Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event

addresses: Peninsula College of Medicine and Dentistry, St Luke's Campus, University of Exeter, Exeter, UK. [email protected]: PMCID: PMC3528446types: Journal Article; Research Support, Non-U.S. Gov't© 2012 Warren et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Adverse consequences of medical interventions are a source of concern, but clinical trials may lack power to detect elevated rates of such events, while observational studies have inherent limitations. Meta-analysis allows the combination of individual studies, which can increase power and provide stronger evidence relating to adverse events. However, meta-analysis of adverse events has associated methodological challenges. The aim of this study was to systematically identify and review the methodology used in meta-analyses where a primary outcome is an adverse or unintended event, following a therapeutic intervention

Intra-abdominal candidiasis: The importance of early source control and antifungal treatment

Intra-abdominal candidiasis (IAC) is poorly understood compared to candidemia. We described the clinical characteristics, microbiology, treatment and outcomes of IAC, and identified risk factors for mortality. We performed a retrospective study of adults diagnosed with IAC at our center in 2012-2013. Risk factors for mortality were evaluated using multi-variable logistic regression. We identified 163 patients with IAC, compared to 161 with candidemia. Types of IAC were intra-abdominal abscesses (55%), secondary peritonitis (33%), primary peritonitis (5%), infected pancreatic necrosis (5%), and cholecystitis/cholangitis (3%). Eighty-three percent and 66% of secondary peritonitis and abscesses, respectively, stemmed from gastrointestinal (GI) tract sources. C. albicans (56%) and C. glabrata (24%) were the most common species. Bacterial co-infections and candidemia occurred in 67% and 6% of patients, respectively. Seventy-two percent of patients underwent an early source control intervention (within 5 days) and 72% received early antifungal treatment. 100-day mortality was 28%, and highest with primary (88%) or secondary (40%) peritonitis. Younger age, abscesses and early source control were independent predictors of survival. Younger age, abscesses and early antifungal treatment were independently associated with survival for IAC stemming from GI tract sources. Infectious diseases (ID) consultations were obtained in only 48% of patients. Consulted patients were significantly more likely to receive antifungal treatment. IAC is a common disease associated with heterogeneous manifestations, which result in poor outcomes. All patients should undergo source control interventions and receive antifungal treatment promptly. It is important for the ID community to become more engaged in treating IAC

Fertility Regulation

In the past two centuries the proportion of couples using some form of conscious pregnancy-prevention has risen from close to zero to about two-thirds. In European populations this radical change in behaviour occurred largely between 1870 and 1930 without the benefit of highly effective methods. In Asia, Africa and Latin America, the change took place after 1950 since when the global fertility rate has halved from 5.0 births to 2.5 births per woman. In this chapter we describe the controversies surrounding the idea of birth control and the role of early pioneers such as Margaret Sanger; the advances in contraceptive and abortion technologies; the ways in which family planning has been promoted by many governments, particularly in Asia; trends in use of specific methods; the problems of discontinuation of use; and the incidence of unintended pregnancies and abortions

Life events in relation to psychopathology among severely and chronically ill children and adolescents

Life events were studied in three groups of severely and chronically ill patients and healthy controls in a matched group design. The amount of life events did not vary significantly between the different types of illness and the controls. Furthermore, there were no significant correlations to severity of psychiatric disorder. The analysis of the relationship between clinical parameters and life events led to some unexpected findings in need of further clarification. The usefulness of the magnitude estimation of life events is critically discussed

Metal release and corrosion effects of modular neck total hip arthroplasty

Modular neck implants are an attractive treatment tool in total hip replacement. Concerns remain about the mechanical stability and metal ion release caused by the modular connection. Five different implant designs were investigated in an experimental set-up. In vivo conditions were simulated and the long-term titanium release was measured. Finally, the modular connections were inspected for corrosion processes and signs of fretting. No mechanical failure or excessive corrosion could be identified for the implants tested. The titanium releases measured were extremely low compared to in vivo and in vitro studies and were not in a critical range

Positive Psychology and Suicide Prevention: an Introduction and Overview of the Literature

Book Summary: This inspiring resource presents theories, findings, and interventions from Positive Suicidology, an emerging strengths-based approach to suicide prevention. Its synthesis of positive psychology and suicidology theories offers a science-based framework for promoting wellbeing to complement or, if appropriate, replace traditional deficit-driven theories and therapies used in reducing suicidal thoughts and behaviors. Coverage reviews interpersonal, intrapersonal, and societal risk factors for suicide, and identifies protective factors, such as hope and resilience, that can be enhanced in therapy. From there, chapters detail a palette of approaches and applications of Positive Suicidology, from the powerful motivating forces described in Self-Determination Theory to meaning-building physical and social activities. Among the topics covered: Future-oriented constructs and their role in suicidal ideation and enactment. Gratitude as a protective factor for suicidal ideation and behavior: theory and evidence. Considering race and ethnicity in the use of positive psychological approaches to suicide. The Six R’s framework as mindfulness for suicide prevention. Community-based participatory research and empowerment for suicide prevention. Applied resiliency and suicide prevention: a strengths-based, risk-reduction framework. Psychotherapists, counselors, social workers, psychiatrists, and health psychologists, as well as educators, clergy and healthcare professionals, will find A Positive Psychological Approach to Suicide an invaluable source of contemporary evidence-based strategies for their prevention and intervention efforts with suicidal clients