scholarly journals A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

2021 ◽  
Author(s):  
Kristen Hindley ◽  
Clare Fenton ◽  
Jennifer McIntosh
Keyword(s):  
Systematic Review ◽  
Eating Disorders ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Oral Intake ◽  
Risk Of Bias ◽  
Primary Research ◽  
Increased Risk ◽  
Tube Removal ◽  
Wide Range

Abstract BackgroundAdolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment.Nasogastric feeding (NGF) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement minimal oral intake or to boost nutritional intake. This systematic review sets out to describe current practice for NGF. MethodsA systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000-2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: mental disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results29 studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of practices in different countries, settings, and the reason for initiation; 2) In the UK, standard practice is to introduce NGF if either oral intake is not met or patients are medically unstable; 3) NGF may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) high calorie feeds are not typically associated with increased risk of refeeding syndrome; 6) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 7) length of stay in hospital is dependent on reason of initiating NGF; 8) psychiatric and medical wards differ in approach; 9) concurrent therapy is often used to facilitate NGF.ConclusionsNGF is currently often implemented in specialist settings where oral intake has been refused or insufficient, in hospital due to medical instability, nocturnally to supplement day-time oral intake, or continuously as standard protocol. Due to high risk of bias as a result of the nature of the studies conducted in adolescents with ED, recommendations for clinical practice cannot yet be justified.

scholarly journals A Systematic Review of Enteral Feeding By Nasogastric Tube in Young People With Eating Disorders

2021 ◽  
Author(s):  
Kristen Hindley ◽  
Clare Fenton ◽  
Jennifer McIntosh
Keyword(s):  
Systematic Review ◽  
Eating Disorders ◽  
Young People ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Oral Intake ◽  
Risk Of Bias ◽  
Primary Research ◽  
Tube Removal ◽  
Wide Range

Abstract BackgroundAdolescents with severe restrictive eating disorders often require enteral feeding to provide lifesavinglifesaving treatment.Nasogastric feeding (NGF) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement minimal poor oral intake or to boostincrease nutritional intake. This systematic review sets out to describe current practice for of NG in young people with eating disordersF. MethodsA systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000-2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: mental disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and participants over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results29 studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of practices in different countries, settings, and the reason for initiation; 2) In the UK, standard practice is to introduce Nasogastric feeds (NG) if medically unstable or oral intake is inadequate; 3) NG may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) high calorie feeds are not typically associated with increased risk of refeeding syndrome; 6) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 7) length of stay in hospital is dependent on reason of initiating NG; 8) psychiatric and medical wards differ in approach; 9) therapeutic interventions can occur alongside NG.ConclusionsA large number of studies were deemed to have a high risk of bias and no studies were able to provide a direct comparison between continuous, nocturnal or bolus NG feeds. This review highlights the need for further high quality research in this area.

When Food is Feared: A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

2020 ◽  
Author(s):  
Kristen Hindley ◽  
Clare Fenton ◽  
Jennifer McIntosh
Keyword(s):  
Systematic Review ◽  
Eating Disorders ◽  
Young People ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Primary Research ◽  
Nasogastric Feeding ◽  
Nasal Irritation ◽  
Increased Risk ◽  
Tube Removal

Abstract BackgroundAdolescents with severe restrictive eating disorders often require enteral feeding. Nasogastric feeding is occasionally used during hospitalisation to treat medical instability as a result of malnourishment, or in a specialist setting to supplement minimal oral intake by underweight patients. There is minimal guidance for clinicians to determine when nasogastric feeding should be implemented, how it should be provided and how to complement feeding with a nasogastric tube. This systematic review sets out to determine best practice for NG feeding.MethodsA systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000-2020. Inclusion terms used were as follows: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: mental disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles.Results28 studies met the full criteria. 51.7% of studies were deemed high risk of bias due to the type of study: 37.9% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) 6-66% required NG feeding; 2) staff and young people understand its necessity but generally view it negatively; 3) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 4) high calorie feeds are not associated with increased risk of refeeding syndrome; 5) Common complications were nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 6) length of stay in hospital may be longer in patients requiring NG feeding; 7) psychiatric and medical wards differ in approach; 8) concurrent therapy reduces NG use and aids recovery.ConclusionsAll studies which reviewed the use of NG over a period of time found that it had increased significantly in recent years. Due to the possibility of patient removal of the tube, it may be beneficial in practice to deliver feeds using a bolus regime which has been tailored to the individual caloric needs of the patient. This review enables cautious recommendations to be made and highlights the lack of high-quality evidence around the use of NG feeding in eating disordered young people.

scholarly journals A systematic review of enteral feeding by nasogastric tube in young people with eating disorders

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Kristen Hindley ◽  
Clare Fenton ◽  
Jennifer McIntosh
Keyword(s):  
Systematic Review ◽  
Eating Disorders ◽  
Young People ◽  
Enteral Feeding ◽  
Oral Intake ◽  
Risk Of Bias ◽  
Calorie Intake ◽  
Primary Research ◽  
Total Calorie ◽  
Total Calorie Intake

Abstract Background Adolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment. Nasogastric feeding (NG) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement poor oral intake or to increase nutritional intake. This systematic review sets out to describe current practice of NG in young people with eating disorders. Methods A systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000 to 2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: psychiatric disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and participants over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results Twenty-nine studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of refeeding regimes depending on country, settings, and the reason for initiation; 2) standard practice is to introduce Nasogastric feeds (NG) if medically unstable or oral intake alone is inadequate; 3) NG may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 6) where NG is routinely implemented to increase total calorie intake, length of stay in hospital may be reduced; however where NG is implemented in correlation to severity of symptoms, it may be increased; 7) both medical and psychiatric wards most commonly report using NG in addition to oral intake. Conclusions NG feeding is a safe and efficacious method of increasing total calorie intake by either supplementing oral intake or continuously. There are currently no direct comparisons between continuous, nocturnal or bolus regimes, which may be used to direct future treatment for YP with ED.

Longitudinal outcomes of patients with pseudodementia: a systematic review

2018 ◽  
Vol 49 (5) ◽  
pp. 727-737 ◽  
Author(s):  
Michael H. Connors ◽  
Lena Quinto ◽  
Henry Brodaty
Keyword(s):  
Systematic Review ◽  
Significant Proportion ◽  
Conversion Disorder ◽  
Bibliographic Databases ◽  
Clinical Value ◽  
Trial Methodology ◽  
Longitudinal Outcomes ◽  
Increased Risk ◽  
Wide Range

AbstractDepression and a number of other psychiatric conditions can impair cognition and give the appearance of neurodegenerative disease. Collectively, this group of disorders is known as ‘pseudodementia’ and are important to identify given their potential reversibility with treatment. Despite considerable interest historically, the longitudinal outcomes of patients with pseudodementia remain unclear. We conducted a systematic review of longitudinal studies of pseudodementia. Bibliographic databases were searched using a wide range of search terms. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 18 studies with follow-up varying from several weeks to 18 years. Overall, 284 patients were studied, including 238 patients with depression, 18 with conversion disorder, 14 with psychosis, and 11 with bipolar disorder. Irrespective of diagnosis, 33% developed irreversible dementia at follow-up, 53% no longer met criteria for dementia, and 15% were lost to follow-up. Considerable variability was identified, with younger age at baseline, but not follow-up duration, associated with better outcomes. ECT and pharmacological interventions were also reported to be beneficial, though findings were limited by the poor quality of the studies. Overall, the findings suggest that pseudodementia may confer an increased risk of irreversible dementia in older patients. The findings also indicate, however, that a significant proportion improve, while many remain burdened with their psychiatric condition, independent of organic dementia. The findings support the clinical value of the construct and the need for its re-examination in light of developments in neuroimaging, genomics, other investigative tools, and trial methodology.

scholarly journals Systematic review to investigate the safety of induction and augmentation of labour among pregnant women with iron-deficiency anaemia

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021793 ◽  
Author(s):  
Kathryn Bunch ◽  
Nia Roberts ◽  
Marian Knight ◽  
Manisha Nair
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Case Reports ◽  
Case Series ◽  
Severe Anaemia ◽  
Risk Of Bias ◽  
Deficiency Anaemia ◽  
Increased Risk

ObjectiveTo conduct a systematic review to investigate the safety of induction and/or augmentation of labour compared with spontaneous-onset normal labour among pregnant women with iron-deficiency anaemia.DesignSystematic review.SettingStudies from all countries, worldwide.PopulationPregnant women with iron-deficiency anaemia at labour and delivery.InterventionAny intervention related to induction and/or augmentation of labour.Outcome measuresPrimary: Postpartum haemorrhage (PPH), heart failure and maternal death. Secondary: Emergency caesarean section, hysterectomy, admission to intensive care unit.MethodWe searched 10 databases, including Medline and Embase, from database inception to 1 October 2018. We included all study designs except cross-sectional studies without a comparator group, case reports, case series, ecological studies, and expert opinion. The searches were conducted by a healthcare librarian and two authors independently screened and reviewed the studies. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approachto ascertain risk of bias and conducted a narrative synthesis.ResultsWe identified 3217 journal articles, 223 conference papers, 45 dissertations and 218 registered trials. Ten articles were included for full-text review and only one was found to fulfil the eligibility criteria. This was a retrospective cohort study from India, which showed that pregnant women with moderate and severe anaemia could have an increased risk of PPH if they underwent induction and/or augmentation of labour, but the evidence was weak (graded as ‘high risk of bias’).ConclusionThe best approach is to prevent anaemia, but a large number of women in low-to-middle-income countries present with severe anaemia during labour. In such women, appropriate peripartum management could prevent complications and death. Our review showed that at present we do not know if induction and augmentation of labour is safe in pregnant women with iron-deficiency anaemia and further research is required.PROSPERO registration numberCRD42015032421.

scholarly journals Aripiprazole as a risk factor for impulse control disorders: a systematic review

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S300-S301
Author(s):  
Benjamin Williams ◽  
Benjamin Williams ◽  
Kishen Neelam ◽  
Saumya Singh
Keyword(s):  
Systematic Review ◽  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Dopamine Agonist ◽  
Impulse Control ◽  
Bipolar Affective Disorder ◽  
Impulse Control Disorders ◽  
Risk Of Bias ◽  
Potential Association ◽  
Increased Risk

AimsAripiprazole is an anti-psychotic medication widely used for bipolar affective disorder and depression. It's primary mechanism of action is as a partial dopamine agonist. Aripiprazole's effect on dopamine signalling in the mesolimbic and mesocortical pathways may lead to impulse control disorders, as seen with other dopamine agonist medications. Aripiprazole is often chosen by prescribers because of its favourable side effect profile. There is a need to synthesise the available epidemiological literature on the potential association between aripiprazole use and impulse control disorders. This is needed to inform patients and prescribers of the best available evidence regarding this potential association. Our aim is to conduct a systematic review of the available non case-study evidence on the potential association between aripiprazole and impulse control disorders.MethodDatabases were searched using MEDLINE, PsychINFO, EMBASE, Cochrane Clinical Trials and Web of science. All studies from no earliest date to December 2020 were included; adult patients with a severe and enduring mental illness prescribed antipsychotic medication were included. Cinician diagnosis, structured interview diagnosis, and interviewer or self-completion questionnaires were used to measure prevalence. The study designs included were experimental designs, cohort study, cross-sectional survey and administrative databases. Exclusion criteria being those with traumatic brain injury, psychosis secondary to autoimmune, iatrogenic, chromosomal or metabolic disorder, those with Learning disability or Autistic Spectrum disorders. studies with majority of participants <18yrs. Those who were on other antipsychotic medications in addition to Aripiprazole, were excluded. To ensure quality assurance, we used ROBINS-I tool and GRADE assessment to measure the risk of bias.Result240 records were retrieved, 187 after duplicates were removed. 8 full text articles were assessed for eligibility, of which 4 were included in the qualitative synthesis. 2 studies were analyses of spontaneous adverse drug reaction reporting systems and 2 of health insurance claims databases. All 4 studies found aripiprazole to be associated with greater risk of impulse control disorders. The single study which compared directly with other antipsychotics had a much smaller effect size. Study heterogeneity precluded meta-analysis. All studies were at high risk of bias. The quality of evidence is very low.ConclusionThe available evidence is consistent with the existing warnings regarding increased risk of impulse control disorders in patients prescribed aripiprazole. Clinicians may wish to monitor for this adverse drug reaction. Further research which can account for potential confounders, examines specific impulse control disorders and which is less susceptible to detection and ascertainment biases is required.

scholarly journals Prevalence of health misinformation in social media: a systematic review (Preprint)

2019 ◽  
Author(s):  
Victor Suarez-Lledo ◽  
Javier Alvarez-Galvez
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Social Media ◽  
Eating Disorders ◽  
Communicable Disease ◽  
Health Concern ◽  
Public Health Concern ◽  
Medical Treatments ◽  
Wide Range ◽  
Social Media Platforms

BACKGROUND The propagation of health misinformation through social media has become a major public health concern over the last two decades. Although today there is broad agreement among researchers, health professionals, and policy makers on the need to control and combat health misinformation, the magnitude of this problem is still unknown. Consequently, before adopting the necessary measures for the adequate control of health misinformation in social media, it is fundamental to discover both the most prevalent health topics and the social media platforms from which these topics are initially framed and subsequently disseminated. OBJECTIVE This systematic review aims to identify the main health misinformation topics and their prevalence on different social media platforms, focusing on methodological quality and the diverse solutions that are being implemented to address this public health concern. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). We searched PubMed, MEDLINE, Scopus and the Web of Science for articles published in English before March 2019 with a particular focus on studying health misinformation in social media. We defined health misinformation as a health-related claim based on anecdotal evidence, false, or misleading due to the lack of existing scientific knowledge. The criteria for inclusion were: 1) articles that focused on health misinformation in social media, including those in which the authors discussed the consequences or purposes of health misinformation; and 2) studies that described empirical findings regarding the measurement of health misinformation in these platforms. RESULTS A total of 69 studies were identified as eligible, covering a wide range of health topics and social media platforms. The topics were articulated around six principal categories: vaccines (32%), drugs or smoking (22%), non-communicable disease (19%), pandemics (10%), eating disorders (9%), and medical treatments (7%). Studies were mainly based on five methodological approaches: Social Network Analysis (28%), Evaluating Content (26%), Evaluating Quality (24%), Content/Text analysis (16%) and Sentiment Analysis (6%). Health misinformation proved to be the most more prevalent in studies related to smoking products and drugs such as opioids or marijuana. Posts with misinformation reached 87% in some studies focused in smoking products. Health misinformation about vaccines was also very common (43%), but studies reported different levels of misinformation depending on the different vaccines, with the Human Papilloma Virus (HPV) vaccine being the most affected. Secondly, health misinformation related to diets or pro eating disorders (pro-ED) arguments were moderate in comparison to the aforementioned topics (36%). Studies focused on diseases (i.e. non-communicable diseases and pandemics) also reported moderate misinformation rates (40%), especially in the case of cancer. Finally, the lowest levels of health misinformation were related to medical treatments (30%). CONCLUSIONS Prevalence of health misinformation was most common on Twitter and on issues related to smoking products and drugs. However, misinformation is also high on major public health issues such as vaccines and diseases. Our study offers a comprehensive characterization of the dominant health misinformation topics and a comprehensive description of their prevalence in different social media platforms, which can guide future studies and help in the development of evidence-based digital policy actions plans. CLINICALTRIAL

PP39 What is the risk of major trauma following a fall down stairs? – A systematic review

2021 ◽  
Vol 38 (9) ◽  
pp. A16.2-A16
Author(s):  
Christopher Holt ◽  
Samuel Keating ◽  
Michael Tonkins ◽  
Daniel Bradbury ◽  
Gordon Fuller
Keyword(s):  
Systematic Review ◽  
Major Trauma ◽  
Alcohol Intoxication ◽  
Grey Literature ◽  
Developed Countries ◽  
Risk Of Bias ◽  
Qualitative Synthesis ◽  
Increased Risk ◽  
Study Heterogeneity ◽  
Serious Injury

BackgroundSpecific mechanisms of injury are stated in pre-hospital triage tools to identify suspected cases of major trauma. Falls down stairs are common presentations in UK emergency departments, yet are frequently overlooked as a causative mechanism of major trauma. No prior systematic review has examined this association.MethodsSeven internationally recognised literature databases and seven grey literature databases were screened utilising a common search strategy from inception until 31 December 2019. Abstracts were screened for relevance by a single reviewer. Full texts were screened and subsequently extracted by 3 separate reviewers against strict inclusion/exclusion criteria. A risk of bias assessment based on GRADE recommendations was performed. In the absence of study heterogeneity, a narrative synthesis was planned. The reporting of this systematic review followed PRISMA 2009 statement guidelines.Results5240 articles were identified from database searching, 89 articles had their full texts assessed for eligibility and 6 articles were included for qualitative synthesis. All studies were retrospective in nature and originated from more economically developed countries. 7431 patients who fell down stairs were analysed, of which, 707 (9.5%) met major trauma definitions. Falls down stairs resulted in a significantly increased risk of serious injury compared to other fall mechanisms (OR: 1.621, 95% CI: 1.381 – 1.902, p<0.0005). Analysis of confounding factors demonstrated age (OR: 2.59, 95% CI: 1.57 – 4.28, p<0.001) and alcohol intoxication (OR: 2.6, 95% CI: 1.4 – 4.7, p=0.001) to be significantly associated with major trauma. Risk of bias was moderate to high across all 6 studies.ConclusionThis systematic review highlighted the paucity of literature surrounding the incidence of major trauma following falls down stairs.A retrospective cohort study is currently being undertaken to analyse the risk of major trauma following falls down stairs. On completion, the results will be incorporated with the results of this systematic review.

scholarly journals Comparative efficacy of teat sealants given prepartum for prevention of intramammary infections and clinical mastitis: a systematic review and network meta-analysis

2019 ◽  
Vol 20 (2) ◽  
pp. 182-198 ◽  
Author(s):  
C. B. Winder ◽  
J. M. Sargeant ◽  
D. Hu ◽  
C. Wang ◽  
D. F. Kelton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Clinical Mastitis ◽  
Risk Of Bias ◽  
Comparative Efficacy ◽  
Primary Research ◽  
Quality Of Reporting ◽  
Intramammary Infections ◽  
Bismuth Subnitrate

AbstractA systematic review and network meta-analysis were conducted to assess the relative efficacy of internal or external teat sealants given at dry-off in dairy cattle. Controlled trials were eligible if they assessed the use of internal or external teat sealants, with or without concurrent antimicrobial therapy, compared to no treatment or an alternative treatment, and measured one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, IMI during the first 30 days in milk (DIM), or clinical mastitis during the first 30 DIM. Risk of bias was based on the Cochrane Risk of Bias 2.0 tool with modified signaling questions. From 2280 initially identified records, 32 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. Use of an internal teat sealant (bismuth subnitrate) significantly reduced the risk of new IMI at calving compared to non-treated controls (RR = 0.36, 95% CI 0.25–0.72). For comparisons between antimicrobial and teat sealant groups, concerns regarding precision were seen. Synthesis of the primary research identified important challenges related to the comparability of outcomes, replication and connection of interventions, and quality of reporting of study conduct.

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