scholarly journals Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis

10.2196/18839 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e18839
Author(s):  
Debaleena Chattopadhyay ◽  
Tengteng Ma ◽  
Hasti Sharifi ◽  
Pamela Martyn-Nemeth
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Virtual Humans ◽  
Conversational Agents ◽  
Desktop Computer ◽  
Cross Sectional ◽  
Head Mounted Display ◽  
Significant Difference

Background Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. Objective The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. Methods Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. Results Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged — simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). Conclusions We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

scholarly journals Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis (Preprint)

2020 ◽  
Author(s):  
Debaleena Chattopadhyay ◽  
Tengteng Ma ◽  
Hasti Sharifi ◽  
Pamela Martyn-Nemeth
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Virtual Humans ◽  
Conversational Agents ◽  
Desktop Computer ◽  
Cross Sectional ◽  
Head Mounted Display ◽  
Significant Difference

BACKGROUND Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. OBJECTIVE The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. METHODS Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. RESULTS Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged — simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, <i>P</i>=.012), but with evidence of some heterogeneity, <i>I<sup>2</sup></i>=49.3%. There were more cross-sectional (<i>k</i>=15) than longitudinal studies (<i>k</i>=11). The intervention was delivered using a personal computer in most studies (<i>k</i>=18), followed by a tablet (<i>k</i>=4), mobile kiosk (<i>k</i>=2), head-mounted display (<i>k</i>=1), and a desktop computer in a community center (<i>k</i>=1). CONCLUSIONS We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness

2021 ◽  
pp. 1-13
Author(s):  
Darin Pauley ◽  
Pim Cuijpers ◽  
Davide Papola ◽  
Clara Miguel ◽  
Eirini Karyotaki
Keyword(s):  
Systematic Review ◽  
Anxiety Disorder ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Wait List ◽  
Digital Interventions ◽  
Significant Difference

Abstract Background Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68–0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: −0.01 to 0.30]. Conclusion The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.

scholarly journals Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis

2020 ◽  
Vol 35 (8) ◽  
pp. 763-773 ◽  
Author(s):  
Petek Eylul Taneri ◽  
Sergio Alejandro Gómez-Ochoa ◽  
Erand Llanaj ◽  
Peter Francis Raguindin ◽  
Lyda Z. Rojas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Iron Metabolism ◽  
Binding Capacity ◽  
Ferritin Level ◽  
Meta Analysis ◽  
Older Age ◽  
Bibliographic Databases ◽  
Distribution Width ◽  
Significant Difference ◽  
The Impact

Abstract Iron metabolism and anemia may play an important role in multiple organ dysfunction syndrome in Coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to evaluate biomarkers of anemia and iron metabolism (hemoglobin, ferritin, transferrin, soluble transferrin receptor, hepcidin, haptoglobin, unsaturated iron-binding capacity, erythropoietin, free erythrocyte protoporphyrine, and erythrocyte indices) in patients diagnosed with COVID-19, and explored their prognostic value. Six bibliographic databases were searched up to August 3rd 2020. We included 189 unique studies, with data from 57,563 COVID-19 patients. Pooled mean hemoglobin and ferritin levels in COVID-19 patients across all ages were 129.7 g/L (95% Confidence Interval (CI), 128.51; 130.88) and 777.33 ng/mL (95% CI, 701.33; 852.77), respectively. Hemoglobin levels were lower with older age, higher percentage of subjects with diabetes, hypertension and overall comorbidities, and admitted to intensive care. Ferritin level increased with older age, increasing proportion of hypertensive study participants, and increasing proportion of mortality. Compared to moderate cases, severe COVID-19 cases had lower hemoglobin [weighted mean difference (WMD), − 4.08 g/L (95% CI − 5.12; − 3.05)] and red blood cell count [WMD, − 0.16 × 1012 /L (95% CI − 0.31; − 0.014)], and higher ferritin [WMD, − 473.25 ng/mL (95% CI 382.52; 563.98)] and red cell distribution width [WMD, 1.82% (95% CI 0.10; 3.55)]. A significant difference in mean ferritin levels of 606.37 ng/mL (95% CI 461.86; 750.88) was found between survivors and non-survivors, but not in hemoglobin levels. Future studies should explore the impact of iron metabolism and anemia in the pathophysiology, prognosis, and treatment of COVID-19.

scholarly journals Cell-Derived Microparticles in Patients with Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis

2016 ◽  
Vol 39 (6) ◽  
pp. 2439-2450 ◽  
Author(s):  
Sheyu Li ◽  
Jia Wei ◽  
Chenghui Zhang ◽  
Xiaodan Li ◽  
Wentong Meng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Meta Analysis ◽  
Cross Sectional ◽  
Significant Difference ◽  
Different Types ◽  
Mean Differences

Background/Aims: The aim of this study was to assess the association between circulating cell-derived microparticles (MPs) and type 2 diabetes mellitus (T2DM). Methods: A literature search was performed systematically in PubMed and Embase to identify available case-control or cross-sectional studies that compared different types of cell-derived MPs in patients with T2DM and non-diabetic controls. Pooled standardized mean differences (SMDs) of each MP type were pooled using meta-analysis. Results: Forty-eight studies involving 2,460 patients with T2DM and 1,880 non-diabetic controls were included for systematic review and 34 of which were included for quantitative study by meta-analysis. In the overall analysis, the levels of circulating total MPs (TMPs), platelet-derived MPs (PMPs), monocyte-derived MPs (MMPs) and endothelium-derived MPs (EMPs) were significantly higher in T2DM patients than those in controls (TMPs: SMD, 0.64; 95%CI, 0.12∼1.15; P=0.02; PMPs: SMD, 1.19; 95%CI, 0.88∼1.50; P <0.00001; MMPs: SMD, 0.92; 95%CI, 0.66∼1.17; P <0.00001; EMPs: SMD, 0.73; 95%CI, 0.50∼0.96; P <0.00001). Meanwhile, no significant difference was shown in leukocyte-derived MPs (LMPs) level between diabetic and non-diabetic groups (SMD, 0.37; 95%CI, -0.15∼0.89; P=0.17). Conclusions: The counts of TMPs, PMPs, MMPs and EMPs elevated in patients with T2DM. And cell-derived MPs may play a role in the pathogenesis of T2DM.

Biopsy versus resection in the management of malignant gliomas: a systematic review and meta-analysis

2010 ◽  
Vol 112 (5) ◽  
pp. 1020-1032 ◽  
Author(s):  
Abraham Tsitlakidis ◽  
Nicolas Foroglou ◽  
Christos A. Venetis ◽  
Ioannis Patsalas ◽  
Athanasios Hatzisotiriou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Overall Survival ◽  
Malignant Glioma ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Malignant Gliomas ◽  
Karnofsky Performance Scale ◽  
Significant Difference

Object The aim of this study was to answer the question whether quality of life and progression-free and overall survival are increased in adults with supratentorial malignant glioma who are treated with cytoreductive resection as compared with those who only undergo biopsy. Methods A literature search of the electronic databases MEDLINE, EMBASE, and CENTRAL was performed to identify relevant studies published before May 2008. Hand-searching of reference lists of the identified studies and relevant review articles was also performed. A study was considered eligible, regardless of study design (prospective or retrospective), if: 1) quality of life and/or progression-free and/or overall survival was compared among adult patients undergoing biopsy or resection, and 2) patient age and Karnofsky Performance Scale scores were not significantly different among the 2 groups compared. Results One randomized controlled trial and 4 retrospective studies (involving a total of 1111 patients) were found eligible for this systematic review. A meta-analysis of the eligible studies demonstrated a significant increase in overall survival in the patients treated with resection instead of biopsy (hazard ratio 0.61, 95% CI 0.52–0.71, p < 0.0001, fixed-effect model). Although statistical pooling was not feasible, the available data suggest that quality of life was increased in patients treated with resection rather than biopsy, while there did not seem to be any significant difference in progression-free survival between the 2 groups. Conclusions Based on the best available evidence, it appears that cytoreductive resection in adults with supratentorial malignant glioma is associated with improved overall survival as compared with biopsy. However, well-designed prospective studies are needed for more solid conclusions to be drawn.

scholarly journals Bidirectional Association between Tooth Loss and Hypertension: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Nan Hu ◽  
Ke Xu ◽  
Chao Gong ◽  
Xizhen Xu
Keyword(s):  
Systematic Review ◽  
Tooth Loss ◽  
Meta Analysis ◽  
Cross Sectional ◽  
Incident Hypertension ◽  
Bidirectional Association ◽  
Significant Difference ◽  
Study Characteristics ◽  
Cross Sectional Studies ◽  
Oral Complication

Abstract Background: To investigate the bidirectional association between tooth loss and hypertensionMethods: PubMed, EMBASE, OVID were searched through May, 2020. Longitudinal and cross-sectional studies reporting the association between tooth loss and hypertension were included. We quantitatively analyzed the basic framework and study characteristics, and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included studies using random-effects meta-analysis.Results: This systematic review included sixteen studies involving about 188,000 participants. Quantitatively summarized results suggested, compared to individuals who have lost fewer than ten teeth, there was no significantly difference in the incidence of hypertension among participants who lost more than ten teeth (OR: 1.09, 95%CI: 0.93,1.28). Besides, there is no significant difference of incident hypertension between individuals who ever lost teeth and never lost teeth (OR:1.03, 95% CI: 0.85,1.25). There was a significant association between hypertension and incidence of tooth loss (OR: 1.33, 95% CI: 1.04,1.70). Subgroup analysis by study design, age, gender ratio and religion showed statistically significant association between hypertension and incidence of tooth loss in specific subgroups.Conclusions: This meta-analysis identified hypertension as a significantly risk factor of tooth loss while tooth loss was not an efficient predictor for incident hypertension. Considering the limited number of available researches and drawback of cross-sectional studies, more high-quality prospective studies of large sample sizes are needed to understand details of this bidirectional association. Since both tooth loss and hypertension are worldwide problems, our study provides new and comprehensive evidence for the prevention in oral complication of hypertensive patients.

scholarly journals Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Saad Alhumaid ◽  
Abbas Al Mutair ◽  
Zainab Al Alawi ◽  
Ali A. Rabaan ◽  
Raghavendra Tirupathi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Case Series ◽  
Incidence Rates ◽  
Effect Sizes ◽  
Cross Sectional ◽  
Randomized Controlled ◽  
Pooled Prevalence ◽  
History Of

Abstract Background Currently there is no systematic review and meta-analysis of the global incidence rates of anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines in the general adult population. Objectives To estimate the incidence rates of anaphylactic and nonanaphylactic reactions after COVID-19 vaccines and describe the demographic and clinical characteristics, triggers, presenting signs and symptoms, treatment and clinical course of confirmed cases. Design A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] statement was followed. Methods Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, and Nature) were searched from 1 December 2020 to 31 May 2021 in the English language using the following keywords alone or in combination: anaphylaxis, non-anaphylaxis, anaphylactic reaction, nonanaphylactic reaction, anaphylactic/anaphylactoid shock, hypersensitivity, allergy reaction, allergic reaction, immunology reaction, immunologic reaction, angioedema, loss of consciousness, generalized erythema, urticaria, urticarial rash, cyanosis, grunting, stridor, tachypnoea, wheezing, tachycardia, abdominal pain, diarrhea, nausea, vomiting and tryptase. We included studies in adults of all ages in all healthcare settings. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. Results Of the 1,734 papers that were identified, 26 articles were included in the systematic review (8 case report, 5 cohort, 4 case series, 2 randomized controlled trial and 1 randomized cross-sectional studies) and 14 articles (1 cohort, 2 case series, 1 randomized controlled trial and 1 randomized cross-sectional studies) were included in meta-analysis. Studies involving 26,337,421 vaccine recipients [Pfizer-BioNTech (n = 14,505,399) and Moderna (n = 11,831,488)] were analyzed. The overall pooled prevalence estimate of anaphylaxis to both vaccines was 5.0 (95% CI 2.9 to 7.2, I2 = 81%, p =  < 0.0001), while the overall pooled prevalence estimate of nonanaphylactic reactions to both vaccines was 53.9 (95% CI 0.0 to 116.1, I2 = 99%, p =  < 0.0001). Vaccination with Pfizer-BioNTech resulted in higher anaphylactic reactions compared to Moderna (8.0, 95% CI 0.0 to 11.3, I2 = 85% versus 2.8, 95% CI 0.0 to 5.7, I2 = 59%). However, lower incidence of nonanaphylactic reactions was associated with Pfizer-BioNTech compared to Moderna (43.9, 95% CI 0.0 to 131.9, I2 = 99% versus 63.8, 95% CI 0.0 to 151.8, I2 = 98%). The funnel plots for possible publication bias for the pooled effect sizes to determine the incidence of anaphylaxis and nonanaphylactic reactions associated with mRNA COVID-19 immunization based on mRNA vaccine type appeared asymmetrical on visual inspection, and Egger’s tests confirmed asymmetry by producing p values < 0.05. Across the included studies, the most commonly identified risk factors for anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines were female sex and personal history of atopy. The key triggers to anaphylactic and nonanaphylactic reactions identified in these studies included foods, medications, stinging insects or jellyfish, contrast media, cosmetics and detergents, household products, and latex. Previous history of anaphylaxis; and comorbidities such as asthma, allergic rhinitis, atopic and contact eczema/dermatitis and psoriasis and cholinergic urticaria were also found to be important. Conclusion The prevalence of COVID-19 mRNA vaccine-associated anaphylaxis is very low; and nonanaphylactic reactions occur at higher rate, however, cutaneous reactions are largely self-limited. Both anaphylactic and nonanaphylactic reactions should not discourage vaccination.

scholarly journals Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019490 ◽  
Author(s):  
María del Mar Fernández ◽  
Jurgita Saulyte ◽  
Hazel M Inskip ◽  
Bahi Takkouche
Keyword(s):  
Systematic Review ◽  
Alcohol Consumption ◽  
Premenstrual Syndrome ◽  
Alcohol Intake ◽  
Meta Analysis ◽  
Harmful Effect ◽  
Personal Contact ◽  
Bibliographic Databases ◽  
Moderate Increase ◽  
Cross Sectional

ObjectivePremenstrual syndrome (PMS) is a very common disorder worldwide which carries an important economic burden. We conducted a systematic review and a meta-analysis to assess the role of alcohol in the occurrence of PMS.MethodsWe searched MEDLINE, EMBASE, the five regional bibliographic databases of the WHO, the Proceedings database and the Open Access Thesis and Dissertations (OATD) from inception to May 2017. We also reviewed the references of every article retrieved and established personal contact with researchers to trace further publications or reports. We did not include any language limitations. Studies were included if: (1) they presented original data from cohort, case-control or cross-sectional studies, (2) PMS was clearly defined as the outcome of interest, (3) one of the exposure factors was alcohol consumption, (4) they provided estimates of odds ratios, relative risks, or any other effect measure and their confidence intervals, or enough data to calculate them.ResultsWe identified 39 studies of which 19 were eligible. Intake of alcohol was associated with a moderate increase in the risk of PMS (OR=1.45, 95% CI: 1.17 to 1.79). Heavy drinking yielded a larger increase in the risk than any drinking (OR=1.79, 95% CI: 1.39 to 2.32).DiscussionOur results suggest that alcohol intake presents a moderate association with PMS risk. Future studies should avoid cross-sectional designs and focus on determining whether there is a threshold of alcohol intake under which the harmful effect on PMS is non-existent.

scholarly journals Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis

Stroke ◽  
2021 ◽  
Author(s):  
Mariam Ali ◽  
Hendrikus J.A. van Os ◽  
Nelleke van der Weerd ◽  
Jan W. Schoones ◽  
Martijn W. Heymans ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sex Differences ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Neurological Symptoms ◽  
Cross Sectional ◽  
Ischemic Attack ◽  
Meta Analyses

Background and Purpose: Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack. Methods: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias. Results: We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11–1.39]; I 2 =75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19–1.61]; I 2 =95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25–1.55]; I 2 =27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94–0.97]; I 2 =0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04–1.24]; I 2 =48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13–1.34]; I 2 =44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54–0.97]; I 2 =72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70–0.99]; I 2 =62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias. Conclusions: There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.

scholarly journals Systematic review of interventions to increase the use of arteriovenous fistulae and grafts in incident haemodialysis patients

2021 ◽  
pp. 112972982110069
Author(s):  
Jonathan De Siqueira ◽  
Alexander Jones ◽  
Mohammed Waduud ◽  
Max Troxler ◽  
Deborah Stocken ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
English Language ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Education Programme ◽  
Outcome Data ◽  
Arteriovenous Fistulae ◽  
Structured Education ◽  
Significant Difference

Background: Patients who commence haemodialysis (HD) through arteriovenous fistulae and grafts (AVF/G) have improved survival compared to those who do so by venous lines. Objectives: This systematic review aims to assimilate the evidence for any strategy which increases the proportion of HD patients starting dialysis through AVF/G. Data sources: Medline, Embase, Cochrane Central and Scopus. Study eligibility, participants and interventions: English language studies comparing any educational, clinical or service organisation intervention for adult patients with end stage renal failure and reporting incident AVF/G use. Study appraisal and synthesis: Two reviewers assessed studies for eligibility independently. Outcome data was extracted and reported as relative risk. Reporting was performed with reference to the PRISMA statement. Results: Of 1272 studies, 6 were eligible for inclusion. Studies varied in design and intervention. Formal meta-analysis was not appropriate. One randomised controlled trial and two cohort studies assessed the role of a renal access coordinator. Two cohort studies assessed the implementation of qualitive initiative programmes and one cohort study assessed a national, structured education programme. Results between studies were contradictory with some reporting improvements in incident AVF/G use and some no significant difference. Quality was generally low. Conclusions: It is not possible to reach firm conclusions nor make strategic recommendations. A comprehensive package of care which educates and identifies patients approaching dialysis in a timely manner may improve incident AVF/G use. An unbiased, robust comparison of different strategies for timing AVF/G referral is required.

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