pathogenesis of psoriasis, its prevalence remains unclear. The aim of this systematic review and meta-analysis was to provide an overview on the prevalence of Candida species in patients with psoriasis. We searched databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and http://clinicaltrials.gov) to identify studies involving subjects of any age with an established diagnosis of psoriasis and healthy controls, who were tested for carriage of Candida spp. on the skin or mucosal membranes (or saliva and stool), or presented with clinical candidiasis with microbiologically confirmed etiology. We identified nine cross-sectional studies including a total of 1038 subjects with psoriasis (psoriatics) and 669 controls. We found Candida species detection rates for psoriatics were significantly higher than those in the controls, especially in the oral mucosa milieux. These results suggest psoriasis may be one of the systemic diseases that predispose to oral Candida spp. carriage and infection.

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