scholarly journals Does routine antenatal fetal testing in well-controlled diabetic pregnancies improve pregnancy outcomes? A systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 13-13
Author(s):  
Farnaz Radsaied ◽  
Sanaz Mousavi ◽  
Nazli Navali ◽  
Hossein Hoseinifard ◽  
Sajjad Pourasghary ◽  
...  

Background: Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers, however there is no sufficient evidence to support this. Objective: The purpose of the present systematic review was to assess the effects of fetal testing on reducing fetal mortality in pregnancies with diabetes. Materials and Methods: The databases were searched to find English and Persian articles published from 1975-2018 about antenatal fetal assessment in pregnancies complicated with diabetes. Relevant sources cited in the selected publications were also searched manually. Keywords were GDM, pregnancy, fetal testing, fetal surveillance, NST, BPP, CTG. A total of 1954 studies were identified. Of these, 1913 were excluded on the basis of title and abstract review. Results: Among the 41 studies retrieved for detailed full-text analysis, a total of 10 fulfilled the inclusion criteria for the analysis. Still birth rate was 5.6/1000, cesarean rate was 418/1000. In diabetic pregnant women (gestational and overt diabetes) with well controlled blood sugar who did fetal surveillance tests the intrauterine fetal death rate isn’t different with general population. Conclusion: As this systematic review suggests, fetal mortality is rare with fetal surveillance tests in pregnant diabetic women with good blood sugar control. No randomized clinical trial has been conducted to investigate this claim.

2021 ◽  
Vol 11 (11) ◽  
pp. 1444
Author(s):  
Mattia Fonderico ◽  
Emilio Portaccio ◽  
Lorenzo Razzolini ◽  
Luisa Pastò ◽  
Angelo Bellinvia ◽  
...  

The presence of intrathecal IgM synthesis (ITMS) has been associated with an aggressive multiple sclerosis (MS) clinical course. In the present systematic review, we aimed at assessing the prevalence of ITMS among different MS phenotypes. Moreover, we aimed at quantifying the risk of a second relapse in ITMS positive and oligoclonal IgG bands (OCGBs)-positive patients. We selected clinical studies reporting the ITMS prevalence assessed as oligoclonal IgM Bands (OCMBs), lipid-specific OCMBs (LS-OCMBs), and/or as an intrathecal IgM production > 0% (IgMLoc, Reiber formula). The overall prevalence of ITMS was higher in relapsing-remitting (RR) than clinically isolated syndrome (CIS) patients (40.1% versus 23.8%, p < 0.00001), while was in line with that detected in primary progressive MS (PPMS, 26.7%). Almost all patients (98%) with ITMS had also OCGBs. The risk of having a second relapse was higher in OCGBs positive patients (HR = 2.18, p = 0.007) but much higher in ITMS positive patients (HR = 3.62, p = 0.0005). This study revealed that the prevalence of ITMS is higher in RRMS patients. It suggests that the risk of having a second relapse, previously ascribed to OCGBs, may, to a certain extent, be related to the presence of intrathecal IgM.


2018 ◽  
Vol 46 (11) ◽  
pp. 2780-2788 ◽  
Author(s):  
Michaela O’Connor ◽  
Anas A. Minkara ◽  
Robert W. Westermann ◽  
James Rosneck ◽  
T. Sean Lynch

Background: The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete’s preparedness for sporting activities. Purpose: To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. Study Design: Systematic review and meta-analysis. Methods: The search terms “hip arthroscopy,” “return to play,” and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. Results: A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement ( r = −0.95, P = .0003). Conclusion: Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.


2020 ◽  
Vol 9 (3) ◽  
pp. 739 ◽  
Author(s):  
Mario Dioguardi ◽  
Mario Alovisi ◽  
Vito Crincoli ◽  
Riccardo Aiuto ◽  
Giancarlo Malagnino ◽  
...  

Propionibacterium are anaerobic/aero-tolerant rod Gram-positive bacteria, and numerous studies are associated with primary and secondary endodontic infections. The data in the literature on the prevalence of Propionibacterium are conflicting, and there are studies that report conflicting data on the prevalence in primary and secondary endodontic infections. This review aims to clarify the prevalence of bacteria of the genus Propionibacterium in endodontic lesions. The present systematic review work was performed on the basis of the Prisma protocol. A search was carried out on the PubMed and Scopus databases with the use of keywords. The research produced 410 records, which, after the elimination of the overlaps and the application of the inclusion and exclusion criteria, led to a number of 36 included articles divided by the three outcomes. The first outcome concerns prevalence of bacteria of the genus Propionibacterium in primary and secondary endodontic lesions. The secondary outcome, differences in the prevalence of bacteria of the genus Propionibacterium between primary endodontic infections and secondary endodontic infections. The tertiary outcome, differences in the prevalence of Propionibacterium Acnes compared to Propionibacterium propionicum in endodontic infections. The results of the meta-analysis show that the genus Propionibacterium bacteria are more prevalent in secondary endodontic infections and that P. acnes has a higher prevalence than P. propionicum.


2017 ◽  
Vol 22 (02) ◽  
pp. 181-189 ◽  
Author(s):  
José Glória ◽  
Ighor Fernandes ◽  
Esmeralda Silveira ◽  
Glaciele Souza ◽  
Ricardo Rocha ◽  
...  

Introduction Mandibular fractures represent a high percentage of all facial fractures, and the bite force is a fundamental parameter to measure the actual mandibular function and, subsequently, the masticatory efficiency and quality of life. Objectives The purpose of the present systematic review was to verify if there is any difference in the bite forces of patients with mandibular fractures fixed by locking or non-locking plates, testing the null hypothesis of no difference in this parameter. Data Synthesis A systematic review of the literature was conducted using four databases (PubMed, Virtual Health Library, Web of Science and Science Direct) without restrictions as to publication date or language. We found 3,039 abstracts, and selected 4 articles for this review. Conclusion The overall results show better performance in bite force for the locking plates when compared with the non-locking plates in the incisor region (mean deviation [MD]: 1.18; 95% confidence interval [95%CI]: 0.13–2.23), right molar region (MD: 4.71; 95%CI: 0.63–8.79) and left molar region (MD: 10.34; 95%CI: 4.55–16.13). Although the results of this study indicated a better bite force result with the locking plates, there is still no sufficient evidence to support this information safely.


2016 ◽  
Vol 209 (4) ◽  
pp. 277-283 ◽  
Author(s):  
Melissa K. Y. Chan ◽  
Henna Bhatti ◽  
Nick Meader ◽  
Sarah Stockton ◽  
Jonathan Evans ◽  
...  

BackgroundPeople with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex.AimsTo undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm.MethodWe conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable.ResultsTwelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the metaanalysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38–2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91–3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16–3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70–2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%.ConclusionsThe four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.


2006 ◽  
Vol 1 (3) ◽  
pp. 3 ◽  
Author(s):  
Denise Koufogiannakis ◽  
Natasha Wiebe

Objective - The objective of this review was to assess which library instruction methods are most effective for improving the information skills of students at an introductory, undergraduate level, using cognitive outcomes (measuring changes in knowledge). The study sought to address the following questions: 1) What is the overall state of research on this topic? 2) Which teaching methods are more effective? Methods - Systematic review methodology was used. Fifteen databases were searched for relevant articles retrieving 4356 potentially relevant citations. Titles and abstracts were reviewed for relevance. Of those, 257 full articles were considered in-depth using a predetermined inclusion/exclusion form. 122 unique studies met the inclusion criteria and underwent an extensive data extraction and critical appraisal process. 55 of these studies met author defined quality criteria to provide information on the effectiveness of different teaching methods. Of these, 16 studies provided sufficient information to enable meta-analyses using standardized mean difference to be undertaken. Results - The overwhelming majority of studies were conducted in the United States (88%). 79 studies (65%) used experimental or quasi-experimental research methods. Teaching methods used in the studies varied, with the majority focused on traditional methods of teaching, followed by computer assisted instruction, and self-directed independent learning. Studies measured outcomes that correlated with Bloom’s lower levels of learning (Remember, Understand, Apply). 16 studies compared traditional instruction with no instruction, and 12 found a positive outcome. Meta-analysis of the data from 4 of these studies agreed with the positive conclusions favouring traditional instruction. 14 studies compared computer assisted instruction with traditional instruction. 9 of these showed a neutral result, and meta-analysis of 8 of these studies agreed with this neutral result. 6 studies compared self-directed independent learning with no instruction, and meta-analysis of 5 of these agreed that the result was positive in favour of self-directed independent learning. Conclusions - Based on the results of this meta-analysis, there is sufficient evidence to suggest that computer assisted instruction is as effective as traditional instruction. Evidence also suggests that both traditional instruction and self-directed independent instruction are more effective than no instruction. Additional comparative research needs to be done across different teaching methods. Studies comparing active learning, computer assisted instruction, and self-directed independent learning would greatly enrich the research literature. Further studies utilizing appropriate methodologies and validated research tools would enrich our evidence base, and contribute to the growth of knowledge about effectiveness of particular teaching methods.


2019 ◽  
Author(s):  
Hui Yue ◽  
Xinxin Xu ◽  
Qin Liu ◽  
Xiaozhi Li ◽  
Yiting Xiao ◽  
...  

Abstract Background: This systematic review aimed to investigate whether periodontal treatment can reduce the systemic inflammatory levels and improve the metabolic levels in patients undergoing hemodialysis (HD) or/and peritoneal dialysis (PD). Methods: Electronic databases (PubMed, EMBASE, CENTRAL, NCKI, and WFPD) were searched up to July 2019. The risk of bias within studies was assessed through the Cochrane Collaboration' s risk assessment tool. The systemic inflammatory and metabolic measures were the highly sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-a), the albumin (Alb), and lipid metabolic levels. Meta-analyses (MAs) were performed to calculate the overall effect size where appropriate. Results: Five studies were eligible for this systematic review. The result of four studies revealed a significant difference in the CRP level after periodontal treatment in patients receiving HD or/and PD. Two studies reported the IL-6 and the Alb level after periodontal treatment but revealed no significant difference. No MAs could be performed on the TNF- a level and the lipid metabolic markers. Conclusions: Periodontal treatment may moderately reduce the serum of CRP levels in HD or/and PD patients. For the TNF-a, IL-6, Alb levels and lipid metabolic markers, no sufficient evidence supports the difference after periodontal treatment. Therefore, larger scales and high-quality randomized-controlled trials (RCTs) are required to assess the effect of periodontal treatment on systemic inflammatory and metabolic parameters in HD or/and PD patients.


10.2196/15140 ◽  
2019 ◽  
Vol 8 (11) ◽  
pp. e15140
Author(s):  
Olivia Schünemann ◽  
Alessa Jansen ◽  
Ulrike Willutzki ◽  
Nina Heinrichs

Background In many countries, humanistic psychotherapy (HPT) is viewed as a broad psychotherapeutic approach and is accepted in health care systems. To qualify for reimbursement by health insurance in Germany, psychotherapy approaches have to be evaluated positively by the German Scientific Board of Psychotherapy (GSBP). The GSBP examined HPT and its subapproaches based on an application by a number of professional organizations affiliated with HPT (Work Group Humanistic Psychotherapy, WGHPT). The GSBP came to the decision that none of the HPT subapproaches provided sufficient evidence to be evaluated as evidence based. Potential reasons for the discrepancy between international recognition of HPT and GSBP’s decision will be explored: researchers’ allegiance may have led to a risk of bias disadvantaging HPT. Furthermore, the evaluation criteria of the GSBP did not systematically consider whether HPT was conceptualized bona fide and implemented with sufficient treatment integrity in the studies. Objective This systematic review will re-examine the studies included in the review of the GSBP. Within 2 comparisons (HPT vs control and HPT vs other psychotherapeutic interventions), we will examine moderating effects of treatment quality (bona fide and treatment integrity) and allegiance on the effectiveness of HPT. Methods This review is based on the prior systematic review by the GSBP. The GSBP examined randomized controlled trials (RCTs) and studies with non-RCTs of HPT interventions for individuals with mental disorders. All studies suggested by the WGHPT were included; moreover, the GSBP conducted searches in standard electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and PSYNDEX) and handsearches in relevant systematic reviews and contacted experts. A total of 2 independent GSBP reviewers performed study screening using a structured form. On the basis of the prior work of the GSBP, all studies that were positively screened by the GSBP will be included in this review. Data will be extracted independently by 4 authors. Standardized mean difference will be calculated, and possible publication bias will be tested using funnel plots and Egger test. A priori defined subgroup or meta-regression analyses will be performed for treatment quality, allegiance, type of nonactive control, study quality, type of subapproach, and target population (children and adolescents or adults). Results The GSBP identified 115 eligible studies that will be reanalyzed in this systematic review. Conclusions Results about moderator effects of treatment quality and allegiance will provide important information about their impact on the evaluation of HPT and other psychotherapy approaches and can be used for further evaluation methods. Trial Registration PROSPERO CRD42019128983; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128983 International Registered Report Identifier (IRRID) PRR1-10.2196/15140


2021 ◽  
Vol 15 ◽  
Author(s):  
Tariq A. Alsalhe ◽  
Nasr Chalghaf ◽  
Noomen Guelmami ◽  
Fairouz Azaiez ◽  
Nicola Luigi Bragazzi

Burnout can be defined as an occupational syndrome resulting from poorly managed chronic workplace stress. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy. Teachers are among the human service professionals particularly vulnerable to occupational burnout. Teaching is a highly demanding and challenging task, in that requires constant confrontation with different stakeholders (students and their parents, administrators). Among teachers, physical education teachers have been particularly understudied even though a recently published systematic review has found that they are exposed to high levels of stress. To better explore burnout syndrome among physical education teachers, the present systematic review was undertaken, searching up to six languages. Fifty-six studies were included in the present review. The reported rate of high emotional exhaustion ranged from 11.52 to 60.6%, according to the single study. Pooling together 12 studies and totaling 2,153 physical education teachers, the prevalence rate of high emotional exhaustion was computed to be 28.6 [95% CI 21.9–35.8]. The reported rate of high depersonalization ranged from 3.6 to 45.2%, according to the single study. Pooling together 11 studies and totaling 2,113 physical education teachers, the prevalence rate of high depersonalization was computed to be 14.5% [95% CI 8.0–22.4]. The reported rate of low personal accomplishment ranged from 13.63 to 55.6%, according to the single study. Pooling together 12 studies and totaling 2,153 physical education teachers, the prevalence rate of low personal accomplishment was computed to be 29.5% [95% CI 23.8–35.4]. The reported rate of overall burnout ranged from 10.0 to 51.6%, according to the single study. Pooling together 7 studies and totaling 1,101 physical education teachers, the prevalence rate of overall burnout was computed to be 23.9% [95% CI 13.6–36.0]. No evidence of publication bias could be found, both visually inspecting the funnel plot and conducting the Egger's linear regression test. Burnout imposes a significant burden among physical education teachers. Based on the information contained in the present systematic review and meta-analysis, tailored interventions could be designed to mitigate such a burden. However, due to the limitations of the studies included in the present systematic review and meta-analysis, further research in the field is urgently warranted.Systematic Review Registration:https://osf.io/69ryu/, identifier: 10.17605/OSF.IO/69RYU.


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