Christopher Stave

All Publications

• Influence of Socioeconomic and Environmental Determinants of Health on Human Infection and Colonization with Antibiotic-Resistant and Antibiotic-Associated Pathogens: A Scoping Review. Surgical infections Forrester, J. D., Cao, S., Schaps, D., Liou, R., Patil, A., Stave, C., Sokolow, S. H., Leo, G. D. 2022

  Abstract

  Background: Antibiotic-resistant and antibiotic-associated pathogens are commonly encountered by surgeons. Pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile infection (CDI), and carbapenem-resistant Enterobacteriaceae (CRE) result in considerable human morbidity, mortality, and excess healthcare expenditure. Human colonization or infection can result from exposure to these pathogens across a range of domains both inside and outside of the built healthcare environment, exposure that may be influenced by socioeconomic and environmental determinants of health, the importance of which has not been investigated fully. Methods: We performed a scoping review of published literature describing potential socioeconomic and environmental variables that may increase the likelihood of human infection or colonization with common antibiotic-resistant or antibiotic-associated pathogens, using MRSA, CDI, and CRE as examples. Results: We identified 7,916 articles meeting initial search criteria. Of these, 101 provided supportive evidence of socioeconomic and environmental determinants of human infection or colonization and were included in the scoping review after abstract and full-text screening. Sixty-seven evaluated MRSA, nine evaluated CRE, and 29 evaluated CDI. Twenty-nine articles evaluated exposure to livestock or companion animals; 28, exposure to antibiotics; 20, impact of socioeconomic factors, education level, or race; 14, the influence of temperature, humidity, or season; 13, the effect of travel or human population migration; 11, exposure to built healthcare environments; and eight assessed impact of population density or urbanization. Conclusions: Although articles outlining socioeconomic and environmental drivers of antibiotic-resistant and antibiotic-associated infection are still disconcertedly few, evidence of such associations are overwhelming for MRSA and CDI and supportive for CRE. Additional research is needed to investigate the role and importance of different potential socioeconomic and environmental drivers of antibiotic-resistant and antibiotic-associated infections and colonization in humans.

  View details for DOI 10.1089/sur.2021.348

  View details for PubMedID 35100052

• The Weight of Surgical Knowledge: Navigating Information Overload. Annals of surgery Choi, J., Stave, C., Spain, D. A. 2021

  View details for DOI 10.1097/SLA.0000000000005365

  View details for PubMedID 35129478

• 2019 global NAFLD prevalence - A systematic review and meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Le, M. H., Yeo, Y. H., Li, X., Li, J., Zou, B., Wu, Y., Ye, Q., Huang, D. Q., Zhao, C., Zhang, J., Liu, C., Chang, N., Xing, F., Yan, S., Hui, W. Z., Sook Yee, N. T., Mayumi, M., Liu, X., Liu, C., Rui, F., Yang, H., Yang, Y., Jin, R., Le, R. H., Xu, Y., Le, D. M., Barnett, S., Stave, C. D., Cheung, R., Zhu, Q., Nguyen, M. H. 2021

  Abstract

  BACKGROUND & AIMS: The increasing rates of obesity and type 2 diabetes mellitus may lead to increased prevalence of NAFLD. We aimed to determine the current and recent trends on the global and regional prevalence of NAFLD.METHODS: Systematic search from inception to March 26, 2020 was performed without language restrictions. Two authors independently performed screening and data extraction. We performed meta-regression to determine trends in NAFLD prevalence.RESULTS: We identified 17,244 articles from literature search and included 245 eligible studies involving 5,399,254 individuals. The pooled global prevalence of NAFLD was 29.8% (95% CI 28.6-31.1); of these, 82.5% of included articles used ultrasound to diagnose NAFLD with prevalence of 30.6% (95% CI 29.2-32.0). South America (3 studies, 5,716 individuals) and North America (4 studies, 18,236 individuals) had the highest NAFLD prevalence at 35.7% (95% CI 34.0-37.5) and 35.3% (95% CI 25.4-45.9), respectively. From 1991-2019, trend analysis showed NAFLD increased from 21.9% to 37.3% [yearly increase of 0.7% (P<0.0001)], with South America showing the most rapid change of 2.7% per year followed by Europe at 1.1%.CONCLUSIONS: Despite regional variation, the global prevalence of NAFLD is increasing overall. Policy makers must work towards reversing the current trends by increasing awareness of NAFLD and promoting healthy lifestyle environments.

  View details for DOI 10.1016/j.cgh.2021.12.002

  View details for PubMedID 34890795

• GLOBAL NAFLD PREVALENCE NOW AND IN THE FUTURE- A META-ANALYSIS WITH TREND AND FORECASTING Le, M., Yeo, Y., Li, X., Li, J., Zou, B., Wu, Y., Ye, Q., Huang, D., Zhao, C., Zhang, J., Liu, C., Chang, N., Xing, F., Yan, S., Hui, W., Yee, N., Maeda, M., Liu, X., Liu, C., Rui, F., Yang, H., Yang, Y., Jin, R., Le, R. X., Xu, Y., Le, D. M., Barnett, S. D., Stave, C., Cheung, R. C., Zhu, Q., Nguyen, M. H. WILEY. 2021: 1011A-1012A

  View details for Web of Science ID 000707188005048

• Pediatric casualties in contemporary armed conflict: A systematic review to inform standardized reporting. Injury Wild, H., Stewart, B. T., LeBoa, C., Stave, C. D., Wren, S. M. 2021

  Abstract

  BACKGROUND: Children represent a significant percentage of casualties in modern conflict. Yet, the epidemiology of conflict-related injury among children is poorly understood. A comprehensive analysis of injuries sustained by children in 21st-century armed conflict is necessary to inform planning of local, military, and humanitarian health responses.METHODS: We conducted a systematic search of databases including PubMed, Embase, Web of Science, World Health Organization Catalog, and Google Scholar to identify records that described conflict-related injuries sustained by children since 2001.RESULTS: The search returned 5,264 records. 9 eligible reports without potentially duplicative data were included in analysis, representing 5,100 pediatric patients injured in 5 conflicts. Blast injury was the most frequent mechanism (57%), compared to 24.8% in adults. Mortality was only slightly higher among children (11.0% compared to 9.8% among adults; p <0.05). Non-uniform reporting prevented pooled analysis and limited the conclusions that could be drawn.CONCLUSIONS: Children sustain a higher proportion of blast injury than adults in conflict. Existing data do support the conclusion that child casualties have higher mortality than adults overall; however, this difference is slighter than has been previously reported. Specific subpopulations of children appear to have worse outcomes. Overall, non-uniform reporting renders currently available data insufficient to understand the needs of children injured in modern conflict.

  View details for DOI 10.1016/j.injury.2021.04.055

  View details for PubMedID 34006405

• EXAMINING CULTURAL ASPECTS OF CAREGIVING IN INTERVENTIONS TARGETING NON-DEMENTIA CAREGIVERS: A SYSTEMATIC REVIEW Mahtani, N., Humber, M. B., Hirayama, S. K., Stave, C., Trivedi, R. B. OXFORD UNIV PRESS INC. 2021: S196

  View details for Web of Science ID 000648922700399

• Use of briefing and debriefing in neonatal resuscitation, a scoping review. Resuscitation plus Fawke, J., Stave, C., Yamada, N. 2021; 5: 100059

  Abstract

  Aim: To review the literature on briefing and debriefing in neonatal resuscitation using International Liaison Committee on Resuscitation (ILCOR) methodology to see if a formal systematic review is justified.Methods: This scoping review was undertaken by an ILCOR Newborn Life Support scoping review team and guided by the ILCOR methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed, compared briefing/debriefing of healthcare professionals who had completed a neonatal resuscitation or simulated resuscitation and reported outcomes for infants, families or staff. PubMed, Embase, Cochrane, and Web of Science databases were searched.Results: This review included four studies that reported on three briefing/debriefing interventions: video debriefing, the use of checklists with a briefing/debriefing component and rapid cycle deliberate practice. Video debriefing was associated with improvements in the process of care and adherence to resuscitation guidelines. Use of checklists was associated with improvements in short term clinical outcomes and a reduction in communication problems. Rapid cycle deliberate practice may lead to short but not sustained improvements in algorithm compliance and timely completion of resuscitation steps.Conclusion: This scoping review did not identify sufficient new evidence to justify conducting new systematic reviews or review of current resuscitation guidelines. Improvements in the process of care, short term clinical outcomes and reduction in communication problems were associated with briefing/debriefing supported by video, checklists or rapid, cycle deliberate practice. It highlights knowledge gaps, including the need to consider briefing/debriefing separately from other interventions, the effect of briefing/debriefing on short- and long-term clinical outcomes and the effect of rapid cycle deliberate practice on resuscitation training.

  View details for DOI 10.1016/j.resplu.2020.100059

  View details for PubMedID 34223331

• The epidemiology of NAFLD and lean NAFLD in Japan: a meta-analysis with individual and forecasting analysis, 1995-2040. Hepatology international Ito, T. n., Ishigami, M. n., Zou, B. n., Tanaka, T. n., Takahashi, H. n., Kurosaki, M. n., Maeda, M. n., Thin, K. N., Tanaka, K. n., Takahashi, Y. n., Itoh, Y. n., Oniki, K. n., Seko, Y. n., Saruwatari, J. n., Kawanaka, M. n., Atsukawa, M. n., Hyogo, H. n., Ono, M. n., Ogawa, E. n., Barnett, S. D., Stave, C. D., Cheung, R. C., Fujishiro, M. n., Eguchi, Y. n., Toyoda, H. n., Nguyen, M. H. 2021

  Abstract

  NAFLD is increasing in Asia including Japan, despite its lower obesity rate than the West. However, NAFLD can occur in lean people, but data are limited. We aimed to investigate the epidemiology of NAFLD in Japan with a focus on lean NAFLD.We searched PubMed, Cochrane Library, EMBASE, Web of Science, and the Japan Medical Abstracts Society (inception to 5/15/2019) and included 73 eligible full-text original research studies (n = 258,531). We used random-effects model for pooled estimates, Bayesian modeling for trend and forecasting, contacted authors for individual patient data and analyzed 14,887 (7752 NAFLD; 7135 non-NAFLD-8 studies) patients.The overall NAFLD prevalence was 25.5%, higher in males (p < 0.001), varied by regions (p < 0.001), and increased over time (p = 0.015), but not by per-person income or gross prefectural productivity, which increased by 0.64% per year (1983-2012) and is forecasted to reach 39.3% in 2030 and 44.8% in 2040. The incidence of NAFLD, HCC, and overall mortality were 23.5, 7.6 and 5.9 per 1000 person-years, respectively. Individual patient-level data showed a lean NAFLD prevalence of 20.7% among the NAFLD population, with lean NAFLD persons being older and with a higher all-cause mortality rate (8.3 vs. 5.6 per 1000 person-years for non-lean NAFLD, p = 0.02). Older age, male sex, diabetes, and FIB-4 were independent predictors of mortality, but not lean NAFLD.NAFLD prevalence has increased in Japan and may affect half of the population by 2040. Lean NAFLD individuals makeup 20% of the NAFLD population, were older, and had higher mortality.

  View details for DOI 10.1007/s12072-021-10143-4

  View details for PubMedID 33580453

• Evidence-based surgery for laparoscopic appendectomy: A stepwise systematic review. Surgery open science Bessoff, K. E., Choi, J., Wolff, C. J., Kashikar, A., Carlos, G. M., Caddell, L., Khan, R. I., Stave, C. D., Spain, D. A., Forrester, J. D. 2021; 6: 29-39

  Abstract

  Appendectomy is a common emergency surgery performed globally. Despite the frequency of laparoscopic appendectomy, consensus does not exist on the best way to perform each procedural step. We identified literature on key intraoperative steps to inform best technical practice during laparoscopic appendectomy.Research questions were framed using the population, indication, comparison, outcome (PICO) format for 6 key operative steps of laparoscopic appendectomy: abdominal entry, placement of laparoscopic ports, division of mesoappendix, division of appendix, removal of appendix, and fascial closure. These questions were used to build literature queries in PubMed, EMBASE, and the Cochrane Library databases. Evidence quality and certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) definitions.Recommendations were rendered for 6 PICO questions based on 28 full length articles. Low quality evidence favors direct trocar insertion for abdominal entry and establishment of pneumoperitoneum. Single port appendectomy results in improved cosmesis with unclear clinical implications. There was insufficient data to determine the optimal method of appendiceal stump closure, but use of a specimen extraction bag reduces rates of superficial surgical site infection and intra-abdominal abscess. Port sites made with radially dilating trocars are less likely to necessitate closure and are less likely to result in port site hernia. When port sites are closed, a closure device should be used.Key operative steps of laparoscopic appendectomy have sufficient data to encourage standardized practice.

  View details for DOI 10.1016/j.sopen.2021.08.001

  View details for PubMedID 34604728

  View details for PubMedCentralID PMC8473533

• Prevalence of hepatic steatosis, fibrosis and associated factors in chronic hepatitis B. Alimentary pharmacology & therapeutics Zheng, Q., Zou, B., Wu, Y., Yeo, Y., Wu, H., Stave, C. D., Cheung, R. C., Nguyen, M. H. 2021

  Abstract

  As the prevalence of hepatitis steatosis (HS) increases, the prevalence of HS among those with chronic hepatitis B (CHB) may also be increasing but data on the effect of HS on CHB disease progression are lacking.To determine the prevalence of HS in CHB and associated factors, prevalence of fibrosis and its association with HS.Two researchers independently searched the literature and extracted data. We included full-length original articles of adults with CHB that evaluated. Prevalence estimates were pooled using a random-effects model. Associations between HS and fibrosis were assessed by pooled odds ratios (ORs) or mean differences (MD).Of the 2821 records screened, 54 eligible studies (28 648 patients) were analysed. The pooled prevalence of HS in CHB was 32.8% (95% CI, 28.9-37.0) with higher prevalence in men and obese patients. Older age, male sex and metabolic factors were associated with HS while an inverse association was observed between HS and HBeAg (OR 0.82, 95% CI, 0.75-0.91) and HBV DNA levels (MD -0.38, 95% CI -1.16--0.42). The pooled prevalence of significant fibrosis (≥F2 or ≥F3) was similar between patients with CHB with or without HS (40.1% vs 42.22%, P = 0.68). HS was not significantly associated with fibrosis (pooled OR 0.87, 95% CI 0.54-1.39, 20 studies, 6232 patients).Approximately 30% of patients with CHB had HS, which was positively associated with male sex, diabetes and metabolic factors, and was negatively associated with HBeAg and HBV DNA. HS was not significantly associated with increased fibrosis.

  View details for DOI 10.1111/apt.16595

  View details for PubMedID 34469587

• THE EPIDEMIOLOGY OF NAFLD AND LEAN NAFLD IN JAPAN: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH INDIVIDUAL PATIENT LEVEL DATA AND FORECASTING, 1995-2040 Ito, T., Ishigami, M., Zou, B., Tanaka, T., Takahashi, H., Kurosaki, M., Maeda, M., Thin, K., Tanaka, K., Takahashi, Y., Itoh, Y., Oniki, K., Seko, Y., Saruwatari, J., Kawanaka, M., Atsukawa, M., Hyogo, H., Ono, M., Ogawa, E., Barnette, S. D., Stave, C., Cheung, R., Fujishiro, M., Eguchi, Y., Toyoda, H., Nguyen, M. H. WILEY. 2020: 999

  View details for Web of Science ID 000574027004096

• COMPARISON OF EUS-GUIDED, ENDOSCOPIC TRANSPAPILLARY AND PERCUTANEOUS GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS: A SYSTEMATIC REVIEW AND NETWORK METANALYSIS Podboy, A. J., Yuan, J. J., Stave, C. D., Chan, S. M., Hwang, J., Teoh, A. Y. MOSBY-ELSEVIER. 2020: AB309

  View details for Web of Science ID 000545678400617

• Safety of Foregoing Operation for Small Bowel Obstruction in the Virgin Abdomen: Systematic Review and Meta-Analysis. Journal of the American College of Surgeons Choi, J. n., Fisher, A. T., Mulaney, B. n., Anand, A. n., Carlos, G. n., Stave, C. D., Spain, D. A., Weiser, T. G. 2020

  Abstract

  Our objective was to assess the safety of foregoing surgery in patients without abdominopelvic surgery history presenting with small bowel obstruction (SBO). Classic dogma has counseled early surgical intervention for small bowel obstruction (SBO) in the virgin abdomen - patients without abdominopelvic surgery history - given their presumed higher risk of malignant or potentially catastrophic etiologies compared to those who underwent prior abdominal operations. The term virgin abdomen was coined before widespread use of computed tomography, which now elucidates many SBO etiologies. Despite recent efforts to re-evaluate clinical management standards, the prevalence of SBO etiologies in the virgin abdomen and the current management landscape (non-operative vs operative) in these patients remain unclear. Our random-effects meta-analysis of six studies including 442 patients found the prevalence of malignant etiologies in patients without abdominopelvic surgery history presenting with SBO varied from 7.7% [95% CI:3.0-14.1] to 13.4% [95% CI:7.6-20.3] on sensitivity analysis. Most malignant etiologies were not suspected prior to surgery. De novo adhesions (54%) were the most common etiology. Over half of patients underwent a trial of non-operative management, which often failed. Subgroups of patients likely have variable risk profiles for underlying malignant etiologies, yet no study had consistent follow-up data and we did not find convincing evidence that foregoing operative management altogether in this population can be generally recommended.

  View details for DOI 10.1016/j.jamcollsurg.2020.06.010

  View details for PubMedID 32574687

• Comparison of EUS-guided endoscopic transpapillary and percutaneous gallbladder drainage for acute cholecystitis: a systematic review with network meta-analysis. Gastrointestinal endoscopy Podboy, A. n., Yuan, J. n., Stave, C. D., Chan, S. M., Hwang, J. n., Teoh, A. Y. 2020

  Abstract

  The optimal method of gallbladder drainage for acute cholecystitis in nonsurgical candidates is uncertain. The aim of the current study was to conduct a network meta-analysis comparing the 3 methods of gallbladder drainage (percutaneous, transpapillary, and EUS-guided).A comprehensive literature search for all comparative studies assessing the efficacy of either of the 2 or all of the modalities used for treatment of acute cholecystitis in patients that were at high risk for cholecystectomy was performed. Primary outcomes of technical and clinical success and postprocedure adverse events were assessed. Secondary outcomes include reintervention, unplanned readmissions, recurrent cholecystitis, and mortality.Ten studies were identified, comprising 1267 patients (472 EUS-GBD, 493 PT-GBD, 302 ETP-GBD). In the network ranking estimate, PT-GBD and EUS-GBD had highest likelihood of technical success (EUS-GBD vs PT-GBD vs ETP-GBD = 2.00 vs 1.02 vs 2.98) and clinical success (EUS-GBD vs PT-GBD vs ETP-GBD = 1.48 vs 1.55 vs 2.98). EUS-GBD had lowest risk of recurrent cholecystitis (EUS-GBD vs PT-GBD vs ETP-GBD = 1.089 vs 2.02 vs 2.891). PT-GBD has highest risk of reintervention (EUS-GBD vs PT-GBD vs ETP-GBD = 1.81 vs 2.99 vs 1.199) and unplanned readmissions (EUS-GBD vs PT-GBD vs ETP-GBD = 1.582 vs 2.944 vs 1.474) whereas ETP-GBD drainage was associated with lowest rates of mortality (EUS-GBD vs PT-GBD vs ETP-GBD = 2.62 vs 2.09 vs 1.29).The 3 modalities of gallbladder drainage have their respective advantages and disadvantages. Selection of the technique will depend on available expertise. In centers with expertise in endoscopic gallbladder drainage, the techniques are preferred over PT-GBD with improved outcomes.

  View details for DOI 10.1016/j.gie.2020.09.040

  View details for PubMedID 32987004

• Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. The lancet. Gastroenterology & hepatology Ye, Q. n., Zou, B. n., Yeo, Y. H., Li, J. n., Huang, D. Q., Wu, Y. n., Yang, H. n., Liu, C. n., Kam, L. Y., Tan, X. X., Chien, N. n., Trinh, S. n., Henry, L. n., Stave, C. D., Hosaka, T. n., Cheung, R. C., Nguyen, M. H. 2020

  Abstract

  Although non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, it is increasingly being identified in non-obese individuals. We aimed to characterise the prevalence, incidence, and long-term outcomes of non-obese or lean NAFLD at a global level.For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Library from inception to May 1, 2019, for relevant original research articles without any language restrictions. The literature search and data extraction were done independently by two investigators. Primary outcomes were the prevalence of non-obese or lean people within the NAFLD group and the prevalence of non-obese or lean NAFLD in the general, non-obese, and lean populations; the incidence of NAFLD among non-obese and lean populations; and long-term outcomes of non-obese people with NAFLD. We also aimed to characterise the demographic, clinical, and histological characteristics of individuals with non-obese NAFLD.We identified 93 studies (n=10 576 383) from 24 countries or areas: 84 studies (n=10 530 308) were used for the prevalence analysis, five (n=9121) were used for the incidence analysis, and eight (n=36 954) were used for the outcomes analysis. Within the NAFLD population, 19·2% (95% CI 15·9-23·0) of people were lean and 40·8% (36·6-45·1) were non-obese. The prevalence of non-obese NAFLD in the general population varied from 25% or lower in some countries (eg, Malaysia and Pakistan) to higher than 50% in others (eg, Austria, Mexico, and Sweden). In the general population (comprising individuals with and without NAFLD), 12·1% (95% CI 9·3-15·6) of people had non-obese NAFLD and 5·1% (3·7-7·0) had lean NAFLD. The incidence of NAFLD in the non-obese population (without NAFLD at baseline) was 24·6 (95% CI 13·4-39·2) per 1000 person-years. Among people with non-obese or lean NALFD, 39·0% (95% CI 24·1-56·3) had non-alcoholic steatohepatitis, 29·2% (21·9-37·9) had significant fibrosis (stage ≥2), and 3·2% (1·5-5·7) had cirrhosis. Among the non-obese or lean NAFLD population, the incidence of all-cause mortality was 12·1 (95% CI 0·5-38·8) per 1000 person-years, that for liver-related mortality was 4·1 (1·9-7·1) per 1000 person-years, cardiovascular-related mortality was 4·0 (0·1-14·9) per 1000 person-years, new-onset diabetes was 12·6 (8·0-18·3) per 1000 person-years, new-onset cardiovascular disease was 18·7 (9·2-31·2) per 1000 person-years, and new-onset hypertension was 56·1 (38·5-77·0) per 1000 person-years. Most analyses were characterised by high heterogeneity.Overall, around 40% of the global NAFLD population was classified as non-obese and almost a fifth was lean. Both non-obese and lean groups had substantial long-term liver and non-liver comorbidities. These findings suggest that obesity should not be the sole criterion for NAFLD screening. Moreover, clinical trials of treatments for NAFLD should include participants across all body-mass index ranges.None.

  View details for DOI 10.1016/S2468-1253(20)30077-7

  View details for PubMedID 32413340

• The epidemiology of NAFLD in Mainland China with analysis by adjusted gross regional domestic product: a meta-analysis. Hepatology international Wu, Y. n., Zheng, Q. n., Zou, B. n., Yeo, Y. H., Li, X. n., Li, J. n., Xie, X. n., Feng, Y. n., Stave, C. D., Zhu, Q. n., Cheung, R. n., Nguyen, M. H. 2020

  Abstract

  Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. This study aimed to estimate the prevalence, incidence, and outcome of NAFLD in the large and diverse population of Mainland China.PubMed, Embase, and the Cochrane Library databases were searched to identify published studies with NAFLD epidemiology data in adult participants (≥ 18 years old) from Mainland China. Random effects models were used to determine pooled estimates.We screened 1,328 studies and included 167 eligible studies (participant n = 1,486,635): 149 studies (n = 1,350,819) for prevalence, 18 studies (n = 147,316) for incidence, 7 studies (n = 5446) for evolution of hepatic steatosis, and 2 studies (n = 647) for mortality analysis. The NAFLD prevalence of the overall populations was 29.88%, with higher rates in males, increasing age and increasing gross regional domestic product (GRDP) per capita (all p ≤ 0.010). The prevalence was the highest in North China (36.41%; higher in Uyghur and Hui Chinese 40.86% and 34.36% vs 28.11% in Han Chinese), higher in diabetics (51.83% vs. 30.76% in non-diabetics) and in obese participants (66.21% vs. 11.72% in lean). The NAFLD incidence was 56.7 (95% CI 47.4-66.8) per 1000 person-years, higher in males and with higher GRDP per capita. The overall mortality was 7.3 (3.3-12.7) per 1000 person-years.The overall prevalence of NAFLD in Mainland China is about 30%. The highest prevalences were found among regions with higher income, North China, the non-Han ethnic minorities, diabetics, and the obese. China's NAFLD prevalence is on par with Western countries.

  View details for DOI 10.1007/s12072-020-10023-3

  View details for PubMedID 32130675

• Epidemiology of Injuries Sustained by Civilians and Local Combatants in Contemporary Armed Conflict: An Appeal for a Shared Trauma Registry Among Humanitarian Actors. World journal of surgery Wild, H. n., Stewart, B. T., LeBoa, C. n., Stave, C. D., Wren, S. M. 2020

  Abstract

  Conflict-related injuries sustained by civilians and local combatants are poorly described, unlike injuries sustained by US, North Atlantic Treaty Organization, and coalition military personnel. An understanding of injury epidemiology in twenty-first century armed conflict is required to plan humanitarian trauma systems capable of responding to population needs.We conducted a systematic search of databases (e.g., PubMed, Embase, Web of Science, World Health Organization Catalog, Google Scholar) and grey literature repositories to identify records that described conflict-related injuries sustained by civilians and local combatants since 2001.The search returned 3501 records. 49 reports representing conflicts in 18 countries were included in the analysis and described injuries of 58,578 patients. 79.3% of patients were male, and 34.7% were under age 18 years. Blast injury was the predominant mechanism (50.2%), and extremities were the most common anatomic region of injury (33.5%). The heterogeneity and lack of reporting of data elements prevented pooled analysis and limited the generalizability of the results. For example, data elements including measures of injury severity, resource utilization (ventilator support, transfusion, surgery), and outcomes other than mortality (disability, quality of life measures) were presented by fewer than 25% of reports.Data describing the needs of civilians and local combatants injured during conflict are currently inadequate to inform the development of humanitarian trauma systems. To guide system-wide capacity building and quality improvement, we advocate for a humanitarian trauma registry with a minimum set of data elements.

  View details for DOI 10.1007/s00268-020-05428-y

  View details for PubMedID 32100067

• SYSTEMATIC REVIEW AND META-ANALYSIS: A NATURAL HISTORY STUDY TO INCLUDE NAFLD INCIDENCE, DISEASE TRANSITION AND OUTCOMES Wu, Y., Yeo, Y., Zou, B., Li, X., Zheng, Q., Li, J., Xie, X., Feng, Y., Stave, C., Cheung, R., Zhu, Q., Nguyen, M. H. WILEY. 2019: 743A

  View details for Web of Science ID 000488653502379

• PREVALENCE AND FACTORS ASSOCIATED WITH HEPATIC STEATOSIS (HS) AND HEPATIC FIBROSIS IN CHRONIC HEPATITIS B (CHB) ASSOCIATED WITH HS: A SYSTEMATIC REVIEW AND META-ANALYTIC ASSESSMENT OF 57 STUDIES AND 268,151 PARTICIPANTS Zheng, Q., Wu, Y., Zou, B., Yeo, Y., Wu, H., Stave, C., Cheung, R., Nguyen, M. H. WILEY. 2019: 570A–571A

  View details for Web of Science ID 000488653502081

• INCREASING PREVALENCE AND FACTORS ASSOCIATED WITH NAFLD IN MAINLAND CHINA: A META-ANALYSIS OF 124 STUDIES AND 1,232,281 PARTICIPANTS Wu, Y., Zheng, Q., Zou, B., Yeo, Y., Li, X., Li, J., Feng, Y., Xie, X., Stave, C., Cheung, R., Zhu, Q., Nguyen, M. H. WILEY. 2019: 742A–743A

  View details for Web of Science ID 000488653502378

• Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Sultan, P., Bampoe, S., Shah, R., Guo, N., Estes, J., Stave, C., Goodnough, L., Halpern, S., Butwick, A. 2019; 222 (1): 19-+

  View details for DOI 10.1016/j.ajog.2018.12.016

  View details for Web of Science ID 000472481100020

• Management of cyclic vomiting syndrome in adults: Evidence review. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society Sharaf, R. N., Venkatesan, T., Shah, R., Levinthal, D. J., Tarbell, S. E., Jaradeh, S. S., Hasler, W. L., Issenman, R. M., Adams, K. A., Sarosiek, I., Stave, C. D., Li, B. U., Sultan, S. 2019; 31 Suppl 2: e13605

  Abstract

  BACKGROUND: This evidence review was conducted to inform the accompanying clinical practice guideline on the management of cyclic vomiting syndrome (CVS) in adults.METHODS: We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and focused on interventions aimed at prophylactic management and abortive treatment of adults with CVS. Specifically, this evidence review addresses the following clinical questions: (a) Should the following pharmacologic agents be used for prophylaxis of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, or mitochondrial supplements? (b) Should the following pharmacologic agents be used for abortive treatment: triptans or aprepitant?RESULTS: We found very low-quality evidence to support the use of the following agents for prophylactic and abortive treatment of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, and mitochondrial supplements. We have moderate certainty of evidence for the use of triptans as abortive therapy. We found limited evidence to support the use of ondansetron and the treatment of co-morbid conditions and complementary therapies.CONCLUSIONS: This evidence review helps inform the accompanying guideline for the management of adults with CVS which is aimed at helping clinicians, patients, and policymakers, and should improve patient outcomes.

  View details for DOI 10.1111/nmo.13605

  View details for PubMedID 31241818

• Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society Venkatesan, T., Levinthal, D. J., Tarbell, S. E., Jaradeh, S. S., Hasler, W. L., Issenman, R. M., Adams, K. A., Sarosiek, I., Stave, C. D., Sharaf, R. N., Sultan, S., Li, B. U. 2019; 31 Suppl 2: e13604

  Abstract

  The increasing recognition of cyclic vomiting syndrome (CVS) in adults prompted the development of these evidence-based guidelines on the management of CVS in adults, which was sponsored by the American Neurogastroenterology and Motility Society (ANMS) and the Cyclic Vomiting Syndrome Association (CVSA). GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was used and a professional librarian performed the literature search. The expert committee included the President of the CVSA who brought a patient perspective into the deliberations. The committee makes recommendations for the prophylaxis of CVS, treatment of acute attacks, diagnosis, and overall management of CVS. The committee strongly recommends that adults with moderate-to-severe CVS receive a tricyclic antidepressant (TCA), such as amitriptyline, as a first-line prophylactic medication and receive topiramate or aprepitant as alternate prophylactic medications. Zonisamide or levetiracetam and mitochondrial supplements (Coenzyme Q10, L-carnitine, and riboflavin) are conditionally recommended as alternate prophylactic medications, either alone or concurrently with other prophylactic medications. For acute attacks, the committee conditionally recommends using serotonin antagonists, such as ondansetron, and/or triptans, such as sumatriptan or aprepitant to abort symptoms. Emergency department treatment is best achieved with the use of an individualized treatment protocol and shared with the care team (example provided). The committee recommended screening and treatment for comorbid conditions such as anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance use with referral to appropriate allied health services as indicated. Techniques like meditation, relaxation, and biofeedback may be offered as complementary therapy to improve overall well-being and patient care outcomes.

  View details for DOI 10.1111/nmo.13604

  View details for PubMedID 31241819

• Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society Venkatesan, T., Levinthal, D. J., Li, B. U., Tarbell, S. E., Adams, K. A., Issenman, R. M., Sarosiek, I., Jaradeh, S. S., Sharaf, R. N., Sultan, S., Stave, C. D., Monte, A. A., Hasler, W. L. 2019; 31 Suppl 2: e13606

  Abstract

  Cannabis is commonly used in cyclic vomiting syndrome (CVS) due to its antiemetic and anxiolytic properties. Paradoxically, chronic cannabis use in the context of cyclic vomiting has led to the recognition of a putative new disorder called cannabinoid hyperemesis syndrome (CHS). Since its first description in 2004, numerous case series and case reports have emerged describing this phenomenon. Although not pathognomonic, a patient behavior called "compulsive hot water bathing" has been associated with CHS. There is considerable controversy about how CHS is defined. Most of the data remain heterogenous with limited follow-up, making it difficult to ascertain whether chronic cannabis use is causal, merely a clinical association with CVS, or unmasks or triggers symptoms in patients inherently predisposed to develop CVS. This article will discuss the role of cannabis in the regulation of nausea and vomiting, specifically focusing on both CVS and CHS, in order to address controversies in this context. To this objective, we have collated and analyzed published case series and case reports on CHS in order to determine the number of reported cases that meet current Rome IV criteria for CHS. We have also identified limitations in the existing diagnostic framework and propose revised criteria to diagnose CHS. Future research in this area should improve our understanding of the role of cannabis use in cyclic vomiting and help us better understand and manage this disorder.

  View details for DOI 10.1111/nmo.13606

  View details for PubMedID 31241817

• Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis LANCET GASTROENTEROLOGY & HEPATOLOGY Li, J., Zou, B., Yeo, Y., Feng, Y., Xie, X., Lee, D., Fujii, H., Wu, Y., Kam, L. Y., Ji, F., Li, X., Chien, N., Wei, M., Ogawa, E., Zhao, C., Wu, X., Stave, C. D., Henry, L., Barnett, S., Takahashi, H., Furusyo, N., Eguchi, Y., Hsu, Y., Lee, T., Ren, W., Qin, C., Jun, D., Toyoda, H., Wong, V., Cheung, R., Zhu, Q., Nguyen, M. H. 2019; 4 (5): 389–98

  View details for DOI 10.1016/S2468-1253(19)30039-1

  View details for Web of Science ID 000463786300024

• Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis. The lancet. Gastroenterology & hepatology Li, J., Zou, B., Yeo, Y. H., Feng, Y., Xie, X., Lee, D. H., Fujii, H., Wu, Y., Kam, L. Y., Ji, F., Li, X., Chien, N., Wei, M., Ogawa, E., Zhao, C., Wu, X., Stave, C. D., Henry, L., Barnett, S., Takahashi, H., Furusyo, N., Eguchi, Y., Hsu, Y., Lee, T., Ren, W., Qin, C., Jun, D. W., Toyoda, H., Wong, V. W., Cheung, R., Zhu, Q., Nguyen, M. H. 2019

  Abstract

  BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden.METHODS: We searched PubMed, EMBASE, and the Cochrane Library from database inception to Jan 17, 2019, for studies reporting NAFLD prevalence, incidence, or outcome in Asia. We included only cross-sectional and longitudinal observational studies of patients with NAFLD diagnosed by imaging, serum-based indices, or liver biopsy. Studies that included patients with overlapping liver disease or that did not screen for excess alcohol consumption were excluded. Two investigators independently screened and extracted data. The main outcomes were pooled NAFLD prevalence, incidence, and hepatocellular carcinoma incidence and overall mortality in patients with NAFLD. Summary estimates were calculated using a random-effects model. This study is registered with PROSPERO, number CRD42018088468.FINDINGS: Of 4995 records identified, 237 studies (13 044 518 participants) were included for analysis. The overall prevalence of NAFLD regardless of diagnostic method was 29·62% (95% CI 28·13-31·15). NAFLD prevalence increased significantly over time (25·28% [22·42-28·37] between 1999 and 2005, 28·46% [26·70-30·29] between 2006 and 2011, and 33·90% [31·74-36·12] between 2012 and 2017; p<0·0001). The pooled annual NAFLD incidence rate was 50·9 cases per 1000 person-years (95% CI 44·8-57·4). In patients with NAFLD, the annual incidence of hepatocellular carcinoma was 1·8 cases per 1000 person-years (0·8-3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5-11·4).INTERPRETATION: NAFLD prevalence in Asia is increasing and is associated with poor outcomes including hepatocellular carcinoma and death. Targeted public health strategies must be developed in Asia to target the drivers of this rising epidemic and its associated complications, especially in high-risk groups, such as older obese men.FUNDING: None.

  View details for PubMedID 30902670

• Combination therapy in overactive bladder-untapped research opportunities: A systematic review of the literature. Neurourology and urodynamics Kasman, A. n., Stave, C. n., Elliott, C. n. 2019

  Abstract

  Overactive bladder (OAB) affects over 17% of the population and significantly effect the health-related quality of life. The treatments for OAB include first line (lifestyle modification, pelvic floor muscle training), second line (anticholinergic or beta-3 agonist medications), and third line therapies (intradetrusor botulinum toxin injection, sacral neurostimulation [SNM], or percutaneous tibial nerve stimulation [PTNS]). For those with urinary incontinence secondary to OAB, complete continence is the goal of therapy, though cure rates are only 5% to 40%. The use of combination therapies can be employed in refractory OAB, however, the efficacy of pooled modalities is relatively unknown. Our objective was to determine the volume of data supporting combination therapy in treating OAB.We systematically reviewed PubMed, EMBASE, the Cochrane Library, and Google Scholar for articles published before October 2018. Each was independently reviewed by two reviewers and examined in detail if they met inclusion criteria.A total of 32 studies met inclusion criteria and were reviewed. Most large prospective studies evaluated combinations of medications with behavioral therapy or medications together. Combination therapy studies of third-line treatments were rare and centered on medication with PTNS. No studies examined intradetrusor botulinum toxin injections in combination with another therapy and only one retrospective study briefly examined SNM therapy in combination with medication.Combination therapy, with certain first, second, and third-line OAB therapies, appears to be efficacious. There is a further need for carefully designed combination therapy studies, particularly those including third line modalities.

  View details for DOI 10.1002/nau.24158

  View details for PubMedID 31483070

• Oral versus intravenous iron therapy for postpartum anemia: A systematic review and meta-analysis. American journal of obstetrics and gynecology Sultan, P., Bampoe, S., Shah, R., Guo, N., Estes, J., Stave, C., Goodnough, T., Halpern, S., Butwick, A. J. 2018

  Abstract

  OBJECTIVE: To perform a systematic review of randomized trials comparing oral versus intravenous iron therapy to treat postpartum anemia.DATA SOURCES: Data sources were: PubMed (1972-2017); Cochrane Central Register of Controlled Trials, CENTRAL (1972-2017); CINAHL (1972-2017); Web of Science; Excerpta Medica Database, and EMBASE (1972-2017).STUDY ELIGIBILITY CRITERIA: We included randomized trials comparing oral versus intravenous iron monotherapy to treat postpartum anemia (classified as a hemoglobin<12 g/dL).STUDY APPRAISAL AND SYNTHESIS METHODS: Study quality was assessed with the Cochrane risk of bias assessment tool. The primary outcome was the hemoglobin concentration at 6 weeks postpartum. Secondary outcomes included: hemoglobin concentration at 1 - 5 weeks postpartum, ferritin concentration at 1 - 6 weeks postpartum; and maternal adverse outcomes. For meta-analysis, mean differences and odds ratios using a random effects model were calculated. Risk of heterogeneity was reported as I2.RESULTS: Fifteen randomized trials met our inclusion criteria (n=1,001 and 1,181 women receiving oral iron and intravenous iron, respectively); 4 studies reported data for our primary outcome. We observed higher postpartum week 6 hemoglobin concentrations in the iv iron group compared to the oral iron group, (mean difference 0.9 g/dL, 95% CI=0.4, 1.3; p=0.0003). Compared to oral iron, women receiving iv iron had higher hemoglobin concentrations at postpartum weeks 1, 2, and 3; higher ferritin concentrations at postpartum weeks 1, 2, 4, and 6; an increased likelihood of skin flushing (odds ratio=6.95; 95% confidence interval, 1.56-31.03; P=0.01; I2=0%); and a decreased likelihood of constipation (odds ratio=0.08, 95% confidence interval, 0.03-0.21; P=<0.00001, I2=27%) and dyspepsia (odds ratio=0.07, 95% confidence interval, 0.01-0.42; P=0.004; I2=0%). The reported event rate for anaphylaxis among women receiving intravenous iron was 0.6%.CONCLUSIONS: In this systematic review, among women with postpartum anemia, hemoglobin concentrations at 6 weeks postpartum were almost 1 g/dL higher in women who received intravenous iron compared to oral iron. The safety profile of intravenous iron was also reassuring. Given the weaker hemoglobin response and higher risk of gastrointestinal side-effects with oral iron use, our findings suggest that intravenous iron be considered as a viable treatment option for postpartum iron deficiency anemia.

  View details for PubMedID 30578747

• Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees. JAMA network open Mazer, L. M., Bereknyei Merrell, S., Hasty, B. N., Stave, C., Lau, J. N. 2018; 1 (3): e180870

  Abstract

  Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care.To document the published programmatic and curricular attempts to decrease the incidence of mistreatment.PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched. Comprehensive searches were run on "mistreatment" and "abuse of medical trainees" on all peer-reviewed publications until November 1, 2017.Citations were reviewed for descriptions of programs to decrease the incidence of mistreatment in a medical school or hospital with program evaluation data. A mistreatment program was defined as an educational effort to reduce the abuse, mistreatment, harassment, or discrimination of trainees. Studies of the incidence of mistreatment without description of a program, references to a mistreatment program without outcome data, or a program that has never been implemented were excluded.Authors independently reviewed all retrieved citations. Articles that any author found to meet inclusion criteria were included in a full-text review. The data extraction form was developed based on the guidelines for Best Evidence in Medical Education. An assessment of the study quality was conducted using a conceptual framework of 6 elements essential to the reporting of experimental studies in medical education.A descriptive review of the interventions and outcomes is presented along with an analysis of the methodological quality of the studies. A separate review of the MedEdPORTAL mistreatment curricula was conducted.Of 3347 citations identified, 10 studies met inclusion criteria. Of the programs included in the 10 studies, all were implemented in academic medical centers. Seven programs were in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The most common format was a combination of lectures, workshops, and seminars over a variable time period. Overall, quality of included studies was low and only 1 study included a conceptual framework. Outcomes were most often limited to participant survey data. The program outcome evaluations consisted primarily of surveys and reports of mistreatment. All of the included studies evaluated participant satisfaction, which was mostly qualitative. Seven studies also included the frequency of mistreatment reports; either surveys to assess perception of the frequency of mistreatment or the frequency of reports via official reporting channels. Five mistreatment program curricula from MedEdPORTAL were also identified; of these, only 2 presented outcome data.There are very few published programs attempting to address mistreatment of medical trainees. This review identifies a gap in the literature and provides advice for reporting on mistreatment programs.

  View details for DOI 10.1001/jamanetworkopen.2018.0870

  View details for PubMedID 30646041

  View details for PubMedCentralID PMC6324298

• Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees JAMA NETWORK OPEN Mazer, L. M., Merrell, S., Hasty, B. N., Stave, C., Lau, J. N. 2018; 1 (3)

  View details for DOI 10.1001/jamanetworkopen.2018.0870

  View details for Web of Science ID 000452641400015

• Real-world effectiveness of sofosbuvir plus ribavirin for chronic hepatitis C genotype 2 in Asia: a systematic review and meta-analysis. BMJ open gastroenterology Wei, B. n., Ji, F. n., Yeo, Y. H., Ogawa, E. n., Zou, B. n., Stave, C. D., Dang, S. n., Li, Z. n., Furusyo, N. n., Cheung, R. C., Nguyen, M. H. 2018; 5 (1): e000207

  Abstract

  Sofosbuvir plus ribavirin (SOF+RBV) for 12 weeks is the standard treatment for chronic hepatitis C (CHC) genotype 2 (GT2) in most of Asia despite availability of new CHC medications. SOF-RBV real-world effectiveness has only been reported in small and/or single-centre studies. Our goal was to determine the real-world effectiveness of 12-week SOF+RBV therapy for CHC GT2 in Asia.A systematic search on PubMed and Embase was conducted through 30 June 2017. We identified full articles and conference proceedings of at least 10 adult patients with CHC GT2 treated with SOF+RBV for 12 weeks under real-world setting in Asia.A total of 2208 patients from 13 studies were included. The pooled sustained virological response 12 weeks after the end of treatment (SVR12) was 95.8% (95% CI 94.6% to 96.9%) with non-significant heterogeneity (I2=34.4%). Anaemia (27.9%) was the most common adverse event (AE), with serious AEs in 2.0% and only 0.7% discontinued therapy prematurely. In subgroup analyses, patients with cirrhosis had 8.7% lower SVR12 than non-cirrhotic patients (P<0.0001), and treatment-experienced patients had 7.2% lower SVR12 than treatment-naïve patients (P=0.0002). Cirrhotic treatment-experienced patients had the lowest SVR12 at 84.5%. There were no significant differences in pooled SVR12 among patient subgroups: RBV dose reduction versus no dose reduction (P=0.30); hepatocellular carcinoma (HCC) versus no HCC (P=0.10); GT 2a versus 2b (P=0.86); and <65 vs ≥65 years of age (P=0.20).SOF+RBV for 12 weeks was safe and effective for patients with CHC GT2 in Asia, although those with cirrhosis and prior treatment failure had a lower pooled SVR12 rate.CRD42017067928.

  View details for PubMedID 30002863

  View details for PubMedCentralID PMC6038840

• Patient-reported outcomes in trauma: a scoping study of published research. Trauma surgery & acute care open Rosenberg, G. M., Stave, C., Spain, D. A., Weiser, T. G. 2018; 3 (1): e000202

  Abstract

  More people are surviving traumatic injury, but disability and reduced quality of life are frequent. Investigators are now focusing on patient-reported outcomes (PROs) to better understand this problem. We performed a scoping study of the literature to explore trends in the study of PROs after injury. The volume of published literature on PROs after injury has consistently increased, but use of measurement tool and categorization of publications are inconsistent. Journal keyword patterns are inconsistent and likely limit the effective dissemination of important findings. In studies of hospitalized trauma patients, more than 100 unique measurement tools were used, and trauma-specific measures were used in fewer than 5% of studies. International investigators are more consistent than those in the USAin the use of validated, classic measurement tools such as the Short-Form 36 and the EuroQoL Five-Dimension tools. Uniform use of measurement tools would help improve the quality and comparability of research on PROs, and trauma-specific measures would enhance the study of long-term injury outcomes.

  View details for PubMedID 30234168

• Systematic review and meta-analysis: real-world effectiveness of direct-acting antiviral therapies in chronic hepatitis C genotype 3 in Asia. BMJ open gastroenterology Wei, B. n., Ji, F. n., Yeo, Y. H., Ogawa, E. n., Stave, C. D., Dang, S. n., Li, Z. n., Furusyo, N. n., Cheung, R. C., Nguyen, M. H. 2018; 5 (1): e000209

  Abstract

  Genotype 3 (GT3) is a common chronic hepatitis C (CHC) genotype in Asia. Direct-acting antiviral (DAA) regimens have high cure rates, but real-world results are limited for Asia.To determine the real-world effectiveness of DAAs for patients with CHC GT3 in Asia.A systematic search was performed in PubMed (including MEDLINE), Embase, and selected international meeting abstract repositories. Eligible studies were postmarketing observational studies from Asia with the primary outcome of sustained virological response 12 weeks after completion of treatment (SVR12).A total of 15 studies with 4230 patients yielded a pooled SVR12 of 92.7%. High heterogeneity (I2=93.2%, P<0.0001) was noted. In subgroup analyses, patients with cirrhosis had 10.9% lower SVR12 than non-cirrhotic patients (88.6% vs 98.9%; P<0.0001) and contributed 69.5% of the heterogeneity. Prior treatment failure did not reduce the pooled SVR12 (treatment-naïve: 94.6%, 95% CI 91.3% to 96.7% vs treatment-experienced: 94.0%, 95% CI 77.5% to 98.6%; P=0.89). Twenty-four weeks of sofosbuvir+ribavirin dual therapy was the most commonly used regimen which led to similar SVR12 (OR=1.1, P=0.73) but lower adverse event rate than 12 weeks of sofosbuvir+ribavirin+pegylated interferon triple therapy.Sofosbuvir+ribavirin for 24 weeks is the most widely used and generally well-tolerated DAA therapy in Asia. However, its effectiveness is not optimal in GT3 patients with cirrhosis.

  View details for PubMedID 30147941

  View details for PubMedCentralID PMC6104766

• Systematic review with meta-analysis: effectiveness and tolerability of interferon-free direct-acting antiviral regimens for chronic hepatitis C genotype 1 in routine clinical practice in Asia. Alimentary pharmacology & therapeutics Ji, F. n., Wei, B. n., Yeo, Y. H., Ogawa, E. n., Zou, B. n., Stave, C. D., Li, Z. n., Dang, S. n., Furusyo, N. n., Cheung, R. C., Nguyen, M. H. 2018

  Abstract

  Direct-acting antiviral (DAA) regimens have shown high efficacy and tolerability for patients with HCV genotype 1/1b (GT1/1b) in clinical trials. However, robust real-world evidence of interferon (IFN)-free DAA treatment for HCV GT1-infected patients in Asia is still lacking.To systematically review and meta-analyse the effectiveness and tolerability of IFN-free DAA therapy for HCV GT1 infection in Asia.We included studies that enrolled adult patients with HCV GT1 infection in routine clinical practice in Asia, using IFN-free DAA regimens, and reported sustained virological response (SVR) after 12/24 weeks end-of-treatment by 31 May 2017. The pooled SVR rates were computed with a random-effects model. Subgroup analysis and meta-regression as previously registered in PROSPERO were performed to determine how pre-planned variables might have affected the pooled estimates.We included 41 studies from eight countries and regions, comprising of 8574 individuals. The pooled SVR rates for GT1 were 89.9% (95% CI 88.6-91.1, I2  = 55.1%) with daclatasvir/asunaprevir (DCV/ASV) and 98.1% (95% CI 97.0-99.0, I2  = 41.0%) with ledipasvir/sofosbuvir ± ribavirin (LDV/SOF ± RBV). Baseline cirrhosis but not prior treatment history and age, attenuated the effectiveness of both regimens. Baseline resistance associated substitutions (RASs) severely attenuated SVR of DCV/ASV (65.4% vs 94.3%, P < 0.001) and only minimally with LDV/SOF ± RBV (94.5% vs 99.2%, P = 0.003). Patients with renal dysfunction treated with DCV/ASV showed a higher SVR rate (93.9% vs 89.8%, P = 0.046). Patients with hepatocellular carcinoma (HCC) LDV/SOF ± RBV achieved a lower SVR than those without HCC (94.1% vs 98.7%, P = 0.001).All oral DAA treatment of HCV GT1 resulted in high cure rates in Asian patients in routine clinical practice setting including elderly patients and those with end-stage renal disease.

  View details for PubMedID 29327780

• Beneficial Effects of Statins on the Rates of Hepatic Fibrosis, Hepatic Decompensation, and Mortality in Chronic Liver Disease: A Systematic Review and Meta-Analysis. American journal of gastroenterology Kamal, S., Khan, M. A., Seth, A., Cholankeril, G., Gupta, D., Singh, U., Kamal, F., Howden, C. W., Stave, C., Nair, S., Satapathy, S. K., Ahmed, A. 2017

  Abstract

  Statins may improve outcomes in patients with chronic liver disease (CLD). We conducted a systematic review and meta-analysis to evaluate the impact of statins in the setting of CLD.We searched several databases from inception to 17 October 2016 to identify comparative studies evaluating the role of statins in CLD. Outcomes of interest were the associations between statin use and progression of fibrosis, development of hepatic decompensation in cirrhosis, and mortality in CLD. Adjusted hazard ratios (HRs) were pooled and analyzed using a random effects model. Subgroup analyses were performed based on the method of detection for progression of hepatic fibrosis and quality of studies.We included 10 studies (1 randomized controlled trial and 9 observational) with 259,453 patients (54,441 statin users and 205,012 nonusers). For progression of hepatic fibrosis, pooled HR (95% confidence interval) was 0.49 (0.39-0.62). On subgroup analysis of studies using ICD-9 (The International Classification of Diseases, Ninth Revision) coding and a second method to detect cirrhosis, pooled HR was 0.58 (0.51-0.65); pooled HR for studies using ICD-9 coding only was 0.36 (0.29-0.44). For progression of fibrosis in patients with hepatitis C virus (HCV) infection, pooled HR was 0.52 (0.37-0.73). For hepatic decompensation in cirrhosis, pooled HR was 0.54 (0.46-0.65). For mortality, pooled HR based on observational studies was 0.67 (0.46-0.98); in the randomized controlled trial, HR was 0.39 (0.15-0.99). However, the quality of evidence for these associations is low as most included studies were retrospective in nature and limited by residual confounding.Statins may retard the progression of hepatic fibrosis, may prevent hepatic decompensation in cirrhosis, and may reduce all-cause mortality in patients with CLD. As the quality (certainty) of evidence is low, further studies are needed before statins can be routinely recommended.Am J Gastroenterol advance online publication, 6 June 2017; doi:10.1038/ajg.2017.170.

  View details for DOI 10.1038/ajg.2017.170

  View details for PubMedID 28585556

• The Role of Cone-Beam CT in Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. Journal of vascular and interventional radiology Pung, L., Ahmad, M., Mueller, K., Rosenberg, J., Stave, C., Hwang, G. L., Shah, R., Kothary, N. 2017; 28 (3): 334-341

  Abstract

  To review available evidence for use of cone-beam CT during transcatheter arterial chemoembolization in hepatocellular carcinoma (HCC) for detection of tumor and feeding arteries.Literature searches were conducted from inception to May 15, 2016, in PubMed (MEDLINE), Scopus, and Cochrane Central Register of Controlled Trials. Searches included "cone beam," "CBCT," "C-arm," "CACT," "cone-beam CT," "volumetric CT," "volume computed tomography," "volume CT," AND "liver," "hepatic*," "hepatoc*." Studies that involved adults with HCC specifically and treated with transcatheter arterial chemoembolization that used cone-beam CT were included.Inclusion criteria were met by 18 studies. Pooled sensitivity of cone-beam CT for detecting tumor was 90% (95% confidence interval [CI], 82%-95%), whereas pooled sensitivity of digital subtraction angiography (DSA) for tumor detection was 67% (95% CI, 51%-80%). Pooled sensitivity of cone-beam CT for detecting tumor feeding arteries was 93% (95% CI, 91%-95%), whereas pooled sensitivity of DSA was 55% (95% CI, 36%-74%).Cone-beam CT can significantly increase detection of tumors and tumor feeding arteries during transcatheter arterial chemoembolization. Cone-beam CT should be considered as an adjunct tool to DSA during transcatheter arterial chemoembolization treatments of HCC.

  View details for DOI 10.1016/j.jvir.2016.11.037

  View details for PubMedID 28109724

• Systematic review with meta-analysis: rifaximin for the prophylaxis of spontaneous bacterial peritonitis. Alimentary pharmacology & therapeutics Goel, A. n., Rahim, U. n., Nguyen, L. H., Stave, C. n., Nguyen, M. H. 2017

  Abstract

  The primary and secondary prevention of spontaneous bacterial peritonitis (SBP) is recommended in high-risk patients with cirrhosis. Several studies evaluating the efficacy of rifaximin for SBP prophylaxis have yielded conflicting results. Rifaximin has the potential advantage of preventing bacterial overgrowth and translocation without the systemic side effects of broad-spectrum antibiotics.To evaluate the efficacy of rifaximin in the primary and secondary prevention of SBP.A literature search using five databases was performed to identify studies on the association between rifaximin and SBP. We performed two meta-analyses: (1) rifaximin compared to systemic antibiotics and (2) rifaximin compared to no antibiotics. Random-effect modelling was conducted to determine overall pooled estimates and 95% confidence intervals (CIs).Five studies with 555 patients (295 rifaximin, 260 systemic antibiotics) compared rifaximin with systemic antibiotics. The pooled odds ratio (OR) for SBP was 0.45 (95% CI 0.16-1.27; P = .13) in patients receiving rifaximin and strengthened on sensitivity analysis (OR 0.38, 95% CI 0.19-0.76, P = .01). In the analysis comparing rifaximin with no antibiotics, there were five studies with 784 patients (186 rifaximin, 598 no antibiotics). The OR for SBP was 0.34 (95% CI 0.11-0.99; P < .05) in patients receiving rifaximin. In subgroup analysis, rifaximin reduced the risk of SBP by 47% compared to no antibiotics for primary prophylaxis and by 74% compared to systemic antibiotics for secondary prophylaxis.Rifaximin may be effective in preventing SBP in patients with cirrhosis and ascites compared to systemically absorbed antibiotics and compared to placebo.

  View details for PubMedID 28994123

• Systematic Review of Physiologic Monitor Alarm Characteristics and Pragmatic Interventions to Reduce Alarm Frequency. Journal of hospital medicine Paine, C. W., Goel, V. V., Ely, E., Stave, C. D., Stemler, S., Zander, M., Bonafide, C. P. 2016; 11 (2): 136-144

  Abstract

  Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety.To critically examine the available literature relevant to alarm fatigue.Articles published in English, Spanish, or French between January 1980 and April 2015 indexed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov.Articles focused on hospital physiologic monitor alarms addressing any of the following: (1) the proportion of alarms that are actionable, (2) the relationship between alarm exposure and nurse response time, and (3) the effectiveness of interventions in reducing alarm frequency.We extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.Our search produced 24 observational studies focused on alarm characteristics and response time and 8 studies evaluating interventions. Actionable alarm proportion ranged from <1% to 36% across a range of hospital settings. Two studies showed relationships between high alarm exposure and longer nurse response time. Most intervention studies included multiple components implemented simultaneously. Although studies varied widely, and many had high risk of bias, promising but still unproven interventions include widening alarm parameters, instituting alarm delays, and using disposable electrocardiographic wires or frequently changed electrocardiographic electrodes.Physiologic monitor alarms are commonly nonactionable, and evidence supporting the concept of alarm fatigue is emerging. Several interventions have the potential to reduce alarms safely, but more rigorously designed studies with attention to possible unintended consequences are needed. Journal of Hospital Medicine 2016;11:136-144. © 2015 Society of Hospital Medicine.

  View details for DOI 10.1002/jhm.2520

  View details for PubMedID 26663904

  View details for PubMedCentralID PMC4778561

• Sports and childhood brain tumors: Can I play? Neuro-oncology practice Perreault, S., Lober, R. M., Davis, C., Stave, C., Partap, S., Fisher, P. G. 2014; 1 (4): 158-165

  Abstract

  It is unknown whether children with brain tumors have a higher risk of complications while participating in sports. We sought to estimate the prevalence of such events by conducting a systematic review of the literature, and we surveyed providers involved with pediatric central nervous system (CNS) tumor patients.A systematic review of the literature in the PubMed, Scopus, and Cochrane databases was conducted for original articles addressing sport-related complications in the brain-tumor population. An online questionnaire was created to survey providers involved with pediatric CNS tumor patients about their current recommendations and experience regarding sports and brain tumors.We retrieved 32 subjects, including 19 pediatric cases from the literature. Most lesions associated with sport complications were arachnoid cysts (n = 21), followed by glioma (n = 5). The sports in which symptom onset most commonly occurred were soccer (n = 7), football (n = 5), and running (n = 5). We surveyed 111 pediatric neuro-oncology providers. Sport restriction varied greatly from none to 14 sports. Time to return to play in sports with contact also varied considerably between providers. Rationales for limiting sports activities were partly related to subspecialty. Responders reported 9 sport-related adverse events in patients with brain tumor.Sport-related complications are uncommon in children with brain tumors. Patients might not be at a significantly higher risk and should not need to be excluded from most sports activities.

  View details for PubMedID 26034627

• Uptake of Genetic Testing by Relatives of Lynch Syndrome Probands: A Systematic Review CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Sharaf, R. N., Myer, P., Stave, C. D., Diamond, L. C., Ladabaum, U. 2013; 11 (9): 1093-1100

  Abstract

  BACKGROUND: Screening of persons with newly diagnosed colorectal cancer (CRC) for Lynch syndrome can yield substantial benefits at acceptable costs, presuming sufficient uptake of genetic testing by first-degree relatives of Lynch syndrome probands. We performed a systematic review of the literature to determine the frequency of, and factors associated with, genetic testing of first-degree relatives of Lynch syndrome probands. METHODS: We searched 4 databases (CINAHL, PsycInfo, PUBMED, and SCOPUS) for articles published through May 2011 reporting uptake of genetic testing by relatives of Lynch syndrome probands. Two investigators independently screened articles to determine whether they met inclusion criteria; data were collected on populations, methodologies, and uptake of genetic testing. A narrative, qualitative systematic review was performed. RESULTS: We identified 1258 potentially relevant articles; 533 were fully reviewed and 8 were included in the final analysis. Of first-degree relatives of Lynch syndrome probands, 52% or less received genetic testing. For each proband, 4.6 or fewer relatives underwent genetic testing. Demographic factors (age <50 y, female sex, parenthood, level of education, employment, participation in medical studies), psychological factors (lack of depressive symptoms), and possibly family history (greater number of relatives with cancer) were associated with uptake of genetic testing. CONCLUSION: Based on a systematic review, genetic testing appears to be underutilized by first-degree relatives of patients with Lynch syndrome. The clinical benefit and economic feasibility of screening persons with CRC for Lynch syndrome depends on optimizing family-wide uptake of genetic testing. Future research and clinical efforts should focus on ways to overcome barriers to genetic testing.

  View details for DOI 10.1016/j.cgh.2013.04.044

  View details for Web of Science ID 000323816100012

• Uptake of genetic testing by relatives of lynch syndrome probands: a systematic review. Clinical gastroenterology and hepatology Sharaf, R. N., Myer, P., Stave, C. D., Diamond, L. C., Ladabaum, U. 2013; 11 (9): 1093-1100

  Abstract

  BACKGROUND: Screening of persons with newly diagnosed colorectal cancer (CRC) for Lynch syndrome can yield substantial benefits at acceptable costs, presuming sufficient uptake of genetic testing by first-degree relatives of Lynch syndrome probands. We performed a systematic review of the literature to determine the frequency of, and factors associated with, genetic testing of first-degree relatives of Lynch syndrome probands. METHODS: We searched 4 databases (CINAHL, PsycInfo, PUBMED, and SCOPUS) for articles published through May 2011 reporting uptake of genetic testing by relatives of Lynch syndrome probands. Two investigators independently screened articles to determine whether they met inclusion criteria; data were collected on populations, methodologies, and uptake of genetic testing. A narrative, qualitative systematic review was performed. RESULTS: We identified 1258 potentially relevant articles; 533 were fully reviewed and 8 were included in the final analysis. Of first-degree relatives of Lynch syndrome probands, 52% or less received genetic testing. For each proband, 4.6 or fewer relatives underwent genetic testing. Demographic factors (age <50 y, female sex, parenthood, level of education, employment, participation in medical studies), psychological factors (lack of depressive symptoms), and possibly family history (greater number of relatives with cancer) were associated with uptake of genetic testing. CONCLUSION: Based on a systematic review, genetic testing appears to be underutilized by first-degree relatives of patients with Lynch syndrome. The clinical benefit and economic feasibility of screening persons with CRC for Lynch syndrome depends on optimizing family-wide uptake of genetic testing. Future research and clinical efforts should focus on ways to overcome barriers to genetic testing.

  View details for DOI 10.1016/j.cgh.2013.04.044

  View details for PubMedID 23669308

• Same-Day Discharge After Percutaneous Coronary Intervention A Meta-Analysis JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Brayton, K. M., Patel, V. G., Stave, C., de Lemos, J. A., Kumbhani, D. J. 2013; 62 (4): 275-285

  Abstract

  This study sought to assess the safety of same-day discharge in patients undergoing percutaneous coronary intervention (PCI).The safety of same-day discharge has previously been evaluated primarily in small, single-center studies.We conducted a meta-analysis of studies reporting outcomes of patients discharged on the same day as PCI. Demographic data, procedural characteristics, and adverse outcomes were collected. Two composite outcomes were pre-specified: 1) death, myocardial infarction (MI), or target lesion revascularization (TLR); and 2) major bleeding or vascular complications.Data from 12,803 patients in 37 studies were collated, including 7 randomized controlled trials (RCTs) (n = 2,738) and 30 observational studies (n = 10,065). The majority of patients in both cohorts underwent PCI for stable angina. The vascular access site was predominantly transradial in the randomized cohort (60.8%) and transfemoral in the observational cohort (70.0%). In the RCTs, no difference was seen between same-day discharge and routine overnight observation with regard to death/MI/TLR (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.43 to 1.87; p = 0.78) or for major bleeding/vascular complications (OR: 1.69; 95% CI: 0.84 to 3.40; p = 0.15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1.00% (95% CI: 0.58% to 1.68%), and major bleeding/vascular complications occurred at a pooled rate of 0.68% (95% CI: 0.35% to 1.32%).In selected patients undergoing largely elective PCI, same-day discharge was associated with a low rate of major complications and appeared to be as safe as routine overnight observation.

  View details for DOI 10.1016/j.jacc.2013.03.051

  View details for Web of Science ID 000322064100004

  View details for PubMedID 23623905

• Comparing performance and impact of first responders on outcome in prehospital emergency medicine in Switzerland EMERGENCIAS Urwyler, N., Theiler, L., Schoenhofer, J., Kaempfen, B., Stave, C., Greif, R. 2012; 24 (6): 426-432

  View details for Web of Science ID 000312351600003

• Are organic foods safer or healthier than conventional alternatives?: a systematic review. Annals of internal medicine Smith-Spangler, C., Brandeau, M. L., Hunter, G. E., Bavinger, J. C., Pearson, M., Eschbach, P. J., Sundaram, V., Liu, H., Schirmer, P., Stave, C., Olkin, I., Bravata, D. M. 2012; 157 (5): 348-366

  Abstract

  The health benefits of organic foods are unclear.To review evidence comparing the health effects of organic and conventional foods.MEDLINE (January 1966 to May 2011), EMBASE, CAB Direct, Agricola, TOXNET, Cochrane Library (January 1966 to May 2009), and bibliographies of retrieved articles.English-language reports of comparisons of organically and conventionally grown food or of populations consuming these foods.2 independent investigators extracted data on methods, health outcomes, and nutrient and contaminant levels.17 studies in humans and 223 studies of nutrient and contaminant levels in foods met inclusion criteria. Only 3 of the human studies examined clinical outcomes, finding no significant differences between populations by food type for allergic outcomes (eczema, wheeze, atopic sensitization) or symptomatic Campylobacter infection. Two studies reported significantly lower urinary pesticide levels among children consuming organic versus conventional diets, but studies of biomarker and nutrient levels in serum, urine, breast milk, and semen in adults did not identify clinically meaningful differences. All estimates of differences in nutrient and contaminant levels in foods were highly heterogeneous except for the estimate for phosphorus; phosphorus levels were significantly higher than in conventional produce, although this difference is not clinically significant. The risk for contamination with detectable pesticide residues was lower among organic than conventional produce (risk difference, 30% [CI, -37% to -23%]), but differences in risk for exceeding maximum allowed limits were small. Escherichia coli contamination risk did not differ between organic and conventional produce. Bacterial contamination of retail chicken and pork was common but unrelated to farming method. However, the risk for isolating bacteria resistant to 3 or more antibiotics was higher in conventional than in organic chicken and pork (risk difference, 33% [CI, 21% to 45%]).Studies were heterogeneous and limited in number, and publication bias may be present.The published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods. Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria.None.

  View details for DOI 10.7326/0003-4819-157-5-201209040-00007

  View details for PubMedID 22944875

• Are Organic Foods Safer or Healthier Than Conventional Alternatives? ANNALS OF INTERNAL MEDICINE Smith-Spangler, C., Brandeau, M. L., Hunter, G. E., Bavinger, C., Pearson, M., Eschbach, P. J., Sundaram, V., Liu, H., Schirmer, P., Stave, C., Olkin, I., Bravata, D. M. 2012; 157 (5): 348-U112

  Abstract

  The health benefits of organic foods are unclear.To review evidence comparing the health effects of organic and conventional foods.MEDLINE (January 1966 to May 2011), EMBASE, CAB Direct, Agricola, TOXNET, Cochrane Library (January 1966 to May 2009), and bibliographies of retrieved articles.English-language reports of comparisons of organically and conventionally grown food or of populations consuming these foods.2 independent investigators extracted data on methods, health outcomes, and nutrient and contaminant levels.17 studies in humans and 223 studies of nutrient and contaminant levels in foods met inclusion criteria. Only 3 of the human studies examined clinical outcomes, finding no significant differences between populations by food type for allergic outcomes (eczema, wheeze, atopic sensitization) or symptomatic Campylobacter infection. Two studies reported significantly lower urinary pesticide levels among children consuming organic versus conventional diets, but studies of biomarker and nutrient levels in serum, urine, breast milk, and semen in adults did not identify clinically meaningful differences. All estimates of differences in nutrient and contaminant levels in foods were highly heterogeneous except for the estimate for phosphorus; phosphorus levels were significantly higher than in conventional produce, although this difference is not clinically significant. The risk for contamination with detectable pesticide residues was lower among organic than conventional produce (risk difference, 30% [CI, -37% to -23%]), but differences in risk for exceeding maximum allowed limits were small. Escherichia coli contamination risk did not differ between organic and conventional produce. Bacterial contamination of retail chicken and pork was common but unrelated to farming method. However, the risk for isolating bacteria resistant to 3 or more antibiotics was higher in conventional than in organic chicken and pork (risk difference, 33% [CI, 21% to 45%]).Studies were heterogeneous and limited in number, and publication bias may be present.The published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods. Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria.None.

  View details for Web of Science ID 000308361500005

• Lack of Significant Interactions Between Clopidogrel and Proton Pump Inhibitor Therapy: Meta-Analysis of Existing Literature DIGESTIVE DISEASES AND SCIENCES Gerson, L. B., McMahon, D., Olkin, I., Stave, C., Rockson, S. G. 2012; 57 (5): 1304-1313

  Abstract

  Published data regarding the effect of concomitant clopidogrel and proton pump inhibitor (PPI) therapy on cardiovascular outcomes have been conflicting.To perform an updated meta-analysis in order to determine changes in risk differences (RD) between primary and secondary outcome analyses.Primary analysis was based on definite vascular outcomes, including all cause mortality, cardiac death, myocardial infarction, and/or stroke. Secondary analysis also incorporated probable cardiac events, which included re-hospitalization for cardiac symptoms or revascularization procedures. RD were combined using a random-effects model.We reviewed 1,204 publications of which 26 studies (16 published articles, 10 abstracts) met inclusion criteria. The meta-analysis of outcomes from the two randomized controlled trials did not show an increased risk (RD 0.0, 95% CI -0.01, 0.01) for adverse outcomes. The meta-analysis of primary outcomes showed a RD of 0.02 (95% CI 0.01, 0.03) for all studies. The meta-analysis for secondary outcomes yielded a RD of 0.02 (95% CI 0.01-0.04) based on 19 published papers and abstracts. When primary and secondary outcomes were combined, the meta-analysis for published papers yielded an overall RD of 0.05 (95% CI 0.03-0.06).In patients using concomitant clopidogrel and PPI therapy, the risk of adverse cardiac outcomes was 0% based on data from well-controlled randomized trials. Data from retrospective studies and the addition of probable vascular events significantly increased the RD estimates, likely due to lack of adjustment for potential confounders.

  View details for DOI 10.1007/s10620-011-2007-1

  View details for PubMedID 22198703

• Systematic review: the relationship between interstitial lung diseases and gastro-oesophageal reflux disease ALIMENTARY PHARMACOLOGY & THERAPEUTICS Hershcovici, T., Jha, L. K., Johnson, T., Gerson, L., Stave, C., Malo, J., Knox, K. S., Quan, S., Fass, R. 2011; 34 (11-12): 1295-1305

  Abstract

  BACKGROUND  A potential relationship has been suggested between gastro-oesophageal reflux disease (GERD) and interstitial lung diseases (ILDs). AIM  To evaluate whether there is a causal relationship between GERD and different ILDs. METHODS  We conducted a systematic search of literature published between 1980 and 2010. After a review by two independent authors, each study was assigned an evidence-based rating according to a standard scoring system. RESULTS  We identified 319 publications and 22 of them met the entry criteria. Of those, the relationship between GERD and idiopathic pulmonary fibrosis (IPF) was investigated in 14 articles, pulmonary involvement in systemic sclerosis (SSc) in six articles and pulmonary involvement in mixed connective tissue disease (MCTD) in two articles. We found the prevalence of GERD and/or oesophageal dysmotility to be higher in patients with different types of ILD as compared with those without ILD [Evidence B]. Among patients with IPF, 67-76% demonstrated abnormal oesophageal acid exposure off PPI treatment. No relationship was demonstrated between severity of GERD and severity of IPF [Evidence B]. Data are scant on outcomes of antireflux treatment in patients with IPF. There is a correlation between the severity of ILD and the degree of oesophageal motor impairment in patients with SSc and MCTD [Evidence B]. CONCLUSIONS  Based on the currently available data, a causal relationship between GERD and idiopathic pulmonary fibrosis cannot be established. There is scant evidence about antireflux therapy in idiopathic pulmonary fibrosis patients. There may be an association between lung and oesophageal involvement in systemic sclerosis and mixed connective tissue disease, but a causal relationship cannot be established.

  View details for DOI 10.1111/j.1365-2036.2011.04870.x

  View details for Web of Science ID 000297100300004

  View details for PubMedID 21999527

• SmartSearch: automated recommendations using librarian expertise and the National Center for Biotechnology Information's Entrez Programming Utilities JOURNAL OF THE MEDICAL LIBRARY ASSOCIATION Steinberg, R. M., Zwies, R., Yates, C., Stave, C., Pouliot, Y., Heilemann, H. A. 2010; 98 (2): 171-175

  View details for DOI 10.3163/1536-5050.98.2.012

  View details for Web of Science ID 000277447300012

  View details for PubMedID 20428285

  View details for PubMedCentralID PMC2859267

• Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease ALIMENTARY PHARMACOLOGY & THERAPEUTICS Johnson, T., Gerson, L., Hershcovici, T., Stave, C., Fass, R. 2010; 31 (6): 607-614

  Abstract

  Carbonated beverages have unique properties that may potentially exacerbate gastro-oesophageal reflux disease (GERD), such as high acidity and carbonation. Cessation of carbonated beverage consumption is commonly recommended as part of lifestyle modifications for patients with GERD.To evaluate the relationship of carbonated beverages with oesophageal pH, oesophageal motility, oesophageal damage, GERD symptoms and GERD complications.A systematic review.Carbonated beverage consumption results in a very short decline in intra-oesophageal pH. In addition, carbonated beverages may lead to a transient reduction in lower oesophageal sphincter basal pressure. There is no evidence that carbonated beverages directly cause oesophageal damage. Carbonated beverages have not been consistently shown to cause GERD-related symptoms. Furthermore, there is no evidence that these popular drinks lead to GERD complications or oesophageal cancer.Based on the currently available literature, it appears that there is no direct evidence that carbonated beverages promote or exacerbate GERD.

  View details for DOI 10.1111/j.1365-2036.2010.04232.x

  View details for Web of Science ID 000274407000001

  View details for PubMedID 20055784

• Systematic Review: Safety and Efficacy of Extended-Duration Antiviral Chemoprophylaxis Against Pandemic and Seasonal Influenza ANNALS OF INTERNAL MEDICINE Khazeni, N., Bravata, D. M., Holty, J. C., Uyeki, T. M., Stave, C. D., Gould, M. K. 2009; 151 (7): 464-W159

  Abstract

  Neuraminidase inhibitors (NAIs) are stockpiled internationally for extended use in an influenza pandemic.To evaluate the safety and efficacy of extended-duration (>4 weeks) NAI chemoprophylaxis against influenza.Studies published in any language through 11 June 2009 identified by searching 10 electronic databases and 3 trial registries.Randomized, placebo-controlled, double-blind human trials of extended-duration NAI chemoprophylaxis that reported outcomes of laboratory-confirmed influenza or adverse events.2 reviewers independently assessed study quality and abstracted information from eligible studies.Of 1876 potentially relevant citations, 7 trials involving 7021 unique participants met inclusion criteria. Data were pooled by using random-effects models. Chemoprophylaxis with NAIs decreased the frequency of symptomatic influenza (relative risk [RR], 0.26 [95% CI, 0.18 to 0.37]; risk difference [RD], -3.9 percentage points [CI, -5.8 to -1.9 percentage points]) but not asymptomatic influenza (RR, 1.03 [CI, 0.81 to 1.30]; RD, -0.4 percentage point [CI, -1.6 to 0.9 percentage point]). Adverse effects were not increased overall among NAI recipients (RR, 1.01 [CI, 0.94 to 1.08]; RD, 0.1 percentage point [CI, -0.2 to 0.4 percentage point]), but nausea and vomiting were more common among those who took oseltamivir (RR, 1.48 [CI, 1.86 to 2.33]; RD, 1.7 percentage points [CI, 0.6 to 2.9 percentage points]). Prevention of influenza did not statistically significantly differ between zanamivir and oseltamivir.All trials were industry-sponsored. No study was powered to detect rare adverse events, and none included diverse racial groups, children, immunocompromised patients, or individuals who received live attenuated influenza virus vaccine.Extended-duration zanamivir and oseltamivir chemoprophylaxis seems to be highly efficacious for preventing symptomatic influenza among immunocompetent white and Japanese adults. Extended-duration oseltamivir is associated with increased nausea and vomiting. Safety and efficacy in several subpopulations that might receive extended-duration influenza chemoprophylaxis are unknown.

  View details for Web of Science ID 000270470500004

  View details for PubMedID 19652173

• Analysis of phase II studies on targeted agents and subsequent phase III trials: What are the predictors for success? JOURNAL OF CLINICAL ONCOLOGY Chan, J. K., Ueda, S. M., Sugiyama, V. E., Stave, C. D., Shin, J. Y., Monk, B. J., Sikic, B. I., Osann, K., Kapp, D. S. 2008; 26 (9): 1511-1518

  Abstract

  To identify the characteristics of phase II studies that predict for subsequent "positive" phase III trials (those that reached the proposed primary end points of study or those wherein the study drug was superior to the standard regimen investigating targeted agents in advanced tumors.We identified all phase III clinical trials of targeted therapies against advanced cancers published from 1985 to 2005. Characteristics of the preceding phase II studies were reviewed to identify predictive factors for success of the subsequent phase III trial. Data were analyzed using the chi(2) test and logistic regression models.Of 351 phase II studies, 167 (47.6%) subsequent phase III trials were positive and 184 (52.4%) negative. Phase II studies from multiple rather than single institutions were more likely to precede a successful trial (60.4% v 39.4%; P < .001). Positive phase II results were more likely to lead to a successful phase III trial (50.8% v 22.5%; P = .003). The percentage of successful trials from pharmaceutical companies was significantly higher compared with academic, cooperative groups, and research institutes (89.5% v 44.2%, 45.2%, and 46.3%, respectively; P = .002). On multivariate analysis, these factors and shorter time interval between publication of phase II results and III study publication were independent predictive factors for a positive phase III trial.In phase II studies of targeted agents, multiple- versus single-institution participation, positive phase II trial, pharmaceutical company-based trials, and shorter time period between publication of phase II to phase III trial were independent predictive factors of success in a phase III trial. Investigators should be cognizant of these factors in phase II studies before designing phase III trials.

  View details for DOI 10.1200/JCO.2007.14.8874

  View details for Web of Science ID 000254178600020

  View details for PubMedID 18285603

• Using pedometers to increase physical activity and improve health - A systematic review JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Bravata, D. M., Smith-Spangler, C., Sundaram, V., Gienger, A. L., Lin, N., Lewis, R., Stave, C. D., Olkin, I., Sirard, J. R. 2007; 298 (19): 2296-2304

  Abstract

  Without detailed evidence of their effectiveness, pedometers have recently become popular as a tool for motivating physical activity.To evaluate the association of pedometer use with physical activity and health outcomes among outpatient adults.English-language articles from MEDLINE, EMBASE, Sport Discus, PsychINFO, Cochrane Library, Thompson Scientific (formerly known as Thompson ISI), and ERIC (1966-2007); bibliographies of retrieved articles; and conference proceedings.Studies were eligible for inclusion if they reported an assessment of pedometer use among adult outpatients, reported a change in steps per day, and included more than 5 participants.Two investigators independently abstracted data about the intervention; participants; number of steps per day; and presence or absence of obesity, diabetes, hypertension, or hyperlipidemia. Data were pooled using random-effects calculations, and meta-regression was performed.Our searches identified 2246 citations; 26 studies with a total of 2767 participants met inclusion criteria (8 randomized controlled trials [RCTs] and 18 observational studies). The participants' mean (SD) age was 49 (9) years and 85% were women. The mean intervention duration was 18 weeks. In the RCTs, pedometer users significantly increased their physical activity by 2491 steps per day more than control participants (95% confidence interval [CI], 1098-3885 steps per day, P < .001). Among the observational studies, pedometer users significantly increased their physical activity by 2183 steps per day over baseline (95% CI, 1571-2796 steps per day, P < .0001). Overall, pedometer users increased their physical activity by 26.9% over baseline. An important predictor of increased physical activity was having a step goal such as 10,000 steps per day (P = .001). When data from all studies were combined, pedometer users significantly decreased their body mass index by 0.38 (95% CI, 0.05-0.72; P = .03). This decrease was associated with older age (P = .001) and having a step goal (P = .04). Intervention participants significantly decreased their systolic blood pressure by 3.8 mm Hg (95% CI, 1.7-5.9 mm Hg, P < .001). This decrease was associated with greater baseline systolic blood pressure (P = .009) and change in steps per day (P = .08).The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure. Whether these changes are durable over the long term is undetermined.

  View details for Web of Science ID 000251055900030

  View details for PubMedID 18029834

• Modeling the relationship between search terms in clinical queries. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Zeiger, R. F., Stave, C. D., Schmitzberger, F., Fagan, L. M. 2005: 1167-?

  Abstract

  We designed hedges for clinical queries sent to MEDLINE and Google in an attempt to explicitly model the relationship, such as treatment or diagnosis, between search terms. A pilot evaluation suggested that mean average precision (MAP) improved for a precomputed diagnostic query but not for a precomputed treatment query. An important limitation to this approach is that target resources do not explicitly model these relationships.

  View details for PubMedID 16779453