Literature Review Of Observational Studies Research Articles

Telemedicine for diagnosis or treatment during Covid-19: systematic review

Objective: To describe the use of telemedicine by health professionals for diagnosis or treatment of patients during the Covid-19 pandemic. Method: This is a systematic literature review of observational studies. Five databases were used. The assessment of the studies methodological quality occurred individually among the revisors and the Joanna Briggs Institute tool was used. Results: The reviewers selected 22 articles from 6,180 works. The services provided through telemedicine were consultation/screening, consultation/follow-up or monitoring, test reports, medication prescriptions and case discussions. The technological resources used were platforms using video and telephone (audio and video). The use of telemedicine made it possible to reduce their exposure to Covid-19, reduce social panic and anxiety, quickly medical specialties access and the possibility of access to diagnosis and treatment of patients with chronic and acute diseases. Conclusion: Telemedicine can be an important tool in healthcare, keeping patients and healthcare professionals safe during the Covid-19 pandemic.

Comparing the Long-Term Success Rates of Tooth Preservation and Dental Implants: A Critical Review.

Implant therapy is considered a predictable, safe, and reliable rehabilitation method for edentulous patients in most clinical scenarios. Thus, there is a growing trend in the indications for implants, which seems attributable not only to their clinical success but also to arguments such as a more "simplified approach" based on convenience or the belief that dental implants are as good as natural teeth. Therefore, the objective of this critical literature review of observational studies was to discuss the evidence concerning the long-term survival rates and treatment outcomes, comparing endodontically or periodontally treated teeth with dental implants. Altogether, the evidence suggests that the decision between keeping a tooth or replacing it with an implant should carefully consider the condition of the tooth (e.g., amount of remaining tooth and degree of attachment loss and mobility), systemic disorders, and patient preference. Although observational studies revealed high success rates and long-term survival of dental implants, failures and complications are common. For this reason, attempts should be made to first save maintainable teeth over the long-term, instead of immediately replacing teeth with dental implants.

Burden of neutropenia and leukopenia among adult kidney transplant recipients: A systematic literature review of observational studies.

Leukopenia and neutropenia (L/N) may affect treatment decisions, potentially resulting in poor clinical and economic outcomes among kidney transplant recipients (KTRs). The burden of L/N is poorly quantified systematically. This systematic literature review aimed to summarize the incidence of, risk factors for, and clinical and economic outcomes associated with L/N post-KT. We systematically searched MEDLINE, Embase, and the Cochrane Library (from database inception-June 14, 2021) and conferences (past 3 years) to identify observational studies examining epidemiology, risk factors, or outcomes associated with L/N among adult KTRs. Of 2081 records, 82 studies met inclusion criteria. Seventy-three studies reported the epidemiology of L/N post-KT. Pooled incidence of neutropenia, defined as absolute neutrophil counts (ANC) <1000/μl, ranged from 13% to 48% within 1-year post-transplant; ANC <500/μl ranged from 15% to 20%. Leukopenia, defined as white blood cell counts <3500/μl, was 19% to 83%. Eleven studies reported independent risk factors associated with L/N post-KT. D+/R- cytomegalovirus status, mycophenolic acid (MPA), and tacrolimus use were the most consistent risk factors across studies. Fourteen studies reported L/N-associated clinical outcomes. We noted a trend toward a positive association between neutropenia and acute rejection/opportunistic infections. Mixed findings were noted on the association between L/N and graft failure or mortality. Dosage modifications of valganciclovir, MPA, cotrimoxazole, and anti-thymoglobulin and the need for granulocyte colony-stimulating factor (G-CSF) use were common with L/N. Findings suggest post-transplant L/N were common and associated with frequent modifications of immunosuppressive agents, requiring G-CSF use, and rejection or opportunistic infections. Findings highlight the need for interventions to reduce risk of L/N post-KT.

Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis.

Background:The majority of patients with chronic obstructive pulmonary disease (COPD) suffer from comorbid cardiovascular (CV) disease. Accumulating evidence suggests a temporal association between COPD exacerbations and acute CV events, possibly due to lung hyperinflation, increased hypoxemia and systemic inflammation. The aims of the study were to estimate the risk of (1) acute CV events [acute myocardial infarction (AMI), CV-related death] or stroke in the months following a COPD exacerbation and (2) COPD exacerbation in the months following an acute CV event.Methods:A systematic literature review of observational studies published since 2000 was conducted by searching literature databases (Medline and Embase). Studies were eligible if conducted in adults with COPD, exposed to either COPD exacerbation or acute CV events, with outcomes of acute CV events or COPD exacerbation reported. Studies were appraised for relevance, bias and quality. Meta-analyses, using random-effect models, were performed for each outcome of interest, thus providing a pooled relative risk (RR) and its 95% confidence interval.Results:Eight studies were identified, of which seven were used for the meta-analyses examining the risk of CV events 1–3 months after an exacerbation compared with none. For stroke (six studies), RR was 1.68 (95% CI = 1.19–2.38). For AMI (six studies), RR was 2.43 (95% CI = 1.40–4.20). No studies exploring risk of exacerbation following an acute CV event were identified.Conclusion:This meta-analysis identified a markedly increased risk of stroke or AMI within a relatively short period of time following a COPD exacerbation. Although the underlying mechanisms are not fully elucidated, patients with COPD should be monitored for risk of CV outcomes after exacerbations. In addition, preventing exacerbations may decrease the risk of subsequent acute CV events.Registration:The study protocol was published via PROSPERO: International Prospective Register of Systematic Reviews (#CRD42020211055).

1706. Association between Cytomegalovirus Infection/Disease and Morbidity and Mortality in Kidney Transplantation: A Systematic Literature Review of Observational Studies

Background Cytomegalovirus (CMV) is a common pathogen in kidney transplant recipients (KTRs). KTRs may develop CMV viremia that is asymptomatic (‘CMV infection’) or associated with clinical and laboratory findings (‘CMV disease’) such as fever, leukopenia/neutropenia, and malaise (‘CMV syndrome’), and/or evidence of specific organ(s) involvement (‘CMV end-organ disease’). The extent to which CMV affects morbidity such as acute rejection (AR), graft loss (GL), other opportunistic infections (OI), or mortality in KTRs has not been systematically evaluated recently. Therefore, we examined the association between CMV infection/disease and morbidity and mortality in KTRs using a systematic review of observational studies from the last decade.MethodsMEDLINE and Embase were searched to identify observational studies published between January 2008 and November 2018 reporting outcomes of interest by CMV status. Meta-analysis was used to derive pooled odds ratio (pOR) with 95% confidence intervals(CIs) using the random-effects models and I2 statistics to estimate heterogeneity between studies using R version 3.5.1.ResultsOf 1,860 retrieved citations, 23 studies with a total of 6,994 KTRs met inclusion criteria. The majority of studies were conducted in Europe (N=14) and included participants regardless of donor/recipient CMV serostatus (N=14). Included studies reported outcomes by different clinical manifestations of CMV. Overall, CMV infection/disease was associated with an increased odd of AR, with significant heterogeneity. CMV infection/disease was also associated with an increase in the odds of GL and mortality compared to no CMV infection/disease without heterogeneity (Figure 1). A higher rate of all-cause hospital readmission and a greater mean number of OI episodes were reported with CMV infection/disease in a single study.Pooled Estimates on the Association between Outcomes and CMV Infection/Disease among Individuals undergoing Kidney Transplant ConclusionCMV infection/disease was associated with increased mortality and GL in adults with KT. The association between CMV and AR remained similar in direction with high heterogeneity limiting the robustness of the conclusion. Nonetheless, our analysis underscores the importance of interventions to reduce the incidence of CMV infection/disease to reduce mortality and GL in KTRs even in the current era.DisclosuresAmit D. Raval, PhD, Merck and Co., Inc (Employee) Kristin Kistler, PhD, Evidera, Inc. (Employee, Evidera, Inc. received the funding to conduct this study.) Yuexin Tang, PhD, Merck and Co., Inc. (Employee) Yoshihiko Murata, MD, PhD, Merck and Co., Inc. (Employee) David R. Snydman, MD, Merck (Consultant)Merck (Advisor or Review Panel member)Pfizer (Consultant)Reviral, Anthrax Vaccine, Influenza Vaccine (Other Financial or Material Support, Data Safety Monitoring Board)Takeda/Shire (Advisor or Review Panel member)

Abstract 15651: The Burden of Nontreatment or Undertreatment Among Non-valvular Atrial Fibrillation Patients With Elevated Stroke Risk: A Systematic Literature Review of Real-world Evidence

Introduction: Global treatment guidelines (e.g., AHA/ACC/HRS, ESC, JCS) recommend treatment with oral anticoagulants (OACs) for patients with non-valvular atrial fibrillation (NVAF) and an elevated stroke risk, defined by CHA 2 DS 2 -VASc score ≥2. However, not all patients with NVAF and an elevated stroke risk receive guideline-recommended therapy. A systematic literature review of observational studies was undertaken based on PRISMA guidelines to identify the body of evidence on untreated and undertreated NVAF among patients with elevated stroke risk, and assess its epidemiological and clinical burden. Methods: An extensive search of MEDLINE, GoogleScholar, the Cochrane Library, relevant conference proceedings, and health technology assessments (HTAs) was conducted for RWE studies. Studies published between 1/2010-4/2020 were included if they evaluated rates of nontreatment or undertreatment in NVAF. Nontreatment was defined as absence of OACs, while undertreatment was defined as treatment with only antiplatelet agents. Studies focusing on valvular AF were excluded. Results: Thirty-nine published studies (13 countries) met inclusion criteria. Rates of nontreatment for patients with elevated stroke risk ranged from 2.0%-51.1% (median: 23.3%), while rates of undertreatment ranged from 10.0%-45.1% (median: 34.6%). Few studies assessed the relationship between nontreatment or undertreatment and clinical outcomes in the evaluated population. Among US outpatients with NVAF and an elevated stroke risk, those undertreated had a higher likelihood of death (HR: 1.22; 95% CI: 1.05-1.41; p=.006) compared to patients treated with OACs. Also, in a separate US study of NVAF patients with varying levels of warfarin exposure, patients with no warfarin exposure had significantly higher rates of ischemic stroke than patients with low adherence (4.41 vs. 1.87 per 100 person-years, p&lt;.001) or high adherence (4.41 vs. 0.72 per 100 person years, p&lt;.001). Conclusion: Rates of nontreatment and undertreatment among NVAF patients with elevated stroke risk remain high and are associated with potentially preventable cardiovascular events and death. Strategies to increase rates of treatment may reduce adverse clinical outcomes.

The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies.

This paper reviews the associations between pornography use and sexual dysfunction based on evidence from observational studies. The existing data in this regard mostly derive from cross-sectional investigations and case reports. There is little if no evidence that pornography use may induce delayed ejaculation and erectile dysfunction, although longitudinal studies that control for confounding variables are required for a full assessment. The associations between pornography use and sexual desire may differ between women and men although the existing data is contradictory and causal relationships cannot be established. The strongest evidence is available for the relation of pornography use with decreased sexual satisfaction, although the results of prospective studies are inconsistent. The paper outlines future research prospects beneficial in understanding the nature of associations between pornography use and sexual dysfunctions in men and women.

The most important risk factors affecting mental health during pregnancy: a systematic review.

Pregnant women comprise a vulnerable population owing to the changes they experience in various stages that affect their mental health. Mental health problems affects nearly one-fifth of pregnant women during the prenatal and postpartum periods. Millennium Development Goals 4 and 5 focus on maternal and child health and specify that overall health cannot be reached without mental health. The aim of this comprehensive systematic review was to evaluate research evidence on the determinants of antenatal mental health disorders among Iranian women. Using a systematic literature review of observational studies in English and Farsi we focused on Iranian women being evaluated for the determinants of antenatal mental health problems. PubMed, Scopus, ISI Web of Science, Scientific Information Databases (SID), Global Medical Article Limberly, Iranian Biomedical Journal and the Iranian Journal Database were independently searched to identify articles published during 2000-2016. Thirty-one studies met the inclusion criteria and the results showed a significant relationship between antenatal mental health risks and variables such as lack of social support, marital status, domestic violence, unintended pregnancy and socioeconomic status. The paucity of high quality research evidence limited proper evidenced-based planning and generating results deemed essential to address antenatal mental health issues for Iranian pregnant women. Our results showed that socioeconomic status and marital quality are the most important risk factors for disturbing mental health among Iranian pregnant women.

Unmet need in the hyperlipidaemia population with high risk of cardiovascular disease: a targeted literature review of observational studies.

BackgroundThe aim of this study was to examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine LDL-C targets recommended by guidelines, and to examine the proportions of patients who do not achieve targeted LDL-C levels in real-world studies.MethodsElectronic databases were searched: Medline, Medline In-Process, Embase, BIOSIS, and the Cochrane Library (1 January 2005 to 31 December 2013). Guideline searches were limited to publications in the last 5 years. There were no geographical or language restrictions.ResultsSeventeen guidelines and 42 observational studies that reported on high-risk hyperlipidaemia patients were identified. The National Cholesterol Education Program–Adult Treatment Panel III’s LDL-C target levels were the most common guidelines used for patients with very high hyperlipidaemia. However, between 68 and 96 % of patients in the studies did not achieve an LDL-C goal <70 mg/dL, except in one study conducted in China (16.9 %). In high-risk patients, 61.8 to 93.8 % did not achieve a target of <100 mg/dL. Regarding common comorbidities, patients with concomitant CVD or diabetes were least likely to reach their target LDL-C goals.ConclusionIn patients with high risk for CVD, the majority of patients do not attain recommended LDL-C goals, highlighting worldwide suboptimal hyperlipidaemia management and missed opportunities for reduction of the patients CVD risk. Lipid-modifying management strategies need to be intensified.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0241-3) contains supplementary material, which is available to authorized users.

P608. Systematic literature review of observational studies that assess the effectiveness of biologic drugs in the treatment of extra-intestinal manifestations in inflammatory bowel disease

P608. Systematic literature review of observational studies that assess the effectiveness of biologic drugs in the treatment of extra-intestinal manifestations in inflammatory bowel disease

Paracetamol: not as safe as we thought? A systematic literature review of observational studies

ObjectivesWe conducted a systematic literature review to assess the adverse event (AE) profile of paracetamol.MethodsWe searched Medline and Embase from database inception to 1 May 2013. We screened for observational...

Sinonasal alterations in computed tomography scans in cystic fibrosis: a literature review of observational studies

Almost all cystic fibrosis (CF) patients reveal upper airway involvement in computed tomography (CT) scans. Sinonasal pathology has become a challenging issue because there are few studies to guide appropriate management. The objective of this study was to provide information about paranasal sinus CT manifestations in CF patients, mainly in adulthood. We performed a literature review of descriptive studies about CT sinonasal findings in CF patients using the following databases: MEDLINE, EMBASE, Web of Science, LILACS, Scielo, and Cochrane. Eighteen articles were included in this review. There was a high variability in methodological aspects for most of the studies. The most prevalent findings reported were opacification of sinuses, presence of frontal and sphenoidal aplasia or hypoplasia, underdevelopment of paranasal sinuses, and medial bulging of the lateral nasal wall in CT scans. There are few studies in the CF adult population regarding sinonasal CT alterations. Many studies report specific pathological features in CF upper airways that could help in the diagnosis of doubtful cases.

Communication in the operating theatre

Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews. A systematic review of the literature for accessible published and grey literature was performed in July 2012. The following information was extracted: year, country, objectives, methods, study design, sample size, healthcare professional focus and main findings. Quality appraisal was conducted using the Critical Appraisal Skills Programme. A meta-ethnographic approach was used to categorize further the main findings under key concepts. Some 1174 citations were retrieved through an electronic database search, reference lists and known literature. Of these, 26 were included for review after application of full-text inclusion and exclusion criteria. The overall quality of the studies was rated as average to good, with 77 per cent of the methodological quality assessment criteria being met. Six key concepts were identified: signs of effective communication, signs of communication problems, effects on teamwork, conditions for communication, effects on patient safety and understanding collaborative work. Communication was shown to affect operating theatre practices in all of the studies reviewed. Further detailed observational research is needed to gain a better understanding of how to improve the working environment and patient safety in theatre.

Overdiagnosis in Mammographic Screening for Breast Cancer in Europe: A Literature Review

Overdiagnosis, the detection through screening of a breast cancer that would never have been identified in the lifetime of the woman, is an adverse outcome of screening. We aimed to determine an estimate range for overdiagnosis of breast cancer in European mammographic service screening programmes. We conducted a literature review of observational studies that provided estimates of breast cancer overdiagnosis in European population-based mammographic screening programmes. Studies were classified according to the presence and the type of adjustment for breast cancer risk (data, model and covariates used), and for lead time (statistical adjustment or compensatory drop). We expressed estimates of overdiagnosis from each study as a percentage of the expected incidence in the absence of screening, even if the variability in the age range of the denominator could not be removed. Estimates including carcinoma in situ were considered when available. There were 13 primary studies reporting 16 estimates of overdiagnosis in seven European countries (the Netherlands, Italy, Norway, Sweden, Denmark, UK and Spain). Unadjusted estimates ranged from 0% to 54%. Reported estimates adjusted for breast cancer risk and lead time were 2.8% in the Netherlands, 4.6% and 1.0% in Italy, 7.0% in Denmark and 10% and 3.3% in England and Wales. The most plausible estimates of overdiagnosis range from 1% to 10%. Substantially higher estimates of overdiagnosis reported in the literature are due to the lack of adjustment for breast cancer risk and/or lead time.

The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease

To comprehensively review the data on the relationship between the consumption of dairy fat and high-fat dairy foods, obesity, and cardiometabolic disease. We have conducted a systematic literature review of observational studies on the relationship between dairy fat and high-fat dairy foods, obesity, and cardiometabolic disease. We have integrated these findings with data from controlled studies showing effects of several minor dairy fatty acids on adiposity and cardiometabolic risk factors, and data on how bovine feeding practices influence the composition of dairy fat. In 11 of 16 studies, high-fat dairy intake was inversely associated with measures of adiposity. Studies examining the relationship between high-fat dairy consumption and metabolic health reported either an inverse or no association. Studies investigating the connection between high-fat dairy intake and diabetes or cardiovascular disease incidence were inconsistent. We discuss factors that may have contributed to the variability between studies, including differences in (1) the potential for residual confounding; (2) the types of high-fat dairy foods consumed; and (3) bovine feeding practices (pasture- vs. grain-based) known to influence the composition of dairy fat. The observational evidence does not support the hypothesis that dairy fat or high-fat dairy foods contribute to obesity or cardiometabolic risk, and suggests that high-fat dairy consumption within typical dietary patterns is inversely associated with obesity risk. Although not conclusive, these findings may provide a rationale for future research into the bioactive properties of dairy fat and the impact of bovine feeding practices on the health effects of dairy fat.