Previous Systematic Reviews Research Articles

Acute Lower Extremity Fracture Management in Chronic Spinal Cord Injury: 2022 Delphi Consensus Recommendations.

Information from a previous systematic review that addressed lower extremity fracture care in persons with an SCI as well as information from interviews of physical and occupational therapists, searches of the literature, and expert opinion were used to develop this CPG. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to determine the quality of evidence and the strength of the recommendations. An overall GRADE quality rating was applied to the evidence. Individuals with a chronic SCI who sustain an acute lower extremity fracture should be provided with education regarding the risks and benefits of operative and nonoperative management, and shared decision-making for acute fracture management should be used. Nonoperative management historically has been the default preference; however, with the advent of greater patient independence, improved surgical techniques, and advanced therapeutics and rehabilitation, increased use of surgical management should be considered. Physical therapists, kinesiotherapists, and/or occupational therapists should assess equipment needs, skills training, and caregiver assistance due to changes in mobility resulting from a lower extremity fracture. Therapists should be involved in fracture management as soon as possible following fracture identification. Pressure injuries, compartment syndrome, heterotopic ossification, nonunion, malunion, thromboembolism, pain, and autonomic dysreflexia are fracture-related complications that clinicians caring for patients who have an SCI and a lower extremity fracture may encounter. Strategies for their treatment are discussed. The underlying goal is to return the patient as closely as possible to their pre-fracture functional level with operative or nonoperative management.

POSC382 Patient Relevant Criteria of Person-Centered Care for Community-Dwelling People with Dementia: A Formative Qualitative Study to Design a Quantitative Preference Study

For people living with Dementia (PwD), Person-Centered Care (PCC) is emphasized. PCC requires knowledge about patient preferences. This formative qualitative study aimed to identify patient-relevant criteria and sub-criteria of PCC for PwD, to design a quantitative preference study. After an initial focus group interview with n=2 Dementia Care Managers to ensure comprehensibility, we conducted individual interviews with n=10 PwD and n=3 informal caregivers (CGs). The interviews followed a semi-structured interview guide including a card game. The cards showed 12 criteria and 12x3 sub-criteria of PCC identified by a previous systematic review. Criteria-cards were shown to the PwD to explore their conception of the 12 criteria of PCC. Subsequently, PwD had to sort and rank the cards to identify the most important criteria of PCC. Interviews were recorded and transcribed verbatim. Two reviewers coded and analyzed the transcripts with qualitative content analysis. Ranking results from the individual card games were coded on a 10-point scale, whereupon sums and means for criteria across interviews were calculated. Analyses were discussed in a final meeting with the research team until consensus. Six patient-relevant criteria with each two sub-criteria of PCC for PwD emerged from the participant’s elaborations and card games; social relationships (indirect contact, direct contact), cognitive training (passive, active), organization of care (decentralized structures & no shared decision-making, centralized structures & shared decision-making), assistance with daily activities (professional, family member), characteristics of professional CG (empathy, education & work experience) and physical activities (alone, group). Our study provides evidence about patient-relevant criteria and sub-criteria of PCC for PwD to design a quantitative preference study. PwD had preferences for PCC and could express them. Future research should pay particular attention to dementia-sensitive wording and the balance between comprehensibility vs. realizability, completeness, independence and relevance of the criteria and sub-criteria in this population.

Return to Driving after Elective Foot & Ankle Surgery: A Systematic Review

Category:Ankle; Arthroscopy; Midfoot/Forefoot; OtherIntroduction/Purpose:Studies investigating when patients can safely return to driving are becomingly increasingly numerous in the orthopedic literature because of the recognition of the importance of the activity to the lives of most adults. Previous systematic reviews have proven helpful by collecting and summarizing these studies to establish concise guidelines that can be presented to patients during the counseling surrounding a procedure. Having these guidelines can be even more crucial when discussing elective procedures. This systematic review summarizes the available studies investigating when it is safe to return to driving following elective foot and ankle procedures.Methods:A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language studies from 1999 to present that investigate return to driving after right-sided elective foot and ankle procedures. Qualitative assessment of each of the included studies was performed independently by two authors. Then data from each study was extracted and broken down into distinct categories for comparison: study details, population, control group, method of evaluation, and results.Results:Eight studies met inclusion criteria. All of the studies investigate brake reaction time (BRT), via a driving simulator, as their primary outcome. A variety of objective and subjective secondary outcomes were collected. Patients undergoing right ankle or subtalar arthroscopic procedures have no significant difference in BRT compared to controls at 2 weeks post-operatively. 92% of patients undergoing right ankle arthroplasty had a BRT that was not significantly different to the control group at 6 weeks post- operatively. Patients who had an ankle arthrodesis had significantly delayed BRT compared to controls even past 1-year post- operatively. The majority of patients after corrective hallux valgus surgery have no significant difference in BRT at 6 weeks post- operatively compared to their pre-operative baselines depending upon how they are doing clinically. The included studies used a variety of patient reported outcomes that were helpful in predicting which patients would fail the driving simulation at the various timepoints.Conclusion:The recommendations from these reviewed studies can guide physicians when counseling their patients on when they can expect to safely return to driving after a specific, elective foot and ankle procedure. However, these recommendations are reliant on routine healing post-operatively and may need to be adjusted if a patient is experiencing any complications. A variety of patient surveys and other subjective scores can be very helpful in assuring a routine post-operative course.

Update on the limited sensitivity of computed tomography relative to RT-PCR for COVID-19: a systematic review.

PurposeThe global and ongoing COVID-19 outbreak has compelled the need for timely and reliable methods of detection for SARS-CoV-2 infection. Although reverse transcription-polymerase chain reaction (RT-PCR) has been widely accepted as a reference standard for COVID-19 diagnosis, several early studies have suggested the superior sensitivity of computed tomography (CT) in identifying SARS-CoV-2 infection. In a previous systematic review, we stratified studies based on risk for bias to evaluate the true sensitivity of CT for detecting SARS-CoV-2 infection. This study revisits our prior analysis, incorporating more current data to assess the sensitivity of CT for COVID-19.Material and methodsThe PubMed and Google Scholar databases were searched for relevant articles published between 1 January 2020, and 25 April 2021. Exclusion criteria included lack of specification regarding whether the study cohort was adult or paediatric, whether patients were symptomatic or asymptomatic, and not identifying the source of RT-PCR specimens. Ultimately, 62 studies were included for systematic review and were subsequently stratified by risk for bias using the QUADAS-2 quality assessment tool. Sensitivity data were extracted for random effects meta-analyses.ResultsThe average sensitivity for COVID-19 reported by the high-risk-of-bias studies was 68% [CI: 58, 80; range: 38-96%] for RT-PCR and 91% [CI: 87, 96; range: 47-100%] for CT. The average sensitivity reported by the low-risk-of-bias studies was 84% [CI: 0.75, 0.94; range: 70-97%] for RT-PCR and 78% [CI: 71, 0.86; range: 44-92%] for CT.ConclusionsOn average, the high-risk-of bias studies underestimated the sensitivity of RT-PCR and overestimated the sensitivity of CT for COVID-19. Given the incorporation of recently published low-risk-of-bias articles, the sensitivities according to low-risk-of-bias studies for both RT-PCR and CT were higher than previously reported.

What treatments work for anxiety and depression in children and adolescents with chronic fatigue syndrome? An updated systematic review

ObjectivesChildren with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective...

A Narrative Review of Current Concerns and Future Perspectives of the Carbohydrate Mouth Rinse Effects on Exercise Performance.

Previous systematic reviews have confirmed that carbohydrate (CHO) mouth rinse may boost physical exercise performance, despite some methodological aspects likely affecting its ergogenic effect. In this review, we discussed if the exercise mode, pre-exercise fasting status, CHO solutions concentration, CHO solutions temperature, mouth rinse duration, and CHO placebo effects may potentially reduce the CHO mouth rinse ergogenic effect, suggesting possible solutions to manage these potential confounders. The effectiveness of CHO mouth rinse as a performance booster is apparently related to the origin of the exercise-induced neuromuscular fatigue, as CHO mouth rinse unequivocally potentiates endurance rather than sprint and strength exercises performance. Furthermore, ergogenic effects have been greater in fasting than fed state, somehow explaining the varied magnitude of the CHO mouth rinse effects in exercise performance. In this regard, the CHO solution concentration and temperature, as well as the mouth rinse duration, may have increased the variability observed in CHO mouth rinse effects in fasting and fed state. Finally, placebo effects have challenged the potential of the CHO mouth rinse as an ergogenic aid. Therefore, we suggest that future studies should consider methodological controls such as sample size and sample homogeneity, proper familiarization with experimental procedures, and the use of alternative placebo designs to provide unbiased evidence regarding the potential of the CHO mouth rinse as an ergogenic aid.

Systematic Mapping: Artificial Intelligence Techniques in Software Engineering

Artificial Intelligence (AI) has become a core feature of today’s real-world applications, making it a trending topic within the software engineering (SE) community. The rise in the availability of AI techniques encompasses the capability to make rapid, automated, impactful decisions and predictions, leading to the adoption of AI techniques in SE. With industry revolution 4.0, the role of software engineering has become critical for developing productive, efficient, and quality software. Thus, there is a major need for AI techniques to be applied to enhance and improve the critical activities within the software engineering phases. Software is developed through intelligent software engineering phases. This paper concerns a systematic mapping study that aimed to characterize the publication landscape of AI techniques in software engineering. Gaps are identified and discussed by mapping these AI techniques against the SE phases to which they contributed. Many systematic mapping review papers have been produced only for a specific AI technique or a specific SE phase or activity. Hence, no previous systematic mapping review has explored the overall trends in AI techniques and their application to all SE phases.

Motor vehicle collision-related injuries and deaths among Indigenous Peoples in Canada: Meta-analysis of geo-structural factors.

Indigenous Peoples are much more likely than non-Indigenous Peoples to be seriously injured or die in motor vehicle collisions (MVCs). This study updates and extends a previous systematic review, suggesting that future research ought to incorporate social-environmental factors. We conducted a systematic review and meta-analysis of the published and grey literature on MVCs involving Indigenous Peoples in Canada between 2010 and 2020. We focussed on personal (e.g. driving an old vehicle) and community social-environmental-economic factors (e.g. prevalent low socioeconomic status). Eleven comparative cohorts that resulted in 23 at minimum, age-standardised, mortality or morbidity rate outcomes were included in our meta-analysis. Indigenous Peoples were twice as likely as non-Indigenous Peoples to be seriously injured (rate ratio [RRpooled] = 2.18) and more than 3 times as likely to die (RRpooled = 3.40) in MVCs. Such great risks to Indigenous Peoples do not seem to have diminished over the past generation. Furthermore, such risks were greater on-reserves and in smaller, rural and remote, places. Such places may lack community resources, including fewer transportation and healthcare infrastructural investments, resulting in poorer road conditions in Indigenous communities and longer delays to trauma care. This seems to add further evidence of geo-structural violence (geographical and institutional violence) perpetrated against Indigenous Peoples in yet more structures (i.e. institutions) of Canadian society. Canada's system of highways and roadways and its remote health-care system represent legitimate policy targets in aiming to solve this public health problem.

The Effectiveness and Harms of Screening for Chronic Obstructive Pulmonary Disease: An Updated Systematic Review and Meta-Analysis.

BackgroundThis study aimed to perform meta-analyses to update a previous systematic review (SR) conducted by the US Preventive Services Task Force (USPSTF) to evaluate the benefits and harms of screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults.MethodsMEDLINE, EMBASE, Cochrane Library, and regional databases were searched from their inception to January 2020. Studies for diagnostic accuracy, preventive services effect, treatment efficacy, and treatment harms were included.ResultsEighteen studies were included, and twelve of these were newly added in this update. In meta-analyses, the pooled sensitivity and specificity for COPD diagnosis using spirometry were 73.4% and 89.0%, respectively. The relative effect of smoking cessation intervention with screening spirometry, presented as abstinence rate, was not statistically significant (risk ratio [RR], 1.21; 95% confidence interval [CI], 0.87–1.67) when all selected studies were pooled, but screening on smoking cessation was effective (RR, 1.58; 95% CI, 1.14–2.19) when limited to studies with smoking cessation programs that provided smoking cessation medicines or intensive counseling at public health centers or medical institutions.ConclusionIn this study, no direct evidence for the impact on health outcomes of screening asymptomatic adults for COPD was identified similar to the previous SR. Further research is necessary to confirm the benefits of COPD screening.

Labor Analgesia: A Systematic Review and Meta-Analysis of Non-Pharmacological Complementary and Alternative Approaches to Pain during First Stage of Labor

the aim of the study was to conduct a meta-analysis to evaluate the efficacy of non-invasive and non-pharmacological techniques on labor first-stage pain intensity. Literature databases were searched from inception to May 2021, and research was expanded through the screening of previous systematic reviews. Inclusion criteria were: (1) population: women in first stage of labor; (2) intervention: non-pharmacological, non-invasive, or minimally invasive intrapartum analgesic techniques alternative and/or complementary to pharmacological analgesia; (3) comparison: routine intrapartum care or placebos; (4) outcomes: subjective pain intensity; and (5) study design: randomized controlled trial. Risk of bias of included studies was investigated, data analysis was performed using R version 3.5.1. Effect size was calculated as difference between the control and experimental groups at posttreatment in terms of mean pain score. A total of 63 studies were included, for a total of 6146 patients (3468 in the experimental groups and 2678 in the control groups). Techniques included were massage (n = 11), birth balls (n = 5) mind-body interventions (n = 8), heat application (n = 12), music therapy (n = 9), dance therapy (n = 2), acupressure (n = 16), and transcutaneous electrical nerve stimulation (TENS) (n = 8). The present review found significant evidence in support of the use of complementary and alternative medicine for labor analgesia, and different methods showed different impact. However, more high-quality trials are needed.

A Meta-Analysis of the Current State of Evidence of the Incredible Years Teacher-Classroom Management Program.

This meta-analysis evaluated the current state of evidence and identified potential treatment moderators of the Incredible Years Teacher Classroom Management (IYTCM) program used to reduce externalizing and internalizing behaviors in school-aged children. Inclusion criteria involved published studies between 1984–2018 and examining the effects of IYTCM as a standalone program on teacher and/or child behavioral outcomes. We identified and narratively summarized potential moderators, which included the severity of child behavior, dosage, study design, and reporting methods. Overall, effect sizes revealed IYTCM had moderate positive effects on teachers and small positive effects on children. Narrative summaries indicated larger effect sizes in higher dosage studies and higher risk children. The results align with previous systematic reviews on the Incredible Years Parent Training (IYPT) program but this is the first study to look at the teacher training program. Overall, IYTCM seems to be an effective intervention; however, what components of this program work best, for whom, and under what conditions require further empirical investigation.

Intrinsic Kidney Pathology Following COVID-19 Infection in Children and Adolescents: A Systematic Review.

Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently been reported in adults since the onset of the global COVID-19 pandemic in December 2019. Gradually, there have been an increased number of COVID-19-associated intrinsic kidney pathologies in children and adolescents reported as well. The pathophysiological mechanisms between COVID-19 and the onset of kidney pathology are not fully known in children; it remains a challenge to distinguish between intrinsic kidney pathologies that were caused directly by COVID-19 viral invasion, and cases which occurred as a result of multisystem inflammatory syndrome due to the infection. This challenge is made more difficult in children, due to the ethical limitations of performing kidney biopsies to reach a biopsy-proven diagnosis. Although previous systematic reviews have summarized the various pathological kidney manifestations that have occurred in adults following acute COVID-19 infection, such reviews have not yet been published for children and adolescents. We describe the results of a systematic review for intrinsic kidney pathology following COVID-19 infection in children and adolescents. Methods: A systematic literature search of published data up until 31 October was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Research articles reporting new-onset or relapsed intrinsic kidney pathology in children or adolescents (≤18 years) following acute COVID-19 infection were included for qualitative review. COVID-19 infection status was defined by a positive result from a RT-PCR, or nuclear antibody testing. Only full-text articles published in the English language were selected for review. Results: Twenty-nine cases from fifteen articles were included in the qualitative synthesis of this systematic review. Nephrotic syndrome, as an umbrella condition, appeared as the most frequently observed presentation (20 cases) with disease remission noted in all cases with steroid treatment. Other cases included numerous glomerulonephritides, such as acute necrotizing glomerulonephritis, MPO vasculitis and collapsing glomerulopathy, and thrombotic microangiopathies, such as aHUS. For patients with transplanted kidneys, T-cell-mediated rejection and mild tubular interstitial infiltration were noted following testing positive for COVID-19. There were no mortalities reported in any of the included cases, although two patients remained dialysis dependent at hospital discharge. Conclusion: This systematic review highlights the various intrinsic pathological kidney manifestations in children and adolescents as a result of acute COVID-19 infection. The clinical timeline and presentation of these cases support the mechanistic hypothesis between COVID-19 infection and the onset of intrinsic kidney pathologies within this context. The progressive introduction of vaccination programs for children and adolescents may hopefully reduce the severity of COVID-19-associated illnesses, and pathological kidney manifestations in this population.

Compassion and complex interpersonal trauma in adolescence: An early systematic review.

Whilst childhood trauma has been identified as a transdiagnostic risk factor for poly-psychopathology, compassion-focused interventions have emerged as transdiagnostic treatment modality. However, no previous systematic review has specifically explored the relationship between complex interpersonal trauma and compassion in adolescence. The aim of this early systematic review was to evaluate the existing evidence on the role of compassion in adolescents with complex interpersonal trauma. A systematic search of electronic databases was undertaken to identify cross-sectional and intervention studies that examined the role of compassion in the amelioration of psychopathology in adolescence. Nine studies, including three intervention studies and six cross-sectional studies, met the inclusion criteria. The findings suggested a mediating role of compassion in trauma-specific and overall psychopathology. Despite the dearth of research, this review suggests that integrating compassion might mediate the relationship between complex trauma and psychopathology in adolescents.

Association of Antenatal Diet and Physical Activity–Based Interventions With Gestational Weight Gain and Pregnancy Outcomes

Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes. A 2-stage systematic literature search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. Randomized trials reporting GWG and maternal and neonatal outcomes. Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. Outcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death. A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (-1.15 kg; 95% CI, -1.40 to -0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (-2.63 kg; 95% CI, -3.87 to -1.40) than physical activity (-1.04 kg; 95% CI, -1.33 to -0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (-0.74 kg; 95% CI, -1.06 to -0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (-1.35 kg; 95% CI, -1.95 to -0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG only. This systematic review and meta-analysis found level 1 evidence that antenatal structured diet and physical activity-based lifestyle interventions were associated with reduced GWG and lower risk of adverse maternal and neonatal outcomes. The findings support the implementation of such interventions in routine antenatal care and policy around the world.

O-BN02 Laparoscopic subtotal cholecystectomy for difficult gallbladders: A lifesaving bailout or an incomplete operation? A systematic review

BackgroundCholecystectomy is one of the commonest abdominal operations performed worldwide. Sometimes, the operation can be technically difficult due to dense adhesions in Calot’s triangle. Conversion to open surgery or subtotal cholecystectomy have been described to deal with these situations. A recent systematic review and meta-analysis on STC suggested high perioperative morbidity associated with STC. These findings are at odds with a previous systematic review and meta-analysis on the topic which concluded that morbidity rates for STC were comparable to those reported for total cholecystectomy. However, both these reviews included patients undergoing Open Subtotal Cholecystectomy (OSTC). This makes it difficult for us to understand the outcomes of LSTC as surgeons are not faced with the choice of converting to open surgery to perform a subtotal cholecystectomy. The choice they face is whether they should perform a LSTC or convert to open surgery to perform a total cholecystectomy. It is, therefore, important to establish the outcomes of LSTC alone (without including patients who underwent OSTC). This is all the more important during COVID-19 pandemic when the complexity of gall stone disease appears to have worsened. There is thus an enhanced need to understand technical nuances and outcomes of LSTC alone.MethodsSearch strategy: We searched PUBMED (Medline), Google Scholar, and Embase for all relevant English language articles describing experience with LSTC in adult human population (≥18 years) anywhere in the world using key-words like “subtotal cholecystectomy”, “gallbladder resection”, “gallbladder excision”, “gallbladder removal”, “partial”, “incomplete”, “insufficient”, “deroofing”, and “near-total”. Case reports, articles only published as conference abstracts, case series with <5 cases, and reviews were excluded. Only English-language studies were included.Participants: All studies with 5 or more cases, describing any experience with an adult cohort (≥18 years) of patients undergoing STC while attempting a Laparoscopic Cholecystectomy were included. Studies on patients who underwent preoperative cholecystostomy were excluded. Studies that had LSTC as part of another surgery were also excluded as we wanted to understand the morbidity and mortality of LSTC alone. Studies on patients who underwent OSTC (Open from start) were excluded as were those where the LSTC cohort was merged with the OSTC cohort and outcomes of LSTC were not separately reported. Study outcome: Primary outcome measure was early (≤30 days) morbidity and mortality. Secondary outcome measures were bile duct injury, bile leak rates, conversion to open surgery rates, duration of hospital stay, and late (>30 days) morbidity.Results45 studies were identified, with a total of 2166 patients. Mean age was 55 +/- 15 years with 51% females; 53% (n = 390) were elective procedures. The conversion rate was 6.2% (n = 135). Most common indication was acute cholecystitis (n = 763). Different techniques were used with the majority having a closed cystic duct/gallbladder stump (n = 1188, 71%). The most common closure technique was intracorporeal suturing (53%) followed by endoloop closure. There were a total of four, 30-day mortality [1] in this review. Early morbidity (≤30 days) included bile duct injury (0.23%), bile leak rates (18%), intra-abdominal collection (4%). Reoperation was reported in 23 patients (1%), most commonly for unresolving intra-abdominal collections and failed ERCP to control bile leak. Long term follow-up was reported in 30 studies with a median follow up period of 22 months. Late morbidity included incisional hernias (6%), CBD stones (2%), and symptomatic gallstones in 4% (n = 41) with 2% (n = 22) requiring completion of cholecystectomy.ConclusionsLaparoscopic subtotal cholecystectomy is an acceptable alternative in patients with a “difficult” Calot’s triangle. However, this has to be taken seriously as it is associated with a high early and late morbidity and mortality.

Effect of Postoperative Coffee Consumption on Postoperative Ileus after Abdominal Surgery: An Updated Systematic Review and Meta-Analysis.

Background: Previous systematic reviews have not clarified the effect of postoperative coffee consumption on the incidence of postoperative ileus (POI) and the length of hospital stay (LOS). We aimed to assess its effect on these postoperative outcomes. Methods: Studies evaluating postoperative coffee consumption were searched using electronic databases until September 2021 to perform random-effect meta-analysis. The quality of evidence was assessed using the Cochrane risk-of-bias tool. Caffeinated and decaffeinated coffee were also compared. Results: Thirteen trials (1246 patients) and nine ongoing trials were included. Of the 13 trials, 6 were on colorectal surgery, 5 on caesarean section, and 2 on gynecological surgery. Coffee reduced the time to first defecation (mean difference (MD) −10.1 min; 95% confidence interval (CI) = −14.5 to −5.6), POI (risk ratio 0.42; 95% CI = 0.26 to 0.69); and LOS (MD −1.5; 95% CI = −2.7 to −0.3). This trend was similar in colorectal and gynecological surgeries. Coffee had no adverse effects. There was no difference in POI or LOS between caffeinated and decaffeinated coffee (p > 0.05). The certainty of evidence was low to moderate. Conclusion: This review showed that postoperative coffee consumption, regardless of caffeine content, likely reduces POI and LOS after colorectal and gynecological surgery.

Reliability, and Convergent and Discriminant Validity of Gaming Disorder Scales: A Meta-Analysis.

Background: An association between gaming disorder (GD) and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs.Methods: Five representative GD instruments (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and IGDS9-SF) were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized.Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 (95% CI = 0.85–0.87) and a mean test-retest estimate of 0.86 (95% CI = 0.81–0.89). Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression (k = 45; number of effect sizes), 0.29 with anxiety (k = 37), 0.30 with aggression (k = 19), –0.22 with quality of life (k = 18), 0.29 with loneliness (k = 18), 0.56 with internet addiction (k = 20), and 0.40 with game playtime (k = 53), respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented.Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies.Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781].

Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis.

BackgroundThe burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa.MethodsWe searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I2 statistic.FindingsIn the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines.InterpretationCompared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity.FundingThis research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.

Alteration of Platelet Count in Patients with Severe Non-Plasmodium falciparum Malaria: A Systematic Review and Meta-Analysis.

Simple SummaryAlteration of platelet count is frequently seen in patients with malaria. However, the platelet biology under severe pathological conditions like severe malaria remains unclear. The present systematic review collated literatures and synthesized the evidence regarding the risks of severe and profound thrombocytopenia in patients with severe non-Plasmodium falciparum malaria. We found that the high prevalence of severe and profound thrombocytopenia in patients with severe non-P. falciparum malaria at 47% and 20%, respectively. Moreover, deaths were seen in patients with severe and profound thrombocytopenia at 11%. Therefore, the present systematic review provided the new insight into the clinical relevance of severe and profound thrombocytopenia in diagnosing and managing non-P. falciparum malaria. Severe thrombocytopenia should serve as a warning sign of increased chances of complications. Meanwhile, profound thrombocytopenia should serve as a marker of mortality among patients with non-P. falciparum malaria.The understanding of platelet biology under physiological and pathological conditions like malaria infection is critical importance in the context of the disease outcome or model systems used. The importance of severe thrombocytopenia (platelet count < 50,000 cells (µL) and profound thrombocytopenia (platelet count < 20,000 cells/µL) in malaria patients remains unclear. This study aimed to synthesize evidence regarding the risks of severe and profound thrombocytopenia in patients with severe non-Plasmodium falciparum malaria. Our overall aim was to identify potential indicators of severe non-P. falciparum malaria and the Plasmodium species that cause severe outcomes. This systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under registration ID CRD42020196541. Studies were identified from previous systematic reviews (n = 5) and the MEDLINE, Scopus, and Web of Science databases from 9 June 2019 to 9 June 2020. Studies were included if they reported the outcome of severe non-Plasmodium species infection, as defined by the World Health Organization (WHO) criteria, in patients with known platelet counts and/or severe and profound thrombocytopenia. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Data were pooled, and pooled prevalence (PP) and pooled odds ratios (ORs) were calculated using random effects models. Of the 118 studies identified from previous meta-nalyses, 21 met the inclusion criteria. Of the 4807 studies identified from the databases, three met the inclusion criteria. Nine studies identified from reference lists and other sources also met the inclusion criteria. The results of 33 studies reporting the outcomes of patients with severe P. vivax and P. knowlesi infection were pooled for meta-analysis. The PP of severe thrombocytopenia (reported in 21 studies) was estimated at 47% (95% confidence interval (CI): 33–61%, I2: 96.5%), while that of profound thrombocytopenia (reported in 13 studies) was estimated at 20% (95% CI: 14–27%, 85.2%). The pooled weighted mean difference (WMD) in platelet counts between severe uncomplicated Plasmodium infections (reported in 11 studies) was estimated at −28.51% (95% CI: −40.35–61%, I2: 97.7%), while the pooled WMD in platelet counts between severe non-Plasmodium and severe P. falciparum infections (reported in eight studies) was estimated at −3.83% (95% CI: −13.90–6.25%, I2: 85.2%). The pooled OR for severe/profound thrombocytopenia comparing severe to uncomplicated Plasmodium infection was 2.92 (95% CI: 2.24–3.81, I2: 39.9%). The PP of death from severe and profound thrombocytopenia was estimated at 11% (95% CI: 0–22%). These results suggest that individuals with severe non-P. falciparum infection (particularly P. vivax and P. knowlesi) who exhibit severe or profound thrombocytopenia should be regarded as high risk, and should be treated for severe malaria according to current WHO guidelines. In addition, severe or profound thrombocytopenia coupled with other clinical and microscopic parameters can significantly improve malaria diagnosis, enhance the timely treatment of malaria infections, and reduce the morbidity and mortality of severe non-P. falciparum malaria.

1190. Burden of Congenital Cytomegalovirus Among Newborns/Infants &amp;lt; 2 Years of Age From 2010 to 2020

Abstract Background Congenital cytomegalovirus (cCMV) is a leading cause of preventable congenital birth defects worldwide. In the United States, approximately 1 in 200 infants are born with cCMV and about 10% exhibit symptoms at birth; of those, 40-60% experience long-term sequelae including sensorineural hearing loss and developmental delays. As routine newborn surveillance is universally absent, it is difficult to assess the absolute burden of cCMV and demonstrate the need for CMV treatment and prevention. Here we describe the global epidemiologic burden of cCMV from 2010-2020 by performing a systematic review of the literature. Methods Publications from 2000-2020 on CMV-related epidemiologic, economic, and humanistic burden across all ages were identified using Medline, Embase, and LILACS. Epidemiologic burden estimates of cCMV in at-risk age groups (newborns [≤ 1 month] and infants [2 months to 2 years]) were extracted from recent studies published from 2010-2020, excluding previous systematic literature reviews, chart reviews, case series, gray literature, and studies in immunosuppressed populations. The primary outcome measure was seroprevalence, defined by CMV-specific immunoglobulin G titer or confirmed by CMV polymerase chain reaction in saliva or urinary samples. Results Of 8970 records on CMV epidemiologic burden across all ages, 3600 were screened (Fig. 1). Records were excluded based on study population, outcome, design, or other reason, yielding 157 articles; 24 reported cCMV infection in newborns/infants in 13 countries (Fig. 2). cCMV seroprevalence estimates differed based on type of screening (Fig. 3). cCMV seroprevalence ranged from 0.28-67.2% among publications reporting on universal screening (n=6), 0.6-29.2% among publications reporting on targeted screening (n=17) based on hearing loss, low birth weight, or small for gestational age, and 36.0% in one publication reporting on prenatal screening. Figure 1. Study selection for epidemiological burden cCMV, congenital cytomegalovirus Figure 2. Global map of the location and number of included studies Figure 3. cCMV seroprevalence and 95% confidence interval* by universal, targeted, and prenatal screening methods *Confidence intervals shown when available. cCMV, congenital cytomegalovirus Conclusion There is a worldwide lack of cCMV epidemiologic data with heterogeneity in seroprevalence, influenced by inconsistent and varied screening efforts. Implementation of consistent screening methods is essential to accurately describe the burden of cCMV, justify future vaccine (or other prevention or treatment) introduction, and measure impact. Disclosures Jacek Mucha, MS, Certara (Employee) Neumann Monika, Information Specialist, Certara (Employee) Witold Lewandowski, MD, BA, Certara (Other Financial or Material Support, Former employee during abstract development)Tata Consultancy Services (Employee) Magdalena Kaczanowska, MPH, Certara (Employee) Elvira Schmidt, MSc, Certara (Employee) Andrew Natenshon, MA, Moderna, Inc. (Employee) Carla Talarico, MPH, PhD, Moderna, Inc. (Employee) Philip Buck, MPH, PhD, Moderna, Inc. (Employee) John D. Diaz-Decaro, MS, PhD, Moderna, Inc. (Employee)