Browsing by Subject "systematic review"

Now showing 1 - 12 of 12
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    Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Language Recovery in Poststroke Survivors With Aphasia: An Updated Meta-analysis.
    (Neurorehabilitation and neural repair, 2021-05-25) Hong, Zhongqiu; Zheng, Haiqing; Luo, Jing; Yin, Mingyu; Ai, Yinan; Deng, Baomei; Feng, Wuwei; Hu, Xiquan
    The effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on treating poststroke aphasia (PSA) remain inconclusive. We aimed to evaluate the efficacy and safety of LF-rTMS on language function poststroke and determine potential factors that may affect treatment effects. Electronic databases, including MEDLINE, EMBASE, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs) concerning the effects of LF-rTMS on language performance poststroke. We adopted fixed- and random-effects models to estimate intervention effects, which were represented by the Hedges' g and 95% CIs. Subgroup analyses regarding several factors potentially influencing the effects of LF-rTMS on language recovery were also conducted. A total of 14 RCTs involving 374 participants were included in the meta-analysis. The pooled analysis showed the positive and significant effects of LF-rTMS on language function, both short-term (Hedges' g = 0.65; P < .05) and long-term (Hedges' g = 0.46; P < .05). Subgroup analyses demonstrated that LF-rTMS for 20 minutes per day over 10 days yielded the largest effect size (Hedges' g = 1.02; P < .05) and that LF-rTMS significantly improved language performance in the chronic stage after stroke (Hedges' g = 0.55; P < .05). Patients with different native languages might have diverse responses to LF-rTMS treatment efficacy. Additionally, there were significant improvements in language subtests, including naming, repetition, comprehension, and writing. Overall, this updated meta-analysis demonstrated that LF-rTMS has significant positive effects on PSA, with moderate treatment effects. It provides additional evidence to support LF-rTMS as a promising complementary therapy to promote language recovery in PSA.
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    Global distribution of Leptospira serovar isolations and detections from animal host species: a systematic review and online database.
    (medRxiv, 2023-10-03) Hagedoorn, Nienke N; Maze, Michael J; Carugati, Manuela; Cash-Goldwasser, Shama; Allan, Kathryn J; Chen, Kevin; Cossic, Brieuc; Demeter, Elena; Gallagher, Sarah; German, Richard; Galloway, Renee L; Habuš, Josipa; Rubach, Matthew P; Shiokawa, Kanae; Sulikhan, Nadezhda; Crump, John A
    OBJECTIVES: Leptospira, the spirochaete causing leptospirosis, can be classified into >250 antigenically distinct serovars. Although knowledge of the animal host species and geographic distribution of Leptospira serovars is critical to understand the human and animal epidemiology of leptospirosis, currently data are fragmented. We aimed to systematically review the literature on animal host species and geographic distribution of Leptospira serovars to examine associations between serovars with animal host species and regions, and to identify geographic regions in need of study. METHODS: Nine library databases were searched from inception through 9 March 2023 using keywords including Leptospira, animal, and a list of serovars. We sought reports of detection of Leptospira, from any animal, characterized by cross agglutinin absorption test, monoclonal antibody typing, serum factor analysis, or pulsed-field gel electrophoresis to identify the serovar. RESULTS: We included 409 reports, published from 1927 through 2022, yielding data on 154 Leptospira serovars. The reports included data from 66 (26.5%) of 249 countries. Detections were from 144 animal host species including 135 (93.8%) from the class Mammalia, 5 (3.5%) from Amphibia, 3 (2.1%) from Reptilia, and 1 (0.7%) from Arachnida. Across the animal host species, Leptospira serovars that were detected in the largest number of animal species included Grippotyphosa (n=39), Icterohaemorrhagiae (n=29), Pomona (n=28), Australis (n=25), and Ballum (n=25). Of serovars, 76 were detected in a single animal host species. We created an online database to identify animal host species for each serovar by country. CONCLUSIONS: We found that many countries have few or no Leptospira serovars detected from animal host species and that many serovars were detected from a single animal species. Our study highlights the importance of efforts to identify animal host species of leptospirosis, especially in places with a high incidence of human leptospirosis. We provide an updated resource for leptospirosis researchers.
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    Multicomponent interventions for enhancing primary care: a systematic review.
    (The British journal of general practice : the journal of the Royal College of General Practitioners, 2021-01) Jimenez, Geronimo; Matchar, David; Koh, Gerald Choon-Huat; Car, Josip

    Background

    Many countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes.

    Aim

    To identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success - that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes).

    Design and setting

    Systematic review and narrative synthesis.

    Method

    Electronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the '4Cs' (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form.

    Results

    From 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes.

    Conclusion

    Most analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.
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    Multivariable risk scores for predicting short term outcomes for emergency department patients with unexplained syncope: a systematic review.
    (Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2020-12-31) Sweanor, Rachel AL; Redelmeier, Robert J; Simel, David L; Albassam, Omar T; Shadowitz, Steven; Etchells, Edward E

    Objectives

    Emergency department patients with unexplained syncope are at risk of experiencing an adverse event within 30 days. Our objective was to systematically review the accuracy of multivariate risk stratification scores for identifying adult syncope patients at high and low risk of an adverse event over the next 30 days.

    Methods

    We conducted a systematic review of electronic databases (MEDLINE, Cochrane, Embase and CINAHL) from database creation until May 2020. We sought studies evaluating prediction scores of adults presenting to an emergency department with syncope. We included studies that followed patients for up to 30 days to identify adverse events such as death, myocardial infarction, stroke, or cardiac surgery. We only included studies with a blinded comparison between baseline clinical features and adverse events. We calculated likelihood ratios and confidence intervals.

    Results

    We screened 13,788 abstracts. We included 17 studies evaluating nine risk stratification scores on 24,234 patient visits, where 7.5% (95% CI 5.3-10%) experienced an adverse event. A Canadian Syncope Risk Score of 4 or more was associated with a high likelihood of an adverse event (LR score=4 or more 11 [95% CI 8.9-14). A Canadian Syncope Risk Score of 0 or less (LR Score = 0 or less 0.10 [95% CI 0.07-0.20]) was associated with a low likelihood of an adverse event. Other risk scores were not validated on an independent sample, had low positive likelihood ratios for identifying patients at high risk, or had high negative likelihood ratios for identifying patients at low risk.

    Conclusion

    Many risk stratification scores are not validated or not sufficiently accurate for clinical use. The Canadian Syncope Risk Score is an accurate validated prediction score for emergency department patients with unexplained syncope. Its impact on clinical decision making, admission rates, cost or outcomes of care is not known.
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    PD-L1/PD-1 Biomarker for Metastatic Urothelial Cancer that Progress Post-platinum Therapy: A Systematic Review and Meta-analysis.
    (Bladder cancer (Amsterdam, Netherlands), 2019-11-22) Tan, Wei Phin; Tan, Wei Shen; Inman, Brant A

    Background

    Immune checkpoint inhibitors (ICI) are extremely expensive and most patients with metastatic urothelial carcinoma (mUC) do not benefit significantly from their use.

    Objective

    We performed a systematic review and meta-analysis to determine response rates and survival outcomes on patients with mUC progressing despite prior platinum-based chemotherapy receiving ICI stratified by biomarker status.

    Methods

    We performed a comprehensive literature search for all articles in PubMed and Embase up to 06/15/2019 to identify all studies pertaining to programmed death-ligand 1 (PD-L1) and programmed death 1 (PD-1) receptor targeted therapies for mUC that reported biomarkers. Given that biomarkers are reported on different scales and with different metrics, we defined each biomarker as either positive or negative using the definitions implemented in each individual trial. We meta-analyzed the data, reconstructed overall (OS) and progression-free survival (PFS) curves, and analyzed response rates by biomarker status. OS and PFS were analyzed in a pooled Kaplan-Meier analysis and pseudo-individualized patient data (IPD) extracted.

    Results

    We identified 1429 manuscripts of which 8 met inclusion criteria, with a total of 1837 treated patients with outcomes data. On proportional hazards survival analysis, patients in the biomarker negative group were associated with a lower PFS (HR 1.48, 95% CI: 1.18 - 1.85, p < 0.001) and lower OS (HR 1.54, 95% CI: 1.32 - 1.80, p < 0.001) when compared to the biomarker positive group. Response data was available for 1641 patients and random effects proportion show complete response in 8% and 3% in biomarker positive and negative patients, respectively.

    Conclusions

    ICI therapy for metastatic UC post platinum therapy has a higher overall response rate, OS and PFS in patients who are biomarker positive compared to those who are negative. However, some patients who are biomarker negative do achieve complete responses. A better biomarker for patient selection is essential before biomarkers can be used to stratify candidates for ICI therapy.
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    Prediction models for depression risk among older adults: systematic review and critical appraisal.
    (Ageing research reviews, 2022-11) Tan, Jie; Ma, Chenxinan; Zhu, Chonglin; Wang, Yin; Zou, Xiaoshuang; Li, Han; Li, Jiarun; He, Yanxuan; Wu, Chenkai

    Objective

    To provide an overview of prediction models for the risk of major depressive disorder (MDD) among older adults.

    Methods

    We conducted a systematic review combined with a meta-analysis and critical appraisal of published studies on existing geriatric depression risk models.

    Results

    The systematic search screened 23,378 titles and abstracts; 14 studies including 20 prediction models were included. A total of 16 predictors were selected in the final model at least twice. Age, physical health, and cognitive function were the most common predictors. Only one model was externally validated, two models were presented with a complete equation, and five models examined the calibration. We found substantial heterogeneity in predictor and outcome definitions across models; important methodological information was often missing. All models were rated at high or unclear risk of bias, primarily due to methodological limitations. The pooled C-statistics of 12 prediction models was 0.83 (95%CI=0.77-0.89).

    Conclusion

    The usefulness of all models remains unclear due to several methodological limitations. Future studies should focus on methodological quality and external validation of depression risk prediction models.
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    Strategies to Scale-Up Global Access and Uptake of Hearing Screening: A Systematic Review
    (2023-04-18) Cionfolo, Haley
    I. ABSTRACT Introduction: Although interventions to address hearing loss exist, access is inequitably distributed across geographic, socioeconomic, and racial axes globally. We sought to determine which scale-up strategies could be useful to bolster the uptake of hearing screening to reduce the global burden of hearing loss. We then provide targeted policy recommendations to aid the implementation of these strategies. Methods: After evaluating articles from five databases using our inclusion/exclusion criteria, we extracted qualitative and statistical evidence related to the uptake of neonatal, child, and adult hearing screening (NHS, CHS, and AHS), specifically their use, adherence, and satisfaction. Two reviewers independently assessed article quality using the Mixed Methods Appraisal Tool (2018). We then categorized and compared the success of interventions. Results: Of the 225 articles screened, 29 studies fit our inclusion criteria. Of the 29 articles, 18 describe findings targeting NHS scale-up interventions, five CHS, four AHS, one NHS/CHS, and one CHS/AHS. Interventions assessed were educational (n=3), policy and systemic (n=3), telehealth (n=2), financial and funding (n=2), expanded screening (n=6), and restructured screening programs (n=7). The evidence from these articles suggests that restructure screening programs, the most documented intervention type, could be the most effective in increasing uptake generally and across HIC and UMIC settings, with no null results. Discussion: We recommend policies and interventions that restructure screening programs or expand their reach as strong options to allocate resources toward in both high- and low-resource settings, relative to existing intervention types previously attempted. More research pertaining to scale-up, especially in lower-income settings, is necessary, however, to make the most appropriate recommendations.
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    The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review.
    (Journal of medical Internet research, 2021-01-11) Jimenez, Geronimo; Matchar, David; Koh, Choon Huat Gerald; van der Kleij, Rianne; Chavannes, Niels H; Car, Josip

    Background

    Several countries around the world have implemented multicomponent interventions to enhance primary care, as a way of strengthening their health systems to cope with an aging chronically ill population and rising costs. Some of these efforts have included technology-based enhancements as one of the features to support the overall intervention, but their details and impacts have not been explored.

    Objective

    This study aimed to identify the role of digital/health technologies within wider multifeature interventions that are aimed at enhancing primary care, and to describe their aims and stakeholders, types of technologies used, and potential impacts.

    Methods

    A systematic review was performed following Cochrane guidelines. An electronic search, conducted on May 30, 2019, was supplemented with manual and grey literature searches in December 2019, to identify multicomponent interventions that included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive narrative synthesis was used for analysis and presentation of the results.

    Results

    Of 37 articles, 14 (38%) described the inclusion of a technology-based innovation as part of their multicomponent interventions to enhance primary care. The most commonly identified technologies were the use of electronic health records, data monitoring technologies, and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased primary care visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed.

    Conclusions

    Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing primary care, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving primary care. Stronger policy and financial support, and advocacy of key stakeholders are needed to encourage the introduction of efficient technological innovations, which are backed by evidence-based research, so that digital technologies can fulfill the promise of supporting strong sustainable primary care.
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    Timing of Decompression in Patients With Acute Spinal Cord Injury: A Systematic Review.
    (Global spine journal, 2017-09-05) Wilson, Jefferson R; Tetreault, Lindsay A; Kwon, Brian K; Arnold, Paul M; Mroz, Thomas E; Shaffrey, Christopher; Harrop, James S; Chapman, Jens R; Casha, Steve; Skelly, Andrea C; Holmer, Haley K; Brodt, Erika D; Fehlings, Michael G
    Systematic review.To conduct a systematic review and synthesis of the literature to assess the comparative effectiveness, safety, and cost-effectiveness of early (≤24 hours) versus late decompression (>24 hours) in adults with acute spinal cord injury (SCI).A systematic search was conducted of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar to identify studies published through November 6, 2014. Studies published in any language, in humans, and with an abstract were considered for inclusion. Included studies were critically appraised and the overall strength of evidence was determined using methods proposed by the Grading of Recommendation Assessment, Development and Evaluation working group.The search yielded 449 potentially relevant citations. Sixteen additional primary studies were identified through other sources. Six studies met inclusion criteria. All but 2 studies were considered to have moderately high risk of bias. Across studies and injury levels, the impact of early surgical decompression (≤24 hours) on clinically important improvement in neurological status was variable. Isolated studies reported statistically significant and clinically important improvements at 6 months (cervical injury, low strength of evidence) and following discharge from inpatient rehabilitation (all levels, very low strength of evidence) but not at other time points; another study observed a statistically significant 6 point improvement in ASIA Impairment Scale (AIS) among patients with AIS B, C, or D, but not for those with AIS A (very low strength of evidence). In one study of acute central cord syndrome without instability, a clinically and statistically meaningful improvement in total motor scores was reported at 6 and 12 months in patients treated early (versus late). There were, however, no significant differences in AIS improvement between early and late surgical groups at 6- or 12-months (very low strength of evidence). One of 3 studies found a shorter length of hospital stay associated with early surgical decompression. Of 3 studies reporting on safety, no significant differences in rates of complications (including mortality, neurologic deterioration, pneumonia or pressure ulcers) were noted between early and late decompression groups.Results surrounding the efficacy of early versus late decompressive surgery, as well as the quality of evidence available, were variable depending on the level of SCI, timing of follow-up, and specific outcome considered. Existing evidence supports improved neurological recovery among cervical SCI patients undergoing early surgery; however, evidence regarding remaining SCI populations and clinical outcomes was inconsistent.
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    Treatment-Related Adverse Events of Chimeric Antigen Receptor T-Cell (CAR T) in Clinical Trials: A Systematic Review and Meta-Analysis.
    (Cancers, 2021-08-03) Lei, Wen; Xie, Mixue; Jiang, Qi; Xu, Nengwen; Li, Ping; Liang, Aibin; Young, Ken H; Qian, Wenbin
    Chimeric antigen receptors T (CAR-T) cell therapy of cancer is a rapidly evolving field. It has been shown to be remarkably effective in cases of hematological malignancies, and its approval by the FDA has significantly increased the enthusiasm for wide clinical usage and development of novel CAR-T therapies. However, it has also challenged physicians and investigators to recognize and deal with treatment-associated toxicities. A total of 2592 patients were included from 84 eligible studies that were systematically searched and reviewed from the databases of PubMed, de, the American Society of Hematology and the Cochrane Library. The meta-analysis and subgroup analysis by a Bayesian logistic regression model were used to evaluate the incidences of therapy-related toxicities such as cytokine release syndrome (CRS) and neurological symptoms (NS), and the differences between different targets and cancer types were analyzed. The pooled all-grade CRS rate and grade ≥ 3 CRS rate was 77% and 29%, respectively, with a significantly higher incidence in the hematologic malignancies (all-grade: 81%; grade ≥ 3: 29%) than in solid tumors (all-grade: 37%; grade ≥ 3: 19%). The pooled estimate NS rate from the individual studies were 40% for all-grade and 28% for grade ≥ 3. It was also higher in the hematologic subgroup than in the solid tumors group. The subgroup analysis by cancer type showed that higher incidences of grade ≥ 3 CRS were observed in anti-CD19 CAR-T therapy for ALL and NHL, anti-BCMA CAR-T for MM, and anti-CEA CAR-T for solid tumors, which were between 24-36%, while higher incidences of grade ≥ 3 NS were mainly observed in CD19-ALL/NHL (23-37%) and BCMA-MM (12%). Importantly, subgroup analysis on anti-CD19 CAR-T studies showed that young patients (vs. adult patients), allologous T cell origin (vs. autologous origin), gamma retrovirus vector, and higher doses of CAR-T cells were associated with high-grade CRS. On the other hand, the patients with NHL (vs ALL), administered with higher dose of CAR-T, and adult patients (vs. young patients) had an increased incidence of grade ≥ 3 NS events. This study offers a comprehensive summary of treatment-related toxicity and will guide future clinical trials and therapeutic designs investigating CAR T cell therapy.
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    Wildlife in the Southern Blue Ridge Ecoregion: Assessing Management Impacts and Establishing Regional Monitoring Efforts
    (2016-04-28) Wojcik, Meredith; Mason, Sara; Sowers, Mark; Le, Markus
    The Southern Blue Ridge Mountains are biologically important, harboring many rare and endangered species and high levels of biodiversity. A history of fire suppression in the region has led to loss of biodiversity through the decline of fire-reliant ecosystems. Forest managers have accelerated the reintroduction of fire into the Southern Blue Ridge, but could benefit from more evidence-based information about the effects that fires, and other related management activities, could have on the region’s wildlife. By performing a systematic review and meta-analysis of relevant literature we summarize the impacts that various management activities have on the abundance and diversity of wildlife taxa in this region. Using our analysis we also provide suggestions for collaborative regional wildlife monitoring, highlighting species and taxa that are most sensitive to management.