Academic literature on the topic 'Review based on clinical risk criteria'
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Journal articles on the topic "Review based on clinical risk criteria"
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Apsari, Nyoman Tyas, Kumara Tini, and I. Putu Eka Widyadharma. "High serum non-high-density lipoprotein and the risk of ischemic stroke: A systematic review." Romanian Journal of Neurology 20, no. 1 (2021): 15–20. http://dx.doi.org/10.37897/rjn.2021.1.2.
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Objectives. High levels of non high density lipoprotein cholesterol (non-HDL-C) are known to contribute to an increased risk of ischemic stroke. This systematic review was conducted to identify the relationship between high non-HDL-C levels and the risk of ischemic stroke. Material and methods. This systematic review using PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement guideline, with a pre-determined search strategy. The search was conducted in Pubmed Central (PMC) and Pubmed from 2009 until 2020 with inclusion criteria, patients with a diagnosis of ischemic stroke, age >18 years, with non-HDL-C levels. The title and abstract of these articles were reviewed for relevance, based on inclusion criteria. This systematic review using STROBE to evaluate the quality in individual study which consists of 22 domains. Results. In the final stage, this systematic review identifies six cohort study consisting 166.720 participants. Overall, the quality in individual studies based on STROBE is good. We reported that there are two studies report that high non-HDL-C levels can significantly increase the risk of ischemic stroke. Meanwhile, there are four studies that report there was no significant relationship between high non-HDL-C levels and the risk of ischemic stroke. Conclusions. Overall, this systematic review provides the result about relationship between high levels of nonHDL-C and the risk of ischemic stroke, there are two studies with a larger population support that high levels of non-HDL-C can increase the risk of ischemic stroke. However, further studies is needed with a large population that specifically identify the relationship between non-HDL-C levels and risk of ischemic stroke and makes a better adjustments for confounding variables.
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Beier, Alexandra D., Dimitrios C. Nikas, Nadege Assassi, et al. "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Closure of Myelomeningocele Within 48 Hours to Decrease Infection Risk." Neurosurgery 85, no. 3 (2019): E412—E413. http://dx.doi.org/10.1093/neuros/nyz264.
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Abstract BACKGROUND Appropriate timing for closure of myelomeningocele (MM) varies in the literature. Older studies present 48 h as the timeframe after which infection complication rates rise. OBJECTIVE The objective of this guideline is to determine if closing the MM within 48 h decreases the risk of wound infection or ventriculitis. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full text articles were then reviewed and when appropriate, included in the evidentiary table. The class of evidence was evaluated, discussed, and assigned to each study that met inclusion criteria. RESULTS A total of 148 abstracts were identified and reviewed. A total of 31 articles were selected for full text analysis. Only 4 of these studies met inclusion criteria. CONCLUSION There is insufficient evidence that operating within 48 h decreases risk of wound infection or ventriculitis in 1 Class III study. There is 1 Class III study that provides evidence of global increase in postoperative infection after 48 h, but is not specific to wound infection or ventriculitis. There is 1 Class III study that provides evidence if surgery is going to be delayed greater than 48 h, antibiotics should be given. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-4.
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Deckers, Kay, Ileana Camerino, Martin P. J. van Boxtel, et al. "Dementia risk in renal dysfunction." Neurology 88, no. 2 (2016): 198–208. http://dx.doi.org/10.1212/wnl.0000000000003482.
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Objective:Renal dysfunction has been linked with increased risk for cognitive impairment and dementia, but studies are conflicting. For that reason, the aim of the present systematic review and meta-analysis is to summarize the best available evidence on the prospective association between potential markers of renal dysfunction and development of cognitive impairment or dementia.Methods:Medline, Embase, and Cochrane Database of Systematic Reviews were searched for potential publications until August 1, 2016. Studies were eligible if they fulfilled the following criteria: population-based study, prospective design, ≥100 participants, aged ≥45 years, ≥1 year follow-up, and cognition/dementia outcomes. Where appropriate, random effects meta-analyses were conducted yielding pooled odds ratios (OR) and 95% confidence intervals (CI).Results:Twenty-two out of 8,494 abstracts fulfilled the eligibility criteria. Sufficient evidence was found for albuminuria, mixed results for estimated glomerular filtration rate (eGFR), insufficient support for cystatin C, and tentative evidence for serum creatinine and creatinine clearance. Meta-analyses of 5 studies representing 27,805 persons showed a 35% increased risk of cognitive impairment or dementia in those with albuminuria (OR 1.35, 95% CI 1.06–1.73, p = 0.015), whereas eGFR <60 mL/min/1.73 m2 showed no significant association (OR 1.28, 95% CI 0.99–1.65, p = 0.063). No meta-analyses could be done for serum creatinine, creatinine clearance, or cystatin C.Conclusions:The overall evidence for an association between renal dysfunction and cognitive impairment or dementia is modest. Evidence suggests that albuminuria is associated with higher odds of developing cognitive impairment or dementia.
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Shenouda, Kerolos, Brian T. Yuhan, Ahsan Mir, et al. "Endoscopic Resection of Pediatric Skull Base Tumors: An Evidence-Based Review." Journal of Neurological Surgery Part B: Skull Base 80, no. 05 (2018): 527–39. http://dx.doi.org/10.1055/s-0038-1676305.
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Abstract Objectives To perform a systematic review examining experiences with endoscopic resection of skull base lesions in the pediatric population, with a focus on outcomes, recurrence, and surgical morbidities. Methods PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases were evaluated. Studies were assessed for level of evidence. Bias risk was evaluated using the Cochrane Bias tool, Grades of Recommendation, Assessment, Development and Evaluation (GRADE), and Methodological Index for Non-Randomized Studies (MINORS) criteria. Patient characteristics, pathology, site of primary disease, presenting symptoms, stage, procedure specific details, and complications were evaluated. Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines. Results Ninety-three studies met criteria for inclusion, encompassing 574 patients with skull base tumors. The GRADE and MINORS criteria determined the overall evidence to be moderate quality. The most common benign and malignant pathologies included juvenile nasopharyngeal angiofibromas (n = 239) and chondrosarcomas (n = 11) at 41.6 and 1.9%, respectively. Of all juvenile nasopharyngeal angiofibroma tumors, most presented at stage IIIa and IIIb (25.8 and 27.3%, respectively). Nasal obstruction (16.5%) and headache (16.0%) were common symptoms at initial presentation. Surgical approaches included endoscopic endonasal (n = 193, 41.2%) and endoscopic extended transsphenoidal (n = 155, 33.1%). Early (< 6 weeks) and late (>6 weeks) complications included cerebrospinal fluid leak (n = 36, 17.3%) and endocrinopathy (n = 43, 20.7%). Mean follow-up time was 37 months (0.5–180 months), with 86.5% showing no evidence of disease and 2.1% having died from disease at last follow-up. Conclusion Endoscopic skull base surgery has been shown to be a safe and effective method of treating a variety of pediatric skull base tumors. If appropriately employed, the minimally invasive approach can provide optimal results in the pediatric population.
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Visvanathan, Kala, Patricia Hurley, Elissa Bantug, et al. "Use of Pharmacologic Interventions for Breast Cancer Risk Reduction: American Society of Clinical Oncology Clinical Practice Guideline." Journal of Clinical Oncology 31, no. 23 (2013): 2942–62. http://dx.doi.org/10.1200/jco.2013.49.3122.
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Purpose To update the 2009 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction. Methods A systematic review of randomized controlled trials and meta-analyses published from June 2007 through June 2012 was completed using MEDLINE and Cochrane Collaboration Library. Primary outcome of interest was BC incidence (invasive and noninvasive). Secondary outcomes included BC mortality, adverse events, and net health benefits. Guideline recommendations were revised based on an Update Committee's review of the literature. Results Nineteen articles met the selection criteria. Six chemoprevention agents were identified: tamoxifen, raloxifene, arzoxifene, lasofoxifene, exemestane, and anastrozole. Recommendations In women at increased risk of BC age ≥ 35 years, tamoxifen (20 mg per day for 5 years) should be discussed as an option to reduce the risk of estrogen receptor (ER) –positive BC. In postmenopausal women, raloxifene (60 mg per day for 5 years) and exemestane (25 mg per day for 5 years) should also be discussed as options for BC risk reduction. Those at increased BC risk are defined as individuals with a 5-year projected absolute risk of BC ≥ 1.66% (based on the National Cancer Institute BC Risk Assessment Tool or an equivalent measure) or women diagnosed with lobular carcinoma in situ. Use of other selective ER modulators or other aromatase inhibitors to lower BC risk is not recommended outside of a clinical trial. Health care providers are encouraged to discuss the option of chemoprevention among women at increased BC risk. The discussion should include the specific risks and benefits associated with each chemopreventive agent.
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Omelchenko, M. A. "Clinical High Risk Psychosis: Issues of Diagnostics and Therapy." Psychiatry 18, no. 2 (2020): 82–91. http://dx.doi.org/10.30629/2618-6667-2020-18-2-82-91.
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The aim of the review: the analysis of modern Russian and foreign literature dedicated to the problem of determining diagnostic criteria for clinical high risk of psychosis (CHR-P) and outlining the therapeutic approaches based on the pathogenic mechanisms of their development. Material and method: the publications found by searching queries for keywords in Russian and English in the MEDLINE/PubMed and eLIBRARY databases for the time period from 2010 to 2020 were then analyzed. Conclusion: the review presents a modern definition of the CHR-P group, along with a clarification of individual diagnostic criteria, which include attenuated psychotic symptoms (APS), brief limited intermittent psychotic symptoms (BLIPS), genetic risk with deterioration of premorbid functioning, as well as basic symptoms (BS). We found heterogeneity of the CHR-P group with different levels of manifestation and outcomes and indicated the involvement of different pathogenic mechanisms in their formation. These findings determine the development of various approaches to treatment, which involve the assessment of the ratio of potential benefits and the risks of side effects. The obtained data, on the one hand, attest to the prospective viability of the therapeutic approach to the patients with CHR-P with the possibility of influencing the course of the disease, delaying its manifestation and improving long-term outcomes, and, on the other hand, the lack of universal standards of therapy at present. Tactics of treatment are determined basing on an individual approach to the patient with a comprehensive psychopathological assessment of complaints, clinical state and its dynamics.
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Manchanda, Ranjit, and Faiza Gaba. "Population Based Testing for Primary Prevention: A Systematic Review." Cancers 10, no. 11 (2018): 424. http://dx.doi.org/10.3390/cancers10110424.
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The current clinical model for genetic testing is based on clinical-criteria/family-history (FH) and a pre-defined mutation probability threshold. It requires people to develop cancer before identifying unaffected individuals in the family to target prevention. This process is inefficient, resource intensive and misses >50% of individuals or mutation carriers at risk. Population genetic-testing can overcome these limitations. It is technically feasible to test populations on a large scale; genetic-testing costs are falling and acceptability and awareness are rising. MEDLINE, EMBASE, Pubmed, CINAHL and PsychINFO databases were searched using free-text and MeSH terms; retrieved reference lists of publications were screened; additionally, web-based platforms, Google, and clinical-trial registries were searched. Quality of studies was evaluated using appropriate check-lists. A number of studies have evaluated population-based BRCA-testing in the Jewish population. This has been found to be acceptable, feasible, clinically-effective, safe, associated with high satisfaction rates and extremely cost-effective. Data support change in guidelines for population-based BRCA-testing in the Jewish population. Population panel testing for BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 gene mutations is the most cost-effective genetic-testing strategy in general-population women and can prevent thousands more breast and ovarian cancers than current clinical-criteria based approaches. A few ongoing studies are evaluating population-based genetic-testing for multiple cancer susceptibility genes in the general population but more implementation studies are needed. A future population-testing programme could also target other chronic diseases.
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Zhou, Hong, Han Hu, Maoyong Tian, et al. "Validation and Refinement of the Baveno VI Criteria for Ruling Out High-Risk Varices." Gastroenterology Research and Practice 2020 (November 27, 2020): 1–10. http://dx.doi.org/10.1155/2020/4217512.
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In the past decade, numerous studies have evaluated the roles of noninvasive methods for diagnosing or excluding varices and high-risk varices in patients with liver cirrhosis. The Baveno VI criteria recommend the use of a simple algorithm based on a liver stiffness measurement < 20 kPa through transient elastography and a platelet count > 150 × 10 9 / L for ruling out high-risk varices in patients with compensated advanced chronic liver disease. A large number of studies have validated the clinical usefulness of Baveno VI criteria for excluding high-risk varices. Several strategies have been proposed to refine the Baveno VI criteria; however, currently there is no review to summarize the diagnostic accuracy and limitations of the Baveno VI criteria after extensive validation. In this review, we summarize the diagnostic accuracy and limitations of the Baveno VI criteria after extensive validation. We also discuss methods to refine these criteria.
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Joe, Sean, Marquisha Lawrence Scott, and Andrae Banks. "What Works for Adolescent Black Males at Risk of Suicide." Research on Social Work Practice 28, no. 3 (2017): 340–45. http://dx.doi.org/10.1177/1049731517702745.
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We reviewed the controlled studies that report outcome findings for Black adolescent males 24 years of age and younger at risk of suicide. Our review identified 48 articles published from 2000 to 2015, 33 that met our initial criteria for full-text articles review, resulting in 6 that met all inclusion criteria. We sought to understand what works for Black males experiencing suicide ideation or engaging in suicidal behaviors (e.g., attempts). We identified crossover effects for multisystemic therapy for reducing the risk for suicide ideation and attempts. Attachment-based family therapy was salient for use as a component of clinical practice for Black males being treated for suicide ideation. While remaining randomized control trials did involve Black youth, disaggregated data based on ethnicity and gender were not reported. Overall, the located studies are too few to provide unequivocal guidance for practice.
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Meek, Claire L. "Natural selection? The evolution of diagnostic criteria for gestational diabetes." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 54, no. 1 (2016): 33–42. http://dx.doi.org/10.1177/0004563216674743.
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Gestational diabetes is a common pregnancy disorder which is generally managed with diet, exercise, metformin or insulin treatment and which usually resolves after delivery of the infant. Identifying and treating gestational diabetes improves maternal and fetal outcomes and allows for health promotion to reduce the mother’s risk of type 2 diabetes in later life. However, there remains considerable controversy about the optimal method of identification and diagnosis of women with gestational diabetes. The NICE-2015 diagnostic criteria (75 g oral glucose tolerance test (OGTT) 0 h ≥5.6 mmol/L; 2 h ≥7.8 mmol/L) are based upon cost-effectiveness estimates using observational data, while the WHO-2013 criteria (75 g OGTT 0 h ≥5.1 mmol/L; 1 h ≥10.0 mmol/L; 2 h ≥8.5 mmol/L) identify women and infants at risk of adverse outcomes according to prospective data. There is also considerable controversy about testing for gestational diabetes using universal or risk factor-based screening, and when and how testing should be performed. The aim of this review is to provide a summary of the clinical biochemistry aspects to these debates and to highlight the importance of appropriate identification of gestational diabetes and subsequent type 2 diabetes in this population.
Dissertations / Theses on the topic "Review based on clinical risk criteria"
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TAVARES, Suelene Brito do Nascimento. "Eficiência do pré-escrutínio rápido, revisão aleatória de 10% e critérios clínicos de risco como métodos de controle interno da qualidade dos exames citopatológicos cervicais." Universidade Federal de Goiás, 2007. http://repositorio.bc.ufg.br/tede/handle/tde/1742.
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Previous issue date: 2007-09-06<br>Cytopathology is an effective method of screening for cervical cancer; however, this
method has high rates of false-negative results (FNR). To reduce FNR, routine
measures of internal and external quality control are required in laboratories. The
10% random review of negative smears (R-10%) is the most commonly used
method; however, it is not effective in reducing FNR. Nevertheless, there is evidence
that the review of smears selected according to clinical risk factors (RCRF) and rapid
prescreening (RPS) of all smears present good results. This study evaluated the
performance of RPS, R-10% and RCRF as methods of internal quality control of
cervical smear testing. The sample was composed of a total of 6,135 cervical
smears from women who had attended Basic Health Clinics in Goiânia Goiás
between March 2006 and March 2007. The cytopathological results were classified
according to the 2001 Bethesda System. Initially, 6,135 smears were submitted to
RPS followed by routine scrutiny (RS). Following RS, smears classified as negative
were selected on the basis of clinical risk criteria, while 10% of all the smears were
selected randomly, both sets then being submitted to the respective reviews. Four
cytologists were responsible for RPS, RS, R-10% and RCRF, and three for reviewing
the abnormal and discordant smears from any of the reviews. The smears classified
as negative in RPS, RS, R-10% and RCRF were considered to have a final diagnosis
(FD) of negative. Smears considered suspect or unsatisfactory at RPS were
analyzed separately by two other cytologists. Smears considered abnormal or
unsatisfactory at RS, R-10% and/or RCRF were likewise reviewed. When the two
reviewing cytologists reached concordant diagnoses, these were considered the FD.
Discordant results were analyzed by a third cytologist and a consensus meeting was
held to define the FD. All stages of the study were performed blinded except for the
consensus meeting. Smears classified as negative at RS, which were suspect at RPS and/or considered abnormal at R-10% and RCRF and confirmed abnormal in
the FD, were considered FN results. Of the 6,135 smears, 5,522 were classified as
negative, 84 as unsatisfactory and 529 as abnormal in the FD. Sensitivity of RPS
was 63.0% for all abnormalities and 96.7% for high-grade squamous intraepithelial
lesion (HSIL) compared to RS. The sensitivity of RPS was 74.9% for all
abnormalities and 95.0% for HSIL compared to FD. The sensitivity of R-10% was
53.8% for all abnormalities when compared to FD. R-10% failed to detect any cases
of HSIL. The sensitivity of RCRF was 64.0% for all abnormalities and 75.0% for HSIL
compared to the FD. RPS identified an additional 132 (2.15%) abnormal smears,
whereas R-10% and RCRF identified an additional 7 (0.11%) and 32 (0.52%),
respectively. In conclusion, RPS is an effective method of internal quality control and
has better sensitivity than R-10% and RCRF for the detection of FN results. It also
allows the FN rate of the laboratory to be monitored and permits continuous
evaluation of the prescreening cytologist and the routine screening cytologist.<br>O exame citopatológico é um método eficiente para prevenir o câncer do colo do
útero, no entanto, apresenta altas taxas de resultados falso-negativos (RFN). Para
reduzir os RFN, são necessárias medidas de controle interno e externo da qualidade
na rotina dos laboratórios. O método de revisão aleatória de 10% dos esfregaços
negativos (R-10%) é o mais utilizado, no entanto, não é eficiente para reduzir os
RFN. Porém, há evidências de que a revisão dos esfregaços selecionados por
critérios clínicos de risco (RCCR) e o pré-escrutínio rápido (PER) apresentam bons
resultados. Esse estudo comparou o desempenho do PER, R-10% e RCCR como
métodos de controle interno da qualidade dos esfregaços cervicais. A casuística foi
constituída por 6.135 esfregaços citopatológicos cervicais de mulheres atendidas
nas Unidades Básicas de Saúde de Goiânia GO, no período de março de 2006 a
março de 2007. Os resultados citopatológicos foram classificados de acordo com o
Sistema de Bethesda 2001. Inicialmente 6.135 esfregaços foram submetidos ao PER
e em seguida ao escrutínio de rotina (ER). Após o ER os esfregaços classificados
como negativos foram selecionados com base em critérios clínicos de risco e
aleatoriamente 10% do total de esfregaços e submetidos às respectivas revisões.
Quatro citologistas foram responsáveis pelo PER, ER, R-10% e RCCR e três pelas
revisões dos esfregaços alterados e discordantes em qualquer revisão. Os
esfregaços com resultados negativos no PER, ER, R-10% e RCCR foram
considerados diagnóstico final (DF). Os esfregaços com resultados suspeitos ou
insatisfatórios, pelo PER, foram analisados separadamente por dois outros
citologistas. Também os esfregaços cujos resultados foram considerados alterados
ou insatisfatórios pelo ER, R-10% e/ou RCCR foram igualmente revisados. Quando
os dois citologistas revisores emitiram diagnósticos concordantes estes foram
considerados DF. Os resultados discordantes foram analisados por um terceiro
citologista e em uma reunião de consenso foi definido o DF. Todas as etapas do
estudo foram realizadas às cegas, exceto na reunião de consenso. Os esfregaços
classificados como negativos pelo ER que foram suspeitos pelo PER e/ou alterados
nas R-10% e RCCR e confirmados pelo DF foram considerados RFN. Dos 6.135
esfregaços, 5.522 foram classificados como negativos, 84 como insatisfatórios e 529
como alterados pelo DF. A sensibilidade do PER foi de 63,0% para todas as
anormalidades e de 96,7% para lesão intra-epitelial escamosa de alto grau (HSIL)
quando comparado ao ER. A sensibilidade do PER foi de 74,9% para todas as
anormalidades e de 95,0% para HSIL quando comparado ao DF. A sensibilidade da
R-10% foi de 53,8% para todas as anormalidades quando comparado ao DF e não
detectou nenhuma HSIL, enquanto a sensibilidade da RCCR foi de 64,0% para
todas as anormalidades e de 75,0% para HSIL quando comparado ao DF. O PER
acrescentou 132 (2,15%) esfregaços alterados, enquanto que a R-10% e a RCCR
acrescentaram sete (0,11%) e 32 (0,52%), respectivamente. Enfim, o PER é uma
alternativa eficiente de controle interno da qualidade, apresentando maior
sensibilidade que as R-10% e RCCR na detecção de RFN. Permite, ainda, monitorar
a taxa de RFN do laboratório, assim como avaliar continuamente o desempenho
tanto do pré-escrutinador quanto do escrutinador de rotina.
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Kaymaz, N., M. Drukker, Roselind Lieb, et al. "Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-117329.
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Background The base rate of transition from subthreshold psychotic experiences (the exposure) to clinical psychotic disorder (the outcome) in unselected, representative and non-help-seeking population-based samples is unknown.
Method A systematic review and meta-analysis was conducted of representative, longitudinal population-based cohorts with baseline assessment of subthreshold psychotic experiences and follow-up assessment of psychotic and non-psychotic clinical outcomes.
Results Six cohorts were identified with a 3–24-year follow-up of baseline subthreshold self-reported psychotic experiences. The yearly risk of conversion to a clinical psychotic outcome in exposed individuals (0.56%) was 3.5 times higher than for individuals without psychotic experiences (0.16%) and there was meta-analytic evidence of dose–response with severity/persistence of psychotic experiences. Individual studies also suggest a role for motivational impairment and social dysfunction. The evidence for conversion to non-psychotic outcome was weaker, although findings were similar in direction.
Conclusions Subthreshold self-reported psychotic experiences in epidemiological non-help-seeking samples index psychometric risk for psychotic disorder, with strong modifier effects of severity/persistence. These data can serve as the population reference for selected and variable samples of help-seeking individuals at ultra-high risk, for whom much higher transition rates have been indicated.
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Kaymaz, N., M. Drukker, Roselind Lieb, et al. "Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results." Technische Universität Dresden, 2012. https://tud.qucosa.de/id/qucosa%3A27014.
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Background The base rate of transition from subthreshold psychotic experiences (the exposure) to clinical psychotic disorder (the outcome) in unselected, representative and non-help-seeking population-based samples is unknown.
Method A systematic review and meta-analysis was conducted of representative, longitudinal population-based cohorts with baseline assessment of subthreshold psychotic experiences and follow-up assessment of psychotic and non-psychotic clinical outcomes.
Results Six cohorts were identified with a 3–24-year follow-up of baseline subthreshold self-reported psychotic experiences. The yearly risk of conversion to a clinical psychotic outcome in exposed individuals (0.56%) was 3.5 times higher than for individuals without psychotic experiences (0.16%) and there was meta-analytic evidence of dose–response with severity/persistence of psychotic experiences. Individual studies also suggest a role for motivational impairment and social dysfunction. The evidence for conversion to non-psychotic outcome was weaker, although findings were similar in direction.
Conclusions Subthreshold self-reported psychotic experiences in epidemiological non-help-seeking samples index psychometric risk for psychotic disorder, with strong modifier effects of severity/persistence. These data can serve as the population reference for selected and variable samples of help-seeking individuals at ultra-high risk, for whom much higher transition rates have been indicated.
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James, Kirsty Michelle. "Mindfulness-Based Cognitive Therapy versus self-help for students with clinical perfectionism: a pilot randomised study ; Psycho-social risk factors for Generalised Anxiety Disorder: an exploratory literature review of current knowledge." Thesis, University of Bath, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.633159.
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Abstracts Mindfulness-Based Cognitive Therapy versus self-help for students with clinical perfectionism: A pilot randomised study Objective: This pilot study compared a mindfulness-based cognitive therapy (MBCT) intervention with a self-help guide based on a cognitive behaviour therapy (CBT) approach for students with clinical perfectionism. Method: Participants were randomised to either MBCT or self-help. Questionnaires were completed at baseline, eight weeks later (the primary outcome point, corresponding to the end of MBCT) and at ten-week follow-up. Results: Post-intervention intention-to-treat (ITT) analyses identified that MBCT participants (n = 28) had significantly lower levels of unhealthy perfectionism and stress than self-help participants (n = 32). There was also significant MBCT superiority for changes in unhelpful beliefs about emotions, rumination, mindfulness, self-compassion and decentering. At ten-week follow-up, effects were maintained in the MBCT group and both ITT and completer (per-protocol) analyses showed superior MBCT outcomes for unhealthy perfectionism and daily impairment caused by perfectionism. Mediational analysis showed that pre-post changes in self-compassion mediated the group differences in pre-post changes in clinical perfectionism. Conclusions: MBCT is a promising intervention for students with clinical perfectionism, which may result in larger improvements than self-help. The findings require replication with a larger sample. Session-by-session outcome monitoring in CAMHS: Clinicians beliefs The CYP-IAPT programme emphasises the meaningful contribution session-by-session routine outcome monitoring (ROM) can make to clinical practice and its importance in highlighting services’ effectiveness. Two studies on issues related to the implementation of ROM in children’s services were conducted. Study one was qualitative; twelve CAMHS professionals participated in focus groups. Themes identified included the idea that ROM could provide objectivity, could be collaborative and empowering. Concerns included how measures may adversely influence therapeutic sessions and how the information may be used by the service. These themes were used to develop a questionnaire about professional’s experience of and views on session-by-session ROM. In study two, 59 professionals from four CAMHS teams completed the questionnaire. It was found that only 6.8% reported “almost always” utilising session-by-session ROM. Detailed analysis of questionnaire responses suggested two factors reflecting the perceived negative and positive impact of session-by-session ROM. It was found that clinicians who currently use session-by-session ROM hold stronger positive and negative beliefs than clinicians who do not. This study suggests that session-by-session ROM is not currently routine practice within CAMHS and highlights the importance of considering how this practice can be best implemented within this setting with reference to clinician attitudes. Psycho-social risk factors for Generalised Anxiety Disorder: An exploratory literature review of current knowledge Research around worry and its central role within Generalised Anxiety Disorder (GAD) has primarily focused on characteristics and treatment, with little investigation into factors involved in its development. The current paper reviews literature to explore our existing understanding of risk factors involved in the aetiology of worry and GAD and briefly reviews how well current cognitive models account for identified aetiological factors. Collectively, current cognitive models vary in their focus on, and explanation of, aetiological factors of worry and GAD and require further theoretical development. Further research within this field focused on the role of parenting and insecure attachment styles, life events and the course of symptoms across gender and the lifespan will be beneficial.
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Kvist, Linda, and Sara Gillhof. "Stödsystem/riktlinjer för riskbedömning av oral hälsa." Thesis, Malmö högskola, Odontologiska fakulteten (OD), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19763.
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Riskbedömning är en väsentlig del av klinikerns vardag. Varje patient ska riskbedömas och riskgrupperas, vilket sedan utgör grund för val av behandling, behandlare och revisionsintervall. I tandvården i Sverige idag används det ett flertal olika stödsystem eller riktlinjer för riskbedömning av oral hälsa. Syftet med studien var att ta reda på vilka stödsystem/riktlinjer som finns för riskbedömning av oral hälsa i Sverige idag och ge en beskrivning av de mest frekvent använda systemen samt göra en jämförelse av dessa. Syftet var också att undersöka huruvida dessa system är evidensbaserade och utvärderade samt att kartlägga kunskapsläget, gällande evidensbasering och utvärdering av stödsystem/riktlinjer, för riskbedömning av oral hälsa. För att skapa oss en allmän bild av stödsystem/riktlinjer för riskbedömning inleddes vårt arbete med en litteraturgenomgång. För att svara på frågeställningen om kunskapsläget över stödsystemens/riktlinjernas evidens och utvärdering, gjordes en systematisk litteraturöversikt. En kartläggning över Folktandvården och kontakt med Praktikertjänst gav oss en bild över vilka system som är aktuella i Sverige idag. För information om de utvalda systemen kontaktades så kallade nyckelpersoner för intervju. Data från intervjuerna har sedan analyserats i relation till vår litteraturgenomgång. Resultaten visar att Beslutsstöd R2 är det system som används mest frekvent inom Folktandvården. Andra förekommande system är Datorstödd Riskbedömning Effica och DentiGroup. Inom Praktikertjänst finns ett system tillgängligt för alla som använder sig av Opus journalsystem. Vår slutsats är att det vetenskapliga underlaget, gällande evidensbasering och utvärdering av stödsystem/riktlinjer, är bristfälligt.<br>Risk assessment is an essential part of dental practice today. Each patient should be assessed and stratified into a well defined group according to risk. This risk assessment should then affect the choice of prevention and treatment, and intervals for recalls and appropriate level of care. Today, in Swedish dental healthcare, different guidelines are being used as support in the assessment of a patient’s oral health. The aim of this study was to find out, compare and describe the most frequent used guidelines/systems for risk assessment of oral health in Sweden today. A second aim was to examine whether these systems are evidence-based and evaluated, and to identify existing knowledge about evidence-based supporting systems for risk assessment of oral health. A systematic review was made where articles published more than 10 years ago and papers which didn’t involve risk assessment of the whole patient were excluded. The Public Dental Service and Praktikertjänst were contacted and enquired about which systems if any were in use. For more in depth information on these systems, persons with key knowledge were interviewed. The information received was then analyzed in relation to the literature review. The results show that the system most frequently used in the Public Dental Service today is Beslutsstöd R2. Other computerbased systems are Datorstödd riskgruppering Effica and DentiGroup. In Praktikertjänst a system is available for all users of Opus Dental practice management system. Our conclusion is that the scientific evidence, regarding evidence-based and evaluation of support / guidelines are inadequate.
Books on the topic "Review based on clinical risk criteria"
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Koczo, Agnes, Reshad Mahmud, and Belinda Rivera-Lebron. Pulmonary Embolism (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0020.
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This chapter examines the diagnosis, risk stratification, and breadth of treatment options for pulmonary embolism (PE). It reviews the decision pathways based on degree of clinical suspicion of PE and assessing pre-test probability using the Geneva and Wells’ Score. It also reviews the Pulmonary Embolism Rule-out Criteria (PERC) and D-dimer with high negative predictive values. Imaging and cardiac biomarkers, which allow classification and risk stratification of PE, are discussed in how they guide management. Options for parenteral anticoagulation including bridging to novel oral anticoagulants or vitamin K antagonists for long term therapy are discussed, as well as clinical situations where systemic or catheter based thrombolysis should be considered. Hemodynamic support involving vasopressors are reviewed. The options for surgical embolectomy, as well as special cases including clot in transit, are discussed.
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Appelbaum, Kenneth L., and Kevin R. Murphy. Attention deficit disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0037.
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The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in correctional settings is in itself problematic and quite contentious; treating the disorder more so. Community prevalence studies estimate that 2.5% to 4% of adults in the United States and worldwide meet diagnostic criteria for ADHD. Some research findings suggest that ADHD occurs at far greater prevalence rates among criminal justice populations than in the population at large. The nature of the condition, its assessment, and its management combine to create a perfect storm of potentially vexing challenges for the prison psychiatrist. This chapter reviews those diagnostic and treatment challenges, including the risk of diversion and misuse of controlled substances among inmates. An assessment and treatment model is presented that takes into account and minimizes risk while helping ensure access to care in appropriately selected cases. Some inmates have a compelling need for treatment, potentially including stimulant medications. Neither unbridled use nor complete elimination of stimulants makes good clinical or administrative sense for correctional systems. An approach that relies on current impairment in significant functional areas, meaningful involvement in treatment, and absence of active misuse of substances will allow access to medication for those with verifiable need while lessening the risks associated with prescription of controlled substances in jails and prisons. The issues of differential diagnosis in a population with epidemic substance abuse, the challenges of appropriate management, and an evidence-based treatment model are discussed in this chapter.
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Raines, James C., ed. Evidence-Based Practice in School Mental Health. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190886578.001.0001.
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Schools have become the default mental health providers for children and adolescents, but they are often poorly equipped to meet the mental health needs of their students. The introduction tackles how to make students eligible for school-based services using the Individuals with Disabilities Education Act or Section 504 of the Rehabilitation Act. Using the new DSM-5 as an organizing principle, this book then addresses the 12 most common mental disorders of childhood and adolescence, ages 3–18. While there are many books that address child and adolescent psychopathology, this book focuses on how to help students with mental disorders in pre-K–12 schools. Each chapter addresses the prevalence of a disorder in school-age populations, appropriate diagnostic criteria, differential diagnosis, comorbid disorders, rapid assessment instruments available, school-based interventions using multitiered systems of support, and easy-to-follow suggestions for progress monitoring. Unique to this book, each chapter has detailed suggestions for how school-based clinicians can collaborate with teachers, parents, and community providers to address the needs of youth with mental health problems so that school, home, and community work together. Each chapter ends with a list of extensive web resources and a real-life case example drawn from the clinical practice of the authors. The final chapter addresses two newly proposed diagnoses for self-harm in the DSM-5 and brings a cautious and sensible approach to assessing and helping students who may be at risk for serious self-injury or suicide.
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Rihmer, Zoltán, Xénia Gonda, and Péter Döme. The assessment and management of suicide risk in bipolar disorder. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0016.
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Bipolar spectrum disorders are among the most frequent psychiatric ailments associated with a considerable risk of suicidal behaviour. Approximately 4–19% of (mostly untreated) patients with bipolar disorders ultimately commit suicide, and about 20–60% of them make at least one suicide attempt in their lifetime. Compared with the general population, the risk of committing suicide is about 10–30 times higher in patients with bipolar disorder. However, the majority of bipolar patients never attempt or commit suicide. Therefore, the routine assessment of several risk factors for suicide in clinical practice may aid in the recognition of those patients who are at the highest risk. This chapter summarizes the clinically most relevant suicide risk and protective factors in bipolar disorders. In addition, we review evidence-based strategies for suicide prevention in bipolar disorder.
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De Braganca, Kevin C., and Roger J. Packer. Medulloblastoma. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0139.
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Medulloblastoma is the most common malignant brain tumor in pediatric patients. Patients are presently stratified to either standard or high-risk groups based on clinical and pathologic criteria. Approximately 80% of patients with standard risk disease are cured of their primary disease. High-risk and recurrent disease groups have a poorer outcome; 5-year progression-free survival is only 65% with high-risk disease. Disease control after recurrence is very poor. Treatment is multimodal and also aims to limit short- and long-term toxicities. Recent identification of four molecular subtypes of medulloblastoma may change risk assignment and therapy. Addressing the medical and psychosocial issues of survivors continues to improve the quality of life for these patients beyond the disease’s treatment.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0049.
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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_001.
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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_002.
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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_003.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Manski, Charles F. Patient Care under Uncertainty. Princeton University Press, 2019. http://dx.doi.org/10.23943/princeton/9780691194738.001.0001.
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Although uncertainty is a common element of patient care, it has largely been overlooked in research on evidence-based medicine. This book strives to correct this glaring omission. Applying the tools of economics to medical decision making, the book shows how uncertainty influences every stage, from risk analysis to treatment, and how this can be reasonably confronted. In the language of econometrics, uncertainty refers to the inadequacy of available evidence and knowledge to yield accurate information on outcomes. In the context of health care, a common example is a choice between periodic surveillance or aggressive treatment of patients at risk for a potential disease, such as women prone to breast cancer. While these choices make use of data analysis, the book demonstrates how statistical imprecision and identification problems often undermine clinical research and practice. Reviewing prevailing practices in contemporary medicine, the book discusses the controversy regarding whether clinicians should adhere to evidence-based guidelines or exercise their own judgment. It also critiques the wishful extrapolation of research findings from randomized trials to clinical practice. Exploring ways to make more sensible judgments with available data, to credibly use evidence, and to better train clinicians, the book helps practitioners and patients face uncertainties honestly. It concludes by examining patient care from a public health perspective and the management of uncertainty in drug approvals. The book explains why predictability in the field has been limited and furnishes criteria for more cogent steps forward.
Book chapters on the topic "Review based on clinical risk criteria"
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Gul, Muhammet, Suleyman Mete, Faruk Serin, and Erkan Celik. "Fine–Kinney Occupational Risk Assessment Method and Its Extensions by Fuzzy Sets: A State-of-the-Art Review." In Fine–Kinney-Based Fuzzy Multi-criteria Occupational Risk Assessment. Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-52148-6_1.
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Peris, Adriano, Jessica Bronzoni, Sonia Meli, et al. "Organ Donor Risk Stratification in Italy." In Textbook of Patient Safety and Clinical Risk Management. Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-59403-9_23.
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AbstractThe permanent gap between organ demand and supply has prompted use of organs from extended criteria donors (ECD). These carry a higher risk of disease transmission, with regard to infections and malignancies. We present herein the donor risk stratification algorithm implemented in Italy since 2004 for identification management of donor-to-recipient risk of disease transmission. The principles underlying this algorithm are: (1) the risk of disease transmission must be assessed against the potential benefit for the transplant recipient (i.e., no donor can be excluded from evaluation and their organs might benefit potential candidates); (2) patients awaiting organ transplantation must be informed that the risk of disease transmission is small but finite (standard risk); and (3) risk evaluation is an ongoing process based on information collected longitudinally after transplantation. Regional and national transplant authorities are committed to regular updating of guidelines based on clinical data derived from clinicians and on evaluation of posttransplant graft and patient survival rates.
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Carvalho, Sandra, Gustavo Rivara, Andre Brunoni, and Felipe Fregni. "Integrity in Research." In Critical Thinking in Clinical Research, edited by Sandra Carvalho, Gustavo Rivara, Andre Brunoni, and Felipe Fregni. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199324491.003.0019.
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This chapter discusses authorship, ethics in research, plagiarism, and misconduct. It summarizes the general criteria for scientific report authorship according to the International Committee of Medical Journal Editors (ICMJE) and Ethics in Research. It discusses ethics in research, based on the famous Tuskegee syphilis study, and the Belmont Report that followed it. Three basic ethical principles derived from the Belmont Report—respect for persons, beneficence, and justice—and their impact on research with human subjects are discussed, along with the direct applications of these three ethical principles: informed consent, risk/benefit ratio, and subject selection. Finally, the chapter reviews the main aspects of research misconduct and presents some examples. Research integrity requires that the research process is governed by honesty, objectivity, and verifiable methods, instead of preconceived ideas and expectations. It is an important topic to be reviewed and discussed before anyone decides to pursue the field of clinical research.
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Farooq, Vasim, John D. Puskas, Patrick W. Serruys, and David P. Taggart. "Evidence basis for decision-making between coronary artery bypass grafting and percutaneous coronary intervention." In State of the Art Surgical Coronary Revascularization, edited by Patrick W. Serruys, David R. Holmes, and Vasim Farooq. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198758785.003.0020.
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Historically, the 15 randomized clinical trials comparing coronary artery bypass graft surgery and percutaneous coronary intervention for intervention in coronary artery disease have been criticized for profound selection bias (‘cherry-picking’ of patients). The stringent clinical and angiographic-based inclusion criteria led to only 2–12% of all screened patients actually being randomized in these trials, resulting in recruitment of mainly low-risk subjects with predominant one- or two-vessel disease (and a low incidence of three-vessel disease), preserved left ventricular ejection fraction, and a low incidence of diabetes. This highly selective selection practice echoes that of a review of 31 antidepressant efficacy trials in 2002, demonstrating that despite the large number of trials and participants, only a minority of patients treated for depression in routine clinical were eligible for inclusion because of a large number of exclusion criteria.
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Robert, Laurine, Chloé Rousseliere, Jean-Baptiste Beuscart, et al. "Integration of Explicit Criteria in a Clinical Decision Support System Through Evaluation of Acute Kidney Injury Events." In Studies in Health Technology and Informatics. IOS Press, 2021. http://dx.doi.org/10.3233/shti210249.
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In Clinical Decision Support System (CDSS), relevance of alerts is essential to limit alert fatigue and risk of overriding relevant alerts by health professionals. Detection of acute kidney injury (AKI) situations is of great importance in clinical practice and could improve quality of care. Nevertheless, to our knowledge, no explicit rule has been created to detect AKI situations in CDSS. The objective of the study was to implement an AKI detection rule based on KDIGO criteria in a CDSS and to optimize this rule to increase its relevance in clinical pharmacy use. Two explicit rules were implemented in a CDSS (basic AKI rule and improved AKI rule), based on KDIGO criteria. Only the improved rule was optimized by a group of experts during the two-month study period. The CDSS provided 1,125 alerts on AKI situations (i.e. 643 were triggered for the basic AKI rule and 482 for the improved AKI rule). As the study proceeds, the pharmaceutically and medically relevance of alerts from the improved AKI rule increased. A ten-fold increase was shown for the improved AKI rule compared to the basic AKI rule. The study highlights the usefulness of a multidisciplinary review to enhance explicit rules integrated in CDSS. The improved AKI is able to detect AKI situations and can improve workflow of health professionals.
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Grazioplene, Rachael G., and Tyrone D. Cannon. "Predictors of conversion to psychosis." In Psychotic Disorders, edited by Albert R. Powers III, Thomas H. McGlashan, and Scott W. Woods. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190653279.003.0014.
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The prodromal phase of psychosis represents an opportunity to understand how psychosis develops, and research in this area has the potential to generate strategies for treatment and prevention. This chapter reviews findings from clinical high risk (CHR) and general population sampling research related to prediction of psychosis, discussing what has been learned from these two approaches as well as theoretical and practical pitfalls of each. Work conducted in the CHR paradigm has yielded practical tools for psychosis prediction as well as evidence that progressive loss of neuronal connectivity may underlie onset of full psychosis, but cases meeting criteria for a CHR syndrome represent a small fraction of new onsets of psychosis in the population. Population-based studies benefit from a broader ascertainment scheme but are limited in feasibility of in-depth or frequent assessments and follow-ups. The chapter concludes with a discussion of how to reconcile different approaches under a transdiagnostic framework.
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Suka Aryana, IGP. "Clinical Relations of Sarcopenia." In Background and Management of Muscular Atrophy. IntechOpen, 2021. http://dx.doi.org/10.5772/intechopen.93408.
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Sarcopenia is one of geriatric syndromes, characterized by decreased muscle mass accompanied by decreased muscle strength and/or performance. It is more prevalent with increase in age, and the prevalence depends on the criteria applied and the characteristic of the elderly. Sarcopenia has a higher risk of morbidity and mortality in elderly patients. The definition criteria of sarcopenia are still controversial, but diagnostic criteria from the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People (EWGSOP) are the most used criteria for clinical practice. Pathogenesis sarcopenia involved a multifactorial process and is divided into intrinsic and extrinsic factors. Risk factors for sarcopenia include constitutional factors, aging, lifestyle, changes in body condition, and chronic diseases. Based on that, sarcopenia is divided into primary and secondary sarcopenia. There are three stage of sarcopenia, which are pre-sarcopenia, sarcopenia, and severe sarcopenia. Nutrition and exercise are the two main pillars to manage sarcopenia.
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Mil, Annette van der Helm-van. "Clinical features of rheumatoid arthritis." In Oxford Textbook of Rheumatoid Arthritis. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198831433.003.0011.
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The diagnosis of rheumatoid arthritis (RA) is based on a combination of symptoms, signs, and investigation results. As such, it is mainly based on pattern recognition. Classification criteria are not developed to make accurate diagnoses in individual patients, but for the primary purpose of defining homogeneous disease groups for scientific studies. The RA classification criteria have changed over time. This chapter discusses the process of diagnosing RA, the range of clinical characteristics that contribute to this process, its relationship with evolving classification criteria for the condition, and important differential diagnoses. Current recommendations encourage early recognition of arthritis and RA. Since clinical presentation may differ with disease stage, this chapter will also review how the RA phenotype changes as prearthritis progresses to early undifferentiated arthritis and established RA.
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Khakha, Raghbir, and Adam Hill. "Evidence-based medicine." In An Introduction to Clinical Research. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780199570072.003.0015.
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The aim of research is to faithfully observe and describe, predict, determine causation, explain the hitherto unexplained, and conjure further questions. Medical research is concerned with the application of the scientific method to investigating both our population at risk, and our patients. However, it is often impossible to study entire populations. Therefore, many studies are undertaken to analyse representative cohorts before extrapolating the data to the population of interest. Every study is susceptible to bias and error. It is important to determine whether the evidence from an individual or groups of studies is strong or weak. In other words, are these data sets truly representative of the entire population of interest, or are the data distorted due to potential confounding factors? Furthermore, have the investigators presented a measured interpretation of their results in the context of the potential errors within their experimental system? It is these questions that have led to the concept of research evidence, or the hierarchical system in which the strength of the argument within some studies is simply better, or more persuasive, than others. When planning a research study, design is the first consideration. The highest possible level of evidence is a systematic review or meta-analysis of randomized controlled trials (RCTs), or an individual RCT. These are considered the ‘gold standard’ of clinical research. The design of RCTs allows exclusion of confounding factors and bias as much as possible. These studies work very well for certain interventions, such as drug trials. However, where the control and sample groups cannot be blinded, (e.g. ‘sham acupuncture’ or ‘sham manipulation’ as the control), RCTs may be less appropriate. Meta-analyses are considered as type 1 evidence. The more data is pooled, the more valid the results. However, the data may be less relevant to individual patients. Therefore, although potentially the most powerful type of evidence, meta-analyses can have some important limitations. A meta-analysis takes a number of trials from the literature, e.g. 10 trials of 100 patients each.
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Lee, Christine U., and James F. Glockner. "Case 11.1." In Mayo Clinic Body MRI Case Review, edited by Christine U. Lee and James F. Glockner. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199915705.003.0279.
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28-year-old woman with secondary amenorrhea and hirsutism Axial fat-suppressed 2D SSFP images (Figure 11.1.1) demonstrate multiple follicles arranged in the periphery of the ovaries bilaterally. Polycystic ovary syndrome PCOS is the most common endocrine disorder in women of reproductive age, affecting between 6% and 15%, depending on the criteria used for diagnosis. It typically presents with anovulatory or oligo-ovulatory menstrual cycles leading to oligomenorrhea, polycystic ovaries, and clinical and biochemical hyperandrogenism. PCOS is also associated with increased risk of obesity, insulin resistance, diabetes mellitus, metabolic syndrome, and infertility....
Conference papers on the topic "Review based on clinical risk criteria"
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Yustinawati, Ratna, and Anhari Achadi. "Risk Factors for Mortality in Patients with Covid-19: A Systematic Review." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.01.26.
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ABSTRACT Background: SARS-CoV-2, a new strain of the coronavirus, caused a global outbreak of fatal acute pneumonia. Globally, WHO has recorded 709,511 deaths from COVID-19, and the number is increasing. This study aimed to determine the risk factors for mortality in COVID-19 patients. Subjects and Method: A systematic review was conducted by searching for articles from ScienceDirect, PubMed, SpringerLink, Scopus, and Google Scholar databases. The inclusion criteria were open access, English-language, and full-text articles published in journals between 20019 and 2020. The keywords were (Coronavirus Disease 2019 AND clinical characteristics AND epidemiological characteristics AND comorbidities) OR (COVID-19 AND clinical characteristics AND epidemiological characteristics AND comorbidities). A total of eight articles was reviewed to answer the research question. The data were analyzed by PRISMA flow chart. Results: Based on the reports from China and Korea, a total of 1,314 (100%) COVID-19 patients who died was aged ≥60 years with comorbidity, in which 845 (64%) were male patients. Before the death of patients, the increase D-dimer level of ≥1 μg/ mL and Sequential Organ Failure Assessment (SOFA) score of ≥4 were reported. It indicated the occurrence of multi-organ failure and Acute Respiratory Distress Syndrome (ARDS). Most of the comorbidities were hypertension, diabetes mellitus, and cardiovascular diseases. Conclusion: Risk factors for mortality in COVID-19 patients include age at ≥60 years, male, and presence of comorbidity. The clinical features are D-dimer levels ≥1 μg / mL, high SOFA score (≥4), and ARDS. Comprehensive efforts are needed to identify risk factors early and conduct effective treatment timely to reduce the mortality of COVID-19 patients. Keywords: SARS-CoV-2, COVID-19, risk factors, mortality, comorbidity Correspondence: Ratna Yustinawati. Master of Public Health Program, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia. Email: ratnayustinawati@gmail.com. Mobile: +628179324304. DOI: https://doi.org/10.26911/the7thicph.01.26
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Jugl, Sebastian, Aimalohi Okpeku, Brianna Costales, et al. "A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the United States, from 2016 to 2019." In 2020 Virtual Scientific Meeting of the Research Society on Marijuana. Research Society on Marijuana, 2021. http://dx.doi.org/10.26828/cannabis.2021.01.000.25.
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Background: Medical cannabis is available to patients by physician order in two-thirds of the United States (U.S.) as of 2020, but remains classified as an illicit substance by federal law. States that permit medical cannabis ordered by a physician typically require a diagnosed medical condition that is considered qualifying by respective state law. Objectives: To identify and map the most recently (2016-2019) published clinical and scientific literature across approved conditions for medical cannabis, and to evaluate the quality of identified recent systematic reviews. Methods: Literature search was conducted from five databases (PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov), with expansion and update from the National Academies of Sciences, Engineering, and Medicine’s (NASEM) comprehensive evidence review through 2016 of the health effects of cannabis on several conditions. Following consultation with experts and stakeholders, 11 conditions were identified for evidence evaluation: amyotrophic lateral sclerosis (ALS), autism, cancer, chronic pain, Crohn’s disease, epilepsy, glaucoma, HIV/AIDS, multiple sclerosis (MS), Parkinson’s disease, and posttraumatic stress disorder (PTSD). The following exclusion criteria were imposed: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome, intervention, sample size, study setting, and reported effect size. Studies classified as systematic reviews with or without meta-analysis were graded using the AMSTAR-2 tool by two raters to evaluate the quality of evidence, with additional raters to resolve cases of evidence grade disagreement. Results: A total of 438 studies were included after screening. Five completed randomized controlled trials (RCTs) were identified, and an additional 11 trials were ongoing, and 1 terminated. Cancer, chronic pain, and epilepsy were the most researched topic areas, representing more than two-thirds of all reviewed studies. The quality of evidence assessment for each condition suggests that few high-quality systematic reviews are available for most conditions, with the exceptions of MS, epilepsy, and chronic pain. In those areas, findings on chronic pain are mostly in alignment with the previous literature, suggesting that cannabis or cannabinoids are potentially beneficial in treating chronic neuropathic pain. In epilepsy, findings suggest that cannabidiol is potentially effective in reducing seizures in pediatric patients with drug-resistant Dravet and Lennox-Gastaut syndromes. In MS, recent high-quality systematic reviews did not include new RCTs, and are therefore not substantially expanding the evidence base. In sum, the most recent clinical evidence suggests that for most of the conditions assessed, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic pain), with the higher quality of evidence for epilepsy driven by FDA-approved formulations for cannabis-based seizure treatments. Conclusion: The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Barbui, T., S. Cortelazzo, M. Galli, F. Parazzini, E. Radici, and E. Rossi. "LUPUS ANTICOAGULANT AND REPEATED ABORTIONS: A CASE- CONTROL STUDY." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1643655.
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In the last few years a role of Lupus Anticoagulant (LAC) in the aetiology of repeated spontaneous abortions and intrauterine deaths has been repeatedly suggested. To quantify this association few da ta are available, since the published reports are generally based on uncontrolled and small clinical series. We have analyzed data from a case-control study conducted in Bergamo and Milan, two contiguous provinces in Lombardia, Italy. Cases were 63 women, mean age 30 years, range 23-40, with 2 or more "sine causa" spontaneous abortions (repeated abortions) admitted between March 1985 and December 1986 to the Ospedali Riuniti of Bergamo and Istituti Clinici di Perfezionamento of Milan. Controls were 63 women, mean age 32 years, range 20-49, with 1 or more live births and without spon taneous abortions, admitted to the same Institutions for neither gynaecological nor cardiovascular acute conditions. Informations were collected on sociodemographic factors, gynaecological and obstetrical data and related medical history. LAC was diagnosed according to the Working Party reccomandations (1983) and Systemic Lupus Erythematosus (SLE) according to the revised criteria of ihe American Rheumatism Association (1982). 11 out of 63 cases (17%) (95% confidence interval ranging from 9.5% to 34% based on the Poisson's approximation) were LAC positive, whereas in none of 63 controls this inhibitor was detected (X2 1adjusted for age = 10.1, p= 0.02). Similarly SLE was diagnosed in 4 cases (all having a Lupus Anticoagulant) and in none control (x2 1adjusted for age= 4.17, p=0.02). These findings confirm that LAC is associated with a positive history of repeated abortions, being present in about 10% of the cases. Conclusive estimate of relative risk is prevented by the small control gr'oup size (i.e. lack of positivity for LAC in controls), but very elevated risk (many tenfold increase) is sugge. sted.
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Doyle, Barry J., and Tim M. McGloughlin. "The Relationship Between Wall Stress and 3D Asymmetry in Repaired and Ruptured Abdominal Aortic Aneurysms." In ASME 2010 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2010. http://dx.doi.org/10.1115/sbc2010-19142.
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Abdominal aortic aneurysm (AAA) is a permanent dilation of the infrarenal aorta and is defined as having a diameter 50% greater than the original diameter. If left untreated, an AAA will continue to expand until rupture. The maximum diameter is currently the primary indicator of rupture-risk with AAAs > 5.5 cm deemed a likely to rupture. There have, however, been many reports identifying the inadequacies of the maximum diameter criterion to accurately determine the threat of rupture. It is believed by many researchers that there is a need to review the decision of surgical intervention based solely on aneurysm diameter, and rather include other relevant risk factors. These additional risk factors could, for example, include, AAA wall stress, AAA expansion rate, degree of asymmetry, presence of intraluminal thrombus (ILT), and hypertension. The addition of these parameters may aid the surgical decision-making process. A previous report by our group identified the relationship between asymmetry and posterior wall stress in patient-specific cases [1,2] and as over 80% of ruptures occur on the posterior wall [3] this finding may have significant clinical relevance. In this previous report, the study group was limited to 15 cases and asymmetry was only measured in the anterior-posterior plane. This current paper furthers this previous work by increasing the cohort to 40 cases of electively repaired AAAs and also examines 8 cases of ruptured AAAs. The methodology has been improved to now measure asymmetry in all three dimensions (3D).
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Syafi’ie, Hisyam, Hanung Prasetya, and Bhisma Murti. "Obesity and the Risk of Suicide in Adults: A Meta-Analysis." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.01.39.
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ABSTRACT Background: Some prospective studies reported that obesity is positively associated with depression. Adults with obese might have higher suicide risk, as patients with major depression disorder have a higher risk of committing suicide compared to the normal population. This study aimed to examine the association between obesity and the risk of suicide in adults. Subjects and Method: This was a meta-analysis and systematic review. The study was collected published articles from 2010 to 2020 in Google Scholar, PubMed, Springer Link, Hindawi, Clinical Key, and ProQuest electronic databases. Searching process by insert “obesity” AND “suicidal” AND “cross sectional” AND “adjusted odd ratio” keywords. The inclusion criteria were full text, in English language, cross-sectional design, and reporting adjusted odds ratio. The data were analyzed by PRISMA flow chart and Revman 5.3. Results: 4 articles reported that obesity increased the risk of suicidal ideas in adults (aOR= 1.12; 95% CI= 0.96 to 1.31; p= 0.14). Conclusion: Obesity increased the risk of suicide in adults. Keywords: obesity, suicidal Correspondence: Hisyam Syafi’ie. Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: bunghifi@gmail.com. Mobile: 081326002006. DOI: https://doi.org/10.26911/the7thicph.01.39
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Vargas-Alcaraz, Epifanio, Adrián Espinosa-Bautista, and Marcelo López-Parra. "Current Situation of Design Criteria for Intervertebral Disc Prosthesis." In ASME 2013 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/imece2013-65499.
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This paper presents the literature review on the design criteria for intervertebral disc prosthesis. The design criteria relate to the design features that intervertebral prosthesis must accomplish (i.e. fixation to bones, spine mobility, energy absorption and etcetera). The need to improve the performance has led to changes in the features which reflect in the current design criteria. Currently, the disc prosthesis technology is experiencing a generational change. The first generation was thoroughly studied while the second generation is in the clinical tests stage. During the time the first generation prostheses were applied in patients there was not a clear trend in the clinical results which produced a lack of trust and reliability in the performance of the disc prosthesis. The changes in the design features of one generation compared to the next generation are based in the deepening in the knowledge of the problem and the results obtained with the first generation prostheses. Some design criteria were identified for the first generation. These criteria were not completely characterized since there was not enough information to be used by the designer. This lack of characterization of most design criteria produced many different versions without a clear focus which help to define the basic design features of disc prostheses. This document presents the necessary information to thoroughly characterize the design criteria outlining the missing information for the design criteria found. An analysis is done of the design criteria in the second generation of prosthesis. Finally if the information contained in the design criteria is enough, the clinical results would be better focused to achieve a more repeatable, reproducible and reliable process for a total disc intervertebral prosthesis replacement as now is considered the vertebral fusion, this is a gold standard.
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Saputri, Eviana Maya. "Urgency of Violence Screening in Pregnant Women: A Scoping Review." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.03.61.
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ABSTRACT Background: Partner violence during pregnancy might contribute to the clinical conditions of pregnant women. Early assessment and supportive response are required to improve clinical diagnosis and subsequent care. This scoping review aimed to identify the partner violence screening practices of community-based health care providers in pregnant women. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selection; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The search included PubMed, Science Direct, EBSCO, Wiley Online Library, and ProQuest databases. The inclusion criteria were English-language and full-text articles published between 2010 and 2020. A total of 580 articles were obtained by the searched database. After the review process, eight articles were eligible for this review. The critical appraisal for searched articles were measured by Mix Methods Appraisal Tools (MMAT). The data were reported by the PRISMA flow chart. Results: Two articles from developing countries (Zimbabwe and Kenya) and six articles from developed countries (Australia, Norway, Italy, and Sweden) met the inclusion criteria with a mixed-method, qualitative, and quantitative (cross-sectional) studies. The existing studies revealed that violence screening in pregnant women was effective to increase awareness of violence by their partners. Screening practice had an empowering effect on women to disclose the violence experienced. Barriers to the health care providers performing partner violence screening included: lack of knowledge, experience and training, confidence in undertaking the screening, taboo cultural practices, and absence of domestic violence screening policies. Conclusion: Partner violence screening practice should be strongly considered at antenatal care visits. Further insights of community-based health care providers are required to perform effective screening. Keywords: partner violence screening, pregnant women, health care providers Correspondence: Eviana Maya Saputri. Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi No. 63, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: evianamaya34@gmail.com. Mobile: +6281367470323. DOI: https://doi.org/10.26911/the7thicph.03.61
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Nurlaili, Riftiani Nikmatul, Yulia Lanti Retno Dewi, and Rita Benya Adriani. "School-Based Intervention to Reduce the Risk of Obesity in Children: A Meta-Analysis." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.03.126.
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ABSTRACT Background: Childhood obesity remains a serious nutritional problem in both developed and developing countries. The prevalence of school-age children with obesity has increased more than ten times, from 11 million in 1975 to 124 million in 2016. One of the efforts to overcome the increase in childhood obesity is providing school-based intervention. This study aimed to estimate the effect of a school-based intervention to reduce the risk of obesity in children according to data from primary studies. Subjects and Method: This was a meta analysis and systematic review. Studies published from 2007 to 2018 were collected from Google Scholar, PubMed, BMJ, ScienceDirect, BMC, and Sage databases. Keywords used (preschool OR school) AND (intervention OR program OR prevention) AND (“children obesity” OR “children overweight”) AND “randomized control trials”. The inclusion criteria were full text, in English language, using randomized controlled trial study design, and reporting risk ratio. The selected articles were analyzed by PRISMA guideline and Revman 5.3. Results: 8 studies from China (3), Meksiko, United States (2), Portugal, and German showed that school-based intervention reduced the risk of obesity in children (RR= 0.91; CI 95%= 0.84 to 0.99; p=0.040) with (I2=35%; p=0.150). Conclusion: School-based intervention can reduce the risk of obesity in children. Keywords: school-based intervention, obesity, children Correspondence: Riftiani Nikmatul Nurlaili. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: riftiani.nurlaili@gmail.com. Mobile: 085746737137. DOI: https://doi.org/10.26911/the7thicph.03.126
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Widiyaningrum, Alfiati Nanda, Bhisma Murti, and Eti Poncorini Pamungkasari. "Effect of Meconium Stained Amniotic Fluid on The Risk of Infants Asphyxia: A Meta-Analysis." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.03.130.
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ABSTRACT Background: Meconium aspiration syndrome refers to the aspiration of meconium and amniotic fluid by the fetus. It can occur when the fetus is still in the uterus, passing through the birth canal or when it takes its first breath after birth. Meconium aspiration is a serious condition with high morbidity and mortality. This study aimed to examine the effect of meconium stained amniotic fluid on the risk of infants asphyxia. Subjects and Method: Meta analysis and systematic review was conducted by collecting published articles from PubMed, Google Scholar, Clinical Key, Science Direct, and Springer Link databases. Keywords used risk factor, asphyxia, birth asphyxia, meconium stained amniotic, meconium stained liquor, and cross sectional. The inclusion criteria were full text, using English language, using cross-sectional study design, and reporting adjusted odds ratio. The study population was infants. Intervention was meconium stained amniotic liquid with comparison clean amniotic liquid. The study outcome was asphyxia. The collected articles were selected by PRISMA flow chart. The quantitative data were analyzed by fixed effect model using Revman 5.3. Results: 7 studies from Ethiopia reported that meconium stained amniotic fluid increased the risk of asphyxia in infants 5.83 (aOR= 5.83; CI 95%= 4.15 to 8.20; p <0.001). Conclusion: Meconium stained amniotic fluid increases the risk of asphyxia in infants. Keywords: meconium, amniotic fluid, asphyxia, infants Correspondence: Alfiati Nanda Widiyaningrum. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: widiyaningruma@gmail.com. Mobile:081327524537. DOI: https://doi.org/10.26911/the7thicph.03.130
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Lestari, Yayuk Puji, and Farida Kartini. "Antenatal Service Quality: A Scoping Review." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.03.31.
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ABSTRACT Background: Maternal mortality rate (MMR) is an indicator of the success of health development in a country. The World Health Organization (WHO) has issued a series of new recommendations to improve the quality of antenatal care to reduce the risk of birth and pregnancy complications and provide a positive pregnancy experience. This study aimed to review the antenatal service quality. Subjects and Method: This was a scoping review using an electronic bibliographic database method. Articles were collected from 5 databases, namely Science Direct, PubMed, EBSCO, Wiley, and ProQuest. This study was carried out systematically from 2009 to 2019. The articles used in this scoping review were described in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flowchart. Results: Based on 10 articles out of 190 articles according to inclusion criteria, the review results showed that the quality of antenatal care was divided into physical examinations and supporting examinations carried out in antenatal care services, suggestions and infrastructure in antenatal care services, and availability of health personnel in antenatal care services. Conclusion: The quality of antenatal care services is strongly influenced by the standard of the equipment used, the standard of examination, facilities and infrastructure and the availability of health personnel. Keywords: quality, antenatal care, scoping review Correspondence: Yayuk Puji Lestari. Universitas ‘Aisyiyah Yogyakarta. Jl. Ringroad Barat No.63, Mlangi Nogotirto, Gamping, Rice Field Area, Nogotirto, Kec. Gamping, Sleman Regency 55592, Yogyakarta Special Region. Email: yayuk.pujilestari1892@gmail.com. Mobile : 085349033588. DOI: https://doi.org/10.26911/the7thicph.03.31
Reports on the topic "Review based on clinical risk criteria"
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Carney, Nancy, Tamara Cheney, Annette M. Totten, et al. Prehospital Airway Management: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepccer243.
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Objective. To assess the comparative benefits and harms across three airway management approaches (bag valve mask [BVM], supraglottic airway [SGA], and endotracheal intubation [ETI]) by emergency medical services in the prehospital setting, and how the benefits and harms differ based on patient characteristics, techniques, and devices. Data sources. We searched electronic citation databases (Ovid® MEDLINE®, CINAHL®, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus®) from 1990 to September 2020 and reference lists, and posted a Federal Register notice request for data. Review methods. Review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center Program methods guidance. Using pre-established criteria, studies were selected and dual reviewed, data were abstracted, and studies were evaluated for risk of bias. Meta-analyses using profile-likelihood random effects models were conducted when data were available from studies reporting on similar outcomes, with analyses stratified by study design, emergency type, and age. We qualitatively synthesized results when meta-analysis was not indicated. Strength of evidence (SOE) was assessed for primary outcomes (survival, neurological function, return of spontaneous circulation [ROSC], and successful advanced airway insertion [for SGA and ETI only]). Results. We included 99 studies (22 randomized controlled trials and 77 observational studies) involving 630,397 patients. Overall, we found few differences in primary outcomes when airway management approaches were compared. • For survival, there was moderate SOE for findings of no difference for BVM versus ETI in adult and mixed-age cardiac arrest patients. There was low SOE for no difference in these patients for BVM versus SGA and SGA versus ETI. There was low SOE for all three comparisons in pediatric cardiac arrest patients, and low SOE in adult trauma patients when BVM was compared with ETI. • For neurological function, there was moderate SOE for no difference for BVM compared with ETI in adults with cardiac arrest. There was low SOE for no difference in pediatric cardiac arrest for BVM versus ETI and SGA versus ETI. In adults with cardiac arrest, neurological function was better for BVM and ETI compared with SGA (both low SOE). • ROSC was applicable only in cardiac arrest. For adults, there was low SOE that ROSC was more frequent with SGA compared with ETI, and no difference for BVM versus SGA or BVM versus ETI. In pediatric patients there was low SOE of no difference for BVM versus ETI and SGA versus ETI. • For successful advanced airway insertion, low SOE supported better first-pass success with SGA in adult and pediatric cardiac arrest patients and adult patients in studies that mixed emergency types. Low SOE also supported no difference for first-pass success in adult medical patients. For overall success, there was moderate SOE of no difference for adults with cardiac arrest, medical, and mixed emergency types. • While harms were not always measured or reported, moderate SOE supported all available findings. There were no differences in harms for BVM versus SGA or ETI. When SGA was compared with ETI, there were no differences for aspiration, oral/airway trauma, and regurgitation; SGA was better for multiple insertion attempts; and ETI was better for inadequate ventilation. Conclusions. The most common findings, across emergency types and age groups, were of no differences in primary outcomes when prehospital airway management approaches were compared. As most of the included studies were observational, these findings may reflect study design and methodological limitations. Due to the dynamic nature of the prehospital environment, the results are susceptible to indication and survival biases as well as confounding; however, the current evidence does not favor more invasive airway approaches. No conclusion was supported by high SOE for any comparison and patient group. This supports the need for high-quality randomized controlled trials designed to account for the variability and dynamic nature of prehospital airway management to advance and inform clinical practice as well as emergency medical services education and policy, and to improve patient-centered outcomes.
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Lumpkin, Shamsie, Isaac Parrish, Austin Terrell, and Dwayne Accardo. Pain Control: Opioid vs. Nonopioid Analgesia During the Immediate Postoperative Period. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/con.dnp.2021.0008.
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Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to providing adequate pain relief, the predicted cost burden of an opioid-free or opioid-sparing approach is significantly less than traditional methods. Methods The following groups were considered in our inclusion criteria: those who speak the English language, all races and ethnicities, male or female, home medications, those who are at least 18 years of age and able to provide written informed consent, those undergoing inpatient or same-day surgical procedures. In addition, our scoping review includes the following exclusion criteria: those who are non-English speaking, those who are less than 18 years of age, those who are not undergoing surgical procedures while admitted, those who are unable to provide numeric pain score due to clinical status, those who are unable to provide written informed consent, and those who decline participation in the study. Data was extracted by one reviewer and verified by the remaining two group members. Extraction was divided as equally as possible among the 11 listed references. Discrepancies in data extraction were discussed between the article reviewer, project editor, and group leader. Results We identified nine primary sources addressing the use of ketamine as an alternative to opioid analgesia and post-operative pain control. Our findings indicate a positive correlation between perioperative ketamine administration and postoperative pain control. While this information provides insight on opioid-free analgesia, it also revealed the limited amount of research conducted in this area of practice. The strategies for several of the clinical trials limited ketamine administration to a small niche of patients. The included studies provided evidence for lower pain scores, reductions in opioid consumption, and better patient outcomes. Implications for Nursing Practice Based on the results of the studies’ randomized controlled trials and meta-analyses, the effects of ketamine are shown as an adequate analgesic alternative to opioids postoperatively. The cited resources showed that ketamine can be used as a sole agent, or combined effectively with reduced doses of opioids for multimodal therapy. There were noted limitations in some of the research articles. Not all of the cited studies were able to include definitive evidence of proper blinding techniques or randomization methods. Small sample sizes and the inclusion of specific patient populations identified within several of the studies can skew data in one direction or another; therefore, significant clinical results cannot be generalized to patient populations across the board.
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Johnson, Corey, Colton James, Sarah Traughber, and Charles Walker. Postoperative Nausea and Vomiting Implications in Neostigmine versus Sugammadex. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/con.dnp.2021.0005.
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Purpose/Background: Postoperative nausea and vomiting (PONV) is a frequent complaint in the postoperative period, which can delay discharge, result in readmission, and increase cost for patients and facilities. Inducing paralysis is common in anesthesia, as is utilizing the drugs neostigmine and sugammadex as reversal agents for non-depolarizing neuromuscular blockers. Many studies are available that compare these two drugs to determine if neostigmine increases the risk of PONV over sugammadex. Sugammadex has a more favorable pharmacologic profile and may improve patient outcomes by reducing PONV. Methods: This review included screening a total of 39 studies and peer-reviewed articles that looked at patients undergoing general anesthesia who received non-depolarizing neuromuscular blockers requiring either neostigmine or sugammadex for reversal, along with their respective PONV rates. 8 articles were included, while 31 articles were removed based on our exclusion criteria. These were published between 2014 and 2020 exclusively. The key words used were “neostigmine”, “sugammadex”, “PONV”, along with combinations “paralytic reversal agents and PONV”. This search was performed on the scholarly database MEDLINE. The data items were PONV rates in neostigmine group, PONV rates in sugammadex group, incidence of postoperative analgesic consumption in neostigmine group, and incidence of postoperative analgesic consumption in sugammadex group. Results: Despite numerical differences being noted in the incidence of PONV with sugammadex over reversal with neostigmine, there did not appear to be any statistically significant data in the multiple peer-reviewed trials included in our review, for not one of the 8 studies concluded that there was a higher incidence of PONV in one drug or the other of an y clinical relevance. Although the side-effect profile tended to be better in the sugammadex group than neostigmine in areas other than PONV, there was not sufficient evidence to conclude that one drug was superior to the other in causing a direct reduction of PONV. Implications for Nursing Practice: There were variable but slight differences noted between both drug groups in PONV rates, but it remained that none of the studies determined it was statically significant or clinically conclusive. This review did, however, note other advantages to sugammadex over neostigmine, including its pharmacologic profile of more efficiently reversing non-depolarizing neuromuscular blocking drugs and its more favorable pharmacokinetics. This lack of statistically significant evidence found within these studies consequentially does not support pharmacologic decision-making of one drug in favor of the other for reducing PONV; therefore, PONV alone is not a sufficient rationale for a provider to justify using one reversal over another at the current time until further research proves otherwise.
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McDonagh, Marian S., Jesse Wagner, Azrah Y. Ahmed, Benjamin Morasco, Devan Kansagara, and Roger Chou. Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain: May 2021 Update. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepccerplantpain3.
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Overview This is the third quarterly progress report for an ongoing living systematic review on cannabis and other plant-based treatments for chronic pain. The first progress report was published in January 2021 and the second in March 2021. The draft systematic review was available for public comment from May 19 through June 15, 2021, on the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care website. The systematic review synthesizes evidence on the benefits and harms of plant-based compounds (PBCs), such as cannabinoids and kratom, used to treat chronic pain, addressing concerns about severe adverse effects, abuse, misuse, dependence, and addiction. The purpose of this progress report is to describe the cumulative literature identified thus far. This report will be periodically updated with new studies as they are published and identified, culminating in an annual systematic review that provides a synthesis of the accumulated evidence. Main Points In patients with chronic (mainly neuropathic) pain with short-term treatment (4 weeks to <6 months): • Studies of cannabis-related products were grouped based on their tetrahydrocannabinol (THC) to cannabidiol (CBD) ratio using the following categories: high THC to CBD, comparable THC to CBD, and low THC to CBD. • Comparable THC to CBD ratio oral spray is probably associated with small improvements in pain severity and may be associated with small improvements in function. There was no effect in pain interference or serious adverse events. There may be a large increased risk of dizziness and sedation, and a moderate increased risk of nausea. • Synthetic THC (high THC to CBD) may be associated with moderate improvement in pain severity and increased risk of sedation, and large increased risk of nausea. Synthetic THC is probably associated with a large increased risk of dizziness. • Extracted whole-plant high THC to CBD ratio products may be associated with large increases in risk of withdrawal due to adverse events and dizziness. • Evidence on whole-plant cannabis, low THC to CBD ratio products (topical CBD), other cannabinoids (cannabidivarin), and comparisons with other active interventions was insufficient to draw conclusions. • Other key adverse event outcomes (psychosis, cannabis use disorder, cognitive deficits) and outcomes on the impact on opioid use were not reported. • No evidence on other plant-based compounds, such as kratom, met criteria for this review.
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Treadwell, Jonathan R., James T. Reston, Benjamin Rouse, Joann Fontanarosa, Neha Patel, and Nikhil K. Mull. Automated-Entry Patient-Generated Health Data for Chronic Conditions: The Evidence on Health Outcomes. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepctb38.
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Background. Automated-entry consumer devices that collect and transmit patient-generated health data (PGHD) are being evaluated as potential tools to aid in the management of chronic diseases. The need exists to evaluate the evidence regarding consumer PGHD technologies, particularly for devices that have not gone through Food and Drug Administration evaluation. Purpose. To summarize the research related to automated-entry consumer health technologies that provide PGHD for the prevention or management of 11 chronic diseases. Methods. The project scope was determined through discussions with Key Informants. We searched MEDLINE and EMBASE (via EMBASE.com), In-Process MEDLINE and PubMed unique content (via PubMed.gov), and the Cochrane Database of Systematic Reviews for systematic reviews or controlled trials. We also searched ClinicalTrials.gov for ongoing studies. We assessed risk of bias and extracted data on health outcomes, surrogate outcomes, usability, sustainability, cost-effectiveness outcomes (quantifying the tradeoffs between health effects and cost), process outcomes, and other characteristics related to PGHD technologies. For isolated effects on health outcomes, we classified the results in one of four categories: (1) likely no effect, (2) unclear, (3) possible positive effect, or (4) likely positive effect. When we categorized the data as “unclear” based solely on health outcomes, we then examined and classified surrogate outcomes for that particular clinical condition. Findings. We identified 114 unique studies that met inclusion criteria. The largest number of studies addressed patients with hypertension (51 studies) and obesity (43 studies). Eighty-four trials used a single PGHD device, 23 used 2 PGHD devices, and the other 7 used 3 or more PGHD devices. Pedometers, blood pressure (BP) monitors, and scales were commonly used in the same studies. Overall, we found a “possible positive effect” of PGHD interventions on health outcomes for coronary artery disease, heart failure, and asthma. For obesity, we rated the health outcomes as unclear, and the surrogate outcomes (body mass index/weight) as likely no effect. For hypertension, we rated the health outcomes as unclear, and the surrogate outcomes (systolic BP/diastolic BP) as possible positive effect. For cardiac arrhythmias or conduction abnormalities we rated the health outcomes as unclear and the surrogate outcome (time to arrhythmia detection) as likely positive effect. The findings were “unclear” regarding PGHD interventions for diabetes prevention, sleep apnea, stroke, Parkinson’s disease, and chronic obstructive pulmonary disease. Most studies did not report harms related to PGHD interventions; the relatively few harms reported were minor and transient, with event rates usually comparable to harms in the control groups. Few studies reported cost-effectiveness analyses, and only for PGHD interventions for hypertension, coronary artery disease, and chronic obstructive pulmonary disease; the findings were variable across different chronic conditions and devices. Patient adherence to PGHD interventions was highly variable across studies, but patient acceptance/satisfaction and usability was generally fair to good. However, device engineers independently evaluated consumer wearable and handheld BP monitors and considered the user experience to be poor, while their assessment of smartphone-based electrocardiogram monitors found the user experience to be good. Student volunteers involved in device usability testing of the Weight Watchers Online app found it well-designed and relatively easy to use. Implications. Multiple randomized controlled trials (RCTs) have evaluated some PGHD technologies (e.g., pedometers, scales, BP monitors), particularly for obesity and hypertension, but health outcomes were generally underreported. We found evidence suggesting a possible positive effect of PGHD interventions on health outcomes for four chronic conditions. Lack of reporting of health outcomes and insufficient statistical power to assess these outcomes were the main reasons for “unclear” ratings. The majority of studies on PGHD technologies still focus on non-health-related outcomes. Future RCTs should focus on measurement of health outcomes. Furthermore, future RCTs should be designed to isolate the effect of the PGHD intervention from other components in a multicomponent intervention.
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Nelson, Gena. A Systematic Review of the Quality of Reporting in Mathematics Meta-Analyses for Students with or at Risk of Disabilities Coding Protocol. Boise State University, 2021. http://dx.doi.org/10.18122/sped138.boisestate.
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The purpose of this document is to provide readers with the coding protocol that authors used to code 22 meta-analyses focused on mathematics interventions for students with or at-risk of disabilities. The purpose of the systematic review was to evaluate reporting quality in meta-analyses focused on mathematics interventions for students with or at risk of disabilities. To identify meta-analyses for inclusion, we considered peer-reviewed literature published between 2000 and 2020; we searched five education-focused electronic databases, scanned the table of contents of six special education journals, reviewed the curriculum vitae of researchers who frequently publish meta-analyses in mathematics and special education, and scanned the reference lists of meta-analyses that met inclusion criteria. To be included in this systematic review, meta-analyses must have reported on the effectiveness of mathematics-focused interventions, provided a summary effect for a mathematics outcome variable, and included school-aged participants with or at risk of having a disability. We identified 22 meta-analyses for inclusion. We coded each meta-analysis for 53 quality indicators (QIs) across eight categories based on recommendations from Talbott et al. (2018). Overall, the meta-analyses met 61% of QIs and results indicated that meta-analyses most frequently met QIs related to providing a clear purpose (95%) and data analysis plan (77%), whereas meta-analyses typically met fewer QIs related to describing participants (39%) and explaining the abstract screening process (48%). We discuss the variation in QI scores within and across the quality categories and provide recommendations for future researchers so that reporting in meta-analyses may be enhanced. Limitations of the current study are that grey literature was not considered for inclusion and that only meta-analyses were included; this limits the generalizability of the results to other research syntheses (e.g., narrative reviews, systematic reviews) and publication types (e.g., dissertations).
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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, et al. Treatments for Acute Pain: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), 2020. http://dx.doi.org/10.23970/ahrqepccer240.
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Objectives. To evaluate the effectiveness and comparative effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic therapy in patients with specific types of acute pain, including effects on pain, function, quality of life, adverse events, and long-term use of opioids. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to August 2020, reference lists, and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) of outpatient therapies for eight acute pain conditions: low back pain, neck pain, other musculoskeletal pain, neuropathic pain, postoperative pain following discharge, dental pain (surgical or nonsurgical), pain due to kidney stones, and pain due to sickle cell disease. Meta-analyses were conducted on pharmacologic therapy for dental pain and kidney stone pain, and likelihood of repeat or rescue medication use and adverse events. The magnitude of effects was classified as small, moderate, or large using previously defined criteria, and strength of evidence was assessed. Results. One hundred eighty-three RCTs on the comparative effectiveness of therapies for acute pain were included. Opioid therapy was probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stones, and might be similarly effective as NSAIDs for low back pain. Opioids and NSAIDs were more effective than acetaminophen for surgical dental pain, but opioids were less effective than acetaminophen for kidney stone pain. For postoperative pain, opioids were associated with increased likelihood of repeat or rescue analgesic use, but effects on pain intensity were inconsistent. Being prescribed an opioid for acute low back pain or postoperative pain was associated with increased likelihood of use of opioids at long-term followup versus not being prescribed, based on observational studies. Heat therapy was probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, acupressure might be effective for acute musculoskeletal pain, an opioid might be effective for acute neuropathic pain, massage might be effective for some types of postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy. Most studies had methodological limitations. Effect sizes were primarily small to moderate for pain, the most commonly evaluated outcome. Opioids were associated with increased risk of short-term adverse events versus NSAIDs or acetaminophen, including any adverse event, nausea, dizziness, and somnolence. Serious adverse events were uncommon for all interventions, but studies were not designed to assess risk of overdose, opioid use disorder, or long-term harms. Evidence on how benefits or harms varied in subgroups was lacking. Conclusions. Opioid therapy was associated with decreased or similar effectiveness as an NSAID for some acute pain conditions, but with increased risk of short-term adverse events. Evidence on nonpharmacological therapies was limited, but heat therapy, spinal manipulation, massage, acupuncture, acupressure, a cervical collar, and exercise were effective for specific acute pain conditions. Research is needed to determine the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge; effects of therapies for acute pain on non-pain outcomes; effects of therapies on long-term outcomes, including long-term opioid use; and how benefits and harms of therapies vary in subgroups.
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Harris, Gregory, Brooke Hatchell, Davelin Woodard, and Dwayne Accardo. Intraoperative Dexmedetomidine for Reduction of Postoperative Delirium in the Elderly: A Scoping Review. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/con.dnp.2021.0010.
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Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain. Methods: The authors developed eligibility criteria for inclusion of articles and performed a systematic search of several databases. Each of the authors initially selected five articles for inclusion in the scoping review. We created annotated literature tables for easy screening by co-authors. After reviewing the annotated literature table four articles were excluded, leaving 11 articles for inclusion in the scoping review. There were six level I meta-analysis/systematic reviews, four level II randomized clinical trials, and one level IV qualitative research article. Next, we created a data-charting form on Microsoft Word for extraction of data items and synthesis of results. Results: Two of the studies found no significant difference in POD between dexmedetomidine groups and control groups. The nine remaining studies noted decreases in the rate, duration, and risk of POD in the groups receiving dexmedetomidine either intraoperatively or postoperatively. Multiple studies found secondary benefits in addition to decreased POD, such as a reduction of tachycardia, hypertension, stroke, hypoxemia, and narcotic use. One study, however, found that the incidence of hypotension and bradycardia were increased among the elderly population. Implications for Nursing Practice: Surgery is a tremendous stressor in any age group, but especially the elderly population. It has been shown postoperative delirium occurs in 17-61% of major surgery procedures with 30-40% of the cases assumed to be preventable. Opioid administration in the elderly surgical population is one of the most significant risk factors for developing POD. With anesthesia practice already leaning towards opioid-free and opioid-limited anesthetic, the incorporation of dexmedetomidine could prove to be a valuable resource in both reducing opioid use and POD in the elderly surgical population. Although more research is needed, the current evidence is promising.
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Nelson, Gena. Special Education Math Interventions. Boise State University, 2021. http://dx.doi.org/10.18122/sped_facpubs/133/boisestate.
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The purpose of document is to provide readers with the coding protocol that authors used to code 22 mathematics intervention meta-analyses focused on participants with or at-risk of disabilities. The author drafted this coding protocol based on the meta-analysis quality indicators recommended by Talbott et al. (2018, pp. 248–249); specifically, the author considered the variables presented in Table 1 of Talbott et al. and supplemented the information so that the variables and definitions were specific to the purpose of this systematic review. We coded each meta-analysis for 53 variables across eight categories, including: Quality of Clear Research Questions, Quality of Eligibility Criteria, Quality of Search Procedures, Quality of Screening Criteria, Quality of Coding Procedures, Quality of Research Participants and Contexts, Quality of Data Analysis Plan, and Quality of Reporting Results. The mean interrater reliability across all codes using this protocol was 87.8% (range across categories = 74% –100%).
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McDonagh, Marian, Andrea C. Skelly, Amy Hermesch, et al. Cervical Ripening in the Outpatient Setting. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepccer238.
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Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.