State-level and system-level opioid prescribing policies: The impact on provider practices and overdose deaths, a systematic review

2016 ◽  
Vol 12 (2) ◽  
pp. 109 ◽  
Author(s):  
Francesca L. Beaudoin, MD, MS ◽  
Geetanjoli N. Banerjee, MPH ◽  
Michael J. Mello, MD, MPH
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
State Level ◽  
Opioid Analgesics ◽  
System Level ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Patient Level ◽  
The Impact

Objective: In response to persistent public health concerns regarding prescription opioids, many states and healthcare systems have implemented legislation and policies intended to regulate or guide opioid prescribing. The overall impact of these policies is still uncertain. The aim of this systematic review was to examine the existing evidence of provider-level and patient-level outcomes preimplementation and postimplementation of policies and legislation constructed to impact provider prescribing practices around opioid analgesics. Design: A systematic search of MEDLINE, EMBASE, the Web of Science, and the Cochrane Database of Systematic Reviews was conducted to identify studies evaluating the impact of opioid prescribing policies on provider-level and patient-level outcomes. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results: Eleven studies were included in the review. A meta-analysis was not possible due to between-study heterogeneity. Six of the studies assessed state-level policies, and five were at the level of the healthcare system or hospital. Studies showed temporal associations between policy implementation and reductions in opioid prescribing, as well as opioid-related overdoses. Results were mixed regarding the impact of policies on misuse. The majority of the studies were judged to be of low quality based on the GRADE criteria.Conclusions: There is low to moderate quality evidence suggesting that the presence of opioid prescribing policy will reduce the amount and strength of opioid prescribed. The presence of these policies may impact the number of overdoses, but there is no clear evidence to suggest that it reduces opioid misuse.

scholarly journals Misuse of medication in adult substance misuse services: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047283
Author(s):  
Rosalind Gittins ◽  
Louise Missen ◽  
Ian Maidment
Keyword(s):  
Systematic Review ◽  
Substance Misuse ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Opioid Analgesics ◽  
Physical And Mental Health ◽  
Qualitative Synthesis ◽  
Treatment Services ◽  
The Impact

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.

scholarly journals Binge drinking in young people: protocol for a systematic review of neuropsychological, neurophysiological and neuroimaging studies

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e023629 ◽  
Author(s):  
Briana Lees ◽  
Louise Mewton ◽  
Lexine Stapinski ◽  
Lindsay M Squeglia ◽  
Caroline Rae ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Young People ◽  
Binge Drinking ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Primary Data ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
The Impact

IntroductionBinge drinking is the most common pattern of alcohol use among young people in Western countries. Adolescence and young adulthood is a vulnerable developmental period and binge drinking during this time has a higher potential for neurotoxicity and interference with ongoing neural and cognitive development. The purpose of this systematic review will be to assess and integrate evidence of the impact of binge drinking on cognition, brain structure and function in youth aged 10–24 years. Cross-sectional studies will synthesise the aberrations associated with binge drinking, while longitudinal studies will distinguish the cognitive and neural antecedents from the cognitive and neural effects that are a consequence of binge drinking.Methods and analysisA total of five peer-reviewed databases (PubMed, EMBASE, Medline, PsychINFO, ProQuest) will be systematically searched and the search period will include all studies published prior to 1 April 2018. The search terms will be a combination of MeSH keywords that are based on previous relevant reviews. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed using The Grades of Recommendation, Assessment, Development and Evaluation approach. All studies will be screened against eligibility criteria designed to synthesise studies that examined a young binge drinking sample and used neuropsychological, neurophysiological or neuroimaging assessment techniques. Studies will be excluded if participants were significantly involved in other substances or if they had been clinically diagnosed with an alcohol use disorder, or any psychiatric, neurological or pharmacological condition. If available data permits, a meta-analysis will be conducted.Ethics and disseminationFormal ethics approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentations and social media.Trial registration numberInternational Prospective Register for Systematic Reviews (PROSPERO) number: CRD42018086856.

Interventions to Influence Opioid Prescribing Practices for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 60 (1) ◽  
pp. e15-e26
Author(s):  
Michael Asamoah-Boaheng ◽  
Oluwatosin A. Badejo ◽  
Louise V. Bell ◽  
Norman Buckley ◽  
Jason W. Busse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Noncancer Pain

scholarly journals Understanding loneliness: a systematic review of the impact of social prescribing initiatives on loneliness

2021 ◽  
pp. 175791392096704
Author(s):  
GY Reinhardt ◽  
D Vidovic ◽  
C Hammerton
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Service Providers ◽  
Meta Analysis ◽  
Grey Literature ◽  
Outpatient Services ◽  
Social Prescribing ◽  
Positive Individual ◽  
Meta Analyses ◽  
The Impact

Aims: The aim of this systematic literature review is to assess the impact of social prescribing (SP) programmes on loneliness among participants and the population. Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search EBSCOHost (CINAHL Complete, eBook Collection, E-Journals, MEDLINE with Full Text, Open Dissertations, PsycARTICLES, and PsycINFO), UK National Institute for Health and Care Excellence (NICE), Web of Science Core Collection, and grey literature. We included studies measuring the effectiveness and impact of SP programmes in terms of loneliness. We excluded systematic reviews and studies without evaluations. Due to the absence of confidence intervals and the low number of studies, we conduct no meta-analysis. Results: From 4415 unique citations, nine articles met the inclusion criteria. The studies do not use uniform measures or randomised samples. All nine studies report positive individual impacts; three report reductions in general practitioner (GP), A&E, social worker, or inpatient/outpatient services; and one shows that belonging to a group reduces loneliness and healthcare usage. Conclusion: The findings of this systematic review indicate that individuals and service providers view SP as a helpful tool to address loneliness. However, evidence variability and the small number of studies make it difficult to draw a conclusion on the extent of the impact and the pathways to achieving positive change. More research is needed into the impact of SP programmes on participants, populations, and communities in terms of loneliness, isolation, and connectedness, especially in light of the surge in SP activity as a key part of pandemic response.

scholarly journals The impact of the COVID-19 pandemic on global neurosurgical education: a systematic review

2021 ◽  
Author(s):  
Raunak Jain ◽  
Raquel Alencastro Veiga Domingues Carneiro ◽  
Anca-Mihaela Vasilica ◽  
Wen Li Chia ◽  
Abner Lucas Balduino de Souza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Teaching And Learning ◽  
Meta Analysis ◽  
Virtual Technology ◽  
Middle Income ◽  
Elective Surgical Procedures ◽  
Surgical Exposure ◽  
Effective Teaching And Learning ◽  
The Impact

Abstract The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This impact has disproportionately affected LMICs (lower- and/or middle-income countries), already burdened by a lack of neurosurgical resources. Thus, a systematic review was conducted to examine these challenges and innovations developed to adapt effective teaching and learning for medical students and neurosurgical trainees. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and The Cochrane Handbook of Systematic Reviews of Interventions. MEDLINE, PubMed, Embase and Cochrane databases were accessed, searching and screening literature from December 2019 to 5th December 2020 with set inclusion and exclusion criteria. Screening identified 1254 articles of which 26 were included, providing data from 96 countries. Twenty-three studies reported transition to online learning, with 8 studies also mentioned redeployment into COVID wards with 2 studies mentioning missed surgical exposure as a consequence. Of 7 studies conducted in LMICs, 3 reported residents suffering financial insecurities from reduced surgical caseload and recession. Significant global disruption in neurosurgical teaching and training has arisen from the COVID-19 pandemic. Decreased surgical exposure has negatively impacted educational provision. However, advancements in virtual technology have allowed for more affordable, accessible training especially in LMICs. Using this, initiatives to reduce physical and mental stress experienced by trainees should be paramount.

scholarly journals Improved couple satisfaction and communication with marriage and relationship programs: are there gender differences?—a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Zeinab Javadivala ◽  
Hamid Allahverdipour ◽  
Mohammad Asghari Jafarabadi ◽  
Somaye Azimi ◽  
Neda Gilani ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Gender Differences ◽  
Mental Health Professionals ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Medium Effect ◽  
Cochrane Library ◽  
Relationship Communication ◽  
The Impact

Abstract Background The aspects of marriage and relationship and their effect on couples’ satisfaction are essential and critical aspects to be explored in this globalized and contemporary world. Since there are no reported meta-analysis and systematic reviews conducted in the last two decades in this area, we aimed to investigate the effect of marriage and relationship programs (MRP) on couples’ relationship satisfaction (CRS) and couples’ relationship communication (CRC) and also to determine the gender differences if any. Method In this systematic review and meta-analysis, the randomized clinical trials (RCTs) published between 2000 and July 26, 2019, were retrieved from several online electronic databases such as Medline, Embase, ProQuest, and Cochrane Library. Inclusion and exclusion criteria were developed using the PICO (Population, Intervention, Comparison, Outcome) framework of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The reported summary statistics were calculated as random effects models based on the heterogeneity between the studies model. Funnel plots and the Egger regression test was used to confirm the presence of any publication bias. Results Of the total 12 intervention studies included, five (5) are education/communication skills programs, three (3) enrichment programs, and four (4) therapy programs. The impact of these programs was investigated on CRS and CRC. Therapy programs had a larger effect than other programs (pooled MD: 0.53 (95% CI = 0.35 to 0.71, I2 = 71.5% p = 0.0001) and had a larger effect size on wives (pooled MD: 0.53 (95% CI 0.25 to 0.80, I2 = 74.1% p = 0.0001) than husbands RS (pooled MD: 0.26 (95% CI 0.25 to 0.76, I2 = 72.4% p = 0.0001). In RC (relationship communication) area, the Enhancement programs showed the small to large effect on CRC (pooled MD: 1.31 (95% CI = 0.13 to 2.50, I2 = 94.7% p = 0.0001)) and educational programs showed small to medium effect (pooled MD: 0.32 (95% CI = 0.13 to 0.50, I2 = 74.5% p = 0.0001) on women and no effect on men. Conclusion Due to the high effect of the therapy programs on CRS and enhancement program on CRC in the current meta-analysis, the priority of their utilizations in interventions, especially by psychologists and mental health professionals, should be emphasized. Therefore, mental health planning in communities to develop MRP and care for couples’ health should be given special attention to men’s health. Due to the high heterogeneity of the results and with scanty literature in this specific domain, we are uncertain about their actual effect. However, well-designed RCTs with a larger sample size would be beneficial in closely examining the effect of MRPs on CRS and CRC.

scholarly journals Impact of treatment as usual on efficacy estimates of face-to-face and internet-based psychotherapy for depression: A pre-registered systematic review and meta-analysis of randomized trials

2021 ◽  
Author(s):  
Thomas Munder ◽  
Alessia Geisshüsler ◽  
Tobias Krieger ◽  
Johannes Zimmermann ◽  
Markus Wolf ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Control Group ◽  
Randomised Trials ◽  
Control Groups ◽  
Treatment As Usual ◽  
Face To Face ◽  
Meta Analyses ◽  
The Impact

Background: Treatment as usual (TAU) is the most frequently used control group in randomised trials of psychotherapy for depression and meta-analyses that summarise these trials. Concerns have been raised over imprecise and biased efficacy estimates because of substantial variability in the treatments provided in TAU. We set out to investigate the impact of the control group intensity (i.e., quantitative and qualitative aspects of treatments in control groups) on results of trials of psychotherapy for depression and confounding due to systematic differences in this intensity in trials of face-to-face (F2F) and internet-based (INT) psychotherapy.Methods: We conducted a pre-registered systematic review and meta-analysis. We searched PsycINFO for systematic reviews of psychotherapy for depression from Jan 1, 2015 to Jan 3, 2020 and retrieved all references of trials included in these systematic reviews. We searched Cochrane’s Central Register of Controlled Trials and PsycINFO for randomised trials from Jan 1, 2018 to Jan 3, 2020. We included trials that compared (individual or group) F2F or (self-guided or guided) INT with TAU or waiting list (WL) in the acute treatment of patients with symptoms of unipolar depression. We excluded trials published before 2000. All information was extracted by two independent researchers. Six dichotomous indicators were used to create a score that expressed the intensity of TAU and WL. Primary outcome: Standardised mean differences (SMD) of treatment and control groups in depressive symptoms at treatment termination. SMDs were extracted from trial reports. A protocol was pre-registered with the Center for Open Science (www.osf.io/4mzyd).Findings: We included 89 eligible trials that randomised 14,474 patients to 113 eligible psychotherapy arms (8,284 patients) and 89 control arms (6,190 patients). TAU was used as control group in 42 trials (47.19%) and WL in 47 trials (52.81%). F2F was investigated in 37 trials (42.05%) and INT in 51 trials (57.95%). Intensity of control groups did not differ between F2F trials (M = 0.86, SD = 1.42) and INT trials (M = 0.39, SD = 0.63, p = .255). Intensity of control group was a significant predictor of trial results in the main analysis (one-sided p = .042), in pre-registered sensitivity analyses, and in all further exploratory analyses. Heterogeneity estimates were high (I2 = 69.30% to 95.37%). The final analysis found psychotherapy effects to be SMD = -0.287 (95% confidence interval [CI] -0.483 to -0.091, one-sided p = .002, I2 = 76.13%) smaller in 24 trials with higher intensity TAU compared to 16 trials with lower intensity TAU. Interpretation: Our findings suggest that the variability of treatments in TAU influences the results of trials on psychotherapy for depression and is likely to introduce imprecision into meta-analyses of these trials. Source of funding: None

scholarly journals The Impact of Genetic Variation on Sensitivity to Opioid Analgesics in Patients with Postoperative Pain: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. 131-152
Author(s):  
Prof. Lin Lu
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Postoperative Pain ◽  
Genetic Polymorphisms ◽  
Postoperative Period ◽  
Meta Analysis ◽  
Receptor Gene ◽  
Opioid Analgesics ◽  
Allele Variant ◽  
The Impact

Background: Individual response to opioid analgesics varies among patients. Objective: This study sought to clarify the impact of distinct genetic variations on pain, opioid consumption, and opioid side effects in patients with postoperative pain. Study Design: A systematic review and meta-analysis of associations between genetic singlenucleotide polymorphisms (SNPs) and opioids used for acute postoperative pain. Setting: This meta-analysis examined all studies involving an association between genetic polymorphisms and the analgesic efficacy or clinical outcome of opioid analgesics for postoperative pain. Methods: A literature search was performed up to January 31, 2014, using the PubMed, EMBase, ISI Web of Science, and Cochrane Library databases. Results: Fifty-nine studies were included in this systematic review, and 23 studies (a total of 5,902 patients) were included in the final meta-analysis. The results showed that human μ-opioid receptor gene (OPRM1) 118G allele variant carriers consumed more opioids for analgesia (SMD = -0.17, 95% CI = [-0.25, -0.10], P < 0.00001), but reported higher pain scores (MD = -0.11, 95% CI = [-0.17, -0.04], P = 0.002) and less nausea and vomiting (odds ratio = 1.30, 95% CI = [1.08, 1.55], P = 0.005) than the homozygous 118AA patients during the first 24 hour but not the 48 hour postoperative period. Moreover, CYP3A4*1G carriers consumed less opioids than homozygous CYP3A4*1/*1 patients during the first 24 hours postoperative period (MD = 45.12, 95% CI = [36.17, 54.06], P < 0.00001). No significant differences were found in CYP3A5*3, ABCB1 C3435T, and G2477T/A genetic polymorphisms. Limitations: Some potential non-genetic factors can modify the effects of gene SNP on pain and opioid consumption during the postoperative period, such as age, gender, mood, anxiety, and drug-drug interactions. But further analyses could not be performed in the present meta-analysis due to limited information. Conclusion: The results indicate that among the genetic SNPs we studied which include those affecting analgesic drug metabolism, transport of analgesic agents across the blood-brain barrier, and their activity at target receptors and ion channels and in the modulation of neurotransmitter pathways, the A118G allele variant of OPRM1 has the most potent influence on pain management of postoperative patients. Opioid receptor gene information may provide valuable information for clinicians to properly manage the analgesic use of opioids individually for better pain management. Key words: Postoperative pain, meta-analysis, single-nucleotide polymorphism, opioid

scholarly journals Protocol for a systematic review assessing ambulatory vital sign monitoring impact on deterioration detection and related clinical outcomes in hospitalised patients

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047715
Author(s):  
Carlos Areia ◽  
Sarah Vollam ◽  
Louise Young ◽  
Christopher Biggs ◽  
Marco Pimentel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Systematic Reviews ◽  
Standard Care ◽  
Meta Analysis ◽  
Ambulatory Monitoring ◽  
Scientific Conference ◽  
Vital Signs Monitoring ◽  
Hospitalised Patients ◽  
The Impact

IntroductionAmbulatory monitoring systems (AMS) can facilitate early detection of clinical deterioration, and have the potential to improve hospitalised patient outcomes. The objective of this systematic review is to assess the impact of vital signs monitoring on detection of deterioration and related outcomes in hospitalised patients using AMS, in comparison with standard care.Methods and analysisA systematic search was conducted on 27 August 2020 in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL and Health Technology Assessment databases, as well as grey literature. Search results will be reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist for systematic reviews. Studies comparing the use of ambulatory monitoring devices against standard care for deterioration detection and related clinical outcomes in hospitalised patients will be included and further clinical and other outcomes will also be explored. Deterioration-related outcomes may include (but not limited to) unplanned intensive care admissions, rapid response team activation and unscheduled emergency interventions, as defined by the included studies. Two reviewers will independently extract study data and assess the quality and risk of bias of included studies. Where possible, a meta-analysis will be conducted and quantitative results presented. Alternatively, a narrative synthesis will be reported.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. This study is part of our virtual High Dependency Unit project and will be disseminated through peer-reviewed publications, public and scientific conference presentations.PROSPERO registration numberCRD42020188633.

A systematic review of head, neck and-facial injuries in cricket

2021 ◽  
Author(s):  
Dulan Kodikara ◽  
Dara M Twomey ◽  
Mandy S Plumb
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Head Injuries ◽  
Common Mechanism ◽  
English Studies ◽  
Facial Fractures ◽  
Type Of Injury ◽  
The Impact ◽  
Head Neck

This systematic review was conducted to identify the incidence, nature and mechanisms of head, neck and facial (HNF) injuries in cricket and the reported use of helmets. Five databases were searched up to 30th November 2020. From peer-reviewed cricket injury studies published in English, studies reporting on HNF cricket injuries as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were selected. Twenty-nine studies were included. HNF injuries had a cumulative total of 794/5,886 injuries equating to 13% of all injuries. Non- specified HNF injuries (n=210, 26%) were the most prevalent type of injury followed by non-specified head injuries (n=130, 16%), other non-specified fractures (n=119, 15%) and concussions (n=60, 8%).The impact of the ball was reported as the most common mechanism for sustaining HNF injuries in cricket. The use of helmet was reported in only three studies (10%). From studies reporting on HNF cricket injuries, facial fractures, and concussions were the most common specified-types of injury. There is little evidence on reporting of HNF cricket injuries as per the international cricket consensus injury definitions, as well as the use of helmets at the time of injury.

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