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1.
Endocrine ; 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34729686

RESUMO

PURPOSE: There is some evidence that women born preterm or with low birth weight (LBW) have an increased future risk of gestational diabetes mellitus (GDM) during pregnancy; however, a quantitative summary of evidence is lacking. In this systematic review and meta-analysis, we examined the published data to investigate whether being born preterm, with LBW or small for gestational age (SGA) are associated with GDM risk. METHODS: We searched the MEDLINE, Embase, and CINAHL databases and study registries, including ClinicalTrials.gov and ICTRP, from launch until 29 October 2020. Observational studies examining the association between birth weight or gestational age and GDM were eligible. We pooled the odds ratios and 95% confidence intervals using the DerSimonian and Laird random-effects model. RESULTS: Eighteen studies were included (N = 827,382). The meta-analysis showed that being born preterm, with LBW or SGA was associated with increased risk of GDM (pooled odds ratio = 1.84; 95% confidence interval: 1.54-2.20; I2 = 78.3%; τ2 = 0.07). Given a GDM prevalence of 2.0, 10, and 20%, the absolute risk differences were 1.6%, 7.0%, and 11.5%, respectively. The certainty of the evidence was low due to serious concerns of risk of bias and publication bias. CONCLUSIONS: Women born prematurely, with LBW or SGA status, may be at increased risk for GDM. However, whether this should be considered in clinical decision-making depends on the prevalence of GDM.

3.
Cochrane Database Syst Rev ; 10: CD013367, 2021 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-34644398

RESUMO

BACKGROUND: Humour-based interventions are defined as any intervention that promotes health and wellness by stimulating a playful discovery, expression, or appreciation of the absurdity or incongruity of life's situations. Humour-based interventions can be implemented in different settings, including hospitals, nursing homes and day care centres. They have been posed as an adjunct to usual care for people with schizophrenia, but a summary of the evidence is lacking. OBJECTIVES: To examine the effects of humour-based interventions as an add-on intervention to standard care for people with schizophrenia. SEARCH METHODS: On 31 July 2019 and 10 February 2021 we searched the Cochrane Schizophrenia Group's study-based register of trials, which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed, and WHO ICTRP. SELECTION CRITERIA: We included all randomised controlled trials comparing humour-based interventions with active controls, other psychological interventions, or standard care for people with schizophrenia. We excluded studies fulfilling our prespecified selection criteria but without useable data from further quantitative synthesis. DATA COLLECTION AND ANALYSIS: Two review authors independently inspected citations, selected studies, extracted data and appraised study quality, following the guidance from the Cochrane Handbook for Systematic Reviews of Interventions. For binary outcomes we calculated risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean differences (MDs) and their 95% CIs. We assessed risks of bias for included studies and created summary of findings tables using the GRADE approach. MAIN RESULTS: We included three studies in this review for qualitative synthesis, although one study did not report any relevant outcomes. We therefore include two studies (n = 96) in our quantitative synthesis. No data were available on the following prespecified primary outcomes: clinically-important change in general mental state, clinically-important change in negative symptoms, clinically-important change in overall quality of life, and adverse effects. As compared with active control, humour-based interventions may not improve the average endpoint score of a general mental state scale (Positive and Negative Syndrome Scale (PANSS) total score: MD -1.70, 95% CI -17.01 to 13.61; 1 study, 30 participants; very low certainty of evidence); positive symptoms (PANSS positive symptom score: MD 0.00, 95% CI -2.58 to 2.58; 1 study, 30 participants; low certainty of evidence), negative symptoms (PANSS negative symptom score: MD -0.70, 95% CI -4.22 to 2.82; 1 study, 30 participants; very low certainty of evidence) and anxiety (State-Trait Anxiety Inventory (STAI): MD -2.60, 95% CI -5.76 to 0.56; 1 study, 30 participants; low certainty of evidence). Due to the small sample size, we remain uncertain about the effect of humour-based interventions on leaving the study early as compared with active control (no event, 1 study, 30 participants; very low certainty of evidence). On the other hand, humour-based interventions may reduce depressive symptoms (Beck Depression Inventory (BDI): MD -6.20, 95% CI -12.08 to -0.32; 1 study, 30 participants; low certainty of evidence). Compared with standard care, humour-based interventions may not improve  depressive symptoms (BDI second edition: MD 0.80, 95% CI -2.64 to 4.24; 1 study, 59 participants; low certainty of evidence). We are uncertain about the effect of humour-based interventions on leaving the study early for any reason compared with standard care (risk ratio 0.38, 95% CI 0.08 to 1.80; 1 study, 66 participants; very low certainty of evidence). AUTHORS' CONCLUSIONS: We are currently uncertain whether the evidence supports the use of humour-based interventions in people with schizophrenia. Future research with rigorous and transparent methodology investigating clinically important outcomes is warranted.


Assuntos
Esquizofrenia , Ansiedade , Transtornos de Ansiedade , Humanos , Qualidade de Vida , Esquizofrenia/terapia , Revisões Sistemáticas como Assunto
4.
Cureus ; 13(8): e17261, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34540484

RESUMO

Recently, underwater endoscopic mucosal resection (UEMR) without submucosal injection was introduced as a new replacement for conventional EMR (CEMR) and was reported to be useful for resecting large colonic polyps. Here, we aimed to assess the efficacy and safety of these two methods by a systematic review and meta-analysis. We comprehensively searched multiple databases until July 2021 to identify randomized controlled trials (RCTs) comparing UEMR with CEMR. The primary outcomes were the proportion of R0 resection and mean procedure time, and the secondary outcomes were the proportion of en bloc resection and all adverse events. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in www.protocols.io (Protocol Integer ID: 40849). We included six RCTs (1,374 polyps). We judged that a meta-analysis was not available, and the data were summarized narratively for the proportion of R0 resection. Regarding procedure time, UEMR likely resulted in a large reduction (mean difference = -64.3 seconds; 95% confidence interval (CI) = -122.5 to -6.0 seconds; I2 = 86%; moderate certainty of evidence). UEMR likely resulted in a large increase in en bloc resection (odds ratio = 1.85; 95% CI = 1.15 to 2.98; I2 = 60%; moderate certainty of evidence). Percentages of adverse events were 0-17% with CEMR and 0-16% with UEMR. In summary, UEMR might have higher efficacy than CEMR in the endoscopic resection of nonpedunculated colorectal polyps, with likely a large reduction in procedure time.

6.
J Clin Epidemiol ; 141: 74-81, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34474114

RESUMO

OBJECTIVES: To assess the proportion of the recent Cochrane reviews that included outcomes in their literature search strategy, how often they acknowledged these limitations, and how qualitatively different the results of outcomes included and not included in the search strategy were. DESIGN AND SETTING: We identified all the Cochrane reviews of the interventions published in 2020 that used a search strategy connecting outcome terms with "AND." Reviews were defined as acknowledging the limitations of searching for outcomes if they mentioned them in the discussion. We compared the characteristics of outcomes included and not included in the search strategy. RESULTS: Of the 523 Cochrane reviews published in 2020, 51 (9.8%) included outcomes in their search strategy. Only one review acknowledged it as a limitation. Forty-seven (92%) assessed outcomes not included in the search strategy. Outcomes included in the search strategies tended to include a larger number of studies and show their effects in favor of the intervention. CONCLUSIONS: Around ten percent of the recent Cochrane reviews included outcomes in their search, which may have resulted in more outcomes significantly in favor of the intervention. Reviewers should be more explicit in acknowledging the potential implications of searching for outcomes.

7.
Cureus ; 13(8): e17188, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34414052

RESUMO

Simulation training is key to developing skills for vascular access. However, the efficacy of simulation-based education remains unclear. We conducted a well-designed and updated systematic review to investigate the efficacy of these programs. Randomized controlled trials (RCTs) were researched using the following databases from inception until July 26, 2020: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Education Resources Information Center (ERIC), Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and International Clinical Trials Registry Platform (ICTRP). RCTs included patients undergoing insertion of central venous catheters (CVCs), peripherally inserted central catheters (PICCs), and radial arterial catheters. We compared the group that received simulation training with the group that received traditional training. We also assessed the success rate, adverse events, and first-attempt success using a random-effects meta-analysis. The protocol was registered at Protocols.io (dx.doi.org/10.17504/protocols.io.biu6keze). Seven RCTs (n=866) were evaluated. The meta-analysis showed that simulation-based education increased the overall success rate compared with traditional education (risk ratio: 1.08, 95% CI: 1.03 to 1.13; six RCTs; 840 participants; I2=0%; moderate certainty of evidence). However, it was unclear whether or not simulation-based education had an effect on reducing adverse events when compared with traditional education (risk ratio: 1.00, 95% CI: 0.63 to 1.58; five studies; 750 participants; I2=37%; very low certainty of evidence) or on raising first-attempt success rates (risk ratio: 1.34, 95% CI: 0.93 to 1.94; three studies; 244 participants; I2=59%; very low certainty of evidence). Simulation-based education may help develop skills for successful vascular access. However, it is unclear whether simulation-based education actually reduces the incidence of adverse events. Fine control of the needle tip is probably necessary to prevent adverse events. Simulation-based education might be required in the future for outcome-based task training.

9.
Artigo em Inglês | MEDLINE | ID: mdl-34223912

RESUMO

PURPOSE: This study aimed to determine the efficacy and safety of cement augmentation for internally fixed trochanteric fractures through a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: We searched the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs, published until July 2020 that examined the effects of cement augmentation of internal fixation of trochanteric fractures. The primary outcomes were reoperation and Parker Mobility Score, whereas the secondary outcomes were 1-year mortality rate, EuroQol 5 Dimension, fixation failures, and adverse events. We conducted meta-analyses of the outcome measures using the random-effects models. We evaluated the certainty of evidence based on the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: We included three RCTs (326 participants). No significant effect was observed in favor of cement augmentation on all these outcomes. The certainty of evidence for fixation failures was very low and that for the other outcomes was low. The overall risk of bias for each outcome was high or of some concern in all included studies. CONCLUSIONS: The effect of cement augmentation of internal fixation of trochanteric fractures was uncertain for the clinical outcomes due to the low certainty of evidence. Further RCTs with a low risk of selection bias may present convincing conclusions on the efficacy and safety of cement augmentation. LEVEL OF EVIDENCE: Level 1.

13.
Cureus ; 13(2): e13257, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33717762

RESUMO

BACKGROUND:  Researchers have been advised to report the point estimate of either sensitivity or specificity and its 95% credible interval (CrI) for a fixed specificity or sensitivity value in the summary of findings (SoF) table for diagnostic test accuracy (DTA) when they use the hierarchical summary receiver operating characteristic (HSROC) model. However, there is no other tool that easily calculates the statistics. RESULTS:  We developed the calculator for the summary points from the HSROC model (CAST-HSROC), a web application for calculating the statistics easily. The existing graphical user interface software such as Review Manager and MetaDTA cannot calculate the statistics. Users should check whether convergence is reached before interpreting the results. CONCLUSIONS:  CAST-HSROC can easily calculate the point estimate of either sensitivity or specificity and its 95% CrI for a fixed specificity or sensitivity value on the HSROC model. The application can help to create an SoF table for DTA when systematic reviewers or guideline developers estimate the certainty of evidence on the HSROC model.

14.
BMC Med Educ ; 21(1): 98, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568114

RESUMO

BACKGROUND: Research engagement contributes to the improvement of patient care. A systematic review is a suitable first scholarly activity because it entails summarization of publicly available data and usually requires neither rigorous ethical review nor research funding. METHODS: This study aimed to develop a model workshop for healthcare staff to acquire skills in creating systematic review protocols based on their own clinical questions at teaching hospitals. We used an action research method to create a model workshop at four hospitals in Japan from April 2015 to March 2017. To improve the program, we solicited reflections using participant questionnaires for each lecture and examined the quality of homework submitted by participants after each lecture. We administered a revised final version of the workshop at five hospitals from April 2016 to March 2017. We evaluated the participants' scholarly productivity related to these workshops. The observation period was a minimum of 2 years following the workshops. RESULTS: Most participants had never developed a formal clinical research protocol and voluntarily participated in the workshop. The action research was developed and implemented at nine teaching hospitals in Japan, including one university hospital. The study developed a model nine-step workshop curriculum: 1) Research question development, 2) Search strategy development, 3) Search strategy brush-up, 4) Exclusion and inclusion criteria development, 5) Risk of bias assessment planning, 6) Meta-analysis planning, 7) Subgroup and sensitivity analysis planning, 8) Planning the presentation of results, and 9) Presentation protocols. A total of 233 participants, including medical doctors and other health professionals, produced 414 research questions. Seventy-nine participants (34%) completed the workshop, and 47 review teams accomplished systematic review protocols. The participants published 13 peer-reviewed articles as a result of the workshop. CONCLUSIONS: We developed a structured scholarly productive model workshop for healthcare staff working at hospitals. We found healthcare staff with clinical subspecialties were able to develop an unexpectedly high number of research questions through this workshop. Medical teachers at hospitals with prior systematic review experience could teach how to develop systematic review protocols using this model. Further research is needed to increase the academic productivity of such workshops. TRIAL REGISTRATION: UMIN (https://www.umin.ac.jp/ctr/), UMIN000017107 (4/15/2015), UMIN000025580 (1/10/2017).


Assuntos
Pessoal de Saúde , Pesquisa sobre Serviços de Saúde , Atenção à Saúde , Hospitais de Ensino , Humanos , Japão , Metanálise como Assunto , Revisões Sistemáticas como Assunto
15.
Pediatr Allergy Immunol ; 32(4): 690-701, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33475191

RESUMO

BACKGROUND: Neonatal jaundice and phototherapy have been associated with the development of allergic diseases. It has been suggested, however, that effect estimates of the associations might be smaller than expected. We sought to update the evidence of their associations including recently published large longitudinal studies. METHODS: We sought published and unpublished observational studies through the major databases. We used a random-effect meta-analysis model weighted by the inverse variance estimate, the Quality in Prognosis Studies tool to assess the methodological quality for each study, and the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the certainty of evidence (COE). RESULTS: Nineteen studies were enrolled in the qualitative syntheses, and fourteen studies were synthesized in the meta-analyses. Neonatal jaundice was associated with a higher risk of childhood-onset asthma (odds ratio [OR], 1.46; 95% confidence interval [95% CI], 1.39-1.53; COE, moderate), atopic dermatitis (AD; OR, 1.30; 95% CI, 1.07-1.57; COE, moderate), and allergic rhinitis (AR; OR, 3.01; 95% CI, 0.8810.30; COE, low). Neonatal phototherapy was also associated with a higher risk of childhood-onset asthma (OR, 1.24; 95% CI, 1.11-1.38; COE, moderate), AD (OR, 1.31; 95% CI, 1.24-1.39; COE, moderate), and AR (OR, 1.38; 95% CI, 0.93-2.04; COE, very low). There were no studies that reported effect estimates of the associations between childhood-onset food allergies and neonatal jaundice and phototherapy. CONCLUSION: Neonatal jaundice and phototherapy were probably a prognostic factor of childhood-onset allergic diseases; however, the associations were likely to be smaller than previously estimated.


Assuntos
Asma , Dermatite Atópica , Icterícia Neonatal , Rinite Alérgica , Asma/epidemiologia , Asma/terapia , Humanos , Recém-Nascido , Icterícia Neonatal/epidemiologia , Icterícia Neonatal/terapia , Fototerapia
16.
Simul Healthc ; 16(5): 341-352, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33428355

RESUMO

SUMMARY STATEMENT: We aimed to assess the learning effects of novice transesophageal echocardiography (TEE) simulator training and to identify gaps in existing studies. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the learning effects of novice TEE training with versus without simulators, searching published articles and proceedings in 6 major databases in June 2019. We included 9 RCTs (268 participants). Compared with nonsimulator training, TEE simulator training resulted in higher skill and knowledge posttraining test scores with large effect sizes (standardized mean difference = 0.81 for skill, 1.61 for knowledge; low-certainty evidence) and higher training satisfaction with a small effect size (standardized mean difference = 0.36; very low-certainty evidence). No RCTs reported training budget or patient outcomes. Additional well-designed studies with low risk of bias and large sample sizes are needed to provide reliable and robust findings and develop more effective TEE simulation-based training curricula.


Assuntos
Ecocardiografia Transesofagiana , Treinamento por Simulação , Currículo , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
19.
J Sleep Res ; 30(4): e13273, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33372341

RESUMO

Key clinical symptoms observed among individuals with psychiatric disorders include difficulty falling asleep or maintaining sleep, poor sleep quality and nightmares. Those suffering from sleep disorders often present with symptoms of discontent with regard to sleep quality, timing and quantity, and these symptoms have an adverse impact on function and quality of life. A minimally invasive technique would be preferable in patients with psychiatric disorders, who tend to be sensitive to environmental change. Accordingly, we evaluated the performance of Zmachine Insight Plus, an ambulatory electroencephalography sleep monitor, in patients with psychiatric disorders. One hundred and three patients undergoing polysomnography were enrolled in this study. Zmachine Insight Plus was performed simultaneously with polysomnography. Total sleep time, sleep efficiency, wake after sleep onset, rapid eye movement (REM) sleep, light sleep (stages N1 and N2) and deep sleep (stage N3) were assessed. Total sleep time, sleep efficiency, wake after sleep onset, REM sleep duration and non-REM sleep duration of Zmachine Insight Plus showed a significant correlation with those of polysomnography. Lower sleep efficiency and increased frequency of waking after sleep onset, the arousal index and the apnea-hypopnea index on polysomnography were significantly associated with the difference in sleep parameters between the two methods. Among patients with psychiatric disorders who are sensitive to environmental change, Zmachine Insight Plus would be a useful technique to objectively evaluate sleep quality.


Assuntos
Eletroencefalografia , Transtornos Mentais/complicações , Monitorização Ambulatorial , Polissonografia , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/diagnóstico , Sono , Feminino , Humanos , Masculino , Transtornos Mentais/fisiopatologia , Pessoa de Meia-Idade , Qualidade de Vida , Transtornos do Sono-Vigília/fisiopatologia
20.
Ann Transl Med ; 8(17): 1059, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33145278

RESUMO

Background: The gut microbiota is involved in the pathophysiology of obesity. It is known that oral antibiotics manipulate the gut microbiota; however, the impact on host metabolism of obese adults without bacterial infection has not been systematically summarized. Methods: We searched for randomized, placebo-controlled trials that investigated the effects of oral antibiotics on the metabolic status in obese adults via Medline, EMBASE, and the Cochrane Library. Primary outcomes were homeostasis model assessment of insulin resistance (HOMA-IR), body weight, and rate of diarrhea. Additional outcomes included fasting plasma glucose (FPG), plasma glucagon-like peptide-1 (GLP-1), waist circumference, fecal short-chain fatty acid (SCFA) levels, and all adverse events. We assessed the certainty of evidence based on Grading of Recommendations, Assessment, Development and Evaluations. Results: Among 1,762 articles screened, four studies were eligible for quantitative analysis, two of which were applied to meta-analysis. Oral antibiotics had low influence on HOMA-IR [mean difference (MD) 0.09 (95% CI: -0.96 to 1.13)], body weight [MD 4.1 kg (95% CI: -23.77 to 31.97)], FPG [MD -0.12 mmol/L (95% CI: -0.47 to 0.23)], and GLP-1 [MD 0.20 pmol/L (95% CI: -2.36 to 2.76)] compared to placebo. Antibiotics treatment altered fecal acetate and butyrate levels, but resulted in little difference in propionate levels [MD -13.60 µmol/g (95% CI: -22.43 to -4.77), MD -7.60 µmol/g (-10.97 to -4.23), MD -1.10 µmol/g (95% CI: -4.18 to 1.98), respectively]. Several adverse events, such as sun sensitivity and gastrointestinal discomfort, were reported following antibiotics treatment, but no diarrhea. The certainty of evidence for most outcomes was very low to low, except for fecal SCFAs. Conclusions: Our results indicate that oral antibiotics treatment is insufficient to ameliorate metabolic parameters in obese adults, suggesting that oral antibiotics treatment may not qualify as a therapeutic approach for obesity.

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