Self‐management education interventions for persons with schizophrenia: A meta‐analysis

Although self‐management education programs for persons with schizophrenia are being developed and advocated, uncertainty about their overall effectiveness remains. The purpose of this meta‐analysis was to examine outcomes of self‐management education interventions in persons with schizophrenia. Six electronic databases were searched. Manual searches were conducted of the reference lists of the identified studies and major psychiatric journals. Randomized controlled trials of self‐management education interventions aimed at reducing relapse and hospital readmissions, as well as improving symptoms, psychosocial functioning, and adherence to medication treatment were identified. Data were extracted and the quality of included studies were rated by two authors independently. Finally, 13 studies with 1404 patients were included. Self‐management education interventions were associated with a significant reduction of relapse events and re‐hospitalizations. Patients who received self‐management education were more likely to improve adherence to medication and symptoms compared to patients receiving other care. However, a benefit on psychosocial functioning was not confirmed in the current meta‐analysis. The study concludes that self‐management education intervention is a feasible and effective method for persons with schizophrenia and should be routinely offered to all persons with schizophrenia.     

Emergency department nurse's attitudes towards patients who self‐harm: A meta‐analysis

Self‐harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self‐harm injuries, and positive therapeutic patient–nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self‐harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta‐analyses examined the attitudes of ED nurses towards patients who self‐harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta‐analysis. The Self‐Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta‐analysis. The Attitudes Towards Deliberate Self‐Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta‐analysis. Results demonstrated limited empathy and negativity towards patients who self‐harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self‐harm educational content for ED staff should include areas of knowledge building including explanations and causes of self‐harm; range, forms, and functions of self‐harm; staff responses to self‐harm; assessment, management, and interventions; professional practice issues.     

Review article: Prophylactic metoclopramide for patients receiving intravenous morphine in the emergency setting: A systematic review and meta‐analysis of randomized controlled trials

The objective of the present study was to conduct a systematic review and meta‐analysis of randomized controlled trials, comparing metoclopramide with placebo, for preventing vomiting in patients who have received i.v. morphine for acute pain in the emergency setting, and to determine the level of evidence supporting the use of prophylactic metoclopramide in this population. Comprehensive systematic electronic searches were conducted of MEDLINE, EMBASE and the Cochrane Library for randomized controlled trials addressing the clinical question. Reference lists of identified articles were hand‐searched. Methodologically appropriate clinical trials identified in the search process were included in a meta‐analysis to provide a pooled estimate of effect. Three randomized controlled trials fulfilled the search criteria. All three studies were included in the final meta‐analysis that demonstrated an overall result of no difference between metoclopramide and placebo for the primary outcome of vomiting (odds ratios 0.72; 95% confidence intervals 0.11–4.58). There was little evidence that routine prophylactic administration of metoclopramide following the administration of i.v. morphine for acute pain management in the emergency setting is clinically beneficial. Routine metoclopramide administration might expose patients to a risk of harm, which is not justifiable given a lack of evidence of benefit.     

Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta‐analysis

Essentials

• Cancer patients are at risk for venous thromboembolism (VTE).
• The risk of VTE in less advanced stage cancer on neoadjuvant chemotherapy is unclear.
• In over 7800 patients, we found a 7% pooled incidence of VTE during neoadjuvant therapy.
• Highest VTE rates were observed in patients with bladder and esophageal cancer.

Summary

Background

Venous thromboembolism (VTE) is a frequent complication in cancer patients receiving adjuvant treatment. The risk of VTE during neoadjuvant chemo‐radiotherapy remains unclear.

Objectives

This systematic review evaluated the incidence of VTE in patients with cancer receiving neoadjuvant treatment.

Methods

MEDLINE and EMBASE databases were searched from inception to October 2017. Search results were supplemented with screening of conference proceedings of the American Society of Clinical Oncology (2009–2016) and the International Society of Thrombosis and Haemostasis (2003–2016). Two review authors independently screened titles and abstracts, and extracted data onto standardized forms.

Results

Twenty‐eight cohort studies (7827 cancer patients, range 11 to 1398) were included. Twenty‐five had a retrospective design. Eighteen cohorts included patients with gastrointestinal cancer, representing over two‐thirds of the whole study population (n = 6002, 78%). In total, 508 of 7768 patients were diagnosed with at least one VTE during neoadjuvant treatment, for a pooled VTE incidence of 7% (95% CI, 5% to 10%) in the absence of substantial between‐study heterogeneity. Heterogeneity was not explained by site of cancer or study design characteristics. VTE presented as pulmonary embolism in 22% to 96% of cases (16 cohorts), and it was symptomatic in 22% to 100% of patients (11 cohorts). The highest VTE rates were observed in patients with bladder (10.6%) or esophageal (8.4%) cancer.

Conclusions

This review found a relatively high incidence of VTE in cancer patients receiving neoadjuvant therapy in the presence of some between‐study variation, which deserves further evaluation in prospective studies.

     

Gastrointestinal safety of coxibs: systematic review and meta‐analysis of observational studies on selective inhibitors of cyclo‐oxygenase 2

Prior meta‐analyses have shown a higher gastrointestinal risk of nonselective NSAIDs versus placebo and a lower gastrointestinal risk of coxibs versus nonselective NSAIDs. However, the available data about gastrointestinal risk for coxibs versus placebo are scarce. The aim of this study was to review the current evidence on the use of coxibs and to evaluate the risk of gastrointestinal adverse outcomes (GAO) associated with coxibs versus nonexposed. Search was conducted on PubMed and Embase databases. We selected cohort observational, case‐control, nested case‐control and case‐crossover studies that reported the risk of GAO associated with coxibs versus nonexposed as relative risk (RR), odds ratio (OR), hazard ratio (HR) or incidence rate ratio (IRR). It was estimated the pooled RR and the 95% confidence interval (CI) for coxibs both individually and as a whole by the DerSimonian and Laird method. Twenty‐eight studies met inclusion criteria. Overall, coxibs were associated with a significant increment in the risk of GAO [RR 1.64 (95% CI 1.44–1.86)]. The analysis by individual drugs showed that etoricoxib [RR 4.85 (95% CI 2.64–8.93)] presented the highest gastrointestinal risk, followed by rofecoxib [RR 2.02 (95% CI 1.56–2.61)] and celecoxib [RR 1.53 (95% CI 1.19–1.97)]. Gastrointestinal risk was also high for the subgroups aged <65 years and low‐dose coxibs. The use of coxibs is associated with a statistically significant increased risk of GAO, which would be high even for low‐dose coxibs and <65‐year‐old subgroups. The risk would be higher for etoricoxib than for celecoxib and rofecoxib.     

Effectiveness,safety and comfort of StatLock securement for peripherally‐inserted central catheters: A systematic review and meta‐analysis

In this systematic review and meta‐analysis, we evaluated the effectiveness, safety and comfort of StatLock for the securement of peripherally‐inserted central catheters. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, WanFang Database, and China Science and Technology Journal Database were searched. Randomized, controlled trials comparing StatLock with tape or suture on the performance of securing peripherally‐inserted central catheters were selected. Meta‐analysis was performed using Review Manager 5.3 software. Thirteen randomized, controlled trials involving 1970 patients were included. Our results showed that StatLock reduced the incidence of catheter dislodgement and unplanned removal. Moreover, patients in the StatLock group had lower incidence of skin ulceration, phlebitis, catheter‐related bloodstream infection, and cellulitis, and felt more comfortable compared with those in the control group. Current evidence suggests that the StatLock securement device offer advantages over tape and suture in preventing catheter‐related complications and improving patient comfort. However, as considerable heterogeneity was found among the included studies, and the quality of evidence for main outcomes was relatively low, the results should be viewed with caution.