Exploratory subgroup analysis, CWEP vs. control in different degrees of contamination.

<p>A clean surgeries; B clean-contaminated surgeries; C contaminated surgeries; D dirty-infected surgeries.</p

Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

<div><p>Importance</p><p>Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.</p><p>Objective</p><p>To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.</p><p>Evidence Review</p><p>A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.</p><p>Findings</p><p>We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I² = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I² = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I² = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I² = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I² = 72%).</p><p>Conclusions and Relevance</p><p>Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations.</p></div

Flow diagram of studies selected according to PRISMA guidelines [34].

<p>Flow diagram of studies selected according to PRISMA guidelines [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121187#pone.0121187.ref034" target="_blank">34</a>].</p

Individual trial data, pooled effect estimates and forest plot of the 16 randomized-controlled trials included in the meta-analysis.

<p>CWEPs vs. control with SSI as outcome parameter (RevMan 5.2 output).</p

Endpoints, surgical site infections and outcomes of included studies. NR: not recorded.

<p>Endpoints, surgical site infections and outcomes of included studies. NR: not recorded.</p

Characteristics of the included studies with description of intervention and control, risk factors for surgical site infections and level of contamination.

<p>NR: not recorded. * unclear whether trial was single center or performed at two trial sites.</p><p>Characteristics of the included studies with description of intervention and control, risk factors for surgical site infections and level of contamination.</p

Additional file 1: of Parenteral nutrition during neoadjuvant chemotherapy for patients with non-metastatic gastric or esophago-gastric cancer to reduce postoperative morbidity (PERCOG): study protocol for a randomized controlled trial

SPIRIT 2013 checklist. (PDF 104 kb

Search strategy for MEDLINE via OvidSP.

<p>Search strategy for MEDLINE via OvidSP.</p

Depressive Symptoms and the Risk of Ischemic Stroke in the Elderly—Influence of Age and Sex

<div><p>Although a relationship between depression and cardiovascular events has been suggested, past study results regarding the risk of stroke in relation to depression by subgroups are ambiguous. The aim of this study was to investigate the influence of depressive symptoms on risk of incident ischemic stroke in elderly according to age and sex. This prospective cohort study followed up 3852 subjects older than 55 years. Baseline depressive symptoms were defined by a score ≥5 on the Geriatric Depression Scale or antidepressant intake. The outcome measure was incident ischemic stroke within 6 years of follow-up. Multivariate Cox-proportional hazard models as well as cumulative survival analyses were computed. A total of 156 ischemic strokes occurred during the study period (24 strokes in the age-group<65 years and 132 strokes in the age-group≥65 years). The distribution of strokes in sex-subgroups was 4.5% in men and 3.7% in women. The multivariate analysis showed an elevated stroke risk (Hazard Ratio (HR): 2.84, 95% CI 1.11–7.29, p = 0.030) in subjects from 55 to 64 years with depressive symptoms at baseline but not in subjects older than 65 years. In the multivariate analysis according to sex the risk was increased in women (HR: 1.62, 95% CI 1.02–2.57, P = 0.043) but not in men. The Cox-regression model for interaction showed a significant interaction between age and sex (HR: 3.24, 95% CI 1.21–8.69, P = 0.020). This study corroborates that depressive symptoms pose an important risk for ischemic stroke, which is particularly remarkable in women and patients younger than 65 years.</p> </div

Sex-dependent multivariate Cox-PH Model for the Risk of Stroke in Subjects With and Without Depression (GDS ≥5)/Antidepressant Medication, Adjusted for Known Risk Factors^*.

*<p>Adjusted for age, sex, BMI, smoking, hypertension, diabetes, hyperlipidemia, previous myocardial infarction, previous TIA, previous stroke, history of atrial fibrillation, and physical activity.</p><p>HR, hazard ratio.</p