scholarly journals Cost-Related Medication Nonadherence in Canada: A Systematic Review of Prevalence, Predictors, and Clinical Impact

2020 ◽  
Author(s):  
Anne Marie Holbrook ◽  
Mei Wang ◽  
Munil Lee ◽  
Zhiyuan Chen ◽  
Michael Garcia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Low Income ◽  
Original Data ◽  
Population Based ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Sampling Frame ◽  
One Year ◽  
The Cochrane Library

Abstract Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, is unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes.Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools.Results: Twenty-six studies of varying quality (n=483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1% to 10.2%. Factors predicting CRNA included high out of pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at one year. Conclusion: CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

scholarly journals Cost-Related Medication Nonadherence in Canada: A Systematic Review of Prevalence, Predictors, and Clinical Impact

2020 ◽  
Author(s):  
Anne Marie Holbrook ◽  
Mei Wang ◽  
Munil Lee ◽  
Zhiyuan Chen ◽  
Michael Garcia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Low Income ◽  
Original Data ◽  
Population Based ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Sampling Frame ◽  
One Year ◽  
The Cochrane Library

Abstract Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, is unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes. Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools. Results: Twenty-six studies of varying quality (n=483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1% to 10.2%. Factors predicting CRNA included high out of pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at one year. Conclusion: CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

scholarly journals Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Anne M. Holbrook ◽  
Mei Wang ◽  
Munil Lee ◽  
Zhiyuan Chen ◽  
Michael Garcia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Low Income ◽  
Original Data ◽  
Population Based ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Sampling Frame ◽  
Financial Flexibility ◽  
The Cochrane Library

Abstract Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, are unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes. Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools. Results Twenty-six studies of varying quality (n = 483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1 to 10.2%. Factors predicting CRNA included high out-of-pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at 1 year. Conclusion CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Jakob Martin Burgstaller ◽  
Johann Steurer ◽  
Ulrike Held ◽  
Beatrice Amann-Vesti
Keyword(s):  
Systematic Review ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cochrane Library ◽  
Compression Stockings ◽  
Post Thrombotic Syndrome ◽  
Study Results ◽  
Preventive Efficacy ◽  
One Year ◽  
The Cochrane Library

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

Calprotectin as a Biomarker for Rheumatoid Arthritis: A Systematic Review

2015 ◽  
Vol 42 (5) ◽  
pp. 760-770 ◽  
Author(s):  
Mads Abildtrup ◽  
Gabrielle H. Kingsley ◽  
David L. Scott
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Longitudinal Data ◽  
Calcium Binding ◽  
Therapeutic Response ◽  
Original Data ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Wide Range ◽  
The Cochrane Library

Objective.Calprotectin (myeloid-related protein 8/14), a heterodimeric complex of calcium-binding proteins, is expressed in granulocytes and monocytes. Calprotectin levels are high in synovial tissue, particularly in activated cells adjacent to the cartilage-pannus junction. This systematic review evaluates the use of calprotectin as an indicator of disease activity, therapeutic response, and prognosis in rheumatoid arthritis (RA).Methods.Medline, Scopus, and the Cochrane Library (1970–2013) were searched for studies containing original data from patients with RA in whom calprotectin levels were measured in plasma/serum and/or synovial fluid (SF). We included studies examining associations between calprotectin levels and clinical and laboratory assessments, disease progression, and therapeutic response. There were no restrictions for sample size, disease duration, or length of followup.Results.We evaluated 17 studies (1988–2013) with 1065 patients enrolled; 11 were cross-sectional and 8 had longitudinal designs with 2 studies reporting cross-sectional and longitudinal data. Systemic and SF levels of calprotectin were raised in RA. There was a wide range of levels and marked interstudy and intrastudy variability. Calprotectin levels were high in active disease and were particularly high in rheumatoid factor (RF)-positive patients. Levels fell with effective treatment. Longitudinal data showed that calprotectin was a significant and independent predictor of erosive progression and therapeutic responses, particularly in patients who received effective biological treatments.Conclusion.SF calprotectin levels are high, suggesting there is substantial local production by inflamed synovium. Blood calprotectin levels, though highly variable, are elevated in active RA and fall with effective therapy. High baseline calprotectin levels predict future erosive damage.

scholarly journals The Impact of CKD Anaemia on Patients: Incidence, Risk Factors, and Clinical Outcomes—A Systematic Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-21
Author(s):  
Eirini Palaka ◽  
Susan Grandy ◽  
Heleen van Haalen ◽  
Phil McEwan ◽  
Oliver Darlington
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Cardiac Events ◽  
Ckd Progression ◽  
Ckd Stage ◽  
Associated Risk Factors ◽  
The Impact

Anaemia is a common consequence of chronic kidney disease (CKD); however, the risk factors for its development and its impact on outcomes have not been well synthesised. Therefore, we undertook a systematic review to fully characterise the risk factors associated with the presence of anaemia in patients with CKD and a contemporary synthesis of the risks of adverse outcomes in patients with CKD and anaemia. We searched MEDLINE, EMBASE, and the Cochrane Library from 2002 until 2018 for studies reporting the incidence or prevalence of anaemia and associated risk factors and/or associations between haemoglobin (Hb) or anaemia and mortality, major adverse cardiac events (MACE), hospitalisation, or CKD progression in adult patients with CKD. Extracted data were summarised as risk factors related to the incidence or prevalence of anaemia or the risk (hazard ratio (HR)) of outcome by Hb level (<10, 10–12, >12 g/dL) in patients not on dialysis and in those receiving dialysis. 191 studies met the predefined inclusion criteria. The risk factor most associated with the prevalence of anaemia was CKD stage, followed by age and sex. Mean HRs (95% CI) for all-cause mortality in patients with CKD on dialysis with Hb <10, 10–12, and >12 g/dL were 1.56 (1.43–1.71), 1.17 (1.09–1.26), and 0.91 (0.87–0.96), respectively. Similar patterns were observed for nondialysis patients and for the risks of hospitalisation, MACE, and CKD progression. This is the first known systematic review to quantify the risk of adverse clinical outcomes based on Hb level in patients with CKD. Anaemia was consistently associated with greater mortality, hospitalisation, MACE, and CKD progression in patients with CKD, and risk increased with anaemia severity. Effective treatments that not only treat the anaemia but also reduce the risk of adverse clinical outcomes are essential to help reduce the burden of anaemia and its management in CKD.

scholarly journals Deep Margin Elevation for Indirect Restorations: A Systematic Review

2021 ◽  
pp. 23-30
Author(s):  
Khaled Alghulikah ◽  
Nada Abdulrahman Alsulaiman ◽  
Haya Saad Al Ibrahim ◽  
Rama Mahmoud AlYamany ◽  
Najla Haif Alqahtani
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Clinical Studies ◽  
Cochrane Library ◽  
Adhesive Dentistry ◽  
Long Term Follow Up ◽  
Deep Margin ◽  
The Cochrane Library

Background: The evolution of adhesive dentistry has increased the demand for improving the clinical outcomes of indirect restorations. There are several challenging factors in restoring teeth with deep interproximal lesions. Surgical crown lengthening has been the primary procedure to avoid violation of the biological width. In recent years, deep marginal elevation (DME) has been proposed as an alternative procedure for maintaining biological width in cases with subgingival defects. The aim of this review was to search for the best available evidence concerning the clinical outcomes of DME. Methodology: A comprehensive online search was performed using three different databases (using PubMed, the Cochrane Library, and the American dental association library for evidence-based dentistry). Four independent authors reviewed studies, collected data, and assessed the risk of bias. Results: The initial search revealed 1,763 studies. Duplicates were removed, and an extensive review was performed. Only six studies met the inclusion criteria and were accepted in the review. Conclusions: The systematic review advocates that DME is a reasonable, predictable, and reliable clinical procedure. There is a limitation of clinical studies in this field; therefore, more clinical studies with long-term follow-up periods are necessary.

scholarly journals EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

2021 ◽  
pp. 174749302110042
Author(s):  
Grace Mary Turner ◽  
Christel McMullan ◽  
Olalekan Lee Aiyegbusi ◽  
Danai Bem ◽  
Tom Marshall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Cochrane Library ◽  
Control Group ◽  
Large Sample Size ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

scholarly journals Lumbar Roll Usage While Sitting Reduces the Forward Head Posture in Healthy Individuals: A Systematic Review with Meta-Analysis

2021 ◽  
Vol 18 (10) ◽  
pp. 5171
Author(s):  
Yusuke Handa ◽  
Kenya Okada ◽  
Hiroshi Takasaki
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Grade System ◽  
Cochrane Library ◽  
Forward Head Posture ◽  
Quality Of Evidence ◽  
Head Posture ◽  
Head Extension ◽  
The Cochrane Library

This systematic review and meta-analysis investigated whether the use of a lumbar roll reduced forward head posture (FHP) while sitting among individuals with or without musculoskeletal disorders. EMBASE, MEDLINE, and the Cochrane Library were systematically searched from their inception to August 2020. The quality of evidence for variables used in the meta-analysis was determined using the GRADE system. Five studies satisfied the criteria for data analysis. All studies included individuals without any spinal symptoms. Data from five studies on neck angle showed a statistically significant (p = 0.02) overall effect (standardized mean difference (SMD) = 0.77), indicating a lesser neck flexion angle while sitting with a lumbar roll than without it. Data from two studies on head angle showed a statistically significant (p = 0.04) overall effect (SMD = 0.47), indicating a lesser head extension angle while sitting with a lumbar roll than without it. In each meta-analysis, the quality of evidence was very low in the GRADE system. The use of a lumbar roll while sitting reduced FHP among individuals without spinal symptoms.

scholarly journals The prevalence of diabetes in Afghanistan: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sohail Akhtar ◽  
Jamal Abdul Nasir ◽  
Amara Javed ◽  
Mariyam Saleem ◽  
Sundas Sajjad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Population Based ◽  
Included Study ◽  
Cochrane Library ◽  
Or Education ◽  
Meta Regression

Abstract Background The aim of this paper is to investigate the prevalence of diabetes and its associated risk factors in Afghanistan through a systematic review and meta–analysis. Methods A comprehensive literature search was conducted using EMBASE, PubMed, Web of Sciences, Google Scholar and the Cochrane library, carried out from inception to April 312,020, without language restriction. Meta–analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. The existence of publication bias was initially assessed by visual inspection of a funnel plot and then tested by the Egger regression test. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity. This systematic review was reported by following the PRISMA guidelines and the methodological quality of each included study was evaluated using the STROBE guidelines. Results Out of 64 potentially relevant studies, only 06 studies fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of diabetes in the general population based on population-based studies were 12.13% (95% CI: 8.86–16.24%), based on a pooled sample of 7071 individuals. Results of univariate meta-regression analysis revealed that the prevalence of diabetes increased with mean age, hypertension and obesity. There was no significant association between sex (male vs female), smoking, the methodological quality of included articles or education (illiterate vs literate) and the prevalence of diabetes. Conclusions This meta-analysis reports the 12.13% prevalence of diabetes in Afghanistan,with the highest prevalence in Kandahar and the lowest in Balkh province. The main risk factors include increasing age, obesity and hypertension. Community-based care and preventive training programmes are recommended. Trial registration This review was registered on PROSPERO (registration number CRD42020172624).

scholarly journals Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1339
Author(s):  
Moustapha Dramé ◽  
Cécilia Cofais ◽  
Maxime Hentzien ◽  
Emeline Proye ◽  
Pécory Souleymane Coulibaly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Clinical Outcomes ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Aged Patients ◽  
Aged People ◽  
Severity Of The Disease

Background: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. Methods: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. Results: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). Conclusion: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

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