MEDLINE Search Strategy Research Articles

Evidence of detrimental effects of prenatal alcohol exposure on offspring birthweight and neurodevelopment from a systematic review of quasi-experimental studies.

BackgroundSystematic reviews of prenatal alcohol exposure effects generally only include conventional observational studies. However, estimates from such studies are prone to confounding and other biases.ObjectivesTo systematically review the evidence on the effects of prenatal alcohol exposure from randomized controlled trials (RCTs) and observational designs using alternative analytical approaches to improve causal inference.Search strategyMedline, Embase, Web of Science, PsychINFO from inception to 21 June 2018. Manual searches of reference lists of retrieved papers.Selection criteriaRCTs of interventions to stop/reduce drinking in pregnancy and observational studies using alternative analytical methods (quasi-experimental studies e.g. Mendelian randomization and natural experiments, negative control comparisons) to determine the causal effects of prenatal alcohol exposure on pregnancy and longer-term offspring outcomes in human studies.Data collection and analysisOne reviewer extracted data and another checked extracted data. Risk of bias was assessed using customized risk of bias tools. A narrative synthesis of findings was carried out and a meta-analysis for one outcome.Main resultsTwenty-three studies were included, representing five types of study design, including 1 RCT, 9 Mendelian randomization and 7 natural experiment studies, and reporting on over 30 outcomes. One study design–outcome combination included enough independent results to meta-analyse. Based on evidence from several studies, we found a likely causal detrimental role of prenatal alcohol exposure on cognitive outcomes, and weaker evidence for a role in low birthweight.ConclusionNone of the included studies was judged to be at low risk of bias in all domains, results should therefore be interpreted with caution.Systematic review registrationThis study is registered with PROSPERO, registration number CRD42015015941

Implementation and Usefulness of Telemedicine During the COVID-19 Pandemic: A Scoping Review.

Objectives:Identify and summarize the available literature on the acceleration in the use of telemedicine in the midst of the COVID-19 pandemic, with an aim to provide justification and guidance for its implementation to overcome the limitations associated with the pandemic worldwide.Methods:We conducted a scoping review through different search strategies in MEDLINE and Google Scholar to identify the available literature reporting data on implementation and usefulness of various modalities of telemedicine during the current pandemic. We summarized the included studies according to field and mode of implementation in a narrative way.Results:We included 45 studies that fulfilled selection criteria. About 38% of the studies were conducted in the United States of America (USA), followed by 15.5% in India and 15.5% in China. Most studies (73%) were cross-sectional studies based on historical records. All publications were written in English with the exception of 1 studied published in Spanish. The majority of reports focused on use of telemedicine for outpatient care, followed by in-hospital care.Conclusion:The COVID-19 pandemic has promoted the use of telemedicine, a tool that has transformed the provision of medical services. Several modes of implementation are useful to overcome difficulties for patient care during the pandemic. Its benefits are specific to different fields of medical practice. Such benefits, along with the guidance and reported experiences should invite health systems to work for an effective and comprehensive implementation of telemedicine in various fields.

Rehabilitation in Parkinson’s disease: Current status and future directions

Parkinson’s disease is a common progressive neurodegenerative disease. Apart from pharmacological treatment, nonpharmacological management in the form of rehabilitation, counselling, and supportive care is an equally important therapeutic pillar. A MEDLINE search strategy using the following terms (1998–2019) was adopted for this review. Limits of “Human” and “English” were applied. Search terms included “Parkinson’s Disease” AND “rehabilitation,” “physical therapy,” “exercise therapy,” “physiotherapy,” and “dance.” Review articles, practice parameters, guidelines, systematic reviews, meta-analyses, randomized controlled trials, and cohort studies were included. Rehabilitation strategies in the management of Parkinson’s disease form a vital component of therapy. There is mounting evidence to support physical therapy in these patients. Rehabilitation should be offered to these patients right from the start to encourage an active lifestyle and to improve quality of life.

Effectiveness of non-pharmacological strategies in the management of type 2 diabetes in primary care: a protocol for a systematic review and network meta-analysis

IntroductionDespite the increasing number of drugs and various guidelines on the management of type 2 diabetes mellitus (T2DM), several patients continue with the disease uncontrolled. There are several non-pharmacological treatments...

Disaster management in rural and remote primary healthcare settings: a scoping review protocol.

This scoping review aims to systematically identify and map the roles of primary healthcare professionals in rural and remote areas during natural, man-made and pandemic disasters. Disasters can be caused by natural events, man-made incidents or infective agents resulting in a pandemic. Healthcare practitioners working in primary care settings have important roles during disaster prevention, preparedness, response and recovery. When rural and remote settings are affected by disasters, there are unique challenges for healthcare professionals. This review will aim to contribute to disaster management knowledge within rural and remote primary health care, and assist in the development of practice-based disaster preparedness and future policy discussion. This review will consider studies that include primary healthcare professionals, defined as having first-level contact with patients in the community, in rural or remote areas only. The role of the healthcare professional will also be discussed within the paper. Research from Australia, Canada, the USA, New Zealand and the UK will be included. Databases to be searched include CINAHL (EBSCOhost), PubMed, Scopus and Embase (Elsevier), as well as gray literature within Trove, MedNar and OpenGrey. The search will be limited to articles written in English and published from 1978 to the present. Titles and abstracts will be screened by two independent reviewers, and full-text studies will be retrieved and assessed against the inclusion criteria. Results will be recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Data will be extracted and presented as a tabular summary with supporting narratives and figures.

Nutrition-related symptoms in adult survivors of critical illness who are eating orally: a scoping review protocol.

This review will explore and map the current literature on the nutritional impact of symptoms reported by adult survivors of critical illness who are eating orally after discharge from the intensive care unit (ICU). Survivors of critical care often experience ICU-acquired weakness and poor functional recovery. It is plausible that nutrition interventions throughout their recovery could improve outcomes for these patients. Although a growing number of studies aim to explore the effect of nutrition delivered in the early phases of critical illness, this is also important post-ICU discharge, particularly in already nutritionally compromised patients presenting with muscle loss and fatigue. Therefore, the development of targeted nutrition interventions will be informed by a comprehensive insight into the physiological, physical, or psychological difficulties that critically ill patients experience after ICU discharge, which may impede oral intake. This review will consider primary research studies with adult patients 18 years and older, who are in the recovery phase after being critically ill, and eating orally. Studies must report on any symptoms related to the ability to eat, or represent nutrition inadequacy or utilization. A scoping review will be conducted in accordance with JBI methodology using a three-step search strategy of MEDLINE, Embase, CINAHL, AMED, Web of Science, Cochrane Database of Systematic Reviews, and JBI Evidence-based Practice Database to obtain primary research studies that meet the inclusion criteria. Duplicates will be removed, and study selection and data extraction will be conducted and cross-checked by two independent reviewers. Data synthesis will involve presenting the results in tabular form.

Efficacy and safety of combined therapy with synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: Systematic literature review

Objective(1) To systematically and critically review the evidence of combined therapy with synthetic disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) and (2) to design practical recommendations on their use. MethodsA systematic literature review (SLR) was performed with a sensitive bibliographic search strategy in Medline, EMBASE and Cochrane Library. We selected randomised clinical trials that analysed the efficacy and/or safety of (1) combined therapy of synthetic compared with sequential therapy of synthetic DMARD in early RA and (2) combination of methotrexate+leflunomide or triple therapy with synthetic DMARD in established RA refractory to synthetic DMARD. Two reviewers made the first selection by title and abstract and 11 performed the selection after detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. Based on the results, related recommendations were agreed upon in a nominal group meeting. ResultsUltimately, no articles were included in the SLR. The analysis of the reviewed articles demonstrated the effectiveness of the treatment with synthetic DMARD following a “treat to target” strategy in early RA patients, and of combination therapy of synthetic DMARD in established RA refractory to synthetic DMARD. This resulted in 6 recommendations concerning combination therapy with synthetic DMARD. ConclusionsThese recommendations aim to facilitate decision-making with the use of combined therapy with DMARD in RA.

Efficacy and safety of glucocorticoids in rheumatoid arthritis: Systematic literature review

Objectives(1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); (2) to generate practical recommendations. MethodsA systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus. ResultsA total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS. ConclusionsThese recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA.

MASCC recommendations on the management of constipation in patients with advanced cancer.

The Palliative Care Study Group of the Multinational Association for Supportive Care in Cancer formed a subgroup to develop evidence-based recommendations on the management of constipation in patients with advanced cancer. These recommendations were developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials respectively. The recommendations were categorised by the level of evidence and a "category of guideline" based on the level of evidence (i.e. "recommendation", "suggestion", or "no guideline possible"). The group produced 15 recommendations, with varying levels of evidence and so varying categories of guideline. The recommendations relate to the assessment, the treatment, and the re-assessment of constipation. These recommendations provide a framework for the management of constipation in advanced cancer, although every patient needs individualised management.

Accesibilidad en salud: revisión sobre niños y niñas con discapacidad en Brasil-Perú-Colombia

(analítico) La investigación tiene como objetivo identificar los principales problemas de acceso a los servicios de salud de niños y niñas con diversidad funcional en América Latina. Se trata de una revisión sistemática. Se desarrollaron estrategias detalladas para la búsqueda individual en Health, Redalyc, Medline y SciELO entre mayo y junio de 2018. Se incluyeron artículos originales publicados entre enero 2013- julio 2018 en portugués, inglés o español. Se realizaron análisis descriptivos para la categorización de los estudios. Se identificaron 9 artículos, todos transversales de diseño descriptivo. A partir de los resultados obtenidos, quedó evidente que las dificultades de acceso a los servicios de salud están asociadas a la mayor vulnerabilidad a factores demográficos, socioeconómicos, siendo necesario traspasar las barreras existentes a través de la creación y efectividad de políticas públicas que garanticen acceso a la salud.

Lilacs search strategy for systematic reviews of diagnostic test accuracy studies.

There are few publications on search strategies to identify diagnostic test accuracy (DTA) studies in lilacs. To translate and customise medline search strategies for use in lilacs and assess their retrieval of studies in Cochrane DTA systematic reviews. We developed a six-step process to translate and customise medline search strategies for use in lilacs (iAHx interface). We identified medline search strategies of published Cochrane DTA reviews, translated/customised them for use in lilacs, ran searches in lilacs and compared the retrieval results of our translated search strategy versus the one used in the published reviews. Our lilacs search strategies translated/customised from the medline strategies retrieved studies in 70 Cochrane DTA reviews. Only 29 of these reviews stated that they had searched the lilacs database and 21 published their lilacs search strategies. Few had used the lilacs database search tools, none exploded the subject headings, and 86% used only English terms. Translating and tailoring a medline search strategy for the lilacs database resulted in the retrieval of DTA studies that would have been missed otherwise.

Quality of life outcomes following surgery for advanced ovarian cancer: a systematic review and meta-analysis

BackgroundQuality of life after ovarian cancer treatment is an important goal for patients. Complex debulking surgeries and platinum based chemotherapy are often required but quality of life after surgery is...

Difficulties in the diagnosis of galactokinase deficiency. Urine usefulness for the diagnosis and control

Galactokinase (GALK) deficiency causes cataract leading to severe developmental consequences unless treated early. Because of the easy prevention and rapid reversibility of cataract with treatment, the Dutch Health Council advised to include GALK deficiency in the Dutch newborn screening program. The aim of this study is to establish the optimal screening method and cut-off value (COV) for GALK deficiency screening by performing a systematic review of the literature of screening strategies and total galactose (TGAL) values and by evaluating TGAL values in the first week of life in a cohort of screened newborns in the Netherlands.Systematic literature search strategies in OVID MEDLINE and OVID EMBASE were developed and study selection, data collection and analyses were performed by two independent investigators. A range of TGAL values measured by the Quantase Neonatal Total Galactose screening assay in a cohort of Dutch newborns in 2007 was evaluated.Eight publications were included in the systematic review. All four studies describing screening strategies used TGAL as the primary screening marker combined with galactose-1-phosphate uridyltransferase (GALT) measurement that is used for classical galactosemia screening. TGAL COVs of 2200 μmol/L, 1665 μmol/L and 1110 μmol/L blood resulted in positive predictive values (PPV) of 100%, 82% and 10% respectively. TGAL values measured in the newborn period were reported for 39 GALK deficiency patients with individual values ranging from 3963 to 8159 μmol/L blood and 2 group values with mean 8892 μmol/L blood (SD ± 5243) and 4856 μmol/L blood (SD ± 461). Dutch newborn screening data of 72,786 newborns from 2007 provided a median TGAL value of 110 μmol/L blood with a range of 30–2431 μmol/L blood.Based on TGAL values measured in GALK deficiency patients reported in the literature and TGAL measurements in the Dutch cohort by newborn screening we suggest to perform the GALK screening with TGAL as a primary marker with a COV of 2500 μmol/L blood, combined with GALT enzyme activity measurement as used in the classical galactosemia screening, to ensure detection of GALK deficiency patients and minimize false positive referrals.

The effect of post mastectomy radiation therapy on breast reconstruction with and without acellular dermal matrix: a systematic review and meta-analysis protocol

BackgroundThe widespread implementation of acellular dermal matrix (ADM) has broadened the reconstructive repertoire for alloplastic breast reconstruction. ADM’s role in the context of postoperative radiation therapy remains unclear. The present review will evaluate whether ADM reduces complication rates in patients undergoing post-mastectomy radiation therapy (PMRT).MethodsA healthcare librarian assisted in performing a search strategy of electronic databases MEDLINE (via Ovid), EMBASE, and CENTRAL. A combination of the keywords and Medical Subject Headings (MESH) to describe the various commercially available ADMs and terms for radiation therapy will be used. The search strategy will identify patients undergoing postoperative radiation following implant-based breast reconstruction and compare outcomes between those with and without ADM. Extracted data will include patient demographics, intraoperative data, and postoperative complications. Data on patient satisfaction and resource utilization will also be extracted if available. The references of selected works will be reviewed for additional studies meeting study criteria. Only peer-reviewed papers written in English will be included. The study data will be assessed for risk of bias and heterogeneity. Providing that sufficient studies can be identified, a meta-analysis will be performed. This review has been registered with PROSPERO (CRD42017056495).ConclusionsTo date, the short- and long-term performance of ADM in the context of postoperative radiation remains unclear. The objective of the present review will be to critically evaluate the literature with the intention of improving postoperative outcomes in the context of mastectomy and radiation.

The effect of dietary salt on blood pressure in individuals receiving chronic dialysis: a systematic review and meta-analysis of randomised controlled trials.

Dietary salt reduction in the general population lowers blood pressure and cardiovascular risk. Despite being widely recommended, there is limited evidence as to whether this is applicable to individuals with end-stage renal disease (ESRD) receiving dialysis. Therefore, we carried out a systematic review and meta-analysis of randomised controlled trials (RCTs) investigating dietary salt reduction in individuals receiving dialysis. Studies were identified through search strategies for CENTRAL, MEDLINE, and EMBASE. Two authors independently assessed studies for eligibility with the inclusion criteria as follows: participants aged 18 years and over; a reduction in salt intake of at least 1 g/day over one week; no concomitant interventions during the study. The primary outcome was change in systolic and diastolic blood pressure. 848 reports were screened, from which 12 studies were selected for the systematic review. Four were RCTs (91 participants) that met the study inclusion criteria: three were conducted in haemodialysis patients and one in peritoneal dialysis patients; three were crossover trials and one was a parallel study. Dietary salt reduction was associated with an 8.4 mmHg reduction in systolic blood pressure (95% CI 4.8-12.0, Ι2 = 0%), and a 4.4 mmHg reduction in diastolic blood pressure (95% CI 2.2-6.6, Ι2 = 0%). In conclusion, few studies have investigated the role of dietary salt reduction in individuals with ESRD receiving dialysis, but these results suggest the importance of this intervention for lowering blood pressure in this group.

Strengthening Delivery of Health Services Using Digital Devices.

Delivery of high-quality efficient health services is a cornerstone of the global agenda to achieve universal health coverage. According to the World Health Organization, health service delivery is considered good when equitable access to a comprehensive range of high-quality health services is ensured within an integrated and person-centered continuum of care. However, good health service delivery can be challenging in low-resource settings. In this review, we summarize and discuss key advances in health service delivery, particularly in the context of using digital health strategies for mitigating human resource constraints. The review updates the foundational systematic review conducted by Agarwal et al. in 2015. We used PubMed, EMBASE, and CINAHL to find relevant English-language peer-reviewed articles published 2018. Our search strategy for MEDLINE was based on MeSH (medical subject headings) terms and text words of key articles that we identified a priori. Our search identified 92 articles. After screening, we selected 24 articles for abstract review, of which only 6 met the eligibility criteria and were ultimately included in this review. Despite encouraging advances in the evidence base on digital strategies for health service delivery, the current body of evidence is still quite limited in 3 main areas: the effectiveness of interventions on health outcomes, improvement in health system efficiencies for service delivery, and the human capacity required to implement and support digital health strategies at scale. Two particular areas, digital health-enhanced referral coordination and mobile clinical decision support systems, demonstrate considerable potential to improve the quality and comprehensiveness of care received by patients, but they require a greater level of standardization and an expanded scope of health worker engagement across the health system in order to scale them up effectively. Additional research is urgently needed to inform the effectiveness of interventions on health outcomes, improvement in health system efficiencies, and cost-effectiveness of service delivery. In particular, more documentation and research on ways to standardize and engage health workers in digital referral and clinical decision support systems can provide the foundation needed to scale these promising approaches in low- and middle-income settings.

The effects of photodynamic and low-level laser therapy for treatment of oral lichen planus-A systematic review and meta-analysis.

Oral lichen planus (OLP) is a chronic immune-mediated disorder that inflicts oral mucosa in 0.5-2% of the population. Surgery, photodynamic therapy, laser therapy and most commonly pharmacological therapy (like corticosteroids) has been used for treating OLP. New phototherapy approaches have been shown to have positive effects on treating some oral lesions and the aim of our study was to assess the effects of different phototherapy treatments on OLP. We conducted a comprehensive electronic search using the determined search strategy in MEDLINE, EMBASE and CENTRAL electronic databases. A hand search of the reference list of the relevant studies and related systematic reviews was also performed. For low-level laser therapy, before and after studies showed a significant difference in pain (MD = -4.39, CI = 95% -4.83, -3.96) and sign score (MD = -1.86, CI = 95% -2.53, -1.19) after treatment. The comparison between corticosteroid therapy and LLLT also showed a significant difference in their effects for severity (MD = 0.57, CI = 95% 0.04, 1.09), but no differences in sign (MD = 0.21, CI = 95% -0.83, 1.24)and pain (MD = -0.10, CI = 95% -0.57,0.38) score was found between these two methods. Before and after studies of photodynamic therapy did not reveal any differences in lesion size. (MD = -1.95, CI = 95% -4.39, 0.490). Low-level laser therapy seems to be a reliable alternative to corticosteroids for treating OLP without the adverse effects associated with the pharmacological method. No conclusive evidence for the effectiveness of photodynamic therapy in treating OLP lesion exists.

Effects of etanercept on the patient-perceived results (PROs) in patients with moderate-to-severe plaque psoriasis: systematic review of the literature and meta-analysis

Purpose: To evaluate the efficacy of etanercept (ETN) compared with placebo for moderate-to-severe psoriasis regarding patient-reported outcomes (PROs).Methods: Systematic review of studies retrieved by a sensitive search strategy in Medline, Embase, Cochrane Library. Selection criteria: (population) studies had to include patients with for moderate-to-severe psoriasis; (intervention and control) studies had to test ETN vs. placebo; and (outcomes), studies had to report PROs including quality of life, pain, pruritus, or sleep. Only randomized controlled trials (RCT) were included. Two reviewers independently selected the articles and collected data. Studies quality was assessed using the Jadad score. For the meta-analysis, a random effects model was followed and statistical heterogeneity was tested with statistic I2.Results: We finally included 12 RCT. Compared with placebo, ETN significantly improved quality of life, patient global assessment, pruritus and pain in the short and medium term, fatigue in the short term (although the effect size and differences with placebo are unclear). ETN also produces a high patient’s satisfaction, which increases over time and is higher compared with placebo and might improve depressive symptoms in the long term.Conclusions: ETN is an effective option for improving PROs in patients with moderate-to-severe psoriasis.

The development of search filters for adverse effects of surgical interventions in medline and Embase.

BackgroundSearch filter development for adverse effects has tended to focus on retrieving studies of drug interventions. However, a different approach is required for surgical interventions.ObjectiveTo develop and validate search filters for medline and Embase for the adverse effects of surgical interventions.MethodsSystematic reviews of surgical interventions where the primary focus was to evaluate adverse effect(s) were sought. The included studies within these reviews were divided randomly into a development set, evaluation set and validation set. Using word frequency analysis we constructed a sensitivity maximising search strategy and this was tested in the evaluation and validation set.ResultsThree hundred and fifty eight papers were included from 19 surgical intervention reviews. Three hundred and fifty two papers were available on medline and 348 were available on Embase. Generic adverse effects search strategies in medline and Embase could achieve approximately 90% relative recall. Recall could be further improved with the addition of specific adverse effects terms to the search strategies.ConclusionWe have derived and validated a novel search filter that has reasonable performance for identifying adverse effects of surgical interventions in medline and Embase. However, we appreciate the limitations of our methods, and recommend further research on larger sample sizes and prospective systematic reviews.

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative

ObjectiveThe objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments. MethodsThe topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee. ResultsFor patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises). ConclusionsA multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.