The impact of hidradenitis suppurativa on work productivity and performance: a systematic review and meta-analysis.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder affecting the skinfold regions. There is growing appreciation of the need for socioeconomic factors to be included in multidisciplinary assessments of HS. However, knowledge regarding HS and workplace function is limited. OBJECTIVES: To assess the relationship between HS and workplace function. METHODS: CINAHL, Embase, MEDLINE, PsycINFO and PubMed were systematically searched to collect data from studies in which validated surveys of workplace function were administered to patients with HS. RESULTS: Of 1932 publications, 12 studies were included in this review and 7 reported sufficient data for meta-analysis. The studies included in this review encompassed 5187 patients with HS and no controls. All studies used the Work Productivity and Activity Impairment questionnaire, reporting percentage scores for absenteeism, presenteeism, total work productivity impairment (TWPI) and total activity impairment (TAI). The pooled mean scores for HS were calculated as 10.17% [95% confidence interval (CI) 8.68-11.66] for absenteeism, 31.13% (95% CI 25.02-37.23) for presenteeism, 34.25% (95% CI 29.37-39.14) for TWPI and 42.23% (95% CI 38.56-45.89) for TAI. Significant heterogeneity was identified; most studies were of 'poor' to 'fair' quality. CONCLUSIONS: Current evidence suggests considerable impairment of workplace functioning in patients with HS. Our findings point to a significant unmet treatment need with respect to improving working capability in HS. The existing literature is inadequate to reliably assess the mechanisms underlying this effect or to comparatively assess the capabilities of HS therapies to improve workplace function.

The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aims to estimate the rate of postoperative meningitis (both immediate and long-term) in patients following cochlear implants (CIs). It aims to do so through a systematic review and meta-analysis of published studies tracking complications after CIs. DATA SOURCES: MEDLINE, Embase, and Cochrane Library. REVIEW METHODS: This review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies tracking complications following CIs in patients were included. Exclusion criteria included non-English language studies and case series reporting <10 patients. Bias risk was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed through DerSimonian and Laird random-effects models. RESULTS: A total of 116/1931 studies met the inclusion criteria and were included in the meta-analysis. Overall, there were 112 cases of meningitis in 58,940 patients after CIs. Meta-analysis estimated an overall rate of postoperative meningitis of 0.07% (95% confidence interval [CIs], 0.03%-0.1%; I2 = 55%). Subgroup meta-analysis showed this rate had 95% CIs crossing 0% in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, those with postoperative acute otitis media (AOM), and those implanted less than 5 years. CONCLUSION: Meningitis is a rare complication following CIs. Our estimated rates of meningitis after CIs appear lower than prior estimates based on epidemiological studies in the early 2000s. However, the rate still appears higher than the baseline rate in the general population. The risk was very low in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, received unilateral or bilateral implantations, developed AOM, those implanted with a round window or cochleostomy techniques, and those under 5 years.