Vehicle Exposure and Spinal Musculature Fatigue in Military Warfighters: A Meta-Analysis

Context: Spinal musculature fatigue from vehicle exposure may place warfighters at risk for spinal injuries and pain. Research on the relationship between vehicle exposure and spinal musculature fatigue is conflicting. A better understanding of the effect of military duty on musculoskeletal function is needed before sports medicine teams can develop injury-prevention programs. Objective: To determine if the literature supports a definite effect of vehicle exposure on spinal musculature fatigue. Data Sources: We searched the MEDLINE, Military & Government Collection (EBSCO), National Institute for Occupational Safety and Health Technical Information Center, PubMed, and Web of Science databases for articles published between January 1990 and September 2015. Study Selection: To be included, a study required a clear sampling method, preexposure and postexposure assessments of fatigue, a defined objective measurement of fatigue, a defined exposure time, and a study goal of exposing participants to forces related to vehicle exposure. Data Extraction: Sample size, mean preexposure and postexposure measures of fatigue, vehicle type, and exposure time. Data Synthesis: Six studies met the inclusion criteria. We used the Scottish Intercollegiate Guidelines Network algorithm to determine the appropriate tool for quality appraisal of each article. Unweighted random-effects model meta-analyses were conducted, and a natural log response ratio was used as the effect metric. The overall meta-analysis demonstrated that vehicle exposure increased fatigue of the spinal musculature (P = .03; natural log response ratio = −0.22, 95% confidence interval = −0.42, −0.02). Using the spinal region as a moderator, we observed that vehicle ride exposure significantly increased fatigue at the lumbar musculature (P = .02; natural log response ratio = −0.27, 95% confidence interval = −0.50, −0.04) but not at the cervical or thoracic region. Conclusions: Vehicle exposure increased fatigue at the lumbar region.

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P1858Meta-analysis of performance of risks scores for predicting outcomes after percutaneous Mitraclip implantation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0609 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T K M Wang ◽

M T M Wang

Keyword(s):

Confidence Interval ◽

Risk Stratification ◽

Clinical Decision Making ◽

Operative Mortality ◽

Data Extraction ◽

Meta Analysis ◽

Critical Role ◽

Clinical Decision ◽

Risk Scores ◽

Sts Score

Abstract Background The Mitraclip is the most established percutaneous mitral valve intervention indicated for severe mitral regurgitation at high or prohibitive surgical risk. Risk stratification plays a critical role in selecting the appropriate treatment modality in high risk valve disease patients but have been rarely studied in this setting. We compared the performance of risk scores at predicting mortality after Mitraclip in this meta-analysis. Methods MEDLINE, Embase and Cochrane databases from 1 January 1980 to 31 December 2018 were searched. Two authors reviewed studies which reported c-statistics of risk models to predict mortality after Mitraclip for inclusion, followed by data extraction and pooled analyses. Results Amongst 494 articles searched, 47 full-text articles were evaluated, and 4 studies totalling 879 Mitraclip cases were included for analyses. Operative mortality was reported at 3.3–7.4% in three studies, and 1-year mortality 11.2%-13.5% in two studies. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.66 (0.57–0.75), EuroSCORE II 0.72 (0.60–0.85) and STS Score 0.64 (0.56–0.73). Respective Peto's odds ratios (95% confidence interval) to assess calibration were EuroSCORE 0.21 (0.14–0.31), EuroSCORE II 0.43 (0.24–0.76) and STS Score 0.36 (0.21–0.61). C-statistics (95% confidence interval) for 1-year mortality were EuroSCORE II 0.64 (0.57–0.70) and STS Score (0.58–0.64). Conclusion All scores over-estimated operative mortality, and EuroSCORE II had the best moderate discrimination while the other two scores were only modestly prognostic. Development of Mitraclip-specific scores may improve accuracy of risk stratification for this procedure to guide clinical decision-making.

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Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

BMJ ◽

10.1136/bmj.l4185 ◽

2019 ◽

pp. l4185 ◽

Cited By ~ 62

Author(s):

Maria Panagioti ◽

Kanza Khan ◽

Richard N Keers ◽

Aseel Abuzour ◽

Denham Phipps ◽

...

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Medical Care ◽

Data Extraction ◽

Meta Analysis ◽

Cost Effective ◽

Mitigation Strategies ◽

Patient Harm ◽

Pooled Prevalence ◽

Preventable Harm

Abstract Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. Design Systematic review and meta-analysis. Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched. Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I 2 statistic, and publication bias was evaluated. Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10). Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

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Welding Fumes, a Risk Factor for Lung Diseases

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072552 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2552 ◽

Cited By ~ 2

Author(s):

Maria Grazia Riccelli ◽

Matteo Goldoni ◽

Diana Poli ◽

Paola Mozzoni ◽

Delia Cavallo ◽

...

Keyword(s):

Risk Factor ◽

Ultrafine Particles ◽

Lung Diseases ◽

Occupational Safety ◽

Meta Analysis ◽

Technical Information ◽

In Vivo Studies ◽

Welding Fumes

(1) Background: Welding fumes (WFs) are composed of fine and ultrafine particles, which may reach the distal airways and represent a risk factor for respiratory diseases. (2) Methods: In vitro and in vivo studies to understand WFs pathogenesis were selected. Epidemiological studies, original articles, review, and meta-analysis to examine solely respiratory disease in welders were included. A systematic literature search, using PubMed, National Institute for Occupational Safety and Health Technical Information Center (NIOSHTIC), and Web of Science databases, was performed. (3) Results: Dose, time of exposure, and composition of WFs affect lung injury. Inflammation, lung defense suppression, oxidative stress, DNA damage, and genotoxic effects were observed after exposure both to mild and stainless steel WFs. (4) Conclusions: The detection of lung diseases associated with specific occupational exposure is crucial as complete avoidance or reduction of the exposure is difficult to achieve. Further studies in the area of particle research may aid the understanding of mechanisms involved in welding-related lung disease and to expand knowledge in welding-related cardiovascular diseases.

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Effect of Taping on Spinal Pain and Disability: Systematic Review and Meta-Analysis of Randomized Trials

Physical Therapy ◽

10.2522/ptj.20130619 ◽

2015 ◽

Vol 95 (4) ◽

pp. 493-506 ◽

Cited By ~ 26

Author(s):

Carla Vanti ◽

Lucia Bertozzi ◽

Ivan Gardenghi ◽

Francesca Turoni ◽

Andrew A. Guccione ◽

...

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Myofascial Pain ◽

Data Extraction ◽

Meta Analysis ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Spinal Pain ◽

Controlled Trials ◽

Cochrane Central Register

Background Taping is a widely used therapeutic tool for the treatment of musculoskeletal disorders, nevertheless its effectiveness is still uncertain. Purpose The purpose of this study was to conduct a current review of randomized controlled trials (RCTs) concerning the effects of elastic and nonelastic taping on spinal pain and disability. Data Sources MEDLINE, CINAHL, EMBASE, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ISI Web of Knowledge, and SPORTDiscus databases were searched. Study Selection All published RCTs on symptomatic adults with a diagnosis of specific or nonspecific spinal pain, myofascial pain syndrome, or whiplash-associated disorders (WAD) were considered. Data Extraction Two reviewers independently selected the studies and extracted the results. The quality of individual studies was assessed using the PEDro scale, and the evidence was assessed using GRADE criteria. Data Synthesis Eight RCTs were included. Meta-analysis of 4 RCTs on low back pain demonstrated that elastic taping does not significantly reduce pain or disability immediately posttreatment, with a standardized mean difference of −0.31 (95% confidence interval=−0.64, 0.02) and −0.23 (95% confidence interval=−0.49, 0.03), respectively. Results from single trials indicated that both elastic and nonelastic taping are not better than placebo or no treatment on spinal disability. Positive results were found only for elastic taping and only for short-term pain reduction in WAD or specific neck pain. Generally, the effect sizes were very small or not clinically relevant, and all results were supported by low-quality evidence. Limitations The paucity of studies does not permit us to draw any final conclusions. Conclusion Although different types of taping were investigated, the results of this systematic review did not show any firm support for their effectiveness.

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Risk Factors for Injuries During Military Static-Line Airborne Operations: A Systematic Review and Meta-Analysis

Journal of Athletic Training ◽

10.4085/1062-6050-51.9.10 ◽

2016 ◽

Vol 51 (11) ◽

pp. 962-980 ◽

Cited By ~ 7

Author(s):

Joseph Knapik ◽

Ryan Steelman

Keyword(s):

Risk Factors ◽

Injury Risk ◽

Data Extraction ◽

Meta Analysis ◽

Technical Information ◽

Heat Index ◽

Landing Zone ◽

Wind Speeds ◽

Ankle Brace ◽

Meta Analyses

Objective: To identify and analyze articles in which the authors examined risk factors for soldiers during military static-line airborne operations. Data Sources: We searched for articles in PubMed, the Defense Technical Information Center, reference lists, and other sources using the key words airborne, parachuting, parachutes, paratrooper, injuries, wounds, trauma, and musculoskeletal. Study Selection: The search identified 17 684 potential studies. Studies were included if they were written in English, involved military static-line parachute operations, recorded injuries directly from events on the landing zone or from safety or medical records, and provided data for quantitative assessment of injury risk factors. A total of 23 studies met the review criteria, and 15 were included in the meta-analysis. Data Extraction: The summary statistic obtained for each risk factor was the risk ratio, which was the ratio of the injury risk in 1 group to that of another (baseline) group. Where data were sufficient, meta-analyses were performed and heterogeneity and publication bias were assessed. Data Synthesis: Risk factors for static-line parachuting injuries included night jumps, jumps with extra equipment, higher wind speeds, higher air temperatures, jumps from fixed-wing aircraft rather than balloons or helicopters, jumps onto certain types of terrain, being a female paratrooper, greater body weight, not using the parachute ankle brace, smaller parachute canopies, simultaneous exits from both sides of an aircraft, higher heat index, winds from the rear of the aircraft on exit entanglements, less experience with a particular parachute system, being an enlisted soldier rather than an officer, and jumps involving a greater number of paratroopers. Conclusions: We analyzed and summarized factors that increased the injury risk for soldiers during military static-line parachute operations. Understanding and considering these factors in risk evaluations may reduce the likelihood of injury during parachuting.

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Participant Characteristics Predicting Communication Outcomes in AAC Implementation for Individuals with ASD and IDD: A Systematic Review and Meta-analysis

10.35542/osf.io/6sgba ◽

2021 ◽

Author(s):

Jay Ganz ◽

James E Pustejovsky ◽

Joe Reichle ◽

Kimberly Vannest ◽

Margaret Foster ◽

...

Keyword(s):

Social Communication ◽

Meta Analysis ◽

Autism Spectrum ◽

Response Ratio ◽

Average Effect ◽

Design Quality ◽

Participant Characteristics ◽

Log Response Ratio ◽

High Degree ◽

Degree Of Heterogeneity

This meta-analysis examined social communication outcomes in augmentative and alternative communication (AAC) interventions, or those that involved aided (e.g., speech generating devices, picture point systems) or unaided AAC (e.g., gestures, manual sign language) as a component of intervention, and the extent to which communication outcomes were predicted by participant characteristics. Variables of interest included chronological age, communication mode used prior to intervention, number of words produced and imitation skills of participants prior to intervention. Investigators identified 117 primary studies that implemented AAC interventions with school-aged individuals (up to 22 years) with autism spectrum disorder and/or intellectual disability associated with complex communication needs and assessed social-communication outcomes. All included studies involved single-case experimental designs and met basic study design quality standards. We synthesized findings across studies using two complementary effect size indices, Tau(AB) and the log response ratio, and multi-level meta-analysis with robust variance estimation. With Tau(AB), the overall average effect across 338 participants was 0.72, 95% CI [0.67, 0.76], with a high degree of heterogeneity across studies. With the log response ratio, the overall average effect corresponded to a 538% increase from baseline levels of responding, 95% CI [388%, 733%], with a high degree of heterogeneity across studies and contrasts. Moderator analyses detected few differences in effectiveness when comparing across diagnoses, ages, the number and type of communication modes the participants used prior to intervention, the number of words used by the participants prior to intervention, and imitation use prior to intervention.

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Bias and correction for the log response ratio in ecological meta-analysis

Ecology ◽

10.1890/14-2402.1 ◽

2015 ◽

Vol 96 (8) ◽

pp. 2056-2063 ◽

Cited By ~ 64

Author(s):

Marc J. Lajeunesse

Keyword(s):

Meta Analysis ◽

Response Ratio ◽

Log Response Ratio

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Microscopic changes in the spinal extensor musculature in patients experiencing chronic spinal pain: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-042729 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042729

Author(s):

Shilpa Purushotham ◽

Robert Stanley Stephenson ◽

Andy Sanderson ◽

Deborah Falla

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Grey Literature ◽

Spinal Pain ◽

Muscle Fibre Types ◽

Lumbar Region ◽

Extensor Muscles ◽

Global Burden Of Diseases ◽

Chronic Spinal Pain

IntroductionChronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have focused on the lumbar region only and the results have been inconclusive. Therefore, in this protocol, we aim to assess microscopic changes in the extensor muscles of all spinal regions, investigating regionally specific changes in muscle fibre types of the spinal extensor muscles in patients with non-specific CSP.Methods/analysisThis protocol was designed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will use the following databases: MEDLINE, Embase, PubMed, CINAHL Plus and Web of Science along with relevant grey literature searches. Two reviewers will conduct the searches, perform data extraction, apply inclusion criteria and conduct risk of bias assessment using Newcastle-Ottawa Scale. Data will be synthesised and analysed independently. If there is sufficient homogeneity, then meta-analysis will be conducted by the reviewers jointly. If not, meta-synthesis or narrative reporting will be performed. The quality of the evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.Ethics and disseminationThe results of this study will be submitted for publication to a peer-reviewed journal and will be presented at conferences. Ethical approval for this systematic review was not required due to no patient data being collated.PROSPERO registration numberCRD42020198087.

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Efficacy of Transparent vs. Pressure Dressing in Prevention of Post-Cardiac Catheterization Pain, Discomfort and Hematoma: A Systematic Review and Meta-analysis of RCTs

Journal of Caring Sciences ◽

10.34172/jcs.2021.019 ◽

2021 ◽

Vol 10 (2) ◽

pp. 103-110

Author(s):

Suresh K Sharma ◽

Kalpana Thakur ◽

Shiv K Mudgal ◽

Barun Kumar

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Cardiac Catheterization ◽

Odds Ratio ◽

English Language ◽

Data Extraction ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Difference ◽

Pressure Dressing

ABSTRACT Introduction: There is lack consensus on superiority of transparent vs. pressure dressing for prevention of post-cardiac catheterization pain, discomfort and hematoma. Therefore, we conducted this systematic review and meta-analysis of available RCTs on this subject. Methods: We performed a systematic search of RCTs published between in 2000-2019 in English language using databases including PubMed Medline, EMBASE, CINAHL, Cochrane Library, ERMED Journals, Clinical trials database, DELNET, Google Scholar and Discovery Search. Studies conducted on adult patients with femoral dressing after cardiac catheterization measuring pain, discomfort, hematoma as intended outcomes have been included. Data extraction, critical appraisal, assessment of risk bias was done and decisions on quality were made on mutual consensus. Mantel-Haenszel (MH) and odds ratio for dichotomous variables was calculated by Review Manager 5.3 software. Results: Out of all identified studies, only 5 studies comprising 664 patients fulfilled the inclusion criteria and met the quality assessment. Incidence of discomfort (25, 333) were significantly less in transparent dressing group as compared to pressure dressing group (149, 331); odds ratio 0.10, 95% confidence interval [CI] 0.06-0.15; I2 = 0%, P= 0.00. Four studies reported significantly lower number of pain cases in transparent dressing (17, 203) as compared to pressure dressing (57, 201); odds ratio 0.13, 95% confidence interval [CI] 0.03-0.59; I2 = 47%, P= 0.01). However, incidence of hematoma did not reveal any significant difference between two groups. Conclusion: Transparent dressing is a better option in patients with femoral/groin dressing after cardiac catheterization as it is more effective in prevention of pain and discomfort.

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Selecting Communicative Interventions Targets for School-Aged participants with ASD and ID: A Single-Case Experimental Design Meta-analysis

10.35542/osf.io/yx5au ◽

2021 ◽

Author(s):

Jay Ganz ◽

James E Pustejovsky ◽

Joe Reichle ◽

Kimberly Vannest ◽

Margaret Foster ◽

...

Keyword(s):

Effect Size ◽

Augmentative And Alternative Communication ◽

Meta Analysis ◽

Autism Spectrum ◽

Original Research ◽

Response Ratio ◽

Alternative Communication ◽

Complex Communication Needs ◽

Log Response Ratio ◽

Communication Needs

Objective: This meta-analysis reviews the literature on communication modes, communicative functions, and types of augmentative and alternative communication (AAC) interventions for school-age participants with autism spectrum disorders and/or intellectual disabilities who experience complex communication needs. Considering potential differences related to outcomes that were targeted for intervention could help identify the most effective means of individualizing AAC interventions. Methods: We performed a systematic literature search using Academic Search Ultimate, ERIC, PsycINFO, Web of Science, and Proquest Dissertations & Theses Global to retrieve research conducted between 1978 and the beginning of 2020. Studies included in the synthesis are (a) in English; (b) has one or more participants with an intellectual delay, developmental disability(ies); (c) reported the results of an augmentative and alternative communication (AAC) intervention to supplement or replace conventional speech for people with complex communication needs; (d) was a SCED; (e) measured social-communicative outcomes. We synthesized results across studies using multi-level meta-analyses of two case-level effect size metrics, Tau and log response ratio. We conducted moderator analyses using meta-regression with robust variance estimation.Results: Across 114 included studies with 330 participants and 767 effect size, overall Tau effects were moderate, Tau = 0.72, 95% CI [0.67, 0.77], and heterogeneous. For the subset of data series where log response ratio could be estimated, the overall average effect was LRR = 1.86, 95% CI [1.58, 2.13], and effects were highly heterogeneous. There were few statistically significant differences found between moderator categories, which included communication mode, communicative function, and type of AAC implemented.Conclusions: This meta-analysis highlights the potential differences related to outcomes that were targeted for AAC interventions for individuals with ASD and IDD. AAC intervention has been shown to improve communication outcomes in this population. However, there was a lack of sufficient data to analyze for some potential moderators such as insufficient descriptive information on participant characteristics. This is likely due to the heterogeneity of the participants and implementation factors; however, these factors were frequently underreported by original study authors which disallowed systematic analysis. That said, there is a need for more detailed participant characteristic descriptions in original research reports to support future aggregation across the literature. Sponsorship: We received funding for the review from the Institute of Education Sciences.Protocol: The review protocol was registered in the PROSPERO system (CRD42018112428).

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