scholarly journals Effectiveness, safety and implementation results of the strategies aimed at the safe prescription of medications in university hospitals in adult patients. Systematic review

2021 ◽  
Vol 49 (4) ◽  
Author(s):  
Jaime David Navarro Cárdenas ◽  
María Cristina Alarcón Nieto ◽  
María Paula Bernal Vargas ◽  
Kelly Estrada-Orozco ◽  
Hernando Gaitán Duarte
Keyword(s):  
Systematic Reviews ◽  
Meta Analysis ◽  
Adult Patients ◽  
Cochrane Library ◽  
University Hospitals ◽  
Computerized Decision Support ◽  
Beneficial Effects ◽  
Medical Order ◽  
Integrated Or ◽  
The Cochrane Library

Introduction: A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years. Objective: to establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals. Methodology: A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143. Results: 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach. Conclusions: The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.

Outcomes of digital biomarker-based interventions: protocol for a systematic review of systematic reviews (Preprint)

2021 ◽  
Author(s):  
Hossein Motahari-Nezhad ◽  
Márta Péntek ◽  
László Gulácsi ◽  
Zsombor Zrubka
Keyword(s):  
Clinical Outcomes ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Clinical Benefits ◽  
The Cochrane Library ◽  
The Impact ◽  
Digital Biomarkers

BACKGROUND Digital biomarkers are defined as objective, quantifiable physiological and behavioral data that are collected and measured by means of digital devices such as portables, wearables, implantables or digestibles. For their widespread adoption in publicly financed healthcare systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. OBJECTIVE To assess the quality and strength of evidence of the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers, reported in systematic reviews. METHODS A comprehensive search for 2019-2020 will be conducted in the PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of reviews. To assess the quality of evidence, we will evaluate systematic reviews using the GRADE tool. To detect the possible presence of reporting bias, we will record whether the protocol of the systematic reviews was published before the start of the study. A qualitative summary of results by digital biomarker technology and outcome will be provided. RESULTS This protocol was submitted before data collection. The next steps in this review will be initiated after the protocol is accepted for publication. CONCLUSIONS Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions. Our results will help identify clinical areas where the use of digital biomarkers leads to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated.

scholarly journals Effects of Adoptive Transfer of Tolerogenic Dendritic Cells on Allograft Survival in Organ Transplantation Models: An Overview of Systematic Reviews

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Yanni Zhou ◽  
Juan Shan ◽  
Yingjia Guo ◽  
Shengfu Li ◽  
Dan Long ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Allograft Survival ◽  
Skin Allografts ◽  
Islet Allografts ◽  
Tolerogenic Dendritic Cells ◽  
Overview Of Systematic Reviews ◽  
The Cochrane Library

Objective. To dissect the efficacy of Tol-DC therapy with or without IS in multiple animal models of transplantation.Methods and Results. PubMed, Medline, Embase, and the Cochrane Library were searched for reviews published up to April 2015. Six systematic reviews and a total of 61 articles were finally included. Data were grouped by organ transplantation models and applied to meta-analysis. Our meta-analysis shows that Tol-DC therapy successfully prolonged allograft survival to varying extents in all except the islet transplantation models and with IS drugs further prolonged the survival of heart, skin, and islet allografts in mice, but not of heart allografts in rats. Compared with IS drugs alone, Tol-DC therapy with IS extended islet allograft survival in rats but failed to influence the survival of skin, small intestine, and heart allografts in rats or of heart and skin allografts in mice.Conclusion. Tol-DC therapy significantly prolonged multiple allograft survival and further prolonged survival with IS. However, standardized protocols for modification of Tol-DC should be established before its application in clinic.

scholarly journals Incidence of injuries and illness and related risk factors in mountain biking events: A systematic review protocol

2020 ◽  
Author(s):  
Kim Buchholtz ◽  
Mike Lambert ◽  
Theresa Burgess
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Narrative Analysis ◽  
Meta Analysis ◽  
Sports Injury ◽  
Cochrane Library ◽  
Mountain Biking ◽  
True Incidence ◽  
Related Risk ◽  
The Cochrane Library

Abstract Background Cycling is a popular sport and method of transportation globally but is a significant contributor to sports injury admissions in hospital emergency units. Mountain biking events present additional challenges with remote venues, and isolated courses. Most mountain biking events will provide on-site medical care for both injury and illness occurring during races. These data are essential to understand the true incidence of injury and illness in mountain biking events as national health data may not represent these unique events specifically. Methods This review will follow the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Search engines PubMed, Scopus, SPORTDiscus (EBSCOhost), PEDro and the Cochrane Library will be systematically searched. Gray literature searches of Google Scholar and manual searching of reference lists and congress abstracts from cycling specific congresses will be conducted. Journal articles documenting illness and injury in adults participating in mountain bike cross-country marathon events will be included. A narrative analysis of the types, severity and area of injuries; and illness type and severity will be performed. A quantitative analysis may be performed should there be sufficient studies reported in the same format. Discussion This protocol outlines a systematic review on injury and illness in mountain biking events. Data from hospital records may not adequately represent the burden of injury and illness at events held in remote venues, especially if those treated on site do not require further hospital based treatment. This review will assist with the development of further research in this area, and in preparation of clinicians working in these types of events. Systematic review registration: This protocol has been registered with PROSPERO International prospective register of systematic reviews (No: CRD42019134586).

USING THE AMSTAR CHECKLIST FOR RAPID REVIEWS: IS IT FEASIBLE?

2016 ◽  
Vol 32 (4) ◽  
pp. 276-283 ◽  
Author(s):  
Jessica Tajana Mattivi ◽  
Barbara Buchberger
Keyword(s):  
Systematic Reviews ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
Time Frame ◽  
Cochrane Library ◽  
Overview Of Reviews ◽  
Surgical Interventions ◽  
Rapid Reviews ◽  
Study Characteristics ◽  
The Cochrane Library

Objectives: Rapid reviews can be conducted in a narrower time frame, as compared to systematic reviews, by featuring restrictions. To estimate the validity of the results, assessment of methodological quality is required. Our aim was to analyze the methodological restrictions of rapid reviews compared with systematic reviews using the AMSTAR checklist and assess its feasibility for rapid reviews.Methods: A systematic search for literature on rapid reviews of surgical interventions was conducted in three databases: Medline, Embase, and the Cochrane library. Additionally, health technology assessment (HTA) databases were searched. We analyzed reviews using AMSTAR and additionally compared the results with those of an overview of reviews on the same topic.Results: Items found more frequently in rapid reviews were search for gray literature (65 percent versus 33 percent), listing of excluded studies (59 percent versus 37 percent), and provision of study characteristics (77 percent versus 44 percent), whereas consideration of study quality in formulating conclusions, conduct of meta-analysis, and statement of conflicts of interest were less frequent. Median time between search and publication was 8 months, with a range between 1 and 27.Conclusions: With some adjustments, AMSTAR can be used as a checklist for rapid reviews to describe methodological restrictions in comparison to systematic reviews and to roughly estimate the validity of the results. Strikingly, only 14.3 percent of rapid reviews were published within 3 months.

scholarly journals Effects of Haloperidol on Delirium in Adult Patients: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 27 (3) ◽  
pp. 250-259 ◽  
Author(s):  
Ying-zi Shen ◽  
Ke Peng ◽  
Juan Zhang ◽  
Xiao-wen Meng ◽  
Fu-hai Ji
Keyword(s):  
Systematic Review ◽  
Second Generation ◽  
Meta Analysis ◽  
Adult Patients ◽  
Surgical Patients ◽  
Cochrane Library ◽  
High Dose ◽  
Qtc Interval ◽  
Second Generation Antipsychotics ◽  
The Cochrane Library

Objective: The aim of this systematic review and meta-analysis was to investigate whether or not the use of haloperidol could reduce the incidence of delirium in adult patients. Subjects and Methods: PubMed, Embase, the Cochrane Library, Elsevier, Wiley, and Ovid were searched for randomized controlled trials and prospective interventional cohort studies that compared haloperidol with placebo for delirium prophylaxis or with second generation antipsychotics for delirium treatment. The primary end point was the incidence and severity of delirium. After reviewing 272 relevant articles, 10 studies with 1,861 patients were finally included (haloperidol vs. placebo in 8 studies [n = 1,734], and haloperidol vs. second-generation antipsychotics in 2 studies [n = 127]). Revman 5.3 was used for the data analysis. Results: Compared with placebo, a high dose of prophylactic haloperidol (≥5 mg/day) may help reduce the incidence of delirium in surgical patients (risk ratio 0.50, 95% CI 0.32, 0.79). There were no differences in the duration of delirium, QTc interval prolongation, extrapyramidal symptoms, intensive care unit stay, hospital stay, or mortality between the haloperidol and placebo groups. For delirium treatment, haloperidol exhibited similar effects as the second-generation antipsychotics. Conclusions: In this study, the limited available data revealed that prophylaxis haloperidol at a dose of ≥5 mg/day might help reduce delirium in adult surgical patients. Further outcome studies with larger sample sizes are required to confirm these findings.

scholarly journals Using of Monofocal Intraocular Lenses Different Types for Cataract Surgery in Adult Patients: Systematic Review

2019 ◽  
Vol 15 (4) ◽  
pp. 484-491
Author(s):  
I. S. Krysanov ◽  
V. S. Krysanova ◽  
V. Yu. Ermakova
Keyword(s):  
Systematic Review ◽  
Clinical Trial ◽  
Surgical Treatment ◽  
Cataract Surgery ◽  
Randomized Clinical Trial ◽  
Meta Analysis ◽  
Adult Patients ◽  
Intraocular Lenses ◽  
Cochrane Library ◽  
The Cochrane Library

Objectives: to perfom analysis of the clinical efficacy and safety of using monofocal IOLs in the surgical treatment of cataracts in adult patients. Material and methods. In available sources (databases of the Cochrane Library and Medline) a search was conducted to evaluate the effectiveness and safety of using monofocal IOLs in cataract surgery in adult patients according to the PICO(S) regimen. A literature review was conducted in July 2018 for the keywords “intraocular lenses” and “cataract” using the following filters: clinical trial, randomized clinical trial, meta-analysis, systematic review (clinical trial, randomized clinical trial, meta-analysis, systematic review). Posting languages: English. Depth of search — 5 years. Last search date is July 27, 2018. Results. An initial search in the Medline database found 21,737 publications and 2157 in the Cochrane Library database. A total of 17,894 links were found. In a meta-analysis Zhao Y. et al., 2017, a comparison of the incidence of opacities of the posterior capsule (secondary cataract) after surgical treatment with the implantation of hydrophobic and hydrophilic IOLs was made. In multicenter retrospective cohort study Ursell P., et al, 2018 assessed the frequency of the Nd: YAG-laser capsulotomy for the treatment of secondary cataract which developed after the implantation of the IOL within the first 3 years after surgery. Conclusion. During the systematic review, the relationship between the incidence of complications (secondary cataracts) and the properties of the IOL material was found. The implantation of lenses from a hydrophobic material is associated with a lower incidence of secondary cataracts than the implantation of lenses from a hydrophilic material.

scholarly journals Incidence of injuries and illness and related risk factors in mountain biking events: A systematic review protocol

2020 ◽  
Author(s):  
Kim Buchholtz ◽  
Mike Lambert ◽  
Theresa Burgess
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Narrative Analysis ◽  
Meta Analysis ◽  
Sports Injury ◽  
Cochrane Library ◽  
Mountain Biking ◽  
True Incidence ◽  
Related Risk ◽  
The Cochrane Library

Abstract Background Cycling is a popular sport and method of transportation globally but is a significant contributor to sports injury admissions in hospital emergency units. Mountain biking events present additional challenges with remote venues, and isolated courses. Most mountain biking events will provide on-site medical care for both injury and illness occurring during races. These data are essential to understand the true incidence of injury and illness in mountain biking events as national health data may not represent these events specifically. Methods This review will follow the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Search engines PubMed, Scopus, CINAHL (EBSCOhost), PEDro and the Cochrane Library will be systematically searched. Gray literature searches of Google Scholar and manual searching of reference lists and congress abstracts from cycling specific congresses will be conducted. Journal articles documenting illness and injury in adults participating in mountain bike cross-country marathon events will be included. A narrative analysis of the types, severity and area of injuries; and illness type and severity will be performed. A quantitative analysis will be performed should there be sufficient studies reported in the same format. Discussion This protocol outlines a systematic review on injury and illness in mountain biking events. Data from hospital records may not adequately represent the burden of injury and illness at events held in remote venues, especially if those treated on site do not require further hospital based treatment. This review will assist with the development of further research in this area, and in preparation of clinicians working in these types of events. Systematic review registration: This protocol has been registered with PROSPERO International prospective register of systematic reviews (No: CRD42019134584).

scholarly journals Efficacy of Acupuncture and Related Techniques on Delirium: Protocol of a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Sulan Tan ◽  
Yu Zhang ◽  
Yiping Bai ◽  
Shuting Yang ◽  
Liming Luan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Guideline Development ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
Major Surgery ◽  
Cochrane Central Register ◽  
Statistical Heterogeneity ◽  
The Cochrane Library

Abstract Background: Delirium, contributing to subsequent increased morbidity and mortality, is common in hospitalized patients, especially in patients undergoing major surgery. Published systematic reviews suggest that certain medications for delirium management may decrease pain scores and analgesic requirements, at the expense of troublesome side effects. People are urgently seeking non-medication strategies for delirium. Acupuncture and related techniques (ART) are increasingly used to provide medical care and have potential to prevent delirium, however, the efficacy of ART on delirium remains controversial.Methods: In accordance with the PRISMA-P guidelines, we will search PubMed, Embase, the Cochrane Library (Cochrane Central Register of Controlled Trials (CENTRAL)), Web of Science, Medline and the Cochrane Library for clinical trials on ART use in people, without language restrictions. The incidence of delirium will be defined our primary outcome. Additional outcomes will be the incidence of adverse events, pain score, consumption of analgesics, number of cumulative delirious days, hemodynamics, length of hospital stay. Two researchers independently complete further review work and data abstraction based on pre-specified inclusion and exclusion criteria. Any discrepancy will be solved by negotiation or a third investigators. Cochrane Risk of Bias tool will be used to assess the methodological quality of all the studies that are finally included. Statistical heterogeneity was assessed by forest plots, confidence intervals (CI) and I² statistic. If feasible, a meta-analysis of included results will be performed.Conclusions: This protocol will be favorable to bridge the gap between non-medication strategies and clinical diseases, and potential to help future guideline development in management of preventing delirium.Systematic review registration: The protocol was prospectively registered on the homepage of the International Prospective Register of Systematic Reviews (PROSPERO): https://www.crd.york.ac.uk/PROSPERO.

scholarly journals Risk Factors for Perioperative Hemodynamic Instability in Pheochromocytoma: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (19) ◽  
pp. 4531
Author(s):  
Fumihiko Urabe ◽  
Shoji Kimura ◽  
Kosuke Iwatani ◽  
Kazuhiro Takahashi ◽  
Kagenori Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Confidence Interval ◽  
Systematic Reviews ◽  
Tumor Size ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Hemodynamic Instability ◽  
Cochrane Library ◽  
The Cochrane Library

Objective: To evaluate the risk factors of perioperative hemodynamic instability in pheochromocytoma, we conducted a systematic search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analysis. Methods: In April 2021, we systematically searched PubMed, the Cochrane library, and Scopus for relevant studies on the risk factors of perioperative hemodynamic instability of adrenalectomy in patients with pheochromocytoma, and we subjected the findings from those studies to formal meta-analysis. Results: Our systematic review identified 14 studies involving 1725 patients, of which nine studies with 967 patients were eligible for meta-analysis. The results of meta-analysis showed that tumor size (odds ratio (OR): 1.14 for each increased cm, 95% confidence interval (CI) 1.03–1.26, z = 2.57) and urinary norepinephrine (OR, 1.51: 95% CI 1.26–1.81; z = 4.50) were most closely associated with the occurrence of perioperative hemodynamic instability. Conclusion: These findings suggest that tumor size and urinary norepinephrine are important predictors and risk factors for perioperative hemodynamic instability in adrenalectomy for pheochromocytoma. Such findings may be of value to surgeons and anesthesiologists when considering or preparing for this procedure.

scholarly journals Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Pharmacology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Shan Deng ◽  
Yonghao Yu
Keyword(s):  
Femur Fracture ◽  
Meta Analysis ◽  
Sensory Block ◽  
Cochrane Library ◽  
Rescue Analgesia ◽  
Block Level ◽  
Block Time ◽  
Sedation Scores ◽  
The Difference ◽  
The Cochrane Library

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

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