The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review.

BACKGROUND: Overuse of head computed tomography (CT) for syncope has been reported. However, there is no literature synthesis on this overuse. We undertook a systematic review to determine the use and yield of head CT and risk factors for serious intracranial conditions among syncope patients. METHODS: We searched Embase, Medline, and Cochrane databases from inception until June 2017. Studies including adult syncope patients with part or all of patients undergoing CT head were included. We excluded case reports, reviews, letters, and pediatric studies. Two independent reviewers screened the articles and collected data on CT head use, diagnostic yield (proportion with acute hemorrhage, tumors or infarct), and risk of bias. We report pooled percentages, I2 , and Cochran's Q-test. RESULTS: Seventeen articles with 3,361 syncope patients were included. In eight ED studies (n = 1,669), 54.4% (95% confidence interval [CI] = 34.9%-73.2%) received head CT with a 3.8% (95% CI = 2.6%-5.1%) diagnostic yield and considerable heterogeneity. In six in-hospital studies (n = 1,289), 44.8% (95% CI = 26.4%-64.1%) received head CT with a 1.2% (95% CI = 0.5%-2.2%) yield and no heterogeneity. In two articles, all patients had CT (yield 2.3%) and the third enrolled patients ≥ 65 years old (yield 7.7%). Abnormal neurologic findings, age ≥ 65 years, trauma, warfarin use, and seizure/stroke history were identified as risk factors. The quality of all articles referenced was strong. CONCLUSION: More than half of patients with syncope underwent CT head with a diagnostic yield of 1.1% to 3.8%. A future large prospective study is needed to develop a robust risk tool.

Sport-based youth development interventions in the United States: a systematic review.

BACKGROUND: The growing number of sport-based youth development interventions provide a potential avenue for integrating sport meaningfully into the U.S. public health agenda. However, efficacy and quality must be reliably established prior to widespread implementation. METHODS: A comprehensive search of databases, peer-reviewed journals, published reviews, and both published and unpublished documents yielded 10,077 distinct records. Title and abstract screening, followed by full-text screening using 6 criteria, resulted in 56 distinct studies (coalescing into 10 sport-based youth development intervention types) included in the synthesis. These studies were then independently assessed and critically appraised. RESULTS: Limited efficacy data were identified, with the quality of methods and evidence largely classified as weak. Processes likely to contribute to the outcomes of sport-based youth development interventions were identified (e.g., predictors of ongoing engagement, alignment between target population and intervention, intervention design), although more rigorous research is needed on these and other processes. Physical health outcomes were only studied in 3 of the 10 intervention types. CONCLUSIONS: The evidence base does not yet warrant wide-scale implementation of sport-based youth development interventions for public health goals within the U. S., although there is promising research that identifies areas for further exploration.

The Effectiveness of Tranexamic Acid at Reducing Blood Loss and Transfusion Requirement for Women Undergoing Myomectomy: A Systematic Review and Meta-analysis.

BACKGROUND: The surgical removal of fibroids can be associated with excessive blood loss requiring transfusion. OBJECTIVE: This review sought to determine the effectiveness of tranexamic acid (TA) in reducing perioperative blood loss in women undergoing myomectomy. METHODS: Electronic bibliographic databases were searched from inception until June 3, 2017. The review included RCTs of women of reproductive age with uterine fibroids who were undergoing myomectomy and who received TA or a comparator. Two independent reviewers extracted relevant data, and meta-analysis was performed. RESULTS: Three studies included women undergoing abdominal myomectomy. TA significantly reduced intraoperative blood loss by a mean difference of 213.1 mL (95% CI -242.4 to -183.7) and postoperative blood loss by a mean difference of 56.3 mL (95% CI -67.8 to -44.8) compared with control arms. However, no significant differences were seen in blood transfusion requirement (relative risk 0.58; 95% CI 0.33-1.00). In one study for women undergoing hysteroscopic myomectomy, TA was not associated with improved outcomes in transfusion requirement and resulted in reduced postoperative hemoglobin levels compared with oxytocin. CONCLUSION: Among women undergoing abdominal myomectomy, TA is effective at reducing perioperative blood loss compared with no treatment or placebo. For women undergoing hysteroscopic myomectomy, TA compared with oxytocin is not associated with improved outcomes in transfusion requirement and resulted in reduced postoperative hemoglobin levels.