Clinical utility of overviews on adverse events of pharmacological interventions.

BACKGROUND: Overviews (i.e., systematic reviews of systematic reviews, meta-reviews, umbrella reviews) are a relatively new type of evidence synthesis. Among others, one reason to conduct an overview is to investigate adverse events (AEs) associated with a healthcare intervention. Overviews aim to provide easily accessible information for healthcare decision-makers including clinicians. We aimed to evaluate the clinical utility of overviews investigating AEs. METHODS: We used a sample of 27 overviews exclusively investigating drug-related adverse events published until 2021 identified in a prior project. We defined clinical utility as the extent to which overviews are perceived to be useful in clinical practice. Each included overview was assigned to one of seven pharmacological experts with expertise on the topic of the overview. The clinical utility and value of these overviews were determined using a self-developed assessment tool. This included four open-ended questions and a ranking of three clinical utility statements completed by clinicians. We calculated frequencies for the ranked clinical utility statements and coded the answers to the open-ended questions using an inductive approach. RESULTS: The overall agreement with the provided statements was high. According to the assessments, 67% of the included overviews generated new knowledge. In 93% of the assessments, the overviews were found to add value to the existing literature. The overviews were rated as more useful than the individual included systematic reviews (SRs) in 85% of the assessments. The answers to the open-ended questions revealed two key aspects of clinical utility in the included overviews. Firstly, it was considered useful that they provide a summary of available evidence (e.g., along with additional assessments, or across different populations, or in different settings that have not been evaluated together in the included SRs). Secondly, it was found useful if overviews conducted a new meta-analysis to answer specific research questions that had not been answered previously. CONCLUSIONS: Overviews on drug-related AEs are considered valuable for clinical practice by clinicians. They can make available evidence on AEs more accessible and provide a comprehensive view of available evidence. As the role of overviews evolves, investigations such as this can identify areas of value.

Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis.

PURPOSE: Iron restricted anemia is prevalent in surgical patients and is associated with an increased risk of allogeneic red blood cell (RBC) transfusion and adverse events. Treatment of anemia includes oral and intravenous iron and erythropoiesis stimulating agents (ESAs). More recent studies have focused on the use of intravenous iron as the primary approach to treating anemia. Nevertheless, the optimal treatment strategy for anemia remains to be established. Our primary objective was to evaluate the efficacy and safety of ESA and iron therapy relative to iron therapy alone in reducing RBC transfusion in surgical patients. SOURCE: We searched the Cochrane Library, MEDLINE, EMBASE, and ClinicalTrials.gov from inception to May 2018. We included randomized-controlled trials in which adult surgical patients received an ESA and iron, vs iron alone, prior to cardiac and non-cardiac surgery. Our primary outcome was RBC transfusion rate. Secondary outcomes included hemoglobin concentration (post-treatment and postoperatively), number of RBC units transfused, mortality, stroke, myocardial infarction (MI), renal dysfunction, pulmonary embolism (PE), and deep vein thrombosis (DVT). PRINCIPAL FINDINGS: In total, 25 studies (4,719 participants) were included. Erythropoiesis stimulating agents and iron therapy reduced RBC transfusion relative to iron therapy (relative risk [RR] 0.57; 95% confidence interval [CI], 0.46 to 0.71) without any change in mortality (RR 1.31; 95% CI, 0.80 to 2.16), stroke (RR 1.91; 95% CI, 0.63 to 5.76), MI (RR 1.12; 95% CI, 0.50 to 2.50), renal dysfunction (RR 0.96; 95% CI, 0.72 to 1.26), PE (RR 0.92; 95% CI, 0.15 to 5.83), or DVT (RR 1.48; 95% CI, 0.95 to 2.31). CONCLUSION: Administration of ESA and iron therapy reduced the risk for RBC transfusion compared with iron therapy alone in patients undergoing cardiac and non-cardiac surgery. Nevertheless, publication bias and heterogeneity reduces the confidence of the finding. Although the analysis was probably under-powered for some outcomes, no difference in the incidence of serious adverse events was observed with ESA and iron compared with iron alone. Further large prospective trials are required to confirm these findings.

A pilot project of school-based intervention integrating drama and language awareness.

BACKGROUND: To help immigrant and refugee adolescents experiencing a severe academic delay cope with adversity, a school-based intervention combining drama workshops and language awareness activities was piloted in two classrooms. METHOD: A qualitative analysis of participant observations was performed and the Strength and Difficulty Questionnaire and its Impairment Supplement was administered before and after the intervention. The observations were carried out in two Montreal high schools serving an underprivileged neighbourhood of immigrants, involving two classrooms of underschooled adolescents (n = 27) and two classes of similarly underschooled adolescents chosen among other teachers interested in the intervention, who accepted to participate as a comparison group (n = 28). RESULTS: The adolescents shared their experiences of adversity and felt empowered by the workshops. Self-reported impairment decreased in the intervention groups. CONCLUSION: The protective effect of creative language activities for immigrant and refugee youth should be further investigated.

Evaluation of a sandplay program for preschoolers in a multiethnic neighborhood.

BACKGROUND: This evaluative study assesses the efficacy of a school-based secondary prevention program consisting of creative expression workshops for immigrant and refugee preschoolers in a predominantly South Asian multiethnic neighborhood. Coincidentally, the program began in the wake of the tsunami. METHOD: Pretest and posttest data were collected from the parents and teachers of 105 preschoolers in 10 classes randomly assigned to an experimental or control status. The parents' and teachers' versions of the Strengths and Difficulties Questionnaire were used to assess the children's mental health. The family's ethnic origins and premigration experiences of organized violence were considered in the analysis. RESULTS: According to both the teachers' and parents' reports, the children in the experimental group benefited moderately from the program, which appeared to reduce the SDQ global score of children whose families had experienced violence in their homelands (t(21) = 3.83, p = .001 (MT(1) = 12.81, MT(2) = 9.59)), in particular those from South Asia. CONCLUSION: This study provides some evidence that immigrant preschoolers whose families have experienced adversity before migration can benefit from the creative expression workshops. Further studies are needed to determine if this program can help address the effects of mass media exposure to a disaster or traumatic event on vulnerable communities.

Classroom drama therapy program for immigrant and refugee adolescents: a pilot study.

This evaluative study assesses the effects of a school drama therapy program for immigrant and refugee adolescents designed to prevent emotional and behavioral problems and to enhance school performance. The 9-week program involved 136 newcomers, aged 12 to 18, attending integration classes in a multiethnic school. Pretest and posttest data were collected from the students and their teachers. The self-report and teacher's forms of the Strengths and Difficulties Questionnaire were used to assess emotional and behavioral symptoms. At the end of the program, although there were no reported improvement in self-esteem or emotional and behavioral symptoms, the adolescents in the experimental group reported lower mean levels of impairment by symptoms than those in the control group, when baseline data were controlled for. Their performance in mathematics also increased significantly compared to that of their control peers. The findings suggest that the workshops may have an impact on social adjustment of recently arrived immigrants and refugees. This drama therapy program appears to be a promising way of working preventively and in a nonstigmatizing manner with adolescents who have been exposed to diverse forms of adversity, among which are war and violence.

[Playing with identities, transforming shared realities: school theatre workshop for immigrant and refugee adolescents]. / Du jeu des identités à la transformation de réalités partagées: un programme d'ateliers d'expression théâtrale pour adolescents immigrants et réfugiés.

Migration during adolescence represents a challenge for the youth who need to simultaneously work through the multiple losses associated with the migratory journey and adapt to a young adult status. The drama workshop program described here was designed to facilitate the adjustment of newly arrived immigrant teens. The aim of the program is to make it easier for adolescents to adjust to their new environment through creative group work around identity issues. The program also seeks to improve intergroup relations in multiethnic schools. The workshops are inspired both from playback theater and from Boal's form theater which emphasizes the collective transformation of the singular experience. The qualitative assessment of the program effects on the adolescents suggests that the workshops constitute a safe space of expression, in which the team and the ritual nature of the play hold the participants. The workshops facilitate the representation of the multiplicity of values in the adolescent world and invite them to reconsider the way in which they interact, with their environment, without splitting between "us" and "them," but rather creating solidarities around issues of social justice. The workshops also address the life transformation associated both with adolescence and migration and help the elaboration of the losses linked to the migratory journey and the construction of a hybrid identity.

Creative expression workshops in school: prevention programs for immigrant and refugee children.

INTRODUCTION: Immigrant and refugee families underutilize mental health services and schools are in a good position to develop prevention programs to help children adapt to their new environment. METHOD: The transcultural psychiatry team at the Montreal Children's Hospital, in partnership with schools, has implemented creative expression workshops for kindergarten, elementary schools, and high school to help the children bridge the gap between past and present, culture of origin and host society. RESULTS: The workshops provide a safe space for expression, acknowledge and value diversity, allow the establishment of continuity, and facilitate the transformation of adversity. CONCLUSION: Refugee and immigrant children's needs should be addressed through intersectoral programs that target exclusion and support a sense of agency.