Background: Nearly 30% of all exacerbations of COPD do not have a clear etiology. Although pulmonary embolism (PE) can exacerbate respiratory
symptoms such as dyspnea and chest pain, and COPD ...patients are at a high risk for PE due to a variety of factors including
limited mobility, inflammation, and comorbidities, the prevalence of PE during exacerbations is uncertain.
Methods: A systematic review of the literature was performed to determine the reported prevalence of PE in acute exacerbations of
COPD in patients who did and did not require hospitalization. The literature search was performed using MEDLINE, CINAHL, and
EMBASE, and complemented by hand searches of bibliographies. Only cross-sectional or prospective studies that used CT scanning
or pulmonary angiography for PE diagnosis were included.
Results: Of the 2,407 articles identified, 5 met the inclusion criteria (sample size, 550 patients). Overall, the prevalence of PE
was 19.9% (95% confidence interval CI, 6.7 to 33.0%; p = 0.014). In hospitalized patients, the prevalence was higher at
24.7% (95% CI, 17.9 to 31.4%; p = 0.001) than those who were evaluated in the emergency department (3.3%). Presenting symptoms
and signs were similar between patients who did and did not have PE.
Conclusions: One of four COPD patients who require hospitalization for an acute exacerbation may have PE. A diagnosis of PE should be
considered in patients with exacerbation severe enough to warrant hospitalization, especially in those with an intermediate-to-high
pretest probability of PE.
Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale.
To estimate the worldwide incidence and ...mortality of sepsis and identify knowledge gaps based on available evidence from observational studies.
We systematically searched 15 international citation databases for population-level estimates of sepsis incidence rates and fatality in adult populations using consensus criteria and published in the last 36 years.
The search yielded 1,553 reports from 1979 to 2015, of which 45 met our criteria. A total of 27 studies from seven high-income countries provided data for metaanalysis. For these countries, the population incidence rate was 288 (95% confidence interval CI, 215-386; τ = 0.55) for hospital-treated sepsis cases and 148 (95% CI, 98-226; τ = 0.99) for hospital-treated severe sepsis cases per 100,000 person-years. Restricted to the last decade, the incidence rate was 437 (95% CI, 334-571; τ = 0.38) for sepsis and 270 (95% CI, 176-412; τ = 0.60) for severe sepsis cases per 100,000 person-years. Hospital mortality was 17% for sepsis and 26% for severe sepsis during this period. There were no population-level sepsis incidence estimates from lower-income countries, which limits the prediction of global cases and deaths. However, a tentative extrapolation from high-income country data suggests global estimates of 31.5 million sepsis and 19.4 million severe sepsis cases, with potentially 5.3 million deaths annually.
Population-level epidemiologic data for sepsis are scarce and nonexistent for low- and middle-income countries. Our analyses underline the urgent need to implement global strategies to measure sepsis morbidity and mortality, particularly in low- and middle-income countries.
This research aims to analyze the effect size of using the Project-Based Learning (PjBL) model on problem-solving abilities in mathematics learning and investigate the effect size based on ...educational levels. The research method employed is quantitative with meta-analysis, aiming to summarize, evaluate, and integrate the results of several published studies. Data collection techniques involve documentary studies by searching national and international journals published between 2015 and 2023. A total of 24 studies met the predetermined inclusion and exclusion criteria, and the effect sizes of each study were calculated. Subsequently, the overall average effect size and effect sizes based on educational levels were calculated. Data analysis was conducted using JASP software version 0.18.1.0. The results of this research indicate that the effect size of the Project-Based Learning model on problem-solving abilities in mathematics learning is significantly large, with an effect size of 0.973. Furthermore, statistically significant differences were reported in the effect sizes of the PjBL model on problem-solving abilities in mathematics learning across educational levels. The implementation of the PjBL model has a very large effect size on problem-solving abilities in mathematics learning for elementary, and college-level students. Meanwhile, at junior high school and the senior high school level, the PjBL model on problem-solving abilities in mathematics learning has a large and amoderate effect size.
Background: During the past decade, an increasing number of prospective studies have focused on the association between vitamin D and cardiovascular disease (CVD). However, the evidence on the ...relation between serum 25-hydroxyvitamin D 25(OH)D and the risk of overt CVD is inconclusive.
Objective: We performed a dose-response meta-analysis to summarize and prospectively quantify the RR of low serum 25(OH)D concentration and total CVD (events and mortality).
Design: We identified relevant studies by searching PubMed and EMBASE up to December 2015 and by hand-searching reference lists. Prospective studies based on the general population and reported RRs and 95% CIs were included. A random-effects model was used to calculate the pooled RRs. Nonlinear association was assessed by using restricted cubic spline analyses.
Results: A total of 34 publications with 180,667 participants were eligible for the meta-analysis. We included 32 publications (27 independent studies) for total CVD events and 17 publications (17 independent studies) for CVD mortality. We observed an inverse association between serum 25(OH)D and total CVD events and CVD mortality, and the pooled RRs per 10-ng/mL increment were 0.90 (95% CI: 0.86, 0.94) for total CVD events and 0.88 (95% CI: 0.80, 0.96) for CVD mortality. A nonlinear association was detected for total CVD events (P-nonlinear < 0.001) and CVD mortality (P-nonlinear = 0.022).
Conclusion: Serum 25(OH)D concentration was inversely associated with total CVD events and CVD mortality from the observed studies.
An Evidence-Based Approach to Scoping Reviews Khalil, Hanan; Peters, Micah; Godfrey, Christina M. ...
Worldviews on evidence-based nursing,
04/2016, Letnik:
13, Številka:
2
Journal Article
Recenzirano
ABSTRACT
Objective
Scoping reviews are used to assess the extent of a body of literature on a particular topic, and often to ensure that further research in that area is a beneficial addition to ...world knowledge. The aim of this paper reports upon the development of a methodology for scoping reviews based upon the Arksey and O'Malley framework, the Levac, Colquhoun, and O'Brien, and the Joanna Briggs Institute methods of evidence synthesis.
Methods
A working group consisting of members of the Joanna Briggs collaborating organizations met to discuss the proposed framework for the methodology and develop a draft for the scoping review methodology based on the Arksey and O'Malley framework and the work of Levac et al. This was followed by a workshop attended by other members of the organizations consisting of 30 international researchers to discuss the proposed methodology. Further refinement of the methodology was undertaken as a result of the feedback received from the workshop.
Results
The development of the methodology focused on five stages of the protocol and review development. These were identifying the research question by clarifying and linking the purpose and research question, identifying the relevant studies using a three‐step literature search in order to balance feasibility with breadth and comprehensiveness, careful selection of the studies to using a team approach, charting the data and collating the results to identify the implications of the study findings for policy, practice, or research.
Linking Evidence to Action
The current methodology recommends including both quantitative and qualitative research, as well as evidence from economic and expert opinion sources to answer questions of effectiveness, appropriateness, meaningfulness and feasibility of health practices and delivery methods. The proposed framework has the potential to provide options when faced with complex concepts or broad research questions.
To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density ...lipoprotein cholesterol (LDL-C) goal achievement.
An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% 95% confidence interval (CI) 52-56 achieved their risk-based 2016 goal and 33% (95% CI 32-35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate-high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination).
Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.
Hazard ratios for cause-specific death were calculated according to baseline diabetes status or fasting glucose level. In addition to its association with vascular disease, diabetes was associated ...with premature deaths from a number of diseases and disorders, independent of several major risk factors.
The presence of diabetes mellitus approximately doubles the risk of a wide range of vascular diseases.
1
Evidence is also emerging that diabetes is associated with nonvascular conditions, including positive associations with certain cancers (e.g., liver cancer) and negative associations with other cancers (e.g., prostate cancer).
2
–
4
However, a joint consensus statement of the American Diabetes Association and the American Cancer Society indicated that it is unclear whether such associations are direct (e.g., due to hyperglycemia) or indirect (e.g., due to diabetes as a marker of underlying biologic factors such as insulin resistance or hyperinsulinemia that alter the risk of cancer) . . .
Restoration of postoperative urinary continence after robot-assisted radical prostatectomy (RARP) is affected by diverse factors. We compared the pad-free and positive margin rates of patients who ...underwent RARP with or without bladder neck sparing (BNS) for prostate cancer. During this systematic review and metaanalysis, we performed an electronic search of the Web of Science, Embase, Cochrane Central Register of Controlled Trials, and PubMed to find original articles comparing RARP with and without BNS for prostate cancer. We identified six studies (2,351 patients in total) who underwent RARP with or without BNS. A metaanalysis of the pad-free rate at 3 months was performed. The overall pad-free rate at 3 months for patients who underwent RARP with BNS was significantly higher than that of patients who underwent RARP alone (control group) (odds ratio, 1.86; 95% confidence interval CI, 1.22–2.82), with high heterogeneity (P = 0.005; I2 = 67.45%). The pad-free rates at 7 days, 6 months, and 1 year and positive surgical margin rates of patients who underwent BNS were not significantly different than those in the control group. Although no statistical difference was observed, the catheterization period of the BNS group was shorter than that of the control group (standardized mean difference = −0.08; 95% CI, −0.16 to 0.01). Although RARP with BNS did not affect the long-term outcome of continence, it had a significant effect on the early recovery of continence.
Metaanalyses of randomized controlled trials have reported contradictory results about the effect of aspirin in the prevention of preeclampsia, both in terms of the gestational age at the onset of ...treatment and the dose of the drug. The controversy may be resolved by a metaanalysis that includes several recently published trials and particularly the large Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention trial and by examination of whether there is a difference of the effect of aspirin on preterm vs term preeclampsia.
We performed a systematic review and metaanalysis that evaluated the prophylactic effect of aspirin during pregnancy.
We completed a literature search through PubMed, Cinhal, Embase, Web of Science, and Cochrane library from 1985 to June 2017. Relative risks with random effect were calculated with their 95% confidence intervals.
Sixteen trials that included 18,907 participants provided data for preterm and term preeclampsia. Eight of the included studies were evaluated as being of good quality, and the other 8 studies were deemed to be of poor or uncertain quality. There was high heterogeneity within studies (I2 >50%) for preterm and term preeclampsia, but no heterogeneity was found in the subgroup of preterm preeclampsia when the onset of treatment was ≤16 weeks of gestation and the daily dose of aspirin was ≥100 mg (I2=0%). Administration of aspirin was associated with reduction in the risk of preterm preeclampsia (relative risk, 0.62; 95% confidence interval, 0.45–0.87), but there was no significant effect on term preeclampsia (relative risk, 0.92; 95% confidence interval, 0.70–1.21). The reduction in preterm preeclampsia was confined to the subgroup in which aspirin was initiated at ≤16 weeks of gestation and at a daily dose of ≥100 mg (relative risk, 0.33; 95% confidence interval, 0.19–0.57). This effect was also observed in the high-quality studies. The reduction in preterm preeclampsia that was observed in the largest trial (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention; n=1620; relative risk, 0.38; 95% confidence interval, 0.20–0.72) was similar to that in the 5 smaller trials in which aspirin was initiated at ≤16 weeks of gestation and at a daily dose of ≥100 mg (n=639; relative risk, 0.22; 95% confidence interval, 0.07–0.66).
Aspirin reduces the risk of preterm preeclampsia, but not term preeclampsia, and only when it is initiated at ≤16 weeks of gestation and at a daily dose of ≥100 mg.
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