MEDLINE OvidSP Research Articles

Terlipressin versus placebo or noradrenalin in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.

Hepatorenal syndrome (HRS) bears a very poor prognosis with unmet need for safe and effective therapies. This systematic review and meta-analysis aimed to re-assess safety and efficacy of terlipressin versus placebo or noradrenaline for HRS, based on previous randomized controlled trials (RCTs). PubMed, EMBASE, MEDLINE (OvidSP) and Cochrane registers were searched for trials reporting HRS treatment by terlipressin or noradrenaline. Search terms included: "hepatorenal syndrome", "terlipressin", "noradrenaline", and corresponding synonyms. Comparisons between terlipressin, noradreanaline, placebo and albumin were included. Meta-analysis was conducted for treatment response (both HRS reversal and complete response), mortality and adverse events. 15 RCTs were included, enrolling 1236 HRS patients (type 1: 1166, type 2: 70). Treatment with terlipressin+albumin resulted in significantly higher treatment response than placebo+albumin or albumin alone (risk ratio [RR]:2.75, 95% confidence interval [CI]:1.96 to 3.84; I2 = 28%, p = 0.23; n = 6). Noradrenaline was equally effective in treatment response compared to terlipressin (RR:1.19, 95% CI:0.96 to 1.46; I2 = 16%, p = 0.31; n = 7), but trials were limited by its non-blind design and small size. Sensitivity analysis showed no survival benefit with terlipressin compared to either placebo (RR:1.03, 95% CI:0.83 to 1.28; I2 = 0%, p = 0.72; n = 3) or noradreanline (RR:0.83, 95% CI:0.69 to 1.00; I2 = 4%, p = 0.39; n = 7) at 30 days of follow-up. Terlipressin carried higher risk of treatment-related adverse events compared to either placebo (RR:2.92, 95% CI:1.48 to 5.77; I2 = 0%, p = 0.75; n = 3) or noradrenaline (RR:2.45, 95% CI:1.37 to 4.37; I2 = 0%, p = 0.92; n = 5). Terlipressin is superior to placebo, and comparable to noradreanline in treatment response, but survival benefit is lacking. Noradrenaline, with low certainty, may be a better alternative for HRS.

Technology-Based Music Interventions to Reduce Anxiety and Pain Among Patients Undergoing Surgery or Procedures: Systematic Review of the Literature.

Hospitalized patients undergoing surgery or procedures may experience negative symptoms. Music is a nonpharmacological complementary approach and is used as an intervention to reduce anxiety, stress, and pain in these patients. Recently, music has been used conveniently in clinical situations with technology devices, and the mode of providing music is an important factor in technology-based music interventions. However, many reviews have focused only on the effectiveness of music interventions. We aimed to review randomized controlled trials (RCTs) of technology-based music interventions for reducing anxiety and pain among patients undergoing surgery or procedures. We examined the clinical situation, devices used, delivery methods, and effectiveness of technology-based music interventions in primary articles. The search was performed in the following 5 electronic databases: PubMed, MEDLINE (OvidSP), CINAHL complete, PSYCINFO, and Embase. This systematic review focused on technology-based music interventions. The following articles were included: (1) RCTs, (2) studies using interactive technology (eg, smartphones, mHealth, tablets, applications, and virtual reality), (3) empirical studies reporting pain and anxiety outcomes, and (4) English articles published from 2018 to 2023 (as of January 18, 2023). The risk of bias was assessed using the Cochrane Risk of Bias tool version 2. Among 292 studies identified, 21 met the inclusion criteria and were included. Of these studies, 9 reported that anxiety scores decreased after music interventions and 7 reported that pain could be decreased before, during, and after procedures. The methodology of the music intervention was important to the results on anxiety and pain in the clinical trials. More than 50% (13/21, 62%) of the studies included in this review allowed participants to select themes themselves. However, it was difficult to distinguish differences in effects depending on the device or software used for the music interventions. Technology-based music interventions could help reduce anxiety and pain among patients undergoing surgery or procedures. The findings of this review could help medical teams to choose a practical methodology for music interventions. Future studies should examine the effects of advanced technology-based music interventions using smart devices and software that promote interactions between medical staff and patients.

Applications of Grounded Theory Methodology to Investigate Hearing Loss: A Methodological Qualitative Systematic Review With Developed Guidelines.

Qualitative methodologies are commonly adopted in hearing loss research. Grounded theory methodology is increasingly used to establish novel theories explaining experiences related to hearing loss. Establishing and improving the quality of grounded theory studies has been emphasized as critical to ensuring theoretical trustworthiness. Thus, the primary aim of the present study was to systematically review hearing loss research studies that have applied grounded theory methodology and assess the methodological quality of those grounded theory applications. Secondarily aims were to (i) explore how grounded theory methodology has been applied to investigate hearing loss, and (ii) use the findings of the review to develop a set of guidelines to aid the future high-quality application of grounded theory methodology to hearing loss research. Original peer-reviewed studies applying grounded theory methodology and published in English were identified through systematic searches in 10 databases; Applied Social Sciences Index and Abstracts, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Global Health, MEDLINE (OvidSP), PsycINFO, PubMed, Scopus, and Web of Science. The quality of studies was assessed according to 12 grounded theory principles using the Guideline for Reporting, Evaluating, and applying the core principles of Grounded Theory studies (GUREGT) tool. Data were analyzed using qualitative inductive thematic analysis. After the removal of duplicates, 155 articles were retrieved. Of those, 39 met the criteria for inclusion in the systematic review. An increase in the adoption of grounded theory methodology to investigate hearing loss was identified with the number of published studies tripling in the last 5 years. Critical appraisal using the GUREGT tool identified four studies as high-quality. Most included studies were of moderate study quality (n = 25), and 10 were classified as being of low study quality. Using inductive thematic analysis, the included studies investigated one of four areas relating to hearing loss: (a) Living with hearing loss, (b) Identity and hearing loss, (c) Coping strategies for hearing loss, and (d) Audiological counseling and rehabilitation. Analysis also identified four main grounded theory factors frequently overlooked in hearing loss research: the different schools of grounded theory, sampling strategy, sample size, and the depth of grounded theory application. Use of grounded theory methodology is increasing at a rapid rate in hearing loss research. Despite this, studies conducted in the field to date do not meet and apply the full spectrum of grounded theory principles, as outlined by the GUREGT tool. To improve methodological rigor in future studies using grounded theory, we propose a set of guidelines that address the most commonly overlooked methodological considerations in hearing loss studies to date. The guidelines are designed to aid researchers to achieve high methodological quality in any field, improve qualitative rigor, and promote theoretical credibility.

Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review

BackgroundExperiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one’s lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus.MethodsIn this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg’s FSN was calculated for both binary and continuous measures.ResultsWe identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression.ConclusionsThe findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.

A137 BALLOON-ASSISTED ENDOSCOPY FOR SMALL BOWEL BLEEDING – A REVIEW

Abstract Background Gastrointestinal (GI) bleeding is a potentially life-threatening medical emergency requiring immediate medical attention. Obscure GI bleeding (OGIB) Is defined as GI bleeding with no obvious culprit lesion found on initial upper or lower endoscopy. Further investigations are needed as 75% of those cases originate in the small bowel. The advent of small bowel endoscopy, consisting of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE) has allowed clinicians to endoscopically visualize the entire GI tract and perform therapeutic interventions. These devices include balloon assisted endoscopy (BAE) and Spiral Endoscopy (SPE). Aims The objectives of this review are to analyze the definitions, etiologies, and risk factors of OGIB. Furthermore, we reviewed the diagnostic and therapeutic yields of DAE and its safety profile. Due to the adverse effects and recall of SPE, we only report here on BAE. Methods A literature review was conducted using PubMed and OvidSP (Medline) to identify articles on the use of VCE and DAE for OGIB. Keywords included a combination of gastrointestinal bleeding with occult, obscure, active and inactive, small bowel bleed, diagnostic yield, therapeutic yield, and rebleeding rate. The information was obtained via systematic review and meta-analysis, retrospective studies, and case reports. Results A total of 32 papers were reviewed. The most common causes of OGIB reported were vascular lesions (23-47%), inflammatory lesions (12-16%), and tumors (5-16%). The risk factors associated with OGIB include age, cardiac disease, liver cirrhosis, chronic kidney disease, and hereditary vascular diseases. The overall diagnostic and therapeutic yields of BAE in OGIB were 76.3% and 49.5%, respectively. Factors that increased the yield included performing an initial VCE (increase by 7%) and performing the procedure within the first 10 days after the initial bleeding episode (87.5%) as compared to after 10 days (11.1%). Recurrent bleeding can occur in up to 46% of patients. Risk factors for rebleeding include cirrhosis, overt bleeding symptoms, and presence of multiple vascular lesions. Associated adverse effects in DAE were minor in 9.1% of patients and severe in less than 2%. These include bleeding (0.8%), perforation (0.3%), and pancreatitis (0.3%). Conclusions OGIB is a challenging clinical entity. BAE now allows clinicians to diagnose and treat culprit lesions in the small bowel with reasonable success and a strong safety profile, however timing and prior VCE can further optimize this. Clinical decisions and follow up should be made based around existing risk stratification tools and scores. Further prospective research is needed to determine optimal timing of DAE from presentation of OGIB that would increase diagnostic and therapeutic yields. Figure 1. A and B) Endoscopic images of small bowel vascular lesion. C) Bleeding vascular lesion treated with hemostatic clips. Funding Agencies None

Education, incentive, and engineering-based interventions to promote the use of seat belts.

Education, incentive, and engineering-based interventions to promote the use of seat belts.

Effect of Recipient Body Mass Index on Kidney Transplantation Outcomes: A Systematic Review and Meta-analysis by the Transplant Committee from the French Association of Urology.

The impact of recipient obesity on kidney transplantation (KT) outcomes remains unclear. The aim of this study was to perform a systematic review and meta-analysis to appraise all available evidence on the outcomes of KT in obese patients (body mass index [BMI] ≥30kg/m2) versus nonobese patients (BMI <30kg/m2). A systematic review and meta-analysis was performed. Search was conducted in the MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and Cochrane databases to identify all studies reporting the outcomes of KT in obese versus nonobese recipients. Fifty-two articles met the inclusion criteria. Delayed graft function and surgical complications were significantly higher in obese recipients (delayed graft function: relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.32-1.57, p<0.01; surgical complications: RR: 1.74, 95% CI: 1.36-2.22, p<0.0001). Five-year patient survival (RR: 0.96, 95% CI: 0.92-1.00, p=0.01), 10-yr patient survival (RR: 0.90, 95% CI: 0.84-0.97, p=0.006), and 10-yr graft survival (RR: 0.87, 95% CI: 0.79-0.96, p=0.01) were significantly inferior in the obese group. KT in obese recipients was associated with lower patient and graft survival, and higher delayed graft function, acute rejection, and medical and surgical complications than nonobese recipients. In the current situation of organ shortage and increasing prevalence of obesity, ways to optimize KT in this setting should be investigated. Compared with nonobese population, kidney transplantation in obese recipients has inferior patient and graft survival, and higher medical and surgical complications.

Measuring Nurses' Knowledge and Awareness of Climate Change and Climate-Associated Diseases: Protocol for a Systematic Review of Existing Instruments.

Climate change is a health emergency. Each year, it is estimated to cost more than 230 million years of life expectancy, with 4-9 million premature deaths associated with air pollution, and 9 million excess deaths due to non-optimal temperatures, representing 7% more temperature-related deaths since 2015 and 66% more since 2000. Identify and evaluate the reliability, fidelity, and validity of instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases. A systematic literature review will retrieve and assess studies examining instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases. Using predefined search terms for nurses, climate change, literacy and scales or tools, we will search for published articles recorded in the following electronic databases, with no language or date restrictions, from their inception until 31 October 2023: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb], from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Library Wiley (from 1992), Web of Science Core Collection (from 1900), the Trip Database (from 1997), JBI OVID SP (from 1998), and the GreenFILE EBSCO. We will also hand-search relevant articles' bibliographies and search for unpublished studies using Google Scholar, ProQuest Dissertations and Theses Global, and DART-EUrope.eu. This will be completed by exploring the gray literature in OpenGrey and the Grey Literature Report, from inception until 31 October 2023, in collaboration with a librarian. Twelve bibliographic databases will be searched for publications up to 31 October 2023. The papers selected will be assessed for their quality. The electronic database searches were completed in May 2023. Retrieved articles are being screened, and the study will be completed by October 2023. After removing duplicates, our search strategy has retrieved 3449 references. This systematic review will provide specific knowledge about instruments to measure nurses' knowledge, awareness, motivation, attitudes, behaviors, beliefs, skills, and competencies regarding climate change and climate-associated diseases.

Implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing in family planning: a protocol for a mixed-methods systematic review

BackgroundEnsuring access to quality family planning (FP) services is fundamental to achieving the Sustainable Development Goals (SDG) targets 3.1, 3.7, and 5.6, including universal access to reproductive health services. However, barriers such as health workforce shortages and restrictive policies on the role of mid and lower-level health workforce cadres limit access to contraceptives and FP in many settings.Workforce reorganization makes more efficient use of human resources. Consequently, the World Health Organization (WHO) recommends task-sharing for FP by different cadres. Evidence on the implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing could inform financing, implementation approaches, and technical assistance of national and global FP task-sharing programs. Therefore, this study aims to describe and assess the quality of the evidence on implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing in FP and the outcome of the scale-up/sustainability interventions.MethodsThis systematic review protocol was developed using relevant guidelines, including the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols (PRISMA-P). A search of five databases, namely CINAHL (EBSCOhost), EMBASE (OvidSP), Global Health (OvidSP), MEDLINE (OvidSP), and Scopus (www.scopus.com), and gray literature resources will be conducted. Two independent reviewers will screen and select studies, assess their quality using the “Mixed Methods Appraisal Tool,” and extract data from eligible studies. Publications or articles are eligible if they report implementation strategies, facilitators, or barriers to scaling up/sustainability of task-sharing in FP/contraception or the outcomes of the scale-up/sustainability interventions. A convergent synthesis that integrates qualitative, quantitative, descriptive, and mixed-methods data into one dataset will be used for analysis based on an a priori framework—the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy of the health system framework. Two independent reviewers will assess the quality of evidence using the GRADE-CERQual guideline.DiscussionTo our knowledge, this systematic review of implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing in family planning is the first in this area. Our rigorous methodology based on up-to-date guidelines can help generate relevant recommendations to support interventions to scale up and sustain task-sharing in family planning.Systematic review registrationPROSPERO CRD42022339885.

P11.04.B ASSESSMENT OF TUMOR ELOQUENCE IN GLIOMA RESECTIONS: A SYSTEMATIC REVIEW

Abstract BACKGROUND Tumor location and eloquence are two crucial factors when deciding on the optimal surgical strategy in glioma management. Consensus is currently lacking on the assessment and definition of eloquent areas. This systematic review aims to evaluate the existing definitions and assessment methods of eloquent areas used in current clinical practice. MATERIAL AND METHODS A computer-aided search of Embase, Medline (OvidSP), and Google Scholar was performed to identify relevant studies. This review includes articles describing preoperative definitions of eloquence in the study’s Methods section. These definitions were compared and categorized by anatomical structure. Additionally, various techniques to preoperatively assess tumor eloquence were extracted, along with their benefits, drawbacks and ease of use. RESULTS This review covers 98 articles including 12,714 participants. Evaluation of these studies indicated considerable variability in defining eloquence. Categorization of these definitions yielded a list of 32 brain regions that were considered eloquent. The most commonly used methods to preoperatively determine tumor eloquence were anatomical classification systems and structural MRI, followed by DTI-FT, functional MRI and nTMS. CONCLUSION None of the definitions or techniques to define eloquence described in the articles are entirely satisfactory as an objective, quantifiable, preoperative factor in glioma treatment and surgical decision-making. Therefore, we propose the development of a new, easily applicable and interpretable anatomical preoperative grading system to assess tumor eloquence. This may aid neurosurgeons in their perioperative decision-making to improve surgical outcomes on an individual patient level and to facilitate the execution and interpretation of multicenter studies.

Risk factors for peri-intubation cardiac arrest: A systematic review and meta-analysis

BackgroundPeri-intubation cardiac arrest (PICA) is an uncommon yet serious complication of intubation. Although some associated risk factors have been identified, the results have been inconsistent. The aim of this study was to systematically review the relevant research and examine the associated risk factors of PICA through meta-analysis. MethodsStudies examining the risk factors for PICA before 1 Nov. 2022 were identified through searches in MEDLINE (OvidSP) and EMBASE. The reported adjusted or unadjusted odds ratios (ORs) and risk ratios (RRs) were recorded. We calculated pooled ORs and created forest plots using a random-effects model to identify the statistically significant risk factors. We assessed the certainty of evidence for each risk factor. ResultsEight studies were included in the meta-analysis. Pre-intubation hypotension, with a pooled OR of 4.96 (95% confidence interval [C.I.]: 3.75–6.57), pre-intubation hypoxemia, with a pooled OR of 4.43 (95% C.I.: 1.24–15.81), and two or more intubation attempts, with a pooled OR of 1.88 (95% C.I.: 1.09–3.23) were associated with a significantly higher risk of PICA. The pooled incidence of PICA was 2.1% (95% C.I.: 1.5%–3.0%). ConclusionsPre-intubation hypotension, hypoxemia, and more intubation attempts are significant risk factors for PICA. The findings could help physicians identify patients at risk under the acute setting.

Effects of yoga on physical and psychological health among community-dwelling older adults: A systematic review and meta-analysis.

To synthesise and critically appraise the quality of existing evidence about the effects of yoga on physical and psychological outcomes among older adults. A systematic review and meta-analysis. Participants aged 60 and above. Nine English and two Chinese electronic bibliographic databases, including MEDLINE OvidSP, PsycINFO, AMED, EMBASE, Global Health, PubMed, Scopus, CINAHL, Cochrane Library, Hyread and WanFang databases, were searched. Randomised controlled trials (RCT) of yoga on physical and psychological outcomes among older adults were included. Meta-analysis was conducted for outcomes studied in three or more studies, otherwise narrative synthesis was performed. Fifteen studies were included for review. The results of meta-analysis after sensitivity analysis showed that yoga significantly improved balance (SMD = 0.81, 95% CI: 0.48-1.14, p < .001, II2 = 59%), flexibility (SMD = 0.38, 95% CI: 0.07-0.68, p = .020, II2 34%), muscle strength (SMD = 0.49, 95% CI: 0.18-0.79, p = .002, I2 43%) and depressive symptoms (SMD = 0.50, 95% CI = 0.09-0.91, p = .01, I2 0%). There was insufficient data for meta-analysis on gait and other psychological outcomes. Narrative synthesis suggested that yoga has positive effects on reducing anxiety, but its effects on improving gait and reducing stress among older adults were inconclusive. The results of this review supported the beneficial effects of yoga on physical outcomes among older adults, but the heterogeneity across studies was relatively high. Evidence related to the effect on psychological outcomes was limited.

Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review

Community-based interventions are increasingly being implemented in Sub-Saharan Africa (SSA) for stillbirth prevention, but the nature of these interventions, their reporting and acceptability are poorly assessed. In addition to understanding their effectiveness, complete reporting of the methods, results and intervention acceptability is essential as it could potentially reduce research waste from replication of inadequately implemented and unacceptable interventions. We conducted a systematic review to investigate these aspects of community-based interventions for preventing stillbirths in SSA. In this systematic review, eight databases (MEDLINE(OvidSP), Embase (OvidSP), Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index (Web of Science Core Collection), CINAHL (EBSCOhost) and Global Index Medicus) and four grey literature sources were searched from January 1, 2000 to July 7, 2023 for relevant quantitative and qualitative studies from SSA (PROSPERO-CRD42021296623). Following deduplication, abstract screening and full-text review, studies were included if the interventions were community-based with or without a health facility component. The main outcomes were types of community-based interventions, completeness of intervention reporting using the TIDier (Template for Intervention Description and replication) checklist, and themes related to intervention acceptability identified using a theoretical framework. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. Thirty-nine reports from thirty-four studies conducted in 18 SSA countries were eligible for inclusion. Four types of interventions were identified: nutritional, infection prevention, access to skilled childbirth attendants and health knowledge/behaviour of women. These interventions were implemented using nine strategies: mHealth (defined as the use of mobile and wireless technologies to support the achievement of health objectives), women's groups, community midwifery, home visits, mass media sensitisation, traditional birth attendant and community volunteer training, community mobilisation and transport vouchers. The completeness of reporting using the TIDier checklist varied across studies with a very low proportion of the included studies reporting the intervention intensity, dosing, tailoring and modification. The quality of the included studies were graded as poor (n=6), fair (n=14) and good (n=18). Though interventions were acceptable, only 4 (out of 7) studies explored women's perceptions, mostly focusing on perceived intervention effects and how they felt, omitting key constructs like ethicality, opportunity cost and burden of participation. Different community-based interventions have been tried and evaluated for stillbirth prevention in SSA. The reproducibility and implementation scale-up of these interventions may be limited by incomplete intervention descriptions in the published literature. To strengthen impact, it is crucial to holistically explore the acceptability of these interventions among women and their families. Clarendon/Balliol/NDPH DPhil scholarship for UGA. MN is funded by a Medical Research Council Transition Support Award (MR/W029294/1).

What are the core recommendations for gout management in first line and specialist care? Systematic review of clinical practice guidelines

BackgroundGout is the most common inflammatory arthritis, increasing in prevalence and burden. Of the rheumatic diseases, gout is the best-understood and potentially most manageable condition. However, it frequently remains untreated or poorly managed. The purpose of this systematic review is to identify Clinical Practice Guidelines (CPG) regarding gout management, evaluate their quality, and to provide a synthesis of consistent recommendations in the high-quality CPGs.MethodsGout management CPGs were eligible for inclusion if they were (1) written in English and published between January 2015-February 2022; focused on adults aged ≥ 18 years of age; and met the criteria of a CPG as defined by the Institute of Medicine; and (2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Gout CPGs were excluded if they required additional payment to access; only addressed recommendations for the system/organisation of care and did not include interventional management recommendations; and/or included other arthritic conditions. OvidSP MEDLINE, Cochrane, CINAHL, Embase and Physiotherapy Evidence Database (PEDro) and four online guideline repositories were searched.ResultsSix CPGs were appraised as high quality and included in the synthesis. Clinical practice guidelines consistently recommended education, commencement of non-steroidal anti-inflammatories, colchicine or corticosteroids (unless contraindicated), and assessment of cardiovascular risk factors, renal function, and co-morbid conditions for acute gout management. Consistent recommendations for chronic gout management were urate lowering therapy (ULT) and continued prophylaxis recommended based on individual patient characteristics. Clinical practice guideline recommendations were inconsistent on when to initiate ULT and length of ULT, vitamin C intake, and use of pegloticase, fenofibrate and losartan.ConclusionManagement of acute gout was consistent across CPGs. Management of chronic gout was mostly consistent although there were inconsistent recommendations regarding ULT and other pharmacological therapies. This synthesis provides clear guidance that can assist health professionals to provide standardised, evidence-based gout care.Trial registrationThe protocol for this review was registered with Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/UB3Y7).

A modular systematic review of antenatal interventions targeting modifiable environmental exposures in improving low birth weight

BackgroundLow birth weight (LBW) increases the risk of short- and long-term morbidity and mortality from early life to adulthood. Despite research effort to improve birth outcomes the progress has been slow. ObjectiveThis systematic search and review of English language scientific literature on clinical trials aimed to compare the efficacy antenatal interventions to reduce environmental exposures including a reduction of toxins exposure, and improving sanitation, hygiene, and health-seeking behaviors, which target pregnant women to improve birth outcomes. MethodsWe performed eight systematic searches in MEDLINE (OvidSP), Embase (OvidSP), Cochrane Database of Systematic Reviews (Wiley Cochrane Library), Cochrane Central Register of Controlled Trials (Wiley Cochrane Library), CINAHL Complete (EbscoHOST) between 17 March 2020 and 26 May 2020. ResultsFour documents identified describe interventions to reduce indoor air pollution: two randomised controlled trials (RCTs), one systematic review and meta-analysis (SRMA) on preventative antihelminth treatment and one RCT on antenatal counselling against unnecessary caesarean section. Based on the published literature, interventions to reduce indoor air pollution (LBW: RR: 0.90 [0.56, 1.44], PTB: OR: 2.37 [1.11, 5.07]) or preventative antihelminth treatment (LBW: RR: 1.00 [0.79, 1.27], PTB: RR: 0.88 [0.43, 1.78]) are not likely to reduce the risk of LBW or Preterm birth (PTB). Data is insufficient on antenatal counselling against caesarian-sections. For other interventions, there is lack of published research data from RCTs. ConclusionsWe conclude that there is a paucity of evidence from RCT on interventions that modify environmental risk factors during pregnancy to potentially improve birth outcomes. Magic bullets approach might not work and that it would be important to study the effect of the broader interventions, particularly in LMIC settings. Global interdisciplinary action to reduce harmful environmental exposures, is likely to help to reach global targets for LBW reduction and sustainably improve long-term population health.

Facility-based stillbirth review processes used in different countries across the world: a systematic review.

Facility-based stillbirth review provides opportunities to estimate incidence, evaluate causes and risk factors for stillbirths, and identify any issues related to the quality of pregnancy and childbirth care which require improvement. Our aim was to systematically review all types and methods of facility-based stillbirth review processes used in different countries across the world, to examine how stillbirth reviews in facility settings are being conducted worldwide and to identify the outcomes of implementing the reviews. Moreover, to identify facilitators and barriers influencing the implementation of the identified facility-based stillbirth reviews processes by conducting subgroup analyses. A systematic review of published literature was conducted by searching MEDLINE (OvidSP) [1946-present], EMBASE (OvidSP) [1974-present], WHO Global Index Medicus (globalindexmedicus.net), Global Health (OvidSP) [1973-2022Week 8] and CINAHL (EBSCOHost) [1982-present] from their inception until 11 January, 2023. For unpublished or grey literature, the WHO databases, Google Scholar and ProQuest Dissertations & Theses Global were searched, as well as hand searching the reference lists of included studies. MESH terms encompassing "∗Clinical Audit", "∗Perinatal Mortality", "Pregnancy Complications", and "Stillbirth" were used with Boolean operators. Studies that used a facility-based review process or any approach to evaluate care prior to stillbirth, and explained the methods used were included. Reviews and editorials were excluded. Three authors (YYB, UGA, and DBT) independently screened and extracted data, and assessed the risk of bias using an adapted JBI's Checklist for Case Series. A logic model was used to inform the narrative synthesis. The review protocol was registered with PROSPERO, CRD42022304239. A total of 68 studies from 17 high-income (HICs) and 22 low-and-middle-income countries (LMICs) met the inclusion criteria from a total of 7258 identified records. These were stillbirth reviews conducted at different levels: district, state, national, and international. Three types were identified: audit, review, and confidential enquiry, but not all desired components were included in most processes, which led to a mismatch between the description of the type and the actual method used. Routine data from hospital records was the most common data source for identifying stillbirths, and case assessment was based on stillbirth definition in 48 out of 68 studies. Hospital notes were the most common source of information about care received and causes/risk factors for stillbirth. Short-term and medium-term outcomes were reported in 14 studies, but impact of the review process on reducing stillbirth, which is more difficult to establish, was not reported in any study. Facilitators and barriers in implementing a successful stillbirth review process identified from 14 studies focused on three main themes: resources, expertise, and commitment. This systematic review's findings identified that there is a need for clear guidelines on how to measure the impact of implementation of changes based on outputs of stillbirth reviews and methods to enable effective dissemination of learning points in the future and promoting them through training platforms. In addition, there is a need to develop and adopt a universal definition of stillbirth to facilitate meaningful comparison of stillbirth rates between regions. The key limitation of this review is that while using a logic model for narrative synthesis was deemed most appropriate for this study, sequence of implementing a stillbirth review in the real world is not linear, and assumptions are often not met. Therefore, the logic model proposed in this study should be interpreted with flexibility when designing a stillbirth review process. The generated learnings from the stillbirth review processes inform the action plans and allow facilities to consider where the changes should happen to improve the quality of care in the facilities, enabling positive short-term and medium-term outcomes. Kellogg College, University of Oxford, Clarendon Fund, University of Oxford, Nuffield Department of Population Health, University of Oxford and Medical Research Council (MRC).

Seeking Help for Tinnitus and Satisfaction With Healthcare Providers Including Diagnosis, Clinical Services, and Treatment: A Scoping Review.

The objective of this scoping review was to describe the extent and type of evidence related to seeking help for tinnitus and satisfaction with healthcare providers including diagnosis, services and treatments along the clinical pathway. The selection criteria were adults aged 18 and over with tinnitus who sought help and where patient satisfaction with healthcare providers was reported. Online databases MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP) and CINAHL plus (EBSCO) were searched for original studies in English. The search had no date limit. Twenty-one records were eligible for data extraction. Studies reported that the most common healthcare providers seen were general practitioners, ear, nose and throat specialists and audiologists. Depression and tinnitus severity were related to an increase in the number of times help was sought and the type of healthcare provider seen may also impact patient satisfaction. The majority of participants were unlikely to receive a referral to a specialist at the initial GP consultation. Although there is limited research in this area, help-seekers for tinnitus were generally dissatisfied and reported negative interactions with healthcare providers. However, once in a specialised tinnitus clinical setting, studies reported that most help-seekers were satisfied and had positive interactions with healthcare providers.

Foot orthoses for flexible flatfeet in children and adults: a systematic review and meta-analysis of patient-reported outcomes

BackgroundThis systematic review and meta-analysis examined the effectiveness of orthoses for flexible flatfeet in terms of patient-reported outcomes in children and adults.MethodsEMBASE, Medline (OvidSP), Web-of-Science, Scopus, CINAHL, Cochrane Central Register of Controlled Clinical Trials, i.e., Cochrane Centraland Pubmed were searched to identify relevant studies since their inception up to February 2021. We included randomized controlled trials (RCT) and prospective studies in which patient reported outcomes at baseline and follow-up in an orthoses group were compared with a no orthoses or sham sole group. Methodological quality of the studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). A meta-analysis was performed where there were multiple studies with the same outcome measures, which was the case for the Visual Analogue Scale (VAS) for pain in adults.ResultsIn total nine studies were included: four RCT in children (N = 353) and four RCT and one prospective study in adults (N = 268) were included. There was considerable heterogeneity between studies. A meta-analysis demonstrated that pain reduction between baseline and follow-up was significantly larger in the orthoses (N = 167) than in the control groups in adults (N = 157; − 4.76, 95% CI [− 9.46, − 0.06], p0.05).ConclusionDue to heterogeneity in study designs, we cannot conclude that foot orthoses are useful for flexible flatfoot in children and adults. However, based on the meta-analysis orthoses might be useful in decreasing pain in adults.The authors did not receive support from any organization for the submitted work.

The Benefits of Accreditation for Healthcare Quality

Background: Accreditation is widely regarded as a reliable method for assessing and improving the quality of medical care provided. However, the effect that it has on performance and outcomes is not yet fully understood. The purpose of this review was to locate and assess the available evidence regarding the effects of hospital accreditation. Methods: We conducted in-depth searches of a variety of electronic databases, including PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, and SciELO, as well as other sources, using subject headings that were pertinent to our inquiry. No matter how the studies were designed or written, we included all quantitative research that had been reviewed by experts and published in the past twenty years. In accordance with the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, two reviewers independently screened the initially identified articles, read the full texts of potentially relevant studies, extracted the necessary data, and evaluated the methodological quality of the studies that were included in the analysis using a validated tool. The results of the accreditation effects were analyzed, and six distinct impact themes were identified and categorized as a result. Results: After reviewing a total of 17,830 studies, we decided to include only 76 of the empirical studies that investigated the effects of accreditation because they satisfied our criteria. Different research approaches were taken in each of these studies. Our findings indicate that hospital accreditation has a consistent and positive effect on safety culture, process-related performance measures, efficiency, and the length of stay for patients. On the other hand, employee satisfaction, patient satisfaction and experience, and the 30-day hospital readmission rate were found to be unrelated to accreditation. Because of the contradictory findings regarding the impact of accreditation on the mortality rate and infections associated with healthcare, it was difficult to reach definitive conclusions regarding these outcome measures. Conclusion: Compliance with accreditation standards is posited to have multiple plausible benefits, one of which is an improvement in a hospital's overall performance, and there is some evidence to support the notion that this proposition. The introduction of hospital accreditation schemes encourages performance improvement and patient safety, despite the lack of evidence supporting a definitive link between the two. It is recommended that efforts be made to modernize accreditation and provide incentives for getting it in order to move toward institutionalization and maintain performance gains.

605. NEOADJUVANT FLOT FOR LOCALLY ADVANCED ESOPHAGEAL CANCERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Whilst multimodality treatment is established as standard of care for locally advanced esophageal cancers the precise choice of oncological neoadjuvant treatment remains unclear. Uptake of FLOT is increasing, yet collective experience in patients with esophageal cancer is unclear. This study aimed to assess the effectiveness of FLOT as first-line treatment in this patient population. A systematic review was performed using Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed Publisher, Cochrane, and Google Scholar until 28st December 2021, for studies of treatment-naive patients of any age who received FLOT as first-line treatment of locally advanced esophageal or gastric cancer. The primary outcome was overall survival. Secondary outcomes were progression-free survival, rates of grade 3 or 4 adverse events; and oncological outcomes This systematic review included six studies comprising 895 patients, of which 479 (54%) patients received FLOT. All studies included patients with distal or gastroesophageal junction esophageal and 441 (92%) had esophageal adenocarcinoma. Pooled overall survival at 1-year, 2-year and 3-year were 81.7% (CI95%: 71.1% - 88.9%), 59.2% (CI95%: 47.4% - 69.9%), and 49.8% (CI95%: 28.9 - 70.8%). Pooled recurrence rates from three studies were 22.6% (CI95%: 12.3% - 37.7%). Oncological outcomes were reported for margin-negative resections (overall: 94.1%, CI95%: 88.1% - 97.2%), complete pCR (overall: 15.2%, CI95%: 7.1% - 29.7%), major pathological response (overall: 41.6%, CI95%: 24.6% - 60.8%). There is limited evidence on FLOT for patients with esophageal or gastroesophageal cancers, despite the increasing use of FLOT in clinical practice. Standardisation in reporting oncological and surgical outcomes following FLOT are needed and future research and randomised controlled trials comparing FLOT are required.