scholarly journals Mid-Regional Pro-Adrenomedullin (MR-proADM) as a Biomarker for Sepsis and Septic Shock: Narrative Review

Healthcare ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 110 ◽  
Author(s):  
Uğur Önal ◽  
Francisco Valenzuela-Sánchez ◽  
Kalwaje Vandana ◽  
Jordi Rello
Keyword(s):  
Septic Shock ◽  
Randomized Controlled Trials ◽  
Organ Failure ◽  
Narrative Review ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Diagnosis And Prognosis ◽  
Sepsis And Septic Shock

Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was conducted to assess the role of mid-regional pro-adrenomedullin (MR-proADM) as a biomarker for sepsis and septic shock. Relevant studies were collected via an electronic PubMed, Web of Science, and The Cochrane Library search. The review focused on both diagnosis and prognosis in patients with sepsis and septic shock and specifically in subpopulations of patients with sepsis and septic shock with burns or malignant tumors. No exclusion criteria regarding age, sex, intensive care unit admission, follow-up duration, or co morbidities were used so as to maximize sensitivity and due to lack of randomized controlled trials, opinion paper and reviews were also included in this review. A total of 22 studies, one opinion paper, and one review paper were investigated. MR-proADM levels were found to be useful in assessing patients’ initial evolution and become even more useful during follow-up with increased area under curve values in the mortality prognosis by exceeding values of 0.8 in the data shown in several studies. These results also improve along with other biomarkers or severity scores and especially correlate with the organ failure degree. The results of this study indicate that MR-proADM is a good biomarker for the diagnosis and prognosis of sepsis and septic shock patients as well as for organ failure. Although several publications have discussed its role as a biomarker for pneumonia, its value as a biomarker for sepsis and septic shock should now be assessed in randomized controlled trials and more collaborative prospective studies with larger patient samples.

scholarly journals A Review of Marital Intimacy-Enhancing Interventions among Married Individuals

2015 ◽  
Vol 8 (8) ◽  
pp. 74 ◽  
Author(s):  
Maryam Kardan-Souraki ◽  
Zeinab Hamzehgardeshi ◽  
Ismail Asadpour ◽  
Reza Ali Mohammadpour ◽  
Soghra Khani
Keyword(s):  
Clinical Trials ◽  
Randomized Controlled Trials ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Main Concern ◽  
Care Providers ◽  
Marital Intimacy ◽  
Randomized Controlled ◽  
The Impact

<p><strong>BACKGROUND:</strong> Lack of intimacy is currently the main concern rather than main concern of the experts in psychology and counseling. It is considered as one of the most important causes for divorce and as such to improve marital intimacy a great number of interventions have been proposed in the literature. Intimacy training and counseling make the couples take effective and successful steps to increase marital intimacy. No study has reviewed the interventions promoting marital intimacy after marriage. Thus, this review study aimed to classify the articles investigating the impact of interventional programs on marital intimacy after marriage.</p><p><strong>SEARCH METHODS:</strong> In April 2015, we performed a general search in Google Scholar search engines, and then we did an advanced search the databases of Science Direct, ProQuest, SID, Magiran, Irandoc, Pubmed, Scopus, <a href="http://www.cochranelibrary.com/">Cochrane Library</a>, and Psych info; Cumulative Index to Nursing and Allied Health Literature (CINAHL). Also, lists of the references of the relevant articles were reviewed for additional citations. Using Medical Subject Headings (MESH) keywords: Intervention (Clinical Trials, Non-Randomized Controlled Trials, Randomized Controlled Trials, Education), intimacy, marital (Marriage) and selected related articles to the study objective were from 1995 to April 2015. Clinical trials that evaluated one or more behavioral interventions to improve marital intimacy were reviewed in the study.</p><p><strong>MAIN RESULTS:</strong> 39 trials met the inclusion criteria. Eleven interventions had follow-up, and 28 interventions lacked follow-up. The quality evidence for 22 interventions was low, for 15 interventions moderate, and for one intervention was considered high. Findings from studies were categorized in 11 categories as the intimacy promoting interventions in dimensions of emotional, psychological, physical, sexual, temporal, communicational, social and recreational, aesthetic, spiritual, intellectual intimacy, and total intimacy.</p><p><strong>AUTHORS’ CONCLUSIONS:</strong> Improving and promoting communication, problem solving, self-disclosure and empathic response skills and sexual education and counseling in the form of cognitive-behavioral techniques and based on religious and cultural context of each society, an effective step can be taken to enhance marital intimacy and strengthen family bonds and stability. Health care providers should consider which interventions are appropriate to the couple characteristics and their relationships.</p>

scholarly journals Are Surgical Patients Satisfied With Remote Consultations? A Comparison of Remote Versus Conventional Outpatient Clinic Follow-Up for Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
pp. 237437352110359
Author(s):  
Emily V Oates ◽  
Grace H C Lim ◽  
Edward J Nevins ◽  
Venkatesh Kanakala
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Cochrane Library ◽  
Surgical Patient ◽  
Controlled Trials ◽  
Analysis Model ◽  
Randomized Controlled ◽  
The Cost

Access to remote appointments (RA) by telephone or video is increasing as technology advances and becomes more available to patients. This meta-analysis of randomized controlled trials (RCTs) aims to discover whether surgical patients are satisfied with RAs when compared with conventional outpatient clinics (OPC). A literature search of RCTs of surgical patient satisfaction of RAs versus OPC appointments was performed. The PubMed, EMBASE, OVID, Cochrane Library, and Google Scholar databases were searched to include articles from January 2000 to 2020. A random-effects meta-analysis model was used to compare outcomes. All 7 RCTs showed that patients were as satisfied with RAs as OPC appointments (RR = 1.00, [0.98-1.02]; P = .73). Furthermore, both patient cohorts would prefer RAs for future follow-up (RR = 2.29, [1.96-2.97]; P < .00001). One RCT found the cost to institutions was less in the RA group ($19.05 vs $52.76) and another found the patients would save $9.96 on transportation costs. The majority of RCTs suggested cost to patients and or institutions would be less for RA. In conclusion, surgical patients are satisfied with RAs and in fact would prefer them.

scholarly journals PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials

Cartilage ◽  
2020 ◽  
pp. 194760352093117 ◽  
Author(s):  
Giuseppe Filardo ◽  
Davide Previtali ◽  
Francesca Napoli ◽  
Christian Candrian ◽  
Stefano Zaffagnini ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Randomized Controlled Trials ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Clinically Significant

Objective To evaluate effectiveness, in terms of patient-reported outcome measures, of platelet-rich plasma (PRP) injections for knee osteoarthritis compared to placebo and other intraarticular treatments. Design PubMed, Cochrane Library, Scopus, Embase, Web of Science, as well as the gray literature were searched on January 17, 2020. Randomized controlled trials (RCTs) comparing PRP injections with placebo or other injectable treatments, in any language, on humans, were included. Risk of bias was assessed following the Cochrane guidelines; quality of evidence was graded using the GRADE guidelines. Results Thirty-four RCTs, including 1403 knees in PRP groups and 1426 in control groups, were selected. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score favored PRP, with a statistically and clinically significant difference versus placebo at 12-month follow-up ( P = 0.02) and versus HA (hyaluronic acid) at 6-month ( P < 0.001) and 12-month ( P < 0.001) follow-ups. A clinically significant difference favoring PRP versus steroids was documented for VAS (Visual Analogue Scale) pain ( P < 0.001), KOOS (Knee Injury and Osteoarthritis Outcome Score) pain ( P < 0.001), function in daily activities ( P = 0.001), and quality of life ( P < 0.001) at 6-month follow-up. However, superiority of PRP did not reach the minimal clinically important difference for all outcomes, and quality of evidence was low. Conclusions The effect of platelet concentrates goes beyond its mere placebo effect, and PRP injections provide better results than other injectable options. This benefit increases over time, being not significant at earlier follow-ups but becoming clinically significant after 6 to 12 months. However, although substantial, the improvement remains partial and supported by low level of evidence. This finding urges further research to confirm benefits and identify the best formulation and indications for PRP injections in knee OA.

scholarly journals Benefits of esmolol in sepsis and septic shock in adults: a meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Chun Chen ◽  
Jing Zhang ◽  
Zemei Zhou
Keyword(s):  
Heart Rate ◽  
Septic Shock ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Volume Index ◽  
Current Evidence ◽  
Controlled Trials ◽  
Central Venous ◽  
Randomized Controlled ◽  
Sepsis And Septic Shock

Abstract Background Sepsis affects millions of people each year, and brings substantial health and economic burden to the global. Esmolol may have the potential in the treatment of sepsis and septic shock in adults. However, current evidence remains controversial. Methods We systematically searched PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from their inception to September 19, 2020 for randomized controlled trials (RCTs) evaluating the efficacy of esmolol in sepsis and septic shock in adults. A random-effects meta-analysis was performed to combine effect estimates. Two investigators independently screened articles, extracted data, and assessed the quality of included studies. Results Seven RCTs were included with a total of 463 patients with sepsis and/or septic shock. Overall, compared with standard treatment, esmolol significantly decreased 28-day mortality (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.52 to 0.88), and heart rate (standardized mean difference [SMD] -1.83, 95% CI -2.95 to -0.70) and troponin I (TnI) level (SMD − 0.59, 95% CI -1.02 to -0.16) at 24 hours after treatment; no significant effect was found on the length of intensive care unit stay, mean arterial pressure, central venous pressure, central venous oxygen saturation, Stroke Volume Index, tumor necrosis factor-a, interleukin 6, White Blood Cells and PO2/FiO2. Conclusions Esmolol treatment may be safe and effective in decreasing 28-day mortality, controlling heart rate, and preventing myocardial damage, but no evidence of effect on lung injury in sepsis and septic shock after fluid resuscitation early. There were no significant adverse effects on tissue perfusion and oxygen utilization.

Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials

2019 ◽  
Vol 48 (8) ◽  
pp. 2042-2050 ◽  
Author(s):  
Graeme Hoit ◽  
Daniel B. Whelan ◽  
Tim Dwyer ◽  
Prabjit Ajrawat ◽  
Jaskarndip Chahal
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Outcome Measures ◽  
Femoroacetabular Impingement ◽  
Meta Analysis ◽  
Hip Pain ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Background: Femoroacetabular impingement is a common and debilitating source of hip pain in young adults. Although physiotherapy is used as a mainstay of nonoperative care for femoroacetabular impingement, the evidence regarding different physiotherapy practices is poorly understood. Purpose: To collect and synthesize the best available evidence and arrive at a summary estimate of treatment effect for the utility of physiotherapy in the management of femoroacetabular impingement. Study Design: Meta-analysis. Methods: A systematic review was performed on February 2, 2019, of PubMed, EMBASE, and Cochrane Library databases using “femoroacetabular impingement OR hip pain” and “physiotherapy OR nonoperative management” and their synonyms as search terms. Central treatment themes were identified across protocols, and pooled analyses were conducted to assess for differences in patient-reported outcome measures across these themes. Results: A total of 5 randomized controlled trials met our inclusion criteria. The studies included 124 patients with a mean age of 35 years, of whom 24% were male. The average follow-up was 9.4 weeks (range, 6-12 weeks), and the follow-up rate across all participants was 86%. Among these 5 studies, 4 studies used a physiotherapy protocol that focused on core strengthening versus no core strengthening, 4 studies compared active strengthening versus passive modalities, and 3 studies compared supervised versus unsupervised physiotherapy. Pooled analysis across all studies demonstrated improved outcomes in the treatment groups compared with the controls (standardized mean difference [SMD], 0.76; 95% CI, 0.38-1.13; P < .0001). Core strengthening (SMD, 0.82; 95% CI, 0.39-1.26; P = .0002), active physiotherapy (SMD, 0.70; 95% CI, 0.29-1.10; P = .0008), and supervised physiotherapy (SMD, 0.58; 95% CI, 0.14-1.03; P = .01) were found to result in statistically significant improvements in functional outcomes compared with no core strengthening, passive modalities, and unsupervised care, respectively. Conclusion: Supervised physiotherapy programs focusing on active strengthening and core strengthening are more effective than unsupervised, passive, and non–core focused programs. Future studies with longer term follow-up and validated femoroacetabular impingement specific outcome measures are required to determine prognostic factors for success with nonoperative care as well as to determine the ideal patient profile and structured rehabilitation protocol.

scholarly journals Does Minimizing Ventricular Pacing Reduce the Incidence of Atrial Fibrillation? A Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Vol 5 (1) ◽  
pp. 1-7
Author(s):  
Ishan Lakhani ◽  
Mengqi Gong ◽  
Cheuk Wai Wong ◽  
George Bazoukis ◽  
Konstantinos P. Letsas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Randomized Controlled

Background: Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fibrillation (AF). However, whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial. Therefore, we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods: The PubMed, Embase, and Cochrane Library databases were searched up to August 1, 2017, for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results: Eleven studies comprising 5705 participants (61% males, mean age 71 years [standard deviation 11 years]) were finally included in the analysis. The mean follow-up duration was 24 months. Use of algorithms for minimizing ventricular pacing significantly reduced the incidence of AF, with an odds ratio of 0.74 (95% confidence interval 0.55‐1.00; P<0.05). There was moderate heterogeneity among studies (I2=63%).Conclusions: The incidence of AF was reduced by 26% with use of algorithms for minimizing ventricular pacing. The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.

Recent Updates in the Pharmacological Management of Sepsis and Septic Shock: A Systematic Review Focused on Fluid Resuscitation, Vasopressors, and Corticosteroids

2018 ◽  
Vol 53 (4) ◽  
pp. 385-395 ◽  
Author(s):  
John M. Allen ◽  
Carinda Feild ◽  
Bethany R. Shoulders ◽  
Stacy A. Voils
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Randomized Controlled Trials ◽  
Fluid Resuscitation ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Recent Developments ◽  
Sepsis And Septic Shock

Objective: Describe recent developments in the pharmacological management of sepsis and septic shock, focusing on fluid resuscitation, vasopressors, and corticosteroids. Data Sources: A literature search limited to randomized controlled trials written in the English language reporting mortality and other clinically relevant outcomes that were published from July 1, 2016, to August 31, 2018, in patients aged ≥ 18 years. Titles and abstracts were reviewed for relevance. References for pertinent review articles were also reviewed. Study Selection and Data Extraction: Relevant randomized controlled trials conducted in patients meeting the pre-defined inclusion criteria were considered for inclusion. Data Synthesis: From an initial search that identified 147 studies, 14 original research studies met inclusion criteria and were included in this review. Risk of bias (ROB) was assessed using the Revised Cochrane ROB assessment tool, with most included studies having a low ROB. Relevance to Patient Care and Clinical Practice: Sepsis and septic shock pose a significant burden on public health. Despite advances in our understanding of sepsis, mortality remains unacceptably high. Recent developments in the pharmacological management of septic shock have focused on determining optimal composition and dosage of fluid resuscitation, enhanced use of vasopressor therapy, and clarifying the role of corticosteroids. This systematic review will provide recommendations for application to practice focusing on recent research on these topics. Conclusions: Although recent developments in the pharmacological management of sepsis are encouraging, clinicians must be keen to utilize patient-specific factors to guide therapy and continue to strive to address the remaining unanswered questions.

scholarly journals Effect of Biocompatible Peritoneal Dialysis Solution on Residual Renal Function: A Systematic Review of Randomized Controlled Trials

2014 ◽  
Vol 34 (7) ◽  
pp. 724-731 ◽  
Author(s):  
Eun-Young Seo ◽  
Sook Hee An ◽  
Jang-Hee Cho ◽  
Hae Sun Suh ◽  
Sun-Hee Park ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Randomized Controlled Trials ◽  
Residual Renal Function ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference

Introduction Residual renal function (RRF) plays an important role in outcome of peritoneal dialysis (PD) including mortality. It is, therefore, important to provide a strategy for the preservation of RRF. The objective of this study was to evaluate relative protective effects of new glucose-based multicompartmental PD solution (PDS), which is well known to be more biocompatible than glucose-based conventional PDS, on RRF compared to conventional PDS by performing a systematic review (SR) of randomized controlled trials. Methods We searched studies presented up to January 2014 in MEDLINE, EMBASE, the COCHRANE library, and local databases. Three independent reviewers reviewed and extracted prespecified data from each study. The random effects model, a more conservative analysis model, was used to combine trials and to perform stratified analyses based on the duration of follow-up. Study quality was assessed using the Cochrane Handbook for risk of bias. Eleven articles with 1,034 patients were identified for the SR. Results The heterogeneity of the studies under 12 months was very high, and the heterogeneity decreased substantially when we stratified studies by the duration of follow-up. The mean difference of the studies after 12 months was 0.46 mL/min/1.73 m2 (95% confidence interval = 0.25 to + 0.67). Conclusion New PDS showed the effect to preserve and improve RRF for long-term use compared to conventional PDS, even though it did not show a significant difference to preserve RRF for short-term use.

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