scholarly journals Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

2018 ◽  
Vol 68 (674) ◽  
pp. e594-e603 ◽  
Author(s):  
Claire Friedemann Smith ◽  
Alice C Tompson ◽  
Nicholas Jones ◽  
Josh Brewin ◽  
Elizabeth A Spencer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Poor Quality ◽  
Study Data ◽  
Direct Access ◽  
Cochrane Library ◽  
Testing Time ◽  
Significant Difference ◽  
The Uk ◽  
The Cochrane Library ◽  
Better Than

BackgroundDirect access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay.AimTo establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations.Design and settingSystematic review assessing the effectiveness of GP DA testing in adults.MethodMEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively.ResultsThe authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high.ConclusionGP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.

scholarly journals SURG-16. SUPRATOTAL VERSUS GROSS TOTAL RESECTION OF GLIOBLASTOMA: A SYSTEMATIC REVIEW

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi243-vi243
Author(s):  
Christina Jackson ◽  
John Choi ◽  
Carrie Price ◽  
Chetan Bettegowda ◽  
Michael Lim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Gross Total Resection ◽  
Cochrane Library ◽  
Study Quality ◽  
Total Resection ◽  
Significant Difference ◽  
Definition Of ◽  
Supratotal Resection ◽  
The Cochrane Library

Abstract INTRODUCTION Due to the infiltrative nature of glioblastoma(GBM) outside of the contrast enhancing region in the peritumoral zone, there is increasing movement to perform supratotal resections (SpTR) by extending the edge of resection beyond the contrast enhancing portion of the tumor. However, there is currently no consensus on the potential survival benefit of SpTR in GBM as compared to gross total resection (GTR). METHODS Therefore, we performed a systematic review using PRISMA guidelines and performed a comprehensive literature search on Pubmed, EMBASE, The Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov, from inception to August 16, 2018, to identify articles comparing overall survival (OS) after SpTR versus GTR. Furthermore, we assessed study quality using the Oxford Centre for Evidence-Based Medicine guidelines. RESULTS We identified 8902 unique citations, of which 11 articles and 2 abstracts met study inclusion criteria. 925 patients underwent SpTR out of a total of 2137 patients. 9 of the 13 studies demonstrated improved survival with SpTR compared to GTR (median improvement in OS of 10.5 months), with no significant difference in post-operative complication rate. Conversely, one abstract found worsened outcomes with SpTR compared to GTR (median decrease in OS of 4 months). However, overall study quality was poor, with 12 of the 13 studies of level IV evidence and one study of level IIIb evidence. We were unable to perform a meta-analysis due to significant clinical and methodological heterogeneity amongst the studies (e.g. differences in adjuvant therapy and lack of standardization of definition of supratotal resection). CONCLUSIONS Our systematic review indicates that SpTR may be associated with improved OS compared to GTR for GBM. However, this is limited by poor study quality and significant clinical and methodological heterogeneity amongst the studies. There is need for prospective clinical trials to further establish standardized guidelines for SpTR in GBM.

Should the duration of head bandaging be reduced after pinnaplasty? A systematic review

2014 ◽  
Vol 128 (11) ◽  
pp. 948-951 ◽  
Author(s):  
A E L McMurran ◽  
I Khan ◽  
S Mohamad ◽  
M Shakeel ◽  
H Kubba
Keyword(s):  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Case Series ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
National Library ◽  
Significant Difference ◽  
Randomised Controlled ◽  
The Cochrane Library

AbstractBackground:It is common practice to use head bandages for 7–10 days following pinnaplasty. However, head bandages are often troublesome for patients and can lead to serious complications.Method:A systematic review was performed to evaluate the use of head bandages after pinnaplasty. A search of Medline, Embase (Ovid) and CINAHL (EBSCO collections), the Cochrane Library, Pubmed (US National Library of Medicine) and Google Scholar identified 34 related articles. Of these, 14 were deemed relevant and 2 randomised controlled trials, 1 cohort study, 3 case series and 1 literature review met the inclusion criteria.Results:The two randomised controlled trials show no statistically significant difference in complications when a head bandage was used for the standard 7–10 days, for 24 hours or not at all. The three case series show that using a head bandage for 24 hours or not at all are safe alternatives. The review article recommended that when head bandages are applied after pinnaplasty it should be for the shortest duration possible.Conclusion:Based on the available evidence, not using a head bandage at all or using one for a maximum of 24 hours following pinnaplasty is recommended.

The effects of fennel on menstrual bleeding: A systematic review and meta-analysis

2018 ◽  
Vol 15 (3) ◽  
Author(s):  
Nafiseh Ghassab Abdollahi ◽  
Mojgan Mirghafourvand ◽  
Sanaz Mollazadeh
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Intervention Group ◽  
Poor Quality ◽  
Mean Difference ◽  
Menstrual Bleeding ◽  
Cochrane Library ◽  
Foeniculum Vulgare ◽  
Mesh Terms ◽  
Significant Difference

Abstract Introduction Fennel has many medicinal properties and is used in the treatment of dysmenorrhea. Given the widespread use of herbal medicine among women for menstrual problems and considering the fact that there has been no study to date about the effect of fennel on menstrual bleeding and duration of menstrual bleeding through systematic review, the present study was conducted to determine the effect of fennel on the amount (primary outcome) and duration of menstrual bleeding and its side-effects (secondary outcomes). Materials All articles, including Persian and English, with no time limit were searched for in the following databases: Medline (through PubMed), Scopus, EMBASE (through Ovid), Cochrane Library, Web of Sciences, Google Scholar, ProQuest, Clininaltrial.gov, SID, Magiran, Irandoc, and Iranmedex, using MeSH terms, including menstrual bleeding, menstruation, severity of bleeding, hypermenorrhea, menorrhagia, fennel, fennelin, Foeniculum vulgare, dysmenorrhea, and painful menstruation, which were searched separately or in combination. Two authors separately reviewed articles to determine the inclusion criteria, and any disagreement was resolved by reaching consensus with a third person. Results A total of 7993 articles were identified through searching the databases, of which 7327 were excluded as duplicates and 666 were screened for inclusion. Six hundread and forty six were excluded by title and abstract based on not being relevant to the review and being conducted on animals. Eventually, six articles were included in the study and four articles entered into the meta-analysis. The results from meta-analysis showed that using fennel caused a significant increase in mean menstrual bleeding in the first cycle after treatment in the intervention group compared to the control (Std. mean difference: 0.46; 95 % CI: 0.18–0.73; p = 0.001; I2 = 9 %). However, it had no significant effect on menstrual bleeding in the second cycle after treatment (Mean difference: 1.44; 95 % CI:-5.09 to 7.96; p = 0.67; I2 = 0 %). Conclusions The results of meta-analysis of four articles showed that in the first cycle after treatment, use of fennel increased menstrual bleeding in the intervention group compared to the control, but meta-analysis of two articles showed no significant difference between intervention and control groups in the amount of menstrual bleeding in the second cycle after treatment. Given the poor quality of articles, conducting clinical trials to determine the effect of fennel on menstrual bleeding appears necessary.

scholarly journals Drug treatments affecting ACE2 in COVID-19 infection: a systematic review protocol

2020 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Ali Albasri ◽  
Sam Hodgson ◽  
Chris Wilcox ◽  
Nazrul Islam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Animal Studies ◽  
Drug Exposure ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Susceptible Population ◽  
Drug Treatments ◽  
Review Protocol ◽  
The Uk ◽  
The Cochrane Library

Abstract Background: The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs which up- or down-regulate ACE2 expression are therefore of critical research interest as agents which might promote or reduce risk of COVID-19 infection in a susceptible population. Aim: To review evidence on routinely prescribed drug treatments in the UK that could up- or down-regulate ACE2 and potentially affect COVID-19 infection. Design and setting: Systematic review of studies published in MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science from inception to April 1st 2020. Method: A systematic review will be conducted in line with PRISMA guidelines. Inclusion criteria will be: i) assess effect of drug exposure on ACE2 level; ii) drug is included in British National Formulary (BNF) and therefore available to prescribe in UK; iii) a control, placebo or sham group is included as comparator. Exclusion criteria will be: i) ACE2 measurement in utero; ii) ACE2 measurement in children under 18 years; iii) drug not in BNF; iv) review article. Quality will be assessed using the Cochrane risk of bias tool for human studies, and the SYRCLE risk of bias tool for animal studies. Results: Data will be reported in summary tables and narrative synthesis. Conclusion: This systematic review will identify drug therapies which may increase or decrease ACE2 expression. This might identify medications increasing risk of COVID-19 transmission, or as targets for intervention in mitigating transmission.

scholarly journals Currently prescribed drugs in the UK that could upregulate or downregulate ACE2 in COVID-19 disease: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e040644
Author(s):  
Hajira Dambha-Miller ◽  
Ali Albasri ◽  
Sam Hodgson ◽  
Christopher R Wilcox ◽  
Shareen Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Angiotensin Receptor Blockers ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Channel Blockers ◽  
Human Lungs ◽  
The Uk ◽  
The Cochrane Library ◽  
The Impact

ObjectiveTo review evidence on routinely prescribed drugs in the UK that could upregulate or downregulate ACE2 and potentially affect COVID-19 disease.DesignSystematic review.Data sourceMEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science.Study selectionAny design with animal or human models examining a currently prescribed UK drug compared with a control, placebo or sham group, and reporting an effect on ACE2 level, activity or gene expression.Data extraction and synthesisMEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science and OpenGrey from inception to 1 April 2020. Methodological quality was assessed using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk-of-bias tool for animal studies and Cochrane risk-of-bias tool for human studies.ResultsWe screened 3360 titles and included 112 studies with 21 different drug classes identified as influencing ACE2 activity. Ten studies were in humans and one hundred and two were in animal models None examined ACE2 in human lungs. The most frequently examined drugs were angiotensin receptor blockers (ARBs) (n=55) and ACE inhibitors (ACE-I) (n=22). More studies reported upregulation than downregulation with ACE-I (n=22), ARBs (n=55), insulin (n=8), thiazolidinedione (n=7) aldosterone agonists (n=3), statins (n=5), oestrogens (n=5) calcium channel blockers (n=3) glucagon-like peptide 1 (GLP-1) agonists (n=2) and Non-steroidal anti-inflammatory drugs (NSAIDs) (n=2).ConclusionsThere is an abundance of the academic literature and media reports on the potential of drugs that could attenuate or exacerbate COVID-19 disease. This is leading to trials of repurposed drugs and uncertainty among patients and clinicians concerning continuation or cessation of prescribed medications. Our review indicates that the impact of currently prescribed drugs on ACE2 has been poorly studied in vivo, particularly in human lungs where the SARS-CoV-2 virus appears to enact its pathogenic effects. We found no convincing evidence to justify starting or stopping currently prescribed drugs to influence outcomes of COVID-19 disease.

scholarly journals Is any job better than no job? A systematic review

2021 ◽  
Author(s):  
Sian Price ◽  
Hannah Shaw ◽  
Fiona Morgan ◽  
Rocio Rodriguez-Lopez ◽  
Kirsty Little ◽  
...  
Keyword(s):  
Systematic Review ◽  
Study Design ◽  
Well Being ◽  
Evidence Base ◽  
Significant Difference ◽  
The Uk ◽  
The Impact ◽  
Mental Well Being ◽  
Health And Well Being ◽  
Better Than

Objectives This systematic review addresses the question Is any job better than no job? Specifically, it compares health and well-being outcomes in those who are unemployed with those who are in jobs that could be considered poor or low quality and the impact of any movement between them. Method We conducted a systematic review following a PROSPERO-registered protocol (CRD42020182794). Medline, Embase, PsycINFO, HMIC, ASSIA, TRIP, Google Scholar and 10 websites were searched in April 2020 and again in May 2021 without date limits. Two reviewers working independently screened search results against the inclusion/exclusion criteria. A checklist for quantitative studies reporting correlations was used to critically appraise articles included at full text. We undertook synthesis without meta-analysis (narrative synthesis) and explored a range of variables (for example, study design and quality, type of outcome measure) that we considered might have an impact on the association between exposure and outcome. Results We included 25 studies reported in 30 journal articles. All 25 studies involved secondary analysis of data from national cohorts, including six from the UK. The most frequent outcomes reported were measures of mental well-being. There was considerable heterogeneity across included studies in terms of design, population, definition of poor/bad or low quality job and outcome types and measures. Overall the quality of the included studies was moderate. The evidence base is inconsistent. There are studies that suggested either labour market position might be preferable, but a number of studies found no statistically significant difference. Cohort and case-control studies looking at mental well-being outcomes showed some support for a poor job being better than unemployment. However, we did not find sufficient numbers of well-designed studies showing a strong association to support a causal relationship. Most included study designs were unable to distinguish whether changes in employment status occurred before a change in outcome. Three studies looking at employment transitions found that moving to a poor job from unemployment was not associated with improved mental health, but moving from a poor job to unemployment was associated with a deterioration. Conclusion Evidence that better health and well-being outcomes are more likely to be associated with a poor/bad or low quality job than with unemployment is inconsistent. Studies conducted in the UK suggest that a poor job is not significantly associated with better health and well-being outcomes than unemployment. The studies we identified do not allow us to distinguish whether this lack of association is the result of a state welfare regime preventing some of the worst ills associated with unemployment, or a reflection of job quality. The evidence base has significant limitations in study design and conduct. In summary, the evidence we found suggests it is not safe to assume that, in the UK, any job will lead to better health and well-being outcomes than unemployment.

scholarly journals Currently prescribed drugs in the UK that could up or downregulate ACE2 in COVID-19 disease: A systematic review

2020 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Ali Albasri ◽  
Sam Hodgson ◽  
Christopher R Wilcox ◽  
Shareen Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Angiotensin Converting Enzyme ◽  
Web Of Science ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Converting Enzyme ◽  
Human Lungs ◽  
The Uk ◽  
The Cochrane Library ◽  
The Impact

Objective: To review evidence on routinely prescribed drugs in the UK that could up or downregulate Angiotensin Converting Enzyme 2 (ACE2) and potentially affect COVID-19 disease Design: Systematic review Data source: MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science Study selection: Any design with animal or human models examining a currently prescribed UK drug compared to a control, placebo or sham group, and reporting an effect on ACE2 level, activity or gene expression. Data extraction and synthesis: MEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science and OpenGrey from inception to 1st April 2020. Methodological quality was assessed using the SYRCLE's risk of bias tool for animal studies and Cochrane risk of bias tool for human studies. Results: We screened 3,360 titles and included 112 studies with 21 different drug classes identified as influencing ACE2 activity. Ten studies were in humans and 102 were in animal models None examined ACE2 in human lungs. The most frequently examined drugs were Angiotensin Receptor Blockers (ARBs) (n= 55) and Angiotensin-Converting Enzyme- Inhibitors (ACE-I) (n= 22). More studies reported upregulation than downregulation with ACE-I (n=22), ARBs (n=55), insulin (n=8), thiazolidinedione (n=7) aldosterone agonists (n=3), statins (n=5), oestrogens (n=5) calcium channel-blockers (n=3) GLP-1 agonists (n=2) and NSAIDs (n=2). Conclusions: There is an abundance of academic literature and media reports on the potential of drugs that could attenuate or exacerbate COVID-19 disease. This is leading to trials of repurposed drugs and uncertainty amongst patients and clinicians concerning continuation or cessation of prescribed medications. Our review indicates that the impact of currently prescribed drugs on ACE2 has been poorly studied in-vivo, particularly in human lungs where the SARS-CoV-2 virus appears to enact its pathogenic effects. We found no convincing evidence to justify starting or stopping currently prescribed drugs to influence outcomes of COVID-19 disease.

Effects of the Mat Pilates Method on Body Composition: Systematic Review With Meta-Analysis

2020 ◽  
Vol 17 (6) ◽  
pp. 673-681
Author(s):  
Allysiê Priscilla de Souza Cavina ◽  
Eduardo Pizzo Junior ◽  
Aryane Flauzino Machado ◽  
Taíse Mendes Biral ◽  
Leonardo Kesrouani Lemos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Body Composition ◽  
Healthy Adult ◽  
Meta Analysis ◽  
Abdominal Circumference ◽  
Cochrane Library ◽  
Fat Percentage ◽  
Pilates Method ◽  
The Cochrane Library ◽  
Better Than

Background: The objective of this systematic review was to determine the efficacy of the mat Pilates method on body composition in healthy adult subjects compared with traditional exercise or control condition models. Design: Systematic review with meta-analysis. Data sources: MEDLINE, EMBASE, SPORTDiscus, PEDro, SciELO, CINAHAL, and the Cochrane Library. Results: A total of 10 eligible studies were selected for revision. The findings of this review demonstrated that the mat Pilates method was not more effective than the traditional exercise or control condition models for the analyzed variables (body mass index, lean mass, body fat percentage, and abdominal circumference). Moreover, in the exploratory analysis with older people, adults, and overweight/obese individuals, the mat Pilates method was also not superior for the analyzed outcomes. Conclusion: The findings of this study suggest that the mat Pilates method is no better than the control condition or other types of training to reduce body composition.

scholarly journals Use and reporting of experience-based codesign studies in the healthcare setting: a systematic review

2019 ◽  
Vol 29 (1) ◽  
pp. 64-76 ◽  
Author(s):  
Theresa Green ◽  
Ann Bonner ◽  
Laisa Teleni ◽  
Natalie Bradford ◽  
Louise Purtell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Service ◽  
English Language ◽  
Healthcare Setting ◽  
Cochrane Library ◽  
Service Improvement ◽  
Consistent Manner ◽  
Registration Number ◽  
The Uk ◽  
The Cochrane Library

BackgroundExperience-based codesign (EBCD) is an approach to health service design that engages patients and healthcare staff in partnership to develop and improve health services or pathways of care. The aim of this systematic review was to examine the use (structure, process and outcomes) and reporting of EBCD in health service improvement activities.MethodsElectronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Library) were searched to identify peer-reviewed articles published from database inception to August 2018. Search terms identified peer-reviewed English language qualitative, quantitative and mixed methods studies that underwent independent screening by two authors. Full texts were independently reviewed by two reviewers and data were independently extracted by one reviewer before being checked by a second reviewer. Adherence to the 10 activities embedded within the eight-stage EBCD framework was calculated for each study.ResultsWe identified 20 studies predominantly from the UK and in acute mental health or cancer services. EBCD fidelity ranged from 40% to 100% with only three studies satisfying 100% fidelity.ConclusionEBCD is used predominantly for quality improvement, but has potential to be used for intervention design projects. There is variation in the use of EBCD, with many studies eliminating or modifying some EBCD stages. Moreover, there is no consistency in reporting. In order to evaluate the effect of modifying EBCD or levels of EBCD fidelity, the outcomes of each EBCD phase (ie, touchpoints and improvement activities) should be reported in a consistent manner.Trial registration numberCRD42018105879.

Reproductive outcomes of testicular and ejaculated sperm for ICSI in patients with previous ICSI failures: a systematic review and meta-analysis

2021 ◽  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Case Series ◽  
Cochrane Library ◽  
Sperm Dna Fragmentation ◽  
Paired Data ◽  
Sperm Dna ◽  
Significant Difference ◽  
Unselected Population ◽  
The Cochrane Library

This systematic review aims to compare and evaluate the outcome of using either testicular sperm (Testi-ICSI) or ejaculated sperm (Ejac-ICSI) in intracytoplasmic sperm injections in patients with recurrent ICSI failure. The Cochrane Library, MEDLINE, EMBASE, and PubMed were used to search for relevant papers up till October 2020. Four cohort studies and two case series studies were included. Four studies investigated males with high sperm DNA fragmentation (SDF) and were classified as ''high SDF'', which included 247 couples and 2712 injected oocytes. The other three studies provided paired data to an unselected population of infertile men with either untested SDF or when anomalous SDF was not used as the basis for deciding to use Testi-ICSI, and were classified as ''noclassify'' in this study. This subgroup consisted of a total of 290 couples and 1061 injected oocytes. There was a higher level of clinical pregnancy rates (CPRs) in the ''high SDF'' subgroup when Testi-ICSI was used as compared to Ejac-ICSI, at 43.4% and 20.8% respectively, with a pooled odds ratio (OR) of 2.87 (95% confidence interval (CI) 1.44–5.71; P = 0.003). Furthermore, in the ''high SDF'' subgroup, Testi-ICSI use was associated with better take home baby rates (38%) as compared to Ejac-ICSI (16%), with a pooled OR of 3.24 (95% CI 1.20–8.76; P = 0.02). In the ''noclassify'' group, there was no statistically significant difference in the CPRs and take home baby rates of Testi-ICSI and Ejac-ICSI, although there was a trend of better CPRs and take home baby rates with Testi-ICSI use. Utilization of Testi-ICSI in recurrent ICSI failure couples, where males were confirmed to have high SDF in their ejaculated sperm, were correlated with greater CPRs and take home baby rates. However, Testi-ICSI may not result in better ICSI outcomes among men with untested SDF or when anomalous SDF was not the main factor influencing the decision to utilize Testi-ICSI.

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