Medicine Grey Literature Research Articles

Imaging Evaluation of Platelet-Rich Fibrin in Post-Exodontic Bone Regeneration: A Systematic Review.

Tooth extraction is the most common procedure in dental practice. However, in the long term, it may cause alveolar ridge atrophy. This systematic review aimed to evaluate the role of platelet-rich fibrin (PRF) in post-exodontic alveolar ridge preservation in terms of its effectiveness in the regeneration of bone tissue as assessed by imaging and its efficacy compared to physiological bone healing. The study is presented in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. This systematic review was conducted using electronic databases such as PubMed, Scopus, Web of Science, and Science Direct. The gray literature search was conducted in the New York Academy of Medicine Grey Literature Report. All the studies in this systematic review were randomized controlled trials (RCTs). The risk of bias was performed according to the Cochrane Handbook for Systematic Reviews of Interventions 6.2 (RevMan 6.2). Considering the inclusion and exclusion criteria, we included 17 randomized clinical trials published up to 2022 investigating the efficacy of PRF in post-exodontic bone regeneration. Based on the results of clinical studies, it can be stated that despite not being statistically significant, PRF promotes neoformation and prevents bone loss between three and four months post-extraction.

The Psychological and Biological Benefits of Mind-Body Therapy Interventions for Informal Caregivers of Individuals With Cancer: A Systematic Review

Background: Caring for an individual with cancer can be physically and emotionally draining and finding an effective intervention that supports caregivers is needed. The purpose of this systematic review was to investigate the psychological and biological effects of mind-body therapies for informal caregivers of individuals with cancer. Methods: A literature search was completed using 6 databases (PubMed, CINAHL, Cochrane, PsycINFO, PEDro, and OTSeekers) and 4 gray literature databases (MedNar, NY Academy of Medicine Grey Literature Report, WorldCat Dissertations and Theses, and Proquest Psychology). Studies were included if they were randomized controlled trials published after 2010; participants were informal caregivers of individuals with cancer; and the main intervention was yoga, meditation, progressive relaxation therapy and guided imagery, mindfulness therapy, tai chi, breathing exercises, qigong, or visual imagery. The researchers completed title, abstract, and full-text screens using the selection criteria. Data were synthesized descriptively according to the different types of interventions. The Physiotherapy Evidence Database (PEDro) scale was used to critically appraise the final articles. Results: There were a total of 11 articles included in this systematic review. There is evidence that certain mind-body therapies can have a positive effect on well-being, anxiety, and fatigue but not mindfulness or stress. One study found significant improvements in biological markers. Conclusion: Medical professionals should consider recommending mind-body therapies, especially to informal caregivers who present with anxiety, fatigue, and impairments in well-being. The major limitation in this review is based mostly on fair quality evidence.

Marginal Fit, Mechanical Properties, and Esthetic Outcomes of CAD/CAM Interim Fixed Dental Prostheses (FDPs): A Systematic Review

This systematic review aimed to study the outcomes of CAD-CAM (milled and 3D-printed) interim dental prostheses when compared to conventional ones. The focused question of "In natural teeth, what are the outcomes of CAD-CAM interim FDPs compared to the conventionally-manufactured ones regarding marginal fit, mechanical properties, esthetics, and color stability" was formulated. The systematic search was conducted electronically in the PubMed/MEDLINE, CENTRAL, EMBASE, Web of Science, New York Academy of Medicine Grey Literature Report, and Google Scholar databases by using the MeSH keywords and keywords associated with the focused question and limiting articles to those published between 2000 and 2022. A manual search was conducted in selected dental journals. The results were analyzed qualitatively and are presented in table format. Of the included studies, 18 studies were in vitro and 1 was a randomized clinical trial. Of the eight studies analyzing the mechanical properties, five studies favored the milled interim restorations, one study favored both 3D-printed and milled interim restorations, and two studies reported better mechanical properties in conventional interim restorations. Among four studies evaluating the marginal discrepancies, two studies favored the marginal fit in milled interim restorations, one study reported a better marginal fit in both milled and 3D-printed interim restorations, and one study found conventional interim restorations have a better marginal fit and smaller marginal discrepancy when compared to both milled and 3D-printed restorations. Among five studies that evaluated both the mechanical properties and marginal fit, 1 study favored 3D-printed interim restorations and four studies favored milled interim restorations over the conventional ones. Two studies analyzing the esthetics outcomes demonstrated better results with milled interim restorations compared to conventional and 3D-printed interim restorations in terms of their color stabilities. The risk of bias was low for all the studies reviewed. The high level of heterogeneity within the studies excluded meta-analysis. Most of the studies favored the milled interim restorations over the 3D-printed and conventional restorations. The results suggested that milled interim restorations offer a better marginal fit, higher mechanical properties, and better esthetic outcomes in terms of color stabilities.

Effectiveness of opiate substitution treatment in reducing HIV risk behaviors among African, Caribbean, and Black people: a systematic review.

The objective of this systematic review is to identify, appraise, and synthesize the best available evidence on the effectiveness of opioid substitution treatment in reducing HIV risk behavior among African, Caribbean, and Black people. Substance use plays an important role in HIV transmission among Black people by increasing risky sexual behavior and the risk of HIV acquisition. Opioid substitution treatment, such as methadone maintenance treatment and buprenorphine therapy, has been found to be an effective measure to minimize HIV transmission attributable to opioid addiction. The current review considered studies that included African, Caribbean, and Black adult patients, aged 18 years or over, who have used methadone maintenance treatment or buprenorphine therapies as part of the intervention for opioid use disorders and have been evaluated for sex- and drug-related HIV risk behaviors. This review considered studies that have evaluated the impact of methadone maintenance treatment or buprenorphine therapy on sex- and drug-related HIV risk behaviors. Multiple databases were searched, including Embase, MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, OpenGrey, Grey Matters, New York Academy of Medicine Grey Literature Report, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Two reviewers independently assessed all titles and abstracts, and potentially relevant studies were retrieved in full. Papers selected for retrieval were assessed by two independent reviewers for methodological validity. Data were then extracted from papers. Statistical pooling of quantitative data and meta-analysis was not possible due to heterogeneity of data. Five articles were included in this review: three randomized controlled trials, one cohort study, and one quasi-experimental study. Four studies focused on methadone maintenance treatment and one study discussed the effectiveness of buprenorphine intervention. All studies were from the United States. One study enrolled participants in methadone maintenance treatment for heroin injectors, of which 10% of the sample was HIV positive. These papers included studies that reported a significant reduction in sex-related HIV risk behavior, including having multiple sex partners, frequency of sexual intercourse, condom use, prostitution, and sex trade. Of the five studies, two reported on drug-related HIV risk behaviors, citing a reduction in drug-related HIV risk behaviors. Also, these papers showed unexpected outcomes relating to frequency of sexual intercourse, prostitution, and sex trade. One study reported a significantly higher number of sexual encounters among persons not participating in treatment. One study reported decreasing prostitution and sex trade among individuals receiving methadone maintenance treatment intervention. Methadone maintenance treatment or buprenorphine therapy can be effective in reducing sex- and drug-related HIV risk behaviors among African, Caribbean, and Black people. However, due to the weaknesses in the body of evidence and the quality of evidence, it is not possible to make strong conclusions about these interventions. Rigorous studies are necessary to generate more findings and reinforce the body of literature. PROSPERO CRD42019126954.

Individuals' experiences of the integration of substance use/addiction and HIV/AIDS services in community settings: a qualitative systematic review protocol.

The objectives of this systematic review are: i) to identify, appraise, and synthesize the best available evidence on individuals' experiences of the integration of substance use/addiction and HIV/AIDS services in community settings, and ii) to identify barriers to and facilitators of the integration of the services. The integration of drug use treatment and HIV services has shown to improve HIV prevention, decrease HIV infection and progression, while improving access to social and support services among substance users. Combined pharmacological and behavioral drug use treatments have been proven to diminish behaviors that increase HIV risk, decrease incidence of the disease, and improve adherence to antiretroviral therapy among individuals who use drugs and are HIV-positive. The populations of interest in this review include patients who have experienced integrated substance use/addiction and HIV services, as well as health care professionals and policy makers who have been involved in developing or implementing integrated substance use/addiction and HIV/AIDS services. Eligible studies will focus on the views, attitudes, understandings, and perceptions of patients, health care professionals, and policy makers resulting from experience in developing or implementing strategies that have or could inform the integration of substance use/addiction and HIV/AIDS services in community settings. Searches will be conducted in MEDLINE, Embase, PsycINFO, and CINHAL. The search for unpublished studies will include OpenGrey, Grey Matters, New York Academy of Medicine's Grey Literature Report, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. Selected studies will be critically appraised by two independent reviewers for methodological quality. Data will be extracted and then synthesized following the JBI meta-aggregative approach. PROSPERO CRD42020185858.

Risk factors for mental illness in adults with atopic eczema or psoriasis: protocol for a systematic review

IntroductionEvidence indicates that people with the common inflammatory skin diseases atopic eczema or psoriasis are at increased risk of mental illness. However, the reasons for the relationship between skin disease...

A systematic literature review of the assessment of treatment burden experienced by patients and their caregivers

BackgroundMany older adults with multiple chronic conditions, particularly those who are functionally impaired, spend considerable time juggling the competing demands of managing their conditions often assisted by caregivers. We examined methods of assessing the treatment burden experienced by this population as a first step to identifying strategies to reduce it.MethodsSystematic searches were performed of the peer-reviewed and grey-literature (PubMed, Cochrane library, CINAHL, EMBASE, Web of Science, SCOPUS, New York Academy of Medicine Grey Literature Review, NLM catalog and ProQuest Digital Theses and Dissertations). After title and abstract screening, both qualitative and quantitative articles describing approaches to assessment of treatment burden were included.ResultsForty-five articles from the peer reviewed and three items from the grey literature were identified. Most articles (34/48) discussed treatment burden associated with a specific condition. All but one examined the treatment burden experienced by patients and six addressed the treatment burden experienced by caregivers. Qualitative studies revealed many aspects of treatment burden including the burdens of understanding the condition, juggling, monitoring and adjusting treatments, efforts to engage with others for support as well as financial and time burdens. Many tools to assess treatment burden in different populations were identified through the qualitative data. The most commonly used instrument was the Treatment Burden Questionnaire.ConclusionsMany instruments are available to assess treatment burden, but no one standardized assessment method was identified. Few articles examined approaches to measuring the treatment burden experienced by caregivers. As people live longer with more chronic conditions healthcare providers need to identify patients and caregivers burdened by treatment and engage in approaches to ameliorate treatment burden. A standard and validated assessment method to measure treatment burden in the clinical setting would help to enhance the care of people with multiple chronic conditions, allow comparison of different approaches to reducing treatment burden, and foster ongoing evaluation and monitoring of burden across conditions, patient populations, and time.

Diagnostic accuracy of midkine on hepatocellular carcinoma: A meta-analysis.

To evaluate the dependability and accuracy of midkine (MK) in the diagnosis of hepatocellular carcinoma (HCC). PubMed, EMBASE, Web of Science, China Biology Medicine disc and grey literature sources were searched from the date of database inception to January 2019. Two authors (B-H.Z. and B.L.) independently extracted the data and evaluated the study quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were estimated using a bivariate model. Moreover, hierarchical summary receiver operating characteristic curves were generated. The diagnostic odds ratio (DOR) and area under the curve (AUC) were pooled using a univariate model. Nine articles (11 studies) were included (1941 participants). The bivariate analysis revealed that the sensitivity and specificity of MK for HCC diagnosis were 0.85 (95% CI 0.78-0.91) and 0.83 (95% CI 0.76-0.88), respectively. We also found a LR+ of 5.05 (95% CI 3.33-7.40), a LR- of 0.18 (95% CI 0.11-0.28), a DOR of 31.74 (95% CI 13.98-72.09) and an AUC of 0.91 (95% CI 0.84-0.99). Subgroup analyses showed that MK provided the best efficiency for HCC diagnosis when the cutoff value was greater than 0.5 ng/mL. MK has an excellent diagnostic value for hepatocellular carcinoma.

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol.

The objective of this review is to evaluate the effectiveness of intravenous administration of tranexamic acid (TXA) within three hours of birth in mothers with a diagnosis of postpartum hemorrhage (PPH). Postpartum hemorrhage, that is, blood loss exceeding 500 mL for vaginal births or 1000 mL for cesarean sections within 24 hours of delivery, is the leading cause of maternal deaths worldwide. The World Health Organization recommends intravenous TXA as an adjuvant therapy for the treatment of PPH, in addition to standard recommended treatments, within three hours of birth. This review will determine whether TXA administration to patients experiencing PPH leads to a reduction in blood loss, the requirement for transfusion of packed red blood cells and the need for emergency hysterectomies, in both developed and developing nations. This review will consider studies that include women under 40 with a diagnosis of postpartum hemorrhage. Studies that evaluate intravenous administration of TXA within three hours of birth as adjuvant treatment of postpartum hemorrhage will be considered. The comparator will be groups that have not received TXA as part of the treatment for postpartum hemorrhage, with or without placebo. MEDLINE, Embase, CINAHL, CENTRAL, Scopus, Web of Science and ProQuest Nursing and Allied Health will be searched for eligible studies. The search for unpublished studies will include: ProQuest Dissertations and Theses (PQDT), ClinicalTrials.gov and New York Academy of Medicine Grey Literature Report. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Meta-analysis will be performed, if possible.

Mechanical Outcomes, Microleakage, and Marginal Accuracy at the Implant-Abutment Interface of Original versus Nonoriginal Implant Abutments: A Systematic Review of In Vitro Studies.

Purpose Instead of original abutments, compatible abutments are often selected for financial reasons. The present study aimed to evaluate mechanical outcomes, microleakage, and marginal accuracy at the implant-abutment interface of original versus nonoriginal implant abutments. Study Selection Search strategy encompassed literature from 1967 up to March 2017 to identify relevant studies meeting the inclusion criteria. The following electronic databases were consulted: PubMed database of the U.S. National Library of Medicine, Embase (Excerpta Medica dataBASE), and the Grey Literature Database (New York Academy of Medicine Grey Literature Report). Quality assessment of the full-text articles selected was performed. Abutments were classified in original (produced by the same implant manufacturer), nonoriginal certified (produced by a third-party milling center, certified by implant companies), and nonoriginal compatible (produced by a third-party milling center for similar connections). Results A total of 16 articles fulfilled inclusion criteria and quality assessment and were selected for the qualitative analysis. All of the included studies were in vitro research with high or moderate risk of bias and reported data from 653 implant abutments. Original and nonoriginal certified abutments showed better results in terms of mechanical outcomes, microleakage, and marginal accuracy compared to nonoriginal compatible abutments. Conclusions Following the clear warnings coming from the present systematic review, clinical suggestions regarding the effect of a nonoriginal abutment can be drawn. However, in vivo, long-term, randomized controlled trials are needed to provide definitive clinical conclusion about the long-term clinical outcomes of original and nonoriginal abutments.

Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis.

Quality improvement (QI) interventions can improve glycemic control, but little is known about their value. We systematically reviewed economic evaluations of QI interventions for glycemic control among adults with type 1 or type 2 diabetes. We used English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, chosen from PubMed, EconLit, Centre for Reviews and Dissemination, New York Academy of Medicine's Grey Literature Report, and WorldCat (January 2004 to August 2016). We extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost (studies lasting ≤3 years), incremental cost-effectiveness ratio (ICER) (studies lasting ≥20 years), and study quality. Weighted least-squares regression analysis was used to estimate mean changes in HbA1c and incremental net cost. Of 3,646 records, 46 unique studies were eligible. Across 19 randomized controlled trials (RCTs), HbA1c declined by 0.26% (95% CI 0.17-0.35) or 3 mmol/mol (2 to 4) relative to usual care. In 8 RCTs lasting ≤3 years, incremental net costs were $116 (95% CI -$612 to $843) per patient annually. Long-term ICERs were $100,000-$115,000/quality-adjusted life year (QALY) in 3 RCTs, $50,000-$99,999/QALY in 1 RCT, $0-$49,999/QALY in 4 RCTs, and dominant in 1 RCT. Results were more favorable in non-RCTs. Our limitations include the fact that the studies had diverse designs and involved moderate risk of bias. Diverse multifaceted QI interventions that lower HbA1c appear to be a fair-to-good value relative to usual care, depending on society's willingness to pay for improvements in health.

Breastfeeding and occlusal development.

Data sourcesPubmed, Embase, Scopus databases and New York Academy of Medicine Grey Literature Report. There were no restrictions on language and publication dates.Study selectionTwo reviewers selected both prospective and retrospective studies of children who had either been exclusively breastfed or were mixed breastfed; who were in either the primary or mixed dentition, and malocclusion was assessed. The following malocclusion traits were included; Class 2 molar, open-bite, non-spaced dentition and posterior crossbite.Data extraction and synthesisData were extracted including type of dentition, type of malocclusion, breastfeeding data collection method, results, breast feeding malocclusion odds ratio (OR) and quality of the article. The ORs of associations between different lengths of breastfeeding and the various malocclusion traits were calculated.ResultsThirty-one studies were included in a qualitative synthesis, nine in the quantitative analysis. All studies were observational, a majority examining malocclusion in the mixed dentition. Two studies looked at associations between no breastfeeding and posterior crossbite, finding children not breastfed presented 1.7 times more posterior crossbite than those breastfed for between one and six months (OR = 1.70 CI 2.01-2.39). ORs were calculated for exclusive breastfeeding and posterior crossbite with different duration of breastfeeding, and duration of breastfeeding and posterior crossbite. With regard to open bite and breastfeeding the OR=1.76 (CI 0.55-5.61) comparing those who were breastfed for less than or more than six months. Children breastfed for up to six months presented 1.25 times more Class 2 molar relationships than those breastfed for over six months. Children breastfed for up to six months presented 1.73 times more non-spaced dentitions than those breastfed for over six months (OR =1.73, CI 1.35-2.22).ConclusionsBreastfeeding is a protective factor against posterior crossbites and Class 2 malocclusion in primary and mixed dentitions, with the protective effect increasing with the months of breastfeeding. There is no clear evidence for breastfeeding proving any benefit against other malocclusion risks; open bite and non-spaced dentitions.

Ginsenoside Rh1: A Systematic Review of Its Pharmacological Properties.

Ginsenoside Rh1 is one of major bioactive compounds extracted from red ginseng, which has been increasingly used for enhancing cognition and physical health worldwide. The objective of this study was to review the pharmacological effects of ginsenoside Rh1 in a systematic manner. We performed searches on eight electronic databases including MEDLINE (Pubmed), Scopus, Google Scholar, POPLINE, Global Health Library, Virtual Health Library, the System for Information on Grey Literature in Europe, and the New York Academy of Medicine Grey Literature Report to select the original research publications reporting the biological and pharmacological effects of ginsenoside Rh1 from in vitro and in vivo studies regardless of publication language and study design. Upon applying the inclusion and exclusion criteria, we included a total of 57 studies for our systemic review. Ginsenoside Rh1 exhibited the potent characteristics of anti-inflammatory, antioxidant, immunomodulatory effects, and positive effects on the nervous system. The cytotoxic effects of ginsenoside Rh1 were dependent on different types of cell lines. Other pharmacological effects including estrogenic, enzymatic, anti-microorganism activities, and cardiovascular effects have been mentioned, but the results were considerably diverged. A higher quality of evidence on clinical trial studies is highly recommended to confirm the consistent efficacy of ginsenoside Rh1.

Main air pollutants and ventricular arrhythmias in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis

ObjectivePrevious studies of ambient air pollutants and ventricular arrhythmias in patients with implantable cardioverter-defibrillator (ICD) have yielded mixed results, and the association between air pollution and ventricular arrhythmias in these patients remains unclear. This study aimed to assess and quantify the association between exposure to major air pollutants [CO, inhalable particles (PM10), SO2, fine particulate matter (PM2.5), O3, and NO2] and the presence of ventricular arrhythmia in patients with ICD. MethodsThe Medline, PubMed, Web of Science, Global Health Library, Virtual Health Library, Population Information Online (POPLINE), and New York Academy of Medicine Grey Literature Report databases were searched to identify studies analyzing the association between ventricular arrhythmias in patients with ICD and the abovementioned main air pollutants. Pooled estimates were generated using a random-effects model or fixed-effects model, according to the value of heterogeneity. Heterogeneity within studies was assessed using Cochran's Q and I2 statistics. Funnel plots, Egger's regression test, and Begg's rank correlation method were used to evaluate publication bias. Sensitivity analyses were also conducted to evaluate the potential sources of heterogeneity. ResultsAfter a detailed screening of 167 studies, seven separate studies were identified. Ventricular arrhythmias in patients with ICD were found to be positively, but not significantly, associated with CO, PM10, SO2, PM2.5, and NO2, with a pooled estimate [odds ratio (OR) associated with each 10 μg/m3 increase in pollutant concentration, except for CO, which was associated with each 1 mg/m3 increase in concentration] of 1.03 [95% confidence interval (CI): 0.92–1.17, P = 0.59] for CO, 1.01 (95%CI: 0.97–1.05, P = 0.55) for PM10, 1.09 (95%CI: 0.95–1.24, P = 0.22) for SO2, 1.07 (95%CI: 0.95–1.21, P = 0.25) for PM2.5, and 1.06 (95%CI: 0.98–1.14, P = 0.16) for NO2. No increased risk of ventricular arrhythmias in patients with ICD was found to be associated with O3 (OR = 1.00; 95%CI: 0.98–1.01, P = 0.56). ConclusionsThe results of this study provide little evidence that ambient air pollutants affect the risk of ICD discharges for treating ventricular arrhythmias.

Association between human herpesvirus infections and dementia or mild cognitive impairment: a systematic review protocol

IntroductionPersisting neurotropic viruses are proposed to increase the risk of dementia, but evidence of association from robust, adequately powered population studies is lacking. This is essential to inform clinical trials...

Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission

Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. To systematically review economic evaluations of QI interventions designed to reduce readmissions. Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, and Worldcat (January 2004 to July 2016). Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs. Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs. We calculated the risk difference and net costs to the health system in 2015 US dollars. Weighted least-squares regression analyses tested predictors of the risk difference and net costs. Main outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Of 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95% CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3% among general populations (95% CI, 4.0%-8.7%; P < .001; 18 studies). The mean net savings to the health system per patient was $972 among patients with HF (95% CI, -$642 to $2586; P = .23; 24 studies), and the mean net loss was $169 among general populations (95% CI, -$2610 to $2949; P = .90; 21 studies), reflecting nonsignificant differences. Among general populations, interventions that engaged patients and caregivers were associated with greater net savings ($1714 vs -$6568; P = .006). Multicomponent QI interventions can be effective at reducing readmissions relative to the status quo, but net costs vary. Interventions that engage general populations of patients and their caregivers may offer greater value to the health system, but the implications for patients and caregivers are unknown.

Prophylactic ondansetron for prevention of maternal hypotension following spinal anesthesia in women undergoing cesarean section

Background: Spinal anesthesia induced hypotension is a common problem that occurs in the parturient undergoing elective cesarean section. Prevention of maternal hypotension (MH) could improve safety of spinal anesthesia and satisfaction for both the patient and anesthesia provider. Many techniques have been researched and utilized to reduce the occurrence of hypotension; nevertheless, no single intervention has surfaced to be entirely successful. Ondansetron, a 5-hydroxytryptamine-3 (5-HT3 or serotonin) receptor antagonist, is a commonly used antiemetic medication in obstetric anesthesia for prevention or treatment of nausea and vomiting but its use for prevention of hypotension is still in question. Objective: The objective of this systematic review was to synthesize the best available evidence on the clinical effectiveness of prophylactic ondansetron on diminishing hypotension following spinal anesthesia. Methods: Types of participants Patients irrespective of ethnicity and age undergoing spinal anesthesia for elective cesarean section who received intravenous prophylactic ondansetron or placebo prior to subarachnoid cannulation and anesthetic administration. Types of intervention(s)/phenomena of interest The review included studies that explored the use of ondansetron to a control group and reported frequency of hypotension. Types of outcomes The review considered studies that reported the incidence of hypotension as defined by the researchers and met the hypotension definition detailed in this review: decrease in systolic, diastolic or mean arterial blood pressure more than 20% compared to baseline, or a systolic measurement less than 90 mmHg or diastolic less than 60 mmHg. Search strategy A comprehensive search strategy was utilized to find both published and unpublished studies in the English language, due to resource constraints, from January 1980 through July 2015. A search of PubMed, EMBASE, Cochrane Central Trials Register, Web of Science, Wiley online Library, TRIP, [email protected], and ScienceDirect was carried out. New York Academy of Medicine Grey Literature Report, AHRQ, and ProQuest Dissertations and Theses were utilized for unpublished research. Methodological quality Two independent reviewers utilized the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials. Data extraction Incidence of hypotension for both the ondansetron and placebo groups was extracted from the studies using the Joanna Briggs Institute Data Extraction Form from JBI-MAStARI. Data Synthesis DerSimonian and Laird random and fixed effects model using the CMA software was applied to the extracted quantitative data after it was pooled for meta-analysis. Standard chi-square test was used to assess for heterogeneity. Results: Two common doses (4 mg and 8 mg) of ondansetron surfaced from the nine included studies in this systemic review. Pooling of data from 7 RCTs indicated a statistically significant decrease in hypotension, p = 0.002 and relative risk (RR) of 0.494, (95% CI 0.314 to 0.779) in the parturient that received 4 mg of ondansetron. Data pooled from 4 RCTs indicated no statistically significant decrease in hypotension when 8 mg of ondansetron was administered, p = 0.753 and RR of 0.964 (95% CI 0.767 to 1.212). Discussion/Conclusion: Administration of ondansetron (4 mg) prior to spinal anesthesia can be recommended to help prevent the incidence of hypotension in the pregnant patient undergoing elective cesarean section. Implications for practice Anesthesia professionals utilizing ondansetron (4 mg) will realize a reduction in spinal anesthesia induced hypotension in the parturient for an elective cesarean section. This may impact patient outcomes and current practices by decreasing the adverse events associated with hypotension in this population and satisfaction in both patient and anesthesia provider.

Interventions for molluscum contagiosum in people infected with human immunodeficiency virus: a systematic review.

Molluscum contagiosum (MC) is a viral skin disease that presents with white, painless papules with central umbilication. In immunocompent individuals, MC is usually a benign infection that resolves without intervention. In HIV positive people, symptoms of MC can be more severe. The aim of this systematic review is to analyze the literature on strategies for treating MC in people concomitantly infected with HIV and subsequently make recommendations on best management strategies for these people. Searches were conducted of the following electronic databases: MEDLINE, EMBASE, Cochrane Library, PubMed, LILACS, IndMED, Global Health, ClinicalTrials.Gov, and Current Controlled Trials. Grey literature was searched via the New York Academy of Medicine Grey Literature Report and Open Grey. References cited in previous reviews and references cited in studies identified as being possibly relevant were also reviewed. No language restrictions were imposed. Papers from 1980 to present were reviewed. Thirteen studies were included in this review. Two papers were comparative studies, one of which was randomized and neither of which were blinded. Ten papers were observational studies with heterogeneous populations. One study was a multicentre cohort study. Given the poor quality of study design, wide array of outcome variables, and lack of objective evidence, no specific recommendation can be made for the treatment of MC in people infected with HIV, other than the initiation of ART. Despite the good impact ART has made on prevalence of dermatologic disease, MC remains an important cause of morbidity in HIV positive populations.

Effectiveness of ketamine gargle in reducing postoperative sore throat in patients undergoing airway instrumentation: a systematic review

Background Postoperative sore throat is a common, minor adverse event, second to postoperative nausea and vomiting, occurring in individuals undergoing general anesthesia. Postoperative sore throat has the potential to not only diminish patient satisfaction, but also increase the need for adjunct pain therapy in the post anesthesia care unit. Many techniques are utilized to reduce postoperative sore throat; however no one intervention has proven to be completely effective. The use of ketamine gargle is a novel intervention but the effectiveness of administering it prior to induction of general anesthesia is still uncertain. Therefore, further evaluation of current evidence is needed to determine the effectiveness of ketamine gargle in reducing the incidence of postoperative sore throat. Objectives The objective of this review was to determine the effectiveness of ketamine gargle in comparison to placebo or another intervention in reducing the incidence of postoperative sore throat in patients undergoing airway instrumentation. Inclusion criteria Types of participants The participants in this review were adult patients who received ketamine gargle or placebo prior to induction of general anesthesia for a variety of surgical procedures requiring endotracheal intubation. Type of intervention This review examined studies that evaluated the effectiveness of ketamine gargle compared to placebo or another intervention in reducing the incidence of postoperative sore throat. Types of outcomes This review considered studies that measured the incidence of postoperative sore throat using a direct question survey with a four-point scale (0 = no sore throat; 1,2,3 = presence of sore throat). Types of studies This review included randomized controlled trials only; no other types of articles were discovered upon searching. Search strategy The comprehensive search strategy aimed to find both English language studies prior to August 2014.Databases used were: EMBASE, CINAHL, MEDLINE, ProQuest, Web of Science and Cochrane Central Register of Controlled Trials. Google Scholar, MEDNAR, New York Academy of Medicine Grey Literature Report and ProQuest Dissertations and Theses were used to locate unpublished studies. Initial keywords included: ketamine, gargle or mouthwash, postoperative, sore throat or pharyngitis, and airway management. Methodological quality Two independent reviewers used the Joanna Briggs Institute Critical Appraisal Checklist for Experimental Studies, a standardized critical appraisal instrument, to assess papers selected for inclusion. Data extraction Incidence of postoperative sore throat for both the treatment and control groups was extracted from the included studies using the Joanna Briggs Institute Data Extraction Form for Experimental Studies. Data synthesis Extracted data was pooled in a meta-analysis utilizing the DerSimonian and Laird random effects model using the JBI Meta-Analysis of Statistics Assessment and Review Instrument. Relative risk and 95% confidence intervals were calculated for analysis. Heterogeneity was assessed using the standard chi-square test. Results Five randomized controlled-trials were included in the meta-analysis. Ketamine gargle caused a statistically significant (p <0.015, RR <0.53) reduction in the incidence of postoperative sore throat compared to placebo across all five time intervals studied (0, 2, 4, 8, and 24 hours). Conclusions Administration of ketamine gargle (40–50 mg) prior to induction of anesthesia significantly reduces the incidence of postoperative sore throat across all studied time intervals in patients undergoing general anesthesia requiring endotracheal intubation. Implications for practice Administration of ketamine gargle prior to induction of general anesthesia with airway instrumentation may improve patient satisfaction by decreasing patient discomfort and the need for adjunct pain therapy in the post anesthesia care unit. This impacts current practice and patient outcomes in that this may decrease the need for adjunct pain therapy and decrease length of stay in the post-anesthesia care unit. Implications for research Additional research is needed to determine the systemic effects of ketamine gargle and whether other n-methyl-d-aspartate antagonists are effective in reducing postoperative sore throat. Future research should include previously excluded populations and expanded to include other methods of airway manipulation.

The experiences of pre-licensure or pre-registration health professional students and their educators in working with intra-professional teams: a systematic review of qualitative evidence protocol

The experiences of pre-licensure or pre-registration health professional students and their educators in working with intra-professional teams: a systematic review of qualitative evidence protocol