Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis

Trauma is one of the leading causes of uncontrolled haemorrhage, death, and disability. Use of a tourniquet can be considered an optimal anti-haemorrhagic resource, in pre-hospital and emergency settings, and its lifesaving effect is clinically contradictory. This review aims to assess the clinical efficacy of the tourniquet in the emergency pre-hospital care setting for the management of haemorrhage. We conducted the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA statement. We searched the following electronic databases: EMBASE, MEDLINE, and Cochrane-CENTRAL. All studies included were appraised for risk of bias. Prevalent primary outcomes were mortality and use of blood products. Secondary outcomes were related to adverse effects. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Four studies were involved (1762 trauma patients). The adjusted odds ratio (aOR) of 0.47 (95% confidence Interval (CI) 0.19–1.16; three studies; 377 patients) for overall mortality estimates did not give a clear indication of the benefits of emergency pre-hospital tourniquets (PH-TQ) versus no pre-hospital tourniquet (NO PH-TQ) placement. The adjusted mean difference for blood product use was −3.28 (95% CI −11.22, 4.66) for packed red blood cells (pRBC) and −4.80 (95% CI −5.61, −3.99) for plasma, respectively. The certainty of evidence was downgraded to very low for all outcomes. Our results suggest an unclear effect of emergency pre-hospital tourniquet placement on overall mortality and blood product use. However, this systematic review highlights the availability of only observational studies and the absence of high quality RCTs assessing the efficacy of PH-TQs. Randomized controlled trials are needed.

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Association between vision impairment and mortality: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-037556 ◽

2020 ◽

Vol 10 (6) ◽

pp. e037556

Author(s):

Joshua R Ehrlich ◽

Jacqueline Ramke ◽

David Macleod ◽

Bonnielin K Swenor ◽

Helen Burn ◽

...

Keyword(s):

Systematic Review ◽

Global Health ◽

Data Extraction ◽

Meta Analysis ◽

Risk Of Bias ◽

Vision Impairment ◽

Published Data ◽

Assessment Development ◽

Evaluation Approach ◽

Meta Analyses

IntroductionDue to growth and ageing of the world’s population, the number of individuals worldwide with vision impairment (VI) and blindness is projected to increase rapidly over the coming decades. VI and blindness are an important cause of years lived with disability. However, the association of VI and blindness with mortality, including the risk of bias in published studies and certainty of the evidence, has not been adequately studied in an up-to-date systematic review and meta-analysis.Methods and analysisThe planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases, including MEDLINE Ovid, Embase Ovid and Global Health, will be searched for relevant studies. Two reviewers will then screen studies and review full texts to identify studies for inclusion. Data extraction will be performed, and for included studies, the risk of bias and certainty of the evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. The prognostic factor in this study is visual function, which must have been measured using a standard objective ophthalmic clinical or research instrument. We will use standard criteria from WHO to categorise VI and blindness. All-cause mortality may be assessed by any method one or more years after baseline assessment of vision. Results from included studies will be meta-analysed according to relevant sections of the Meta-analysis Of Observational Studies in Epidemiology checklist.Ethics and disseminationThis review will only include published data; therefore, ethics approval will not be sought. The findings of this review and meta-analysis will be published in an open-access, peer-reviewed journal and will be included in the ongoing Lancet Global Health Commission on Global Eye Health.

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Effect of postoperative coffee consumption on postoperative ileus after abdominal surgery: An updated systematic review and meta-analysis (protocol) v1

10.17504/protocols.io.bymmpu46 ◽

2021 ◽

Author(s):

Jun Watanabe ◽

Atsushi Miki ◽

Kazuhiko Kotani ◽

Naohiro Sata

Keyword(s):

Systematic Review ◽

Abdominal Surgery ◽

Postoperative Ileus ◽

Meta Analysis ◽

Coffee Consumption ◽

Random Effects Models ◽

Assessment Development ◽

Evaluation Approach ◽

Meta Analyses ◽

Analysis Protocol

Introduction: Coffee, a popular and cheap beverage worldwide, may have an important effect on postoperative ileus (POI). However, previous systematic reviews have not clarified whether the effect is due to caffeine or coffee itself, or shortening hospital stay. We will aim to assess the effect of postoperative coffee consumption on POI. Methods: Studies evaluating the effect of postoperative coffee consumption will be searched using the electronic databases and the trial registries. Meta-analyses will be performed using random-effects models. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to assess the certainty of evidence.

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Comparing the Effects of Docosahexaenoic and Eicosapentaenoic Acids on Inflammation Markers Using Pairwise and Network Meta-Analyses of Randomized Controlled Trials

Advances in Nutrition ◽

10.1093/advances/nmaa086 ◽

2020 ◽

Author(s):

Cécile Vors ◽

Janie Allaire ◽

Sonia Blanco Mejia ◽

Tauseef A Khan ◽

John L Sievenpiper ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Eligibility Criteria ◽

Necrosis Factor Alpha ◽

Assessment Development ◽

Evaluation Approach ◽

Tnf Α ◽

Mean Differences ◽

Meta Analyses

ABSTRACT Recent data from randomized clinical trials (RCTs) suggest that DHA may have stronger anti-inflammatory effects than EPA. This body of evidence has not yet been quantitatively reviewed. The aim of this study was to compare the effect of DHA and EPA on several markers of systemic inflammation by pairwise and network meta-analyses of RCTs. MEDLINE, EMBASE, and The Cochrane Library were searched through to September 2019. We included RCTs of ≥7 d on adults regardless of health status that directly compared the effects of DHA with EPA and RCTs of indirect comparisons, in which the effects of DHA or EPA were compared individually to a control fatty acid. Differences in circulating concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and adiponectin were the primary outcome measures. Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic) in the pairwise meta-analysis. Inconsistency and transitivity were evaluated in the network meta-analysis. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Eligibility criteria were met by 5 RCTs (N = 411) for the pairwise meta-analysis and 20 RCTs (N = 1231) for the network meta-analysis. In the pairwise meta-analysis, DHA and EPA had similar effects on plasma CRP [MDDHA versus EPA = 0.14 mg/L (95% CI: –0.57, 0.85); I2 = 61%], IL-6 [MDDHA versus EPA = 0.10 pg/mL (–0.15, 0.34); I2 = 40%], and TNF-α [MDDHA versus EPA = –0.10 pg/mL (–0.37, 0.18); I2 = 40%]. In the network meta-analysis, the effects of DHA and EPA on plasma CRP [MDDHA versus EPA = –0.33 mg/L (–0.75, 0.10)], IL-6 [MDDHA versus EPA = 0.09 pg/mL (–0.12, 0.30)], and TNF-α [MDDHA versus EPA = –0.02 pg/mL (–0.25, 0.20)] were also similar. DHA and EPA had similar effects on plasma adiponectin in the network meta-analysis. Results from pairwise and network meta-analyses suggest that supplementation with either DHA or EPA does not differentially modify systemic markers of subclinical inflammation.

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Effectiveness of trauma centers verification: Protocol for a systematic review

Systematic Reviews ◽

10.1186/s13643-019-1239-6 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 3

Author(s):

Brice Batomen ◽

Lynne Moore ◽

Mabel Carabali ◽

Pier-Alexandre Tardif ◽

Howard Champion ◽

...

Keyword(s):

Systematic Review ◽

Trauma Center ◽

Assessment Tool ◽

Meta Analysis ◽

The Body ◽

World Health ◽

Trauma Patients ◽

Assessment Development ◽

Health Organization

Abstract Background The implementation of trauma systems in many high-income countries over the last 50 years has led to important reductions in injury mortality and disability in many healthcare jurisdictions. Injury organizations including the American College of Surgeons and the Trauma Association of Canada as well as the World Health Organization provide consensus-based recommendations on resources and processes for optimal injury care. Many hospitals treating trauma patients seek verification to demonstrate that they meet these recommendations. This process may be labeled differently across jurisdictions. In Canada for example, it is called accreditation, but it has the same objective and very similar modalities. The objective of the study described in this protocol is to systematically review evidence on the effectiveness of trauma center verification for improving clinical processes and patient outcomes in injury care. Methods We will perform a systematic review of studies evaluating the association between trauma center verification and hospital mortality (primary outcome), as well as morbidity, resource utilization, and processes of care (secondary outcomes). We will search CINAHL, EMBASE, HealthStar, MEDLINE, and ProQuest databases, as well as key injury organization websites for gray literature. We will assess the methodological quality of studies using the Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I) assessment tool. We are planning to conduct a meta-analysis if feasible based on the number of included studies and their heterogeneity. We will evaluate the quality of cumulative evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group methodology. Discussion This review will provide a synthesis of the body of evidence on trauma center verification effectiveness. Results could reinforce current verification modalities and may suggest ways to optimize them. Results will be published in a peer-reviewed journal and presented at an international clinical conference. Systematic review registration PROSPERO CRD42018107083.

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Mortality rate and predictors of Stroke: A Meta-Analysis and Systematic Review

10.21203/rs.2.16369/v1 ◽

2019 ◽

Author(s):

Amanual Getnet Mersha ◽

Tadesse Melaku Abegaz ◽

Mohammed Assen Seid ◽

Eyob Alemayehu Gebreyohannes ◽

Akshaya Srikanth Bhagavath ◽

...

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Observational Studies ◽

Meta Analysis ◽

Random Effect ◽

Stroke Mortality ◽

Stroke Event ◽

Meta Analyses ◽

Random Effect Models ◽

Overall Mortality

Abstract Background Global data on stroke mortality remained to be sparse. In light of this, we aimed to conduct a Meta-analysis and systematic review of observational studies to estimate the mortality of stroke and to identify risk factors that predispose patients for stroke-related death.Methods This study was conducted based on the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. Overall mortality, in-hospital and 30- day mortality due to stroke were the primary outcome measures of the study. The meta-analysis was performed using Stata (Version 14, Stata Corp, College Station, Texas). Random-effect models were used for estimating pooled effects.Findings Overall, thirty two studies assessed overall mortality due to stroke. A total number of 2,885, 126 patients were recruited for the study. Pooled estimate indicated that the overall mortality of stroke was reported to be 20% (19%-22%). Whereas, the 30-day and In-hospital mortality were found to be 18% (16%-20%) and 16% (16%-19%), respectively. A subgroup analysis revealed that Africa registered the highest stroke-related death 29% (23%-36%). Hypertension was found to be an important risk factor for mortality secondary to stroke 61.9% (52.8%-71.1%).Conclusion Overall mortality of stroke was estimated to be twenty percent. The burden of stroke mortality was prominent in Africa region. Hypertension remained to be an independent risk factor for stroke mortality. Mortality of stroke can be minimized by establishing stroke centers that promptly deliver emergency management of stroke event.

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Parent–Infant Interventions to Promote Parental Sensitivity During NICU Hospitalization: Systematic Review and Meta-Analysis

Journal of Early Intervention ◽

10.1177/1053815121991928 ◽

2021 ◽

pp. 105381512199192

Author(s):

Andréane Lavallée ◽

Gwenaëlle De Clifford-Faugère ◽

Ariane Ballard ◽

Marilyn Aita

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Standard Care ◽

Assessment Tool ◽

Meta Analysis ◽

Risk Of Bias ◽

Parental Sensitivity ◽

Assessment Development ◽

Implementation Failure ◽

Meta Analyses

This systematic review and meta-analysis examined the effectiveness of parent–infant interventions for parents of preterm infants on parental sensitivity compared to standard care or active comparators. This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration ID: CRD42016047083). Database searches were performed from inception to 2020 to identify eligible randomized controlled trials. Two review authors independently selected studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias assessment tool and quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) guidelines. A total of 19 studies ( n = 2,111 participants) were included and 14 were suitable to be pooled in our primary outcome meta-analysis. Results show no significant effect of parent–infant interventions over standard care or basic educational programs, on parental sensitivity. Results may not necessarily be due to the ineffectiveness of the interventions but rather due to implementation failure or high risk of bias of included studies.

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Impact and use of reviews and ‘overviews of reviews’ to inform clinical practice guideline recommendations: protocol for a methods study

BMJ Open ◽

10.1136/bmjopen-2019-031442 ◽

2020 ◽

Vol 10 (1) ◽

pp. e031442

Author(s):

Carole Lunny ◽

Cynthia Ramasubbu ◽

Savannah Gerrish ◽

Tracy Liu ◽

Douglas M Salzwedel ◽

...

Keyword(s):

Clinical Practice ◽

Systematic Reviews ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Data Extraction ◽

Meta Analysis ◽

Assessment Development ◽

Evaluation Approach ◽

Meta Analyses ◽

The Impact

IntroductionGuidelines are systematically developed recommendations to assist practitioner and patient decisions about treatments for clinical conditions. High quality and comprehensive systematic reviews and ‘overviews of systematic reviews’ (overviews) represent the best available evidence. Many guideline developers, such as the WHO and the Australian National Health and Medical Research Council, recommend the use of these research syntheses to underpin guideline recommendations. We aim to evaluate the impact and use of systematic reviews with and without pairwise meta-analysis or network meta-analyses (NMAs) and overviews in clinical practice guideline (CPG) recommendations.Methods and analysisCPGs will be retrieved from Turning Research Into Practice and Epistemonikos (2017–2018). The retrieved citations will be sorted randomly and then screened sequentially by two independent reviewers until 50 CPGs have been identified. We will include CPGs that provide at least two explicit recommendations for the management of any clinical condition. We will assess whether reviews or overviews were cited in a recommendation as part of the development process for guidelines. Data extraction will be done independently by two authors and compared. We will assess the risk of bias by examining how each guideline developed clinical recommendations. We will calculate the number and frequency of citations of reviews with or without pairwise meta-analysis, reviews with NMAs and overviews, and whether they were systematically or non-systematically developed. Results will be described, tabulated and categorised based on review type (reviews or overviews). CPGs reporting the use of the Grading of Recommendations, Assessment, Development and Evaluation approach will be compared with those using a different system, and pharmacological versus non-pharmacological CPGs will be compared.Ethics and disseminationNo ethics approval is required. We will present at the Cochrane Colloquium and the Guidelines International Network conference.

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Does pain influence force steadiness? A protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-042525 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042525

Author(s):

Michail Arvanitidis ◽

Deborah Falla ◽

Andy Sanderson ◽

Eduardo Martinez-Valdes

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Meta Analysis ◽

Grey Literature ◽

Force Steadiness ◽

Assessment Development ◽

Ethical Approval ◽

Registration Number ◽

Meta Analyses

IntroductionPerforming contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of experimental or clinical musculoskeletal pain on force steadiness but with conflicting findings. The aim of this systematic review is to summarise the current literature to determine whether pain, whether it be clinical or experimental, influences force steadiness.Methods and analysisThis protocol for a systematic review was informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Handbook for Systematic Reviews of Interventions. Key databases will be searched from inception to 31 August 2020, including MEDLINE, EMBASE, PubMed, CINAHL Plus, ZETOC and Web of Science. Grey literature and key journals will be also reviewed. Risk of bias will be assessed with the Newcastle-Ottawa tool, and the quality of the cumulative evidence assessed with the Grading of Recommendations, Assessment, Development and Evaluation guidelines. If homogeneity exists between groups of studies, meta-analysis will be conducted. Otherwise, a narrative synthesis approach and a vote-counting method will be used, while the results will be presented as net increases or decreases of force steadiness.Ethics and disseminationThe findings will be presented at conferences and the review will be also submitted for publication in a refereed journal. No ethical approval was required.PROSPERO registration numberCRD42020196479

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Association of sociodemographic factors with the prescription pattern of opioids for dental patients: A systematic review protocol

PLoS ONE ◽

10.1371/journal.pone.0255743 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255743

Author(s):

Alex Junio Silva Cruz ◽

Lucas Guimarães Abreu ◽

Suellen da Rocha Mendes ◽

Lia Silva de Castilho ◽

Mauro Henrique Nogueira Guimarães de Abreu

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Sociodemographic Factors ◽

Cross Sectional ◽

Opioid Prescription ◽

Prescription Pattern ◽

Assessment Development ◽

Dental Patients ◽

Evaluation Approach

Introduction Oral health practitioners are responsible for a significant share of opioid prescriptions that seem to be influenced by many aspects, including sociodemographic factors. However, there is no consensus on the factors associated with opioid prescription in Dentistry. Objective To identify whether patients’ sociodemographic factors are associated with the prescription pattern of opioids in Dentistry. Materials and methods This systematic review will include observational studies (cross-sectional, case-control, and cohort). Electronic searches will be conducted in MEDLINE (PubMed), EMBASE, Scopus, Web of science, LILACS, SciELO, and Google Scholar. Grey literature will also be consulted. Two independent reviewers will screen all retrieved articles for eligibility, extract data, and assess the methodological quality of the included studies. The results will be presented as a narrative synthesis and, where possible, a meta-analysis will be conducted. Certainty of the evidence will be assessed with the Grading of Recommendations, Assessment, Development, and Evaluation approach. Systematic review registration number PROSPERO CRD42020211226.

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Is There Association Between Stress and Bruxism? A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2020.590779 ◽

2020 ◽

Vol 11 ◽

Author(s):

Victória dos Santos Chemelo ◽

Yago Gecy de Sousa Né ◽

Deborah Ribeiro Frazão ◽

Renata Duarte de Souza-Rodrigues ◽

Nathalia Carolina Fernandes Fagundes ◽

...

Keyword(s):

Systematic Review ◽

Quantitative Analysis ◽

Meta Analysis ◽

Fixed Effect Model ◽

Risk Of Bias ◽

Cross Sectional ◽

Assessment Development ◽

Effect Model ◽

Two Factors ◽

Meta Analyses

This systematic review and meta-analysis aimed to investigate a possible association between stress and bruxism in humans. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines under the code CRD42020188862, and the searches were performed on the following databases: PubMed, Scopus, Web of Science, Cochrane, LILACS, OpenGrey, and Google Scholar. This systematic review evaluated observational studies in adult humans with and without stress to verify the association between bruxism and the presence of stress. The risk of bias was evaluated through the Joanna Briggs Institute Critical Appraisal Tools for Analytical Cross-Sectional Studies. In quantitative analysis, the Odds Ratio (OR) and their 95% confidence interval (CI) were calculated through a fixed-effect model. Furthermore, a summary of the overall strength of evidence was presented using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). A total of 1,458 studies were identified, and six were included in this systematic review. Two studies included were classified with a low risk of bias, and the others were classified with a moderate risk of bias. In three articles, a meta-analysis was performed and showed an association between these two factors (OR 2.07 [1.51, 2.83], p < 0.00001, I2 = 45%). Besides that, a low certainty of the evidence was detected among this association. Stressed individuals show a higher chance of presenting bruxism when compared to healthy individuals. Despite the low heterogeneity found in the quantitative analysis among the articles reporting an association between stress and bruxism, further studies with similar methods are necessary to understand this relationship better.

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