scholarly journals Effects of Telemetric Interventions on Maternal and Fetal or Neonatal Outcomes in Gestational Diabetes: Systematic Meta-Review (Preprint)

2020 ◽  
Author(s):  
Claudia Eberle ◽  
Stefanie Stichling
Keyword(s):  
Glycemic Control ◽  
Systematic Reviews ◽  
Glycated Hemoglobin ◽  
Neonatal Outcomes ◽  
Controlled Trials ◽  
High Quality ◽  
Randomized Controlled ◽  
Glycated Hemoglobin A ◽  
Meta Analyses

BACKGROUND In 2019, 1 of 6 births was affected by gestational diabetes mellitus (GDM) globally. GDM results in adverse maternal, fetal, and neonatal outcomes in the short and long term, such as pregnancy and birth complications, type 2 diabetes, metabolic syndrome, and cardiovascular disease. In the context of “transgenerational programming,” diabetes mellitus during pregnancy can contribute to “programming” errors and long-term consequences for the child. Therefore, early therapy strategies are required to improve the clinical management of GDM. The interest in digital therapy approaches, such as telemetry, has increased because they are promising, innovative, and sustainable. OBJECTIVE This study aimed to assess the current evidence regarding the clinical effectiveness of telemetric interventions in the management of GDM, addressing maternal glycemic control, scheduled and unscheduled visits, satisfaction, diabetes self-efficacy, compliance, maternal complications in pregnancy and childbirth, as well as fetal and neonatal outcomes. METHODS Medline via PubMed, Web of Science Core Collection, Embase, Cochrane Library, and CINAHL databases were systematically searched from January 2008 to April 2020. We included randomized controlled trials, systematic reviews, meta-analyses, and clinical trials in English and German. Study quality was assessed using “A MeaSurement Tool to Assess systematic Reviews” and “Effective Public Health Practice Project.” RESULTS Our search identified 1116 unique studies. Finally, we included 11 suitable studies (including a total of 563 patients and 2779 patient cases): 4 systematic reviews or meta-analyses (1 of high quality and 3 of moderate quality), 6 randomized controlled trials (2 of high quality and 4 of moderate quality), and 1 low-quality nonrandomized controlled trial. We classified 4 “asynchronous interventions” and 3 “asynchronous and real-time interventions.” Our findings indicate that telemetric therapy clearly improves glycemic control and effectively reduces glycated hemoglobin A<sub>1c</sub> levels. Furthermore, in 1 study, telemetry proved to be a significant predictor for a better glycemic control (hazard ratio=1.71, 95% CI 1.11-2.65; <i>P</i>=.02), significantly fewer insulin titrations were required (<i>P</i>=.04), and glycemic control was achieved earlier. Telemetric therapy significantly reduced scheduled and unscheduled clinic visits effectively, and women were highly satisfied with the treatment (<i>P</i>&lt;.05). From fetal and neonatal short-term outcomes, some improving tendencies in favor of telemetry were determined. No long-term outcomes were detected. CONCLUSIONS Telemetric interventions clearly improved glycemic control, notably glycated hemoglobin A<sub>1c</sub> levels, and reduced scheduled and unscheduled clinic visits effectively, which reinforces this digital approach in the treatment of GDM.

scholarly journals Effects of Telemetric Interventions on Maternal and Fetal or Neonatal Outcomes in Gestational Diabetes: Systematic Meta-Review

JMIR Diabetes ◽  
10.2196/24284 ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. e24284
Author(s):  
Claudia Eberle ◽  
Stefanie Stichling
Keyword(s):  
Glycemic Control ◽  
Systematic Reviews ◽  
Hemoglobin A1c ◽  
Glycated Hemoglobin ◽  
Neonatal Outcomes ◽  
Controlled Trials ◽  
High Quality ◽  
Randomized Controlled ◽  
Meta Analyses

Background In 2019, 1 of 6 births was affected by gestational diabetes mellitus (GDM) globally. GDM results in adverse maternal, fetal, and neonatal outcomes in the short and long term, such as pregnancy and birth complications, type 2 diabetes, metabolic syndrome, and cardiovascular disease. In the context of “transgenerational programming,” diabetes mellitus during pregnancy can contribute to “programming” errors and long-term consequences for the child. Therefore, early therapy strategies are required to improve the clinical management of GDM. The interest in digital therapy approaches, such as telemetry, has increased because they are promising, innovative, and sustainable. Objective This study aimed to assess the current evidence regarding the clinical effectiveness of telemetric interventions in the management of GDM, addressing maternal glycemic control, scheduled and unscheduled visits, satisfaction, diabetes self-efficacy, compliance, maternal complications in pregnancy and childbirth, as well as fetal and neonatal outcomes. Methods Medline via PubMed, Web of Science Core Collection, Embase, Cochrane Library, and CINAHL databases were systematically searched from January 2008 to April 2020. We included randomized controlled trials, systematic reviews, meta-analyses, and clinical trials in English and German. Study quality was assessed using “A MeaSurement Tool to Assess systematic Reviews” and “Effective Public Health Practice Project.” Results Our search identified 1116 unique studies. Finally, we included 11 suitable studies (including a total of 563 patients and 2779 patient cases): 4 systematic reviews or meta-analyses (1 of high quality and 3 of moderate quality), 6 randomized controlled trials (2 of high quality and 4 of moderate quality), and 1 low-quality nonrandomized controlled trial. We classified 4 “asynchronous interventions” and 3 “asynchronous and real-time interventions.” Our findings indicate that telemetric therapy clearly improves glycemic control and effectively reduces glycated hemoglobin A1c levels. Furthermore, in 1 study, telemetry proved to be a significant predictor for a better glycemic control (hazard ratio=1.71, 95% CI 1.11-2.65; P=.02), significantly fewer insulin titrations were required (P=.04), and glycemic control was achieved earlier. Telemetric therapy significantly reduced scheduled and unscheduled clinic visits effectively, and women were highly satisfied with the treatment (P<.05). From fetal and neonatal short-term outcomes, some improving tendencies in favor of telemetry were determined. No long-term outcomes were detected. Conclusions Telemetric interventions clearly improved glycemic control, notably glycated hemoglobin A1c levels, and reduced scheduled and unscheduled clinic visits effectively, which reinforces this digital approach in the treatment of GDM.

scholarly journals An Overview of Systematic Reviews of Randomized Controlled Trials on Acupuncture Treating Migraine

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Xia-tian Zhang ◽  
Xin-yi Li ◽  
Chen Zhao ◽  
Ye-yin Hu ◽  
Yi-yi Lin ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Systematic Reviews ◽  
Preventive Treatment ◽  
Sham Acupuncture ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Overview Of Systematic Reviews ◽  
Meta Analyses ◽  
Pain Improvement

Objectives. To review the evidence of acupuncture for acute and preventive treatment of migraine for further awareness of the effect of acupuncture for migraine. Design. An overview of systematic reviews and meta-analyses (SR/MAs) for randomized controlled trials. Material and Methods. We searched PubMed, Embase, the Cochrane Library, China Knowledge Resource Integrated Database, VIP Chinese Journal Full Text Database, WANFANG Data, and China Biology Medicine disc from their establishment to May 27, 2018. SR/MAs of randomized controlled trials comparing the effect of the acupuncture intervention with another treatment control in migraine patients were included. Results. 428 SRs were identified, and 15 of them were included. Only 4 SR/MAs were assessed by GRADE, which showed certainty of most evidence being low or very low. Assessed by AMSTAR-2, fourteen was critically low rating overall confidence in the results, and 1 was low rating overall confidence in the results. Evidence suggested that acupuncture has a significant advantage of pain improvement, efficacy, and safety relative to blank control, sham acupuncture, or drug treatment, but some of these results are contradictory. Conclusions. We found that acupuncture on treating migraine has the advantage for pain improvement and safety, but the quality of SR/MAs of acupuncture for migraine remains to be improved.

Immediate versus wait-and-gradual discontinuation in antipsychotic switching: A meta-analysis

2020 ◽  
Vol 34 (8) ◽  
pp. 914-919
Author(s):  
Hiroyoshi Takeuchi ◽  
Gary Remington
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Outcome Data ◽  
Controlled Trials ◽  
Double Blind ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Meta Analyses ◽  
Switching Strategies

Introduction: In two previous meta-analyses of randomized controlled trials (RCTs) examining antipsychotic switching strategies in patients with schizophrenia, we showed no significant differences in any clinical outcomes between immediate versus gradual and gradual versus wait-and-gradual discontinuation of the pre-switch antipsychotic. In this report, we compared immediate versus wait-and-gradual antipsychotic discontinuation. Methods: We identified five RCTs examining immediate versus wait-and-gradual discontinuation of the pre-switch antipsychotic in antipsychotic switching involving patients with schizophrenia. However, no data were available from one RCT. The following clinical outcome data were extracted and meta-analyzed: study discontinuation, psychopathology, extrapyramidal symptoms, and treatment-emergent adverse events that were reported in two or more of the studies. Results: The meta-analysis included four RCTs involving 351 patients ( n=175 for immediate and n=176 for wait-and-gradual antipsychotic discontinuation). A significant difference was found in study discontinuation due to all causes ( n=4, n=351, risk ratio=1.58, 95% confidence interval 1.15–2.17, p=0.005, I2=0%) between the immediate and wait-and-gradual antipsychotic discontinuation groups, while there was no significant difference in any other clinical outcomes. The group difference in study discontinuation due to all causes remained significant for the studies adopting immediate antipsychotic initiation but not for the studies switching to ziprasidone. Conclusion: Findings suggest that wait-and-gradual antipsychotic discontinuation may be preferable when a more cautious antipsychotic switch is needed. However, further long-term, double-blind RCTs are needed to confirm the present findings.

scholarly journals Deep Neural Network for Reducing the Screening Workload in Systematic Reviews for Clinical Guidelines: Algorithm Validation Study

10.2196/22422 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e22422
Author(s):  
Tomohide Yamada ◽  
Daisuke Yoneoka ◽  
Yuta Hiraike ◽  
Kimihiro Hino ◽  
Hiroyoshi Toyoshiba ◽  
...  
Keyword(s):  
Machine Learning ◽  
Randomized Controlled Trials ◽  
Systematic Reviews ◽  
Clinical Guidelines ◽  
Learning System ◽  
Controlled Trials ◽  
Data Set ◽  
Randomized Controlled ◽  
Fold Reduction ◽  
Meta Analyses

Background Performing systematic reviews is a time-consuming and resource-intensive process. Objective We investigated whether a machine learning system could perform systematic reviews more efficiently. Methods All systematic reviews and meta-analyses of interventional randomized controlled trials cited in recent clinical guidelines from the American Diabetes Association, American College of Cardiology, American Heart Association (2 guidelines), and American Stroke Association were assessed. After reproducing the primary screening data set according to the published search strategy of each, we extracted correct articles (those actually reviewed) and incorrect articles (those not reviewed) from the data set. These 2 sets of articles were used to train a neural network–based artificial intelligence engine (Concept Encoder, Fronteo Inc). The primary endpoint was work saved over sampling at 95% recall (WSS@95%). Results Among 145 candidate reviews of randomized controlled trials, 8 reviews fulfilled the inclusion criteria. For these 8 reviews, the machine learning system significantly reduced the literature screening workload by at least 6-fold versus that of manual screening based on WSS@95%. When machine learning was initiated using 2 correct articles that were randomly selected by a researcher, a 10-fold reduction in workload was achieved versus that of manual screening based on the WSS@95% value, with high sensitivity for eligible studies. The area under the receiver operating characteristic curve increased dramatically every time the algorithm learned a correct article. Conclusions Concept Encoder achieved a 10-fold reduction of the screening workload for systematic review after learning from 2 randomly selected studies on the target topic. However, few meta-analyses of randomized controlled trials were included. Concept Encoder could facilitate the acquisition of evidence for clinical guidelines.

Antimicrobially Impregnated Catheters: An Overview of Randomized Controlled Trials

2003 ◽  
Vol 4 (3) ◽  
pp. 102-110 ◽  
Author(s):  
P. Gastmeier ◽  
I. Zuschneid ◽  
C. Geffers
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Randomized Controlled Trials ◽  
Bloodstream Infections ◽  
Controlled Trials ◽  
Catheter Colonization ◽  
High Quality ◽  
Randomized Controlled ◽  
End Point ◽  
Meta Analyses

In order to acquire an overview of the effectiveness of antimicrobially impregnated catheters on the prevention of catheter related bloodstream infections (CRI), we conducted a systematic review concentrating on randomized controlled trials (RCTs). The analysis end point was CRI; therefore, studies focussing only on catheter colonization were excluded. We did not consider abstracts for analysis. We identified 24 RCTs investigating the effectiveness of antimicrobially impregnated catheters. In addition, we discovered five meta-analyses and four studies investigating cost effectiveness. For the majority of antimicrobially impregnated catheter types only a few studies were available, and not enough to draw conclusions. Therefore, despite a relatively large number of RCTs available, the routine use of antimicrobially impregnated catheters as a measure for CRI prevention remains controversial, with a need for more high quality studies.

scholarly journals Clinical Application of Chinese Herbal Injection for Cancer Care: Evidence-Mapping of the Systematic Reviews, Meta-analyses, and Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Ming Yang ◽  
Si-jia Zhu ◽  
Chen Shen ◽  
Rui Zhai ◽  
Duo-duo Li ◽  
...  
Keyword(s):  
Health Insurance ◽  
Randomized Controlled Trials ◽  
Clinical Application ◽  
Systematic Reviews ◽  
Cancer Care ◽  
Controlled Trials ◽  
Evidence Mapping ◽  
Randomized Controlled ◽  
Chinese Herbal ◽  
Meta Analyses

Background and objective: Cancer is a life-threatening disease worldwide and current standard therapy cannot fulfill all clinical needs. Chinese herbal injections have been widely used for cancer in Chinese and Western hospitals in China. This study aimed to apply evidence mapping in order to provide an overview of the clinical application of Chinese herbal injections in cancer care based on randomized controlled trials, systematic reviews, and meta-analyses.Methods and results: Seven databases were systematically searched for eligible randomized controlled trials, systematic reviews, and meta-analyses for ten Chinese herbal injections used in cancer treatment and covered in the Chinese national essential health insurance program. Excel 2016 and RStudio were used to integrate and process the data.In total 366 randomized controlled trials and 48 systematic reviews and meta-analyses were included in the evidence mapping of herbal medicines including; Compound Kushen, Shenqi Fuzheng, Aidi, Kangai, Kanglaite, Xiaoaiping, Cinobufacin, Brucea javanica oil emulsion, Polyporus polysaccharide injection, and Astragalus polysaccharide for injection. Health insurance restricts the scope of clinical application for these herbal injections. The numbers of studies published increased, especially around 2013–2015. The most studied cancer types were lung cancer (118, 32.2%), colorectal cancer (39, 10.7%), and gastric cancer (39, 10.7%), and the most used injections were Compound Kushen (78, 21.3%), Shenqi Fuzheng (76, 20.8%), and Aidi (63, 17.2%). The most consistently reported benefits were observed for Compound Kushen, Shenqi Fuzheng, Aidi, and Kangai for tumor response, quality of life, myelosuppression, and enhancing immunity.Conclusion: The current evidence mapping provides an overview of the outcomes and effects of Chinese herbal injections used in cancer care, and offers information on their clinical application which warrants further evidence-based research in order to inform clinical and policy decision-making.

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