A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

Background and objectivesCompared with hemodialysis, home peritoneal dialysis alleviates the burden of travel, facilitates independence, and is less costly. Physical, cognitive, or psychosocial factors may preclude peritoneal dialysis in otherwise eligible patients. Assisted peritoneal dialysis, where trained personnel assist with home peritoneal dialysis, may be an option, but the optimal model is unknown. The objective of this work is to characterize existing assisted peritoneal dialysis models and synthesize clinical outcomes.Design, setting, participants, & measurementsA systematic review of MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and CINAHL was conducted (search dates: January 1995–September 2018). A focused gray literature search was also completed, limited to developed nations. Included studies focused on home-based assisted peritoneal dialysis; studies with the assist provided exclusively by unpaid family caregivers were excluded. All outcomes were narratively synthesized; quantitative outcomes were graphically depicted.ResultsWe included 34 studies, totaling 46,597 patients, with assisted peritoneal dialysis programs identified in 20 jurisdictions. Two categories emerged for models of assisted peritoneal dialysis on the basis of type of assistance: health care and non–health care professional assistance. Reported outcomes were heterogeneous, ranging from patient-level outcomes of survival, to resource use and transfer to hemodialysis; however, the comparative effect of assisted peritoneal dialysis was unclear. In two qualitative studies examining the patient experience, the maintenance of independence was identified as an important theme.ConclusionsReported outcomes and quality were heterogeneous, and relative efficacy of assisted peritoneal dialysis could not be determined from included studies. Although the patient voice was under-represented, suggestions to improve assisted peritoneal dialysis included using a person-centered model of care, ensuring continuity of nurses providing the peritoneal dialysis assist, and measures to support patient independence. Although attractive elements of assisted peritoneal dialysis are identified, further evidence is needed to connect assisted peritoneal dialysis outcomes with programmatic features and their associated funding models.

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Análise da Revisão Cochrane: Alta Hospitalar Precoce para Hospitalização Domiciliária. Cochrane Database Syst Rev. 2017;6:CD000356.

Acta Médica Portuguesa ◽

10.20344/amp.9791 ◽

2017 ◽

Vol 30 (12) ◽

pp. 835

Author(s):

Mariana Alves ◽

Miguel Bigotte Vieira ◽

João Costa ◽

António Vaz Carneiro

Keyword(s):

Systematic Review ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Care Group ◽

Cochrane Central Register ◽

Cochrane Database ◽

Central Register ◽

Objective Evidence ◽

Hospital At Home ◽

At Home

Hospital at home is a service that provides active treatment by healthcare professionals in the patient’s home for a condition that otherwise would require acute hospital in-patient care. However, the clinical benefit of this intervention and its effect on health costs are not established. This Cochrane systematic review aimed to assess the effectiveness and costs of managing patients with hospital at home compared with inpatient hospital care. A systematic review of the literature was carried out by searching the following databases to 9 January 2017: Cochrane Effective Practice and Organization of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, EconLit and clinical trials registries. Thirty-two randomized trials (2 of which unpublished), including 4746 patients, were included. The present review provides insufficient objective evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.

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Evaluation of Spontaneous Swallow Frequency in Healthy People and Those With, or at Risk of Developing, Dysphagia: A Systematic Review and Meta-Analysis.

10.21203/rs.3.rs-153473/v1 ◽

2021 ◽

Author(s):

Joseph M Bulmer ◽

Caroline Ewers ◽

Michael J Drinnan ◽

Victoria C Ewan

Keyword(s):

Systematic Review ◽

At Risk ◽

Meta Analysis ◽

Quality Criteria ◽

Clinical Variable ◽

Normative Values ◽

Healthy Population ◽

Cochrane Central Register ◽

Cochrane Database ◽

Central Register

Abstract BackgroundDysphagia is a common, and frequently undetected, complication of many neurological disorders and of sarcopoenia in ageing persons. However it is difficult to detect dysphagia clinically until the point of visible aspiration, and there are relatively few trained speech and language therapists, whose time and remit are limited to those with obvious disorders. Reduction in spontaneous swallowing frequency (SSF) has been mooted as a possible proxy for dysphagia. We therefore conducted a systematic review of the literature to describe SSF in both the healthy population, and in disease specific populations, in order to assess its utility as a screening tool to identify dysphagia.MethodsWe searched Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases. Metadata were extracted, collated, and analysed via a random effects model to give quantitative insight.ResultsThree hundred and twelve articles were retrieved, with 19 meeting inclusion and quality criteria. Heterogeneity between studies was high (I2 = 98%), in part, due to the variety of methods for swallow identification reported. The mean SSF in Healthy younger groups was 0.98/min [CI: 0.78; 1.23]. In the Parkinson’s groups mean SSF was 0.59/min [0.41; 0.85]. Mean SSF in Healthy older, Higher risk and Dysphagic populations were similar (0.21/min [0.12; 0.37], 0.26/min [0.14; 0.85]), (0.27/min [0.17; 0.43] respectively).ConclusionsSSF is a novel, non-invasive clinical variable which warrants further explorations as to its potential to identify persons at risk of dysphagia. Larger, well-conducted studies are needed to develop objective, standardised methods for detecting SSF, and develop normative values in healthy populations.

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Poststroke depression and risk of stroke recurrence and mortality: protocol of a meta-analysis and systematic review

BMJ Open ◽

10.1136/bmjopen-2018-026316 ◽

2018 ◽

Vol 8 (12) ◽

pp. e026316 ◽

Cited By ~ 7

Author(s):

Wa Cai ◽

Robert Stewart ◽

Christoph Mueller ◽

Yi-Jing Li ◽

Wei-Dong Shen

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Stroke Recurrence ◽

Cochrane Central Register ◽

Poststroke Depression ◽

Stroke Outcomes ◽

Cochrane Database ◽

Central Register ◽

Registration Number

IntroductionA number of observational studies have indicated that poststroke depression could increase the risk of stroke outcomes. There is a meta-analysis indicating that poststroke depression is a risk factor of all-cause mortality. This paper reports the protocol for a systematic review and meta-analysis to clarify the associations of poststroke depression with stroke recurrence and mortality in order to determine whether poststroke depression is a predictor of stroke outcomes according to data extracted from relevant observational studies.Methods and analysisMEDLINE, Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews will be used to conduct the search. Published studies written in English will be included. The risk of bias for the studies included in the systematic review or meta-analysis will be assessed by the Newcastle–Ottawa Quality Assessment Scale. HRs for stroke recurrence and mortality with 95% CIs will be included as primary outcomes. Subgroup analyses and meta-regression will be performed.Ethics and disseminationEthics approval will not be needed because the data used in this systematic review will be extracted from published studies. The results of the systematic review focusing on whether depression after stroke is a predictor for stroke recurrence and mortality will be disseminated by publication in a peer-reviewed journal.PROSPERO registration numberCRD42018107944.

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Statins Reduce Mortality After Non-severe but Not After Severe Pneumonia: A Systematic Review and Meta-Analysis

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j34307 ◽

2015 ◽

Vol 18 (3) ◽

pp. 286 ◽

Cited By ~ 8

Author(s):

Mingwang Jia ◽

Wenjie Huang ◽

Li Li ◽

Zhong Xu ◽

Lichan Wu

Keyword(s):

Systematic Review ◽

Protective Effect ◽

Meta Analysis ◽

Severe Pneumonia ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Pneumonia Severity ◽

Cochrane Database ◽

Central Register ◽

Statin Use

PURPOSE: The objective of this study was to perform a systematic review and meta-analysis of the effects of statins on mortality for patients with non-severe pneumonia or severe pneumonia. METHODS: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane central register of controlled trials and Clinicaltrials.gov were searched for the association between statins and non-severe/severe pneumonia. Eligible articles were analyzed in Stata 12.0. RESULTS: The database search yielded a total of 566 potential publications, 24 studies involving 312,309 patients met the eligibility criteria. Pooled unadjusted data showed that statin use was associated with lower mortality after non-severe pneumonia (odds ratio [OR] 0.70, 95% confidence interval [CI], 0.66-0.73), but not severe pneumonia (OR 1.05; 95% CI, 0.86-1.28). However, this protective effect of statins was weakened using adjusted estimates (OR 0.78, 95% CI, 0.75-0.82). Besides, protective effect of statins was attenuated by confounders in a subgroup analysis, especially when accounting for pneumonia severity indicators (OR 0.88; 95% CI, 0.80-0.96). CONCLUSIONS: Statin use was associated with reduced mortality after non-severe pneumonia but not severe pneumonia and this protective effect was weakened in subgroups. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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Functional cortical changes associated with shoulder instability – a systematic review

Shoulder & Elbow ◽

10.1177/17585732211019016 ◽

2021 ◽

pp. 175857322110190

Author(s):

Morissa F Livett ◽

Deborah Williams ◽

Hayley Potter ◽

Melinda Cairns

Keyword(s):

Systematic Review ◽

Joint Instability ◽

Glenohumeral Joint ◽

Controlled Trials ◽

Cochrane Central Register ◽

Cortical Function ◽

High Quality Research ◽

Central Register ◽

Rehabilitative Measures ◽

Randomised Controlled

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

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Use of opioids in patients with cancer with hepatic impairment—a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003065 ◽

2021 ◽

pp. bmjspcare-2021-003065

Author(s):

Lewis Thomas Hughes ◽

David Raftery ◽

Paul Coulter ◽

Barry Laird ◽

Marie Fallon

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Hepatic Impairment ◽

Evaluation System ◽

Meta Analysis ◽

Hepatic Function ◽

Cochrane Central Register ◽

Assessment Development ◽

Patients With Cancer ◽

Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

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Dynamic compared to rigid fixation in lumbar spine: a systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.60.02.013 ◽

2014 ◽

Vol 60 (2) ◽

pp. 151-155 ◽

Cited By ~ 1

Author(s):

Ricardo Vieira Botelho ◽

Rafael Bastianello Junior ◽

Luciana DiniGianini de Albuquerque ◽

Wanderley Marques Bernardo

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Randomized Trials ◽

Published Data ◽

Rigid Fixation ◽

Cochrane Central Register ◽

Pedicle Fixation ◽

Central Register ◽

Spine Fixation

Objective: The objective of this review is to reveal the quality of published data and the effect size of DPFs compared to rigid fixation in lumbar spine. Summary of background data: since 2002, several dynamic pedicle fixation (DPF) systems have been developed with the aim to stabilize the spine without the undesirable effects of rigid lumbar spine fixation. Nearly ten years later, there are several studies on these dynamic systems. Methods: A systematic review was done in MEDLINE/PubMED, Embase, Cochrane Central Register of Randomized Trials and Google Scholar to assess the quality of published literature and the available studied outcomes in randomized controlled trials of DPF. Results: Only three papers described randomized trials studying DPF. One of them focused on protection of adjacent level disease provided by DPF. Conclusion: It was not possible to reveal any evidence for benefits using DPF compared to rigid fixation in surgery for lumbar spine.

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Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

Journal of Medical Internet Research ◽

10.2196/18636 ◽

2020 ◽

Vol 22 (6) ◽

pp. e18636 ◽

Cited By ~ 4

Author(s):

Jobbe P L Leenen ◽

Crista Leerentveld ◽

Joris D van Dijk ◽

Henderik L van Westreenen ◽

Lisette Schoonhoven ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Clinical Outcomes ◽

Health Care Professionals ◽

Continuous Monitoring ◽

Vital Signs ◽

Current Evidence ◽

Cochrane Central Register ◽

Wireless Devices

Background Continuous monitoring of vital signs by using wearable wireless devices may allow for timely detection of clinical deterioration in patients in general wards in comparison to detection by standard intermittent vital signs measurements. A large number of studies on many different wearable devices have been reported in recent years, but a systematic review is not yet available to date. Objective The aim of this study was to provide a systematic review for health care professionals regarding the current evidence about the validation, feasibility, clinical outcomes, and costs of wearable wireless devices for continuous monitoring of vital signs. Methods A systematic and comprehensive search was performed using PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2009 to September 2019 for studies that evaluated wearable wireless devices for continuous monitoring of vital signs in adults. Outcomes were structured by validation, feasibility, clinical outcomes, and costs. Risk of bias was determined by using the Mixed Methods Appraisal Tool, quality assessment of diagnostic accuracy studies 2nd edition, or quality of health economic studies tool. Results In this review, 27 studies evaluating 13 different wearable wireless devices were included. These studies predominantly evaluated the validation or the feasibility outcomes of these devices. Only a few studies reported the clinical outcomes with these devices and they did not report a significantly better clinical outcome than the standard tools used for measuring vital signs. Cost outcomes were not reported in any study. The quality of the included studies was predominantly rated as low or moderate. Conclusions Wearable wireless continuous monitoring devices are mostly still in the clinical validation and feasibility testing phases. To date, there are no high quality large well-controlled studies of wearable wireless devices available that show a significant clinical benefit or cost-effectiveness. Such studies are needed to help health care professionals and administrators in their decision making regarding implementation of these devices on a large scale in clinical practice or in-home monitoring.

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

10.1101/2021.08.03.21261414 ◽

2021 ◽

Author(s):

Luis Ayerbe ◽

Ivo Forgnone ◽

Carlos Risco-Risco ◽

Maria Perez-Pinar ◽

Salma Ayis

Keyword(s):

Systematic Review ◽

Clinical Severity ◽

Future Research ◽

Controlled Trials ◽

Clinical Settings ◽

Cochrane Central Register ◽

Random Effects Models ◽

Central Register ◽

Significant Difference ◽

Observational Design

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

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

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314504 ◽

2018 ◽

Vol 104 (3) ◽

pp. 280-285 ◽

Cited By ~ 3

Author(s):

Christopher Stutchfield ◽

Anna Davies ◽

Amber Young

Keyword(s):

Systematic Review ◽

Fluid Resuscitation ◽

Primary Data ◽

Controlled Trials ◽

Burn Shock ◽

Cochrane Central Register ◽

Study Protocols ◽

Central Register ◽

Affect Patient Outcome ◽

Randomised Controlled

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

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