Bringing new technology and evidence into cardiovascular practice: the utility of translational science No abstract available

Slaying the dragons: rehabilitating emergency services personnel No abstract available

Electronic textile-based electrocardiogram monitoring in cardiac patients: a scoping review Objective: The objectives of this scoping review were to explore, organize and present the existing research literature on the use of electronic textile (e-textile)-based resting, signal-averaged, ambulatory or exercise electrocardiogram (ECG) monitoring to evaluate the application of e-textile technologies for ECG cardiac monitoring. Introduction: E-textile-based ECG monitoring of cardiac patients offers a possible new alternative for in-hospital monitoring and post-discharge monitoring during cardiac rehabilitation. Inclusion criteria: Studies that included patients (inpatients or outpatients) who qualified for cardiac rehabilitation programs or continuous ambulatory ECG monitoring were considered. The key concepts that were addressed included resting, signal-averaged, ambulatory or exercise ECG monitoring based on e-textile technologies or e-textile-based cardiac rehabilitation. Studies were excluded if they focused only on specific aspects of the e-textile ECG system rather than a complete ECG system. Methods: Research reports, dissertations or books that evaluated e-textile-based ECG monitoring of cardiac patients in a hospital or at home, written in English, and published between January 2000 and March 2018 were considered for inclusion. Published and unpublished literature was located through databases including Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central (PMC), Institute of Electrical and Electronics Engineers (IEEE Xplore), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, Web of Science, Scopus, Expanded Academic ASAP, ProQuest Dissertations and Theses Global, SPORTDiscus, and ENGINE–Australian Engineering Database (Informit). Two independent reviewers screened citations for inclusion while the third reviewer resolved any discrepancies. Meta-data from each study were extracted, and a narrative summary was used to present the results. Furthermore, 38 study authors were contacted to request missing or additional data as required, with 16 responding within eight weeks. Results: Of the 207 studies that were eligible for full-text review, only 8% (n = 17) were included in the final study. Eighty-eight percent (n = 15) of included studies were conducted with an adult population, and 11 studies reported an in-hospital application. Only three groups of researchers reported e-textile integration beyond the textile electrodes, mostly in the form of wiring and custom-made printed circuit boards. Eight studies utilized two ECG sensors, while single-lead ECG was the most common configuration, used in 10 studies. ECG result was the primary parameter reported across the included studies. Resting ECG was the most common form of ECG acquired (n = 10), followed by exercise ECG (n = 6) and ambulatory ECG (n = 5). Eight studies addressed the issue of power requirements, and seven studies used Bluetooth for wireless communication. The primary problem reported across all studies was noise from motion artifact. Conclusions: The recent advances in signal quality and noise reduction for e-textile-based ECG applications are promising. However, the use of a 12-lead, personalized, home-based cardiac rehabilitation monitor system containing fully textile-integrated electronics with diagnostic capability is yet to be reported. Therefore, there is potential for future research in this area. Additionally, motion artifact continues to be a challenge.

Vocational rehabilitation for emergency services personnel: a scoping review Objective: The objective of this scoping review is to examine and map the range of vocational rehabilitation available for emergency services personnel. Introduction: Employee work absence due to illness and injury is an international burden. The emergency service sector (police officers, firefighters and ambulance/paramedic staff) workforce has been shown to report a higher prevalence of illness/injury and sick leave compared to the general population. Despite the evidence of physical and psychological problems that emergency service sector workers can face, vocational rehabilitation (VR) interventions and the structure and effectiveness of VR for these workers are less well known. Inclusion criteria: This scoping review considered studies that included adult emergency medical services personnel (e.g. police officers, firefighters and ambulance/paramedic staff), regardless of age, sex or rank. Emergency medical services personnel from any developed nation were included. The interventions included any VR regardless of condition, work status (VR to prevent sick leave or for workers on sick leave) or focus (e.g. mental health issues, neurological problems or musculoskeletal conditions). Vocational rehabilitation interventions can include work conditioning, work hardening, physiotherapy, counseling, functional restoration and occupational rehabilitation. Methods: Published and unpublished literature in English from 2007 to 2017 was included in this review. A three-step search strategy was followed that included five databases and nine websites. Data extraction was performed by two reviewers using a pre-determined data extraction form developed by the authors. Results: This review identified 24,271 sources of information, of which 48 were screened at full-text stage, and 22 sources were eligible to be included in the final scoping review. The majority of the sources provided evidence of VR for police officers and firefighters. Vocational rehabilitation is typically provided in residential rehabilitation settings as well as some outpatient, off-site and workplace settings. The main type of VR provided is physical, but there is also evidence of psychological rehabilitation and addiction/substance misuse rehabilitation. Conclusions: This review demonstrated that there is a lack of information in the public domain on VR for staff working in the emergency service sector, as well as a lack of rigorous evaluation available on the effectiveness of VR within the emergency service sector. There is inconsistent provision of VR internationally for emergency service sector staff.

Effectiveness and harms of pharmacological interventions for the treatment of delirium in adults in intensive care units after cardiac surgery: a systematic review Objective: The objective of this review was to synthesize the best available evidence on the effectiveness and harms of pharmacological interventions for the treatment of delirium in adult patients in the intensive care unit (ICU) after cardiac surgery. Introduction: Patients who undergo cardiac surgery are at high risk of delirium (incidence: 50–90%). Delirium has deleterious effects, increasing the risk of death and adversely affecting recovery. Clinical interventional trials have been conducted to prevent and treat postoperative delirium pharmacologically including antipsychotics and sedatives. These trials have provided some evidence about efficacy and influenced clinical decision making. However, much reporting is incomplete and provides biased assessments of efficacy; benefits are emphasized while harms are inadequately reported. Inclusion criteria: Participants were ≥ 16 years, any sex or ethnicity, who were treated postoperatively in a cardiothoracic ICU following cardiac surgery and were identified as having delirium. Any pharmacological intervention for the treatment of delirium was included, regardless of drug classification, dosage, intensity or frequency of administration. Outcomes of interest of this review were: mortality, duration and severity of delirium, use of physical restraints, quality of life, family members’ satisfaction with delirium management, duration/severity of the aggressive episode, associated falls, severity of accidental self-harm, pharmacological harms, harms related to over-sedation, ICU length of stay, hospital length of stay (post ICU), total hospital length of stay, need for additional intervention medication and need for rescue medication. Randomized controlled trials were considered first and in their absence, non-randomized controlled trials and quasi-experimental would have been considered, followed by analytical observational studies. Methods: A search was conducted in PubMed, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, Epistemonikos, Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, Clinical Trials in New Zealand, and ProQuest Dissertations and Theses to locate both published and unpublished studies. There was no date limit for the search. A hand search for primary studies published between January 1, 2012 and November 17, 2018 in relevant journals was also conducted. Only studies published in English were considered for inclusion. Two reviewers independently assessed the methodological quality using standardized critical appraisal instruments from JBI and McMaster University. Quantitative data were extracted using the standardized JBI data extraction tool. A meta-analysis was not performed, as there was too much clinical and methodological heterogeneity in the included studies. Results have been presented in a narrative form. Standard GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) evidence assessment of outcomes has been reported. Results: Three RCTs investigating morphine versus haloperidol (n = 53), ondansetron versus haloperidol (n = 72), and dexmedetomidine versus midazolam (n = 80) were included. Due to heterogeneity and incomplete reporting, a meta-analysis was not feasible. Overall, the methodological quality of these studies was found to be low. Additionally, this review found reporting of harms to be inadequate and superficial for all three studies and did not meet the required standards for harms reporting, as defined by the CONSORT statement extension for harms. Conclusions: It was not possible to draw any valid conclusions regarding the effectiveness of morphine vs haloperidol, ondansetron vs haloperidol or dexmedetomidine vs midazolam in treating delirium after cardiac surgery. This is due to the low number of studies, the poor methodological quality in conducting and reporting and the heterogeneity between the studies.

Effects of flavonoid-rich fruits on hypertension in adults: a systematic review Objective: The objective of this systematic review was to synthesize the best available research evidence on the effectiveness of flavonoid-rich fruits in the treatment of hypertension. Introduction: Hypertension is a serious public health concern as it contributes to a significant burden of disease, leading to millions of deaths globally. Complementary therapies including flavonoids have generated interest in assisting the treatment of hypertension. Flavonoids are a type of polyphenol abundant in fruits and a growing body of evidence suggests antihypertensive effects of the flavonoids due to their antioxidant properties. To date, no systematic review has been performed to collate the evidence on the effects of flavonoid-rich fruits on hypertension in adults. Inclusion criteria: This systematic review included randomized controlled trials (RCTs) that compared the administration of any type of flavonoid-rich fruit or equivalent supplement with a placebo or other intervention in adults with hypertension. Trials that measured blood pressure using objective outcome measures such as a manual mercury sphygmomanometer were included. Studies that did not specify the flavonoid component of the fruit or fruit supplement were excluded from the review. Secondary outcomes, including change in weight, blood glucose level, triglycerides and total blood cholesterol levels, were also assessed. Methods: A three-step search was undertaken, including a comprehensive search of the MEDLINE, Embase, Cochrane Trials (CENTRAL) and CINAHL databases, in September 2018. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies for inclusion were assessed using the critical appraisal checklist for randomized controlled trials as recommended by JBI. Data were pooled in a statistical meta-analysis model. Subgroup-analysis according to type of intervention and length of intervention period was performed. Where statistical pooling was not possible, the findings have been presented in a narrative form. Results: Fifteen randomized controlled trials involving 572 participants were included in the review. The subclasses of flavonoids assessed included: anthocyanins, naringin, narirutin and flavan-3-ols. The overall methodological quality of the trials was high. Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of four of the trials demonstrated no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference = −1.02, 95% confidence interval [CI] −3.12, 1.07; p = 0.34, I2 = 0%; diastolic mean difference = −0.90, 95% CI −2.10, 0.31; p = 0.15, I2 = 0%). Similarly, pooled results from two crossover RCTs with two-timed dosed interventions in a 24-hour period demonstrated no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials assessed blood pressure following the flavonoid intervention at more than four weeks follow-up. Meta-analysis of five of the trials demonstrated evidence of no effect on either systolic blood pressure (mean difference = −0.95, 95%CI −3.58, 1.68; p = 0.478, I2 = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI −1.11, 2.82; p = 0.393, I2 = 0%). Conclusions: The findings of this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Flavonoids have no effect on systolic and diastolic blood pressure. Further robust RCTs using sample sizes based on power calculations are needed to provide evidence for the use of flavonoid-rich fruits for the management of hypertension.

Impact of lifestyle modification on absolute cardiovascular disease risk: a systematic review protocol Objective: The objective of this review is to synthesize the available evidence on the effectiveness of lifestyle-based interventions for reducing absolute cardiovascular disease (CVD). Introduction: Cardiovascular disease prevention guidelines recommend tailoring the choice and intensity of preventive interventions based on absolute CVD risk score. Several studies employing lifestyle-based interventions to mitigate CVD risk have reported heterogeneous outcomes, necessitating a systematic review to provide an exhaustive summary of current evidence. Inclusion criteria: Eligible studies will include individuals at high-risk of CVD who are at least 18 years of age, with no history of CVD at baseline, regardless of sex, ethnicity and socio-economic status. Studies that compare lifestyle-based intervention to no intervention or usual care will be included. The outcome of interest is change in absolute CVD risk from baseline to post-intervention. Experimental and quasi-experimental study designs will be included. Methods: Searches will be conducted in PubMed, EMBASE and CINAHL from the inception of each database. The search for gray literature will include ProQuest Dissertations and Theses Global, Grey Literature Report, Web of Science, BIOSIS Previews and the Proceedings database. Selected studies will be critically appraised by two independent reviewers at the study level for methodological quality. Extracted data will include details about the interventions, populations, study methods and outcomes of significance to the review question and objectives. Where possible, papers will be pooled in statistical meta-analysis. Effect sizes will be expressed as either odds ratios or standardized mean differences, and their 95% confidence intervals will be calculated for analysis. Systematic review registration number: PROSPERO CRD42017073543

Quality of life in patients with advanced heart failure and an implanted left ventricular assist device: an umbrella review protocol Objective: This review aims to evaluate the effectiveness of implanted left ventricular assist devices on quality of life in patients with advanced heart failure. Introduction: Approximately 500,000 patients worldwide are diagnosed with advanced heart failure. The preferred treatment for patients who remain symptomatic after standard medical treatment is heart transplantation. However, due to the shortage of donor organs, left ventricular assist devices are increasingly used as an alternative. This umbrella review is necessary to advise clinicians so they may provide patients and families with clear information on standard medical treatment, implanted left ventricular assist devices and heart transplantation. Inclusion criteria: This umbrella review will consider research syntheses that include patients 16 years or over with advanced heart failure and an implanted left ventricular assist device. The primary outcome is quality of life, and secondary outcomes include patient survival rates and the New York Heart Association functional classification changes. Methods: An initial search of PubMed and CINAHL has been undertaken to identify articles and create a search strategy. Retrieved articles will be screened against the inclusion criteria. Included studies will be critically appraised for methodological quality according to JBI umbrella review methodology, and data will be extracted using the standardized JBI data extraction tool. The results will be presented in a Summary of Evidence, and a GRADE Summary of Findings will be produced for grading the quality of the evidence.

Duration and determinants of Chagas latency: an etiology and risk systematic review protocol Objective: The objective of this systematic review is to explore and discuss the latency duration among asymptomatic people with chronic Chagas disease. Introduction: Studies estimate the latency period of Chagas disease to be approximately 10–30 years. However, new findings may indicate that this latency period is shorter and depends on the presence of clinical factors. This systematic review protocol will explore the duration and factors affecting this latency period to inform treatment, with the potential of improving outcomes. Inclusion criteria: Eligible studies will include asymptomatic people with indeterminate Chagas disease confirmed through positive serologic testing and the absence of structural cardiomyopathy with no heart failure symptoms and normal electrocardiography results. Studies that involve a longitudinal observation period of participants will be considered. This period must start from the acute acquisition of the infection or an already established indeterminate form of the disease until the development of a primary or secondary cardiac outcome. Methods: The following electronic databases will be searched: MEDLINE, Embase, Cochrane Library, Web of Science Core Collection and LILACS. The search will include the following concepts: Chagas disease, latency duration and determinants of the Chagas latency period. The languages will be restricted to English, Spanish and Portuguese. Two reviewers will review the selected studies for methodological quality using critical appraisal tools and conduct data extraction. Studies will, where possible, be pooled in a statistical meta-analysis. All data will be presented and synthesized through tables, summaries, figures and charts. Systematic review registration number: PROSPERO CRD42019118019

Effectiveness of deep general anesthesia compared to the standard depth of general anesthesia for acute postoperative pain and patient safety: a systematic review protocol Objective: The objective of this systematic review is to synthesize the best available evidence related to the effectiveness of deep general anesthesia on acute postoperative pain and patient safety in adult patients. Introduction: Acute postoperative pain is a common physiological side effect of surgery that should be alleviated as soon as possible to reduce suffering and other detrimental effects. Given the adverse effects related to the use of opioids for pain management, and in the current opioid epidemic, evidence-based clinical practice recommendations are needed to reduce the use of opioids in the treatment of acute postoperative pain. Inclusion criteria: This review will include studies of adult patients that incorporate the intervention of deep general anesthesia (bispectral index values of 45 or less), compared to the provision of a standard depth of general anesthesia (bispectral index values 45–60). Included studies will report acute postoperative pain (within the first 48 hours after surgery) as a primary outcome variable. Secondary outcomes of interest include opioid consumption and any reported adverse outcomes. Methods: A three-step search strategy will be used to locate studies published in English from 1992 (advent of electroencephalography index monitoring technology) in Ovid MEDLINE, Embase and CINAHL databases. Two independent reviewers will assess retrieved studies against inclusion criteria, complete critical appraisal for methodological quality and extract data using a standardized tool. Data will be synthesized using statistical meta-analysis, where possible.