2019 Canadian guideline for physical activity throughout pregnancy

No. 367-2019 Canadian Guideline for Physical Activity throughout Pregnancy.

This consensus aims to provide guidance for postpartum women and people, healthcare providers and exercise professionals on physical activity, sedentary behaviour and sleep throughout the first year postpartum. The development...

The Society of Obstetricians and Gynaecologists of Canada/Canadian Society for Exercise Physiology 2019 Canadian guideline for physical activity throughout pregnancy provides evidence-based recommendations for pregnant women to optimise maternal/fetal health.1–4...

Technical Update No. 467: Progesterone for Previous Spontaneous Preterm Birth.

The purpose of this guideline is to promote recognition and preventive strategies for obstetrical anal sphincter injuries. Furthermore, it provides guidance on primary repair and immediate postpartum management for obstetrical anal sphincter tears in order to minimize further negative sequelae. All patients having a vaginal delivery and those who have sustained an obstetrical anal sphincter injury. Certain preventive strategies have been associated with lower rates of obstetrical anal sphincter injuries (e.g., fetal head flexion and control, appropriate use of mediolateral episiotomy). Management strategies, including appropriate diagnosis and repair of obstetrical anal sphincter injuries, antibiotic prophylaxis, and bowel and bladder function management can decrease associated short- and long-term complications. Implementation of the recommendations in this guideline may increase detection, prevention, and appropriate management of obstetrical anal injuries, thus limiting the future burden associated with these injuries. Implementation of the recommended classification of obstetrical anal sphincter injuries will improve national and international research efforts. Published literature was retrieved through searches of PubMed, Ovid, Medline, Embase, Scopus, and the Cochrane Library from September 1, 2014, through November 30, 2023, using appropriate MeSH terms (delivery, obstetrics, obstetric surgical procedures, obstetric labor complications, anal canal, episiotomy) and keywords (OASIS, obstetrical anal sphincter injury, anal injury, anal sphincter, vaginal delivery, suture, fecal incontinence, anal incontinence, overlap repair, end-to-end repair, bladder protocol, analgesia). Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to English- or French-language materials. Evidence was supplemented with references from the 2015 Society of Obstetricians and Gynaecologists of Canada guideline no.330. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (TablesA1 for definitions and A2 for interpretations of strong and conditional recommendations). Obstetrical care providers. Updated Canadian guideline on recognition, prevention and management of obstetrical anal sphincter injuries (OASIS). RECOMMENDATIONS.

Background:Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, increase risk of acute complications, later development of hypertension and coronary artery disease and maternal mortality. Prenatal physical activity (PPA) reduces the risk of HDP development. Obstetric care providers (OCPs) are crucial in advising patients on safe PPA. Despite the belief among OCPs in other developed countries that PPA is beneficial, few are familiar with endorsed guidelines or discuss PPA with their patients.Objectives:This study aimed to explore what a subset of OCPs based in Southwestern Ontario believe, know and practice with respect to PPA and its endorsement for HDP prevention.Design:Virtual, qualitative interview-based study.Methods:Semi-structured virtual interviews were conducted with nurse practitioners (n = 2; 39.5 ± 4.9 (X ± SD) years of age) and midwives (n = 4; 39.5 ± 7.3 years of age) who were actively practising in Southwestern Ontario.Results:Four overarching themes were identified using reflexive thematic analysis: (1) Restricted Scope of PPA Practice for HDP, (2) PPA is Very Important for Health in and Beyond Pregnancy, (3) PPA is a Highly Individualized Patient Experience and (4) Lack of Training in PPA Among Providers. All participants strongly affirmed the benefits and importance of PPA in general, despite constraints imposed by referral protocols for those with HDP. This belief stemmed from experience, knowledge of Canadian PPA guidelines and evidence-based literature. PPA recommendations were individualized yet grounded in national guidelines. Participants identified a gap in PPA training and provided suggestions for improvement.Conclusion:PPA participation may assist in the prevention or management of HDP and promote comprehensive wellbeing for patients. Further exploration of OCP recommendation and patient uptake of PPA for HDP within a Southwestern Ontarian context and beyond is warranted.

BackgroundWhether trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis prevents nocardiosis in solid organ transplant (SOT) recipients is controversial. ObjectivesTo assess the effect of TMP-SMX in the prevention of nocardiosis after SOT, its dose-response relationship, its effect on preventing disseminated nocardiosis, and the risk of TMP-SMX resistance in case of breakthrough infection. MethodsA systematic review and individual patient data meta-analysis. Data sourcesMEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection, and Scopus up to 19 September 2023. Study eligibility criteria(a) Risk of nocardiosis between SOT recipients with and without TMP-SMX prophylaxis, or (b) sufficient details to determine the rate of TMP-SMX resistance in breakthrough nocardiosis. ParticipantsSOT recipients. InterventionTMP-SMX prophylaxis versus no prophylaxis. Assessment of risk of biasRisk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) for comparative studies; dedicated tool for non-comparative studies. Methods of data synthesisFor our primary outcome (i.e. to determine the effect of TMP-SMX on the risk of nocardiosis), a one-step mixed-effects regression model was used to estimate the association between the outcome and the exposure. Univariate and multivariable unconditional regression models were used to adjust for the potential confounding effects. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ResultsIndividual data from three case-control studies were obtained (260 SOT recipients with nocardiosis and 519 uninfected controls). TMP-SMX prophylaxis was independently associated with a significantly decreased risk of nocardiosis (adjusted OR = 0.3, 95% CI 0.18–0.52, moderate certainty of evidence). Variables independently associated with an increased risk of nocardiosis were older age, current use of corticosteroids, high calcineurin inhibitor concentration, recent acute rejection, lower lymphocyte count, and heart transplant. Breakthrough infections (66/260, 25%) were generally susceptible to TMP-SMX (pooled proportion 98%, 95% CI 92–100). ConclusionsIn SOT recipients, TMP-SMX prophylaxis likely reduces the risk of nocardiosis. Resistance appears uncommon in case of breakthrough infection.

Females with persistent pelvic pain (PPP) report great variability in the treatments recommended to them despite the availability of clinical practice guidelines (CPGs) that aim to standardise care. A clear consensus for the best practice care for PPP is required. To identify and summarise treatment recommendations across CPGs for the management of PPP, and appraise their quality. MEDLINE, CENTRAL, EMBASE, EmCare, SCOPUS, the Cochrane Database of Systematic Reviews, Web of Science Core Collection and relevant guideline databases were searched from their inception to June 2021. Included CPGs were those for the management of urogynaecological conditions in adult females published in English, of any publication date, and endorsed by a professional organisation or society. We screened 1379 records and included 20 CPGs. CPG quality was assessed using The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Descriptive synthesis compiled treatment recommendations across CPGs. The CPGs for seven conditions provided 270 individual recommendations. On quality appraisal, guidelines on average scored 'excellent' for the domains 'scope and purpose' (80.6%, SD=13.3) and 'clarity and presentation' (74.4%, SD=12.0); for other domains, average scores were satisfactory or poor. Four guidelines (for Endometriosis: NICE, RANZCOG and ESHRE; for polycystic ovary syndrome: Teede et al. 2018, International Evidence Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, Monash University, Melbourne, Australia) were deemed recommended for use. Recommendations were most frequent for pharmaceutical and surgical interventions. Recommendations were variable for psychological, physiotherapy and other conservative interventions. The quality of CPGs for PPP is generally poor. Several CPGs endorse the consideration of biopsychosocial elements of PPP. Yet most recommend pharmaceutical, surgical and other biomedical interventions.

Guideline No. 439: Diagnosis and Management of Vasa Previa

The main objective of this clinical practice guideline is to provide a series of recommendations for healthcare and exercise professionals, such as neurologists, physical therapists, and exercise physiologists, regarding exercise prescription for patients with migraine.This guideline was developed following the methodology and procedures recommended in the Appraisal of Guidelines for Research and Evaluation (AGREE). The quality of evidence and strength of recommendations were evaluated with the Scottish Intercollegiate Guidelines Network (SIGN). A systematic literature review was performed and an established appraisal process was employed to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology).The evaluation of the current evidence, the elaboration of the grades of recommendation, and their validation show a B grade of recommendation for aerobic exercise, moderate-continuous aerobic exercise, yoga, and exercise and lifestyle recommendations for the improvement of symptoms, disability, and quality of life in patients with migraine. Relaxation techniques, high-intensity interval training, low-intensity continuous aerobic exercise, exercise and relaxation techniques, Tai Chi, and resistance exercise obtained a C grade of recommendation for the improvement of migraine symptoms and disability.

Heart failure leads to adverse clinical and patient-reported outcomes. Its prevalence has increased markedly among adults aged 60 years and over. Transitional care interventions are recommended to address these issues; however, their effectiveness on health outcomes, particularly in older adults, remains limited and inconclusive. This study aimed to systematically review and synthesise the existing evidence from randomised controlled trials on the effectiveness of transitional care interventions on health outcomes among older adults with heart failure. Only randomised controlled trials were included. This systematic review and meta-analysis were conducted according to the Cochrane Collaboration methodology and were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies from 2001 to the present were identified through searches of PubMed, the Cochrane Library, Web of Science Core Collection, and Cumulative Index to Nursing and Allied Health Literature Plus with full text. Risk ratios, mean differences, and standardised mean differences were calculated. Heterogeneity was evaluated with the I2 statistic. The certainty of the evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation criteria. Eight studies with 967 subjects (483 in the intervention group and 484 in the control group) were included in this systematic review and meta-analysis. Transitional care interventions were associated with improvements in self-care confidence and reductions in heart failure-specific readmission. There were no statistically significant effects on self-care maintenance, self-care management, or heart failure knowledge. Findings for health-related quality of life, functional status, and event-free survival varied across studies. The certainty of the evidence ranged from very low to moderate. Transitional care interventions were associated with improved self-care confidence and reduced heart failure-specific readmissions in older adults with heart failure. However, variations in the certainty of the evidence create uncertainty about the intervention's effect. The limited number of trials included in this review demonstrates an evidence gap in this area. Further high-quality studies with transparent reporting through prospective trial registration should be conducted to determine the optimal content of the transitional care intervention. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021229464). Not applicable.

BackgroundMycotoxins are toxic fungal secondary metabolites that contaminate a wide spectrum of essential foods worldwide, such as grain-based products, nuts and spices, causing adverse health effects pertaining to their carcinogenic, nephrotoxic and hepatotoxic nature, among others. AimThe aim of this systematic review (SR) is to systematically search for, appraise and synthesize primary research evidence to identify what is known about dietary mycotoxin-related health effects and what remains unknown, as well as the uncertainty around findings and the recommendations for the future. Search strategy and eligibility criteriaSearch strategies, as well as eligibility criteria were structured according to a predefined PECO (population, exposure, comparison, and outcome) research question and developed in an iterative scoping process. Several bibliographic databases, including Embase, Cochrane Library, Pubmed, Web of Science Core Collection and Scopus, will be searched. Primary research on any measured or modelled dietary exposure to a single or multiple mycotoxins, and adverse human health outcomes (i.e. cancer, non-carcinogenic diseases, and reproductive & developmental adverse outcomes) will be included, and references will be imported into Covidence. In vitro, ex vivo, in silico, animal and review studies, as well as expert’s opinions, secondary literature, conference abstracts, presentations, posters, book chapters, dissertations and studies involving non-dietary mycotoxin exposure, will be excluded. Study selectionTwo independent reviewers will screen titles and abstracts, and review full-texts. Any disagreements will be resolved by a third reviewer based on two-third majority. Data extractionData from retained eligible studies will be extracted by the principal reviewer, and peer-checked by a second reviewer. Study quality assessmentEligible studies will be evaluated for risk of bias (Overall High-Quality Assessment Tool, OHAT) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation, GRADE). Evidence synthesisA detailed summary of the included studies will be provided within a tabular format and narratively discussed. Heat maps will be constructed to provide information on available knowledge (gaps), and a meta-analysis may be performed based on the variability in predefined PECO elements and depending on the heterogeneity of studies. ConclusionThis protocol describes the methodology for the conduct of a SR on mycotoxin-related human health risks, that could guide future research and inform regulatory decisions, as emphasized by the European Commission within the field of regulatory risk assessment for emerging chemicals.

The Surviving Sepsis Campaign strongly recommends that all hospitals screen for sepsis as part of performance improvement. The effect of screening for sepsis on mortality, time to antibiotics, and length of stay is uncertain. A systematic literature search was conducted using Cochrane Library, Google Scholar, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection from earliest entry to June 1, 2024. We included all randomized controlled studies of any type of alert system to screen adult patients for sepsis. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes were pooled using random effects meta-analysis. Strength of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. In total, we found 7 studies of 3409 patients with sepsis. The pooled odds ratio for mortality for patients randomized to early warning systems was 0.84 (95% CI, 0.60, 1.18). The average time to antibiotics was reported in 4 studies and found to be 0.08h faster in the screening group (95% CI, - 0.44, 0.28). Length of stay was reported in 4 studies and found to be 0.27days less in the screening group (95%, - 1.21, 0.66). All differences were non-significant. Overall strength of evidence was low due to risk of bias and imprecision. Based on the current body of randomized controlled studies, there is insufficient evidence to recommend screening for sepsis. Guidelines should reconsider current recommendations for screening for sepsis. CRD42024563222.

Mosquito-borne diseases represent a global public health concern and are responsible for over 700 000 deaths globally every year. Additionally, many mosquito species have undergone a dramatic global expansion due to various factors, including climate change, and forecasts indicate that mosquito populations will persist in dispersing beyond their present geographic range, namely in temperate climates. The research literature on this topic has grown in recent years, including some systematic evidence synthesis. However, to provide a comprehensive overview of this growing literature needed for policy action, a summary of this evidence, including existing systematic reviews, is required. This study aims to undertake an umbrella review that explores the impacts of climate change on the emergence and reemergence of diseases transmitted by mosquitoes in temperate zones and the publication of the protocol is a fundamental step to ensure the credibility, transparency and reproducibility of this research. Studies published in scientific journals indexed by PubMed, EMBASE, Cochrane Library, Epistemonikos, and Web of Science Core Collection to be included in this umbrella review will meet the following criteria: the topic of study (climate change and mosquito-borne diseases), regions (temperate zones), study designs (systematic reviews and meta-analysis), language (any) and date (since inception until December 31st, 2023). Titles and abstracts from selected articles will be evaluated by two authors independently and any discrepancy will be resolved through consensus or, if not possible, through a third author. The data will be extracted, and the risk of bias will be evaluated. The quality of the methodology of the included reviews will be assessed using AMSTAR 2. A narrative synthesis will examine the included systematic reviews. The quality of evidence for all outcomes will be judged using the Grading of Recommendations Assessment, Development and Evaluation working group methodology.

To evaluate the impact of wearable devices when associated with usual care on the incidence of major adverse cardiovascular events (MACE) in patients with ischemic heart disease compared with usual care alone. Randomised clinical trials with patients aged 18years and above with ischemic heart disease, using wearable devices and assessing at least one of the primary outcomes (myocardial infarction, stroke, cardiovascular mortality, or major adverse cardiovascular events) or secondary outcomes (all-cause mortality, hospitalisation, all arrhythmias, heart failure, unstable angina or revascularisation procedures) were included. MEDLINE, EMBASE, Cochrane Library, CINHAL, INAHTA and the Web of Science Core Collection were searched in April 2024. Studies were also identified via citation searching. Cochrane Risk of Bias version 1 was applied as provided in Covidence. Meta-analyses were performed when possible. Six studies of moderate quality were included. Wearables showed positive effects in reducing major adverse cardiovascular events (RR 0.75, 95% CI 0.57-0.98, two studies) and all-cause mortality (RR 0.64, 95% CI 0.43-0.96, three studies); no significant effects were found on myocardial infarction (RR 0.89, 95% CI 0.59-1.34, four studies), cardiovascular mortality (RR 0.35, 95% CI 0.07-1.73, three studies), hospitalisations (RR 0.77, 95% CI 0.56-1.07, five studies), all arrhythmias (RR 1.10, 95% CI 0.49-2.48, two studies), and heart failure (RR 0.85, 95% CI 0.61-1.18, two studies). Meta-analysis could not be performed for stroke, unstable angina, and revascularisation procedures. Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence was deemed low or very low. While wearables seem to have some positive effects for patients with ischemic heart disease, only weak recommendations for use are possible. More large-scale, high-quality randomised clinical trials are needed to recommend the routine use of wearables in combination with usual care. CRD42024586137.