Browsing by Subject "Systematic Review"

Now showing 1 - 6 of 6
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    Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis
    (BMC, 2021-10) Alhumaid, Saad; Al Mutair, Abbas; Al Alawi, Zainab; Rabaan, Ali A.; Alomari, Mohammed A.; Al Salman, Sadiq A.; Al-Alawi, Ahmed S.; Al Hassan, Mohammed H.; Alhamad, Hesham; Al-Kamees, Mustafa A.; Almousa, Fawzi M.; Mufti, Hani N.; Alwesabai, Ali M.; Dhama, Kuldeep; Al-Tawfiq, Jaffar A.; Al-Omari, Awad; Medicine, School of Medicine
    BACKGROUND: One possible reason for increased mortality due to SARS-CoV-2 in patients with diabetes is from the complication of diabetic ketoacidosis (DKA). OBJECTIVES: To re-evaluate the association of SARS-CoV-2 and development of DKA and analyse the demographic and biochemical parameters and the clinical outcomes in COVID-19 patients with DKA. DESIGN: A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. METHODS: Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature) were searched from 1 December 2019 to 30 June 2021 in the English language using the following keywords alone or in combination: COVID-19 OR SARS-CoV-2 AND diabetic ketoacidosis OR DKA OR ketosis OR ketonemia OR hyperglycaemic emergency OR hyperglycaemic crisis. We included studies in adults and children of all ages in all healthcare settings. Binary logistic regression model was used to explore the effect of various demographic and biochemical parameters variables on patient's final treatment outcome (survival or death). RESULTS: Of the 484 papers that were identified, 68 articles were included in the systematic review and meta-analysis (54 case report, 10 case series, and 4 cohort studies). Studies involving 639 DKA patients with confirmed SARS-CoV-2 [46 (7.2%) were children and 334 (52.3%) were adults] were analyzed. The median or mean patient age ranged from < 1 years to 66 years across studies. Most of the patients (n = 309, 48.3%) had pre-existing type 2 diabetes mellitus. The majority of the patients were male (n = 373, 58.4%) and belonged to Hispanic (n = 156, 24.4%) and black (n = 98, 15.3%) ethnicity. The median random blood glucose level, HbA1c, pH, bicarbonate, and anion gap in all included patients at presentation were 507 mg/dl [IQR 399-638 mg/dl], 11.4% [IQR 9.9-13.5%], 7.16 [IQR 7.00-7.22], 10 mmol/l [IQR 6.9-13 mmol/l], and 24.5 mEq/l [18-29.2 mEq/l]; respectively. Mortality rate was [63/243, 25.9%], with a majority of death in patients of Hispanic ethnicity (n = 17, 27%; p = 0.001). The odd ratios of death were significantly high in patients with pre-existing diabetes mellitus type 2 [OR 5.24, 95% CI 2.07-15.19; p = 0.001], old age (≥ 60 years) [OR 3.29, 95% CI 1.38-7.91; p = 0.007], and male gender [OR 2.61, 95% CI 1.37-5.17; p = 0.004] compared to those who survived. CONCLUSION: DKA is not uncommon in SARS-CoV-2 patients with diabetes mellitus and results in a mortality rate of 25.9%. Mortality key determinants in DKA patients with SARS-CoV-2 infection are individuals with pre-existing diabetes mellitus type 2, older age [≥ 60 years old], male gender, BMI ≥ 30, blood glucose level > 1000 mg/dl, and anion gap ≥ 30 mEq/l.
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    Hydroxychloroquine safety: A meta-analysis of randomized controlled trials
    (Elsevier, 2020-07-06) Eljaaly, Khalid; Alireza, Kasim Huseein; Alshehri, Samah; Al-Tawfiq, Jaffar A.; Medicine, School of Medicine
    Background: Hydroxychloroquine (HCQ) is currently being examined for COVID-19. No previous meta-analysis has evaluated its side effects versus placebo. We conducted this meta-analysis to compare the safety of HCQ versus placebo. Methods: Two authors independently searched PubMed and EMBASE databases for randomized controlled trials (RCTs) of adults comparing the adverse events (AEs) of HCQ versus placebo for any indication. Peto odds ratios (Peto ORs) and 95% confidence intervals (CIs) were calculated based on random-effects models. The heterogeneity (I2) was assessed using Cochran's Q test. Results: Nine RCTs (eight were double-blind) with a total of 916 patients were included. HCQ caused significantly more skin pigmentation than placebo (Peto OR, 4.64; 95% CI, 1.13 to 19.00; P-value = 0.033; I2 = 0%). The increase in other AEs did not reach statistical significance: rash (Peto OR, 1.11; 95% CI, 0.3 to 3.77; P-value = 0.03; I2 = 0%); gastrointestinal AEs (Peto OR, 1.43; 95% CI, 0.55 to 3.72; P-value = 0.46; I2 = 15.17%); headache (Peto OR, 1.94; 95% CI, 0.65 to 5.78; P-value = 0.23; I2 = 9.99%); dizziness (Peto OR, 1.32; 95% CI, 0.49 to 3.52; P-value = 0.58; I2 = 0%); fatigue (Peto OR, 2.13; 95% CI, 0.76 to 5.98; P-value = 0.15; I2 = 0%); and visual AEs (Peto OR, 1.61; 95% CI, 0.76 to 3.41; P-value = 0.22; I2 = 0%). Cardiac toxicity was not reported. Conclusions: This meta-analysis of RCTs found a significantly higher risk of skin pigmentation in HCQ users versus placebo. More data are needed to evaluate HCQ in the context of COVID-19 treatment.
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    Meta-analysis & Review of Learner Performance & Preference: Virtual vs. Optical Microscopy
    (Wiley, 2016) Wilson, Adam B.; Taylor, Melissa A.; Klein, Barbie A.; Sugrue, Megan K.; Whipple, Elizabeth C.; Brokaw, James J.; Department of Anatomy & Cell Biology, IU School of Medicine
    Background & Purpose: For nearly two decades, a wealth of literature has been published describing the various capabilities, uses, and adaptations of virtual microscopy (VM). Many studies have investigated the effects and benefits of VM on student learning compared to optical microscopy (OM). As such, this study statistically aggregated the findings of multiple comparative studies through a meta-analysis to summarize and substantiate the pedagogical efficacy of teaching with VM. Methods Using predefined eligibility criteria, teams of paired researchers screened the titles and abstracts of VM studies retrieved from seven different databases. After two rounds of screening, numerical and thematic data were extracted from the eligible studies for analysis. A summary effect size and estimate of heterogeneity were calculated to determine the effects of VM on learner performance and the amount of variance between studies, respectively. Trends in student perceptions were also analyzed and reported. Results: Of the 725 records screened, 72 studies underwent full-text review. In total, 12 studies were viable for meta-analysis and additional studies were reviewed to extract themes relating to learners’ perceptions of VM. The meta-analysis detected a small yet significant positive effect on learner performance (SMD=0.28, [CI=0.09, 0.47], p=0.003), indicating that learners experience marked knowledge gains when exposed to VM over OM. Variation among studies was evident as high heterogeneity was reported. An analysis of trends in learner perceptions noted that respondents favored VM over OM by a large margin. Conclusions: Despite many individual studies reporting non-significant findings when comparing VM to OM, the enhanced power afforded by meta-analysis revealed that the pedagogical approach of VM is modestly superior to OM and is preferred by learners.
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    The impact of narrow and tiered networks on costs, access, quality, and patient steering: A systematic review
    (Sage, 2022-10) Mazurenko, Olena; Taylor, Heather L.; Menachemi, Nir
    Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.
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    The Relationship Between Instrumental Activities of Daily Living and Hospitalizations: A Systematic Review and Meta-Analysis
    (2024-07) Collins, Jason Joseph; Newhouse, Robin P.; Levoy, Krisin; Basile, David P.; Jung, Miyeon
    Instrumental activities of daily living (IADL) have been defined as the activities for which their performance is necessary for continued independent living arrangements and that are more complex than routine activities of daily living. Evidence has reported the presence of IADL impairments in patients discharging from hospital. However, there is little research evaluating the role of IADLs as a modifiable risk factor in preventing hospitalizations among high-risk groups, such as heart failure. This oversight leaves gaps in discharge planning, in connecting patients to needed services that address impaired IADLs. The purpose of this dissertation was to improve knowledge of the relationship between IADLs and hospitalizations by: 1) describing the theory that underpins the relationship between IADLs and hospitalizations; 2) completing a systematic review to narratively synthesize the state of use of IADL scales across studies examining hospitalizations among high-risk groups (i.e., heart failure); 3) completing a meta-analysis to estimate the overall association between IADLs and hospitalizations among the high-risk groups; 4) conducting tests of moderation using meta-analytic techniques to determine whether the overall association between IADLs and hospitalizations varied based on certain IADL scale characteristics (e.g., number of components). Founded upon the Theory of Self-Care of Chronic Illness, the systematic search produced 4,932 articles, with 23 meeting criteria. The systematic review revealed that IADL discussions have been present in healthcare literature internationally since 1969; significant heterogeneity exists in the number of IADL components; the legacy work of Lawton and Brody (1969) remains prevalent but not panoptic; and IADLs have been studied in a wide variety of illnesses. The meta-analysis revealed that IADL impairments were positively associated with hospitalizations (OR=1.40, 95% CI: 1.24, 1.58; k=22, p<.001). Tests of moderation indicated that the IADL scale (QM=0.496, p=0.481) and item composition (QM=0.189, p=0.664) did not explain variation among effect sizes, indicating that the IADL scale formulation did not impact the relationship between IADLs deficits and hospitalizations. This dissertation provides compelling evidence that assessing IADLs may yield a significant opportunity to identify modifiable risk factors to reduce hospitalization. More work is needed to standardize IADL measurement at discharge to identify patients at high risk.
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    Wheeled mobility use outcomes: a systematic review protocol of measurement properties
    (Wolters Kluwer, 2024-09) Mendoza, Kiera; Loeser, Madison; Ouellet, Béatrice; Best, Krista L.; Paula, Rushton W.; Kenyon, Lisa K.; Hinrichs, Rachel J.; Chase, Tony
    Numerous tools have been developed to measure constructs related to wheelchair use. Currently, no toolkit comprehensively details assessments of wheeled mobility device use based on the quality of their measurement properties. The current review aims to systematically identify high-quality assessment tools that measure different aspects of wheeled mobility use. The objectives are two-fold: i) to synthesize outcome measures that assess use of wheeled mobility devices, and ii) to evaluate measurement properties of the assessment tools. The populations of interest are manual wheelchair users, power wheelchair users, and scooter users of any age, diagnosis, or setting. Instruments of any type will be included. The JBI methodology for systematic reviews of measurement properties will guide this review. A search strategy will be developed to search the following databases: MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), PsycTests (EBSCOhost), Web of Science, and Google Scholar. The article selection process, data extraction, and quality appraisal will be performed by 2 independent reviewers, with a third reviewer being consulted to achieve consensus. The methodological quality of the studies will be assessed through the Consensus Standards for the Selection of Measurement Instruments (COSMIN) Risk of Bias tool and the COSMIN Checklist. The quality of the pooled evidence and individual measurement properties will be graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the COSMIN Criteria for Good Measurement Properties recommendations. Measurement properties of each instrument will be described, with the goal of developing a toolkit that identifies appropriate assessment tools for wheeled mobility use outcomes.