Rady Faculty of Health Sciences Scholarly Works
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Browsing Rady Faculty of Health Sciences Scholarly Works by Author "Abou-Setta, Ahmed"
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- ItemOpen AccessHigh-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis(2017-10-16) Leeies, Murdoch; Flynn, Eric; Turgeon, Alexis F; Paunovic, Bojan; Loewen, Hal; Rabbani, Rasheda; Abou-Setta, Ahmed M; Ferguson, Niall D; Zarychanski, RyanAbstract Background We performed a systematic review and meta-analysis to evaluate the efficacy and safety of high-flow oxygen via nasal cannulae (HFNC) compared to non-invasive ventilation (NIV) and/or standard oxygen in patients with acute, hypoxemic respiratory failure. Methods We reviewed randomized controlled trials from CENTRAL, EMBASE, MEDLINE, Scopus and the International Clinical Trials Registry Platform (inception to February 2016), conference proceedings, and relevant article reference lists. Two reviewers independently screened and extracted trial-level data from trials investigating HFNC in patients with acute, hypoxemic respiratory failure. Internal validity was assessed in duplicate using the Cochrane Risk of Bias tool. The strength of evidence was assessed in duplicate using the Grading of Recommendations Assessment, Development and Evaluation framework. Our primary outcome was mortality. Secondary outcomes included dyspnea, PaO2:FiO2 ratio, PaCO2, and pH. Safety outcomes included respiratory arrest, intubation, delirium, and skin breakdown. Results From 2023 screened citations, we identified seven trials (1771 patients) meeting inclusion criteria. All trials were at high risk of bias due to lack of blinding. There was no evidence for a mortality difference in patients receiving HFNC vs. NIV and/or standard oxygen (RR 1.01, 95% CI 0.69 to 1.48, I 2 = 63%, five trials, 1629 patients). In subgroup analyses of HFNC compared to NIV or standard oxygen individually, mortality differences were not observed. Measures of patient tolerability were heterogeneous. The PaO2:FiO2 ratio at 6–12 h was significantly lower in patients receiving oxygen via HFNC compared to NIV or standard oxygen for hypoxemic respiratory failure (MD − 53.34, 95% CI − 71.95 to − 34.72, I 2 = 61%, 1143 patients). There were no differences in pH, PaCO2, or rates of intubation or cardio-respiratory arrest. Delirium and skin breakdown were infrequently reported in included trials. Conclusions In patients with acute hypoxemic respiratory failure HFNC was not associated with a difference in mortality compared to NIV or standard oxygen. Secondary outcomes including dyspnea, tolerance, and safety were not systematically reported. Residual heterogeneity and variable reporting of secondary outcomes limit the conclusions that can be made in this review. Prospective trials designed to evaluate the efficacy and safety of HFNC in patients with acute hypoxemic respiratory failure are required.
- ItemOpen AccessImplementation strategies in emergency management of children: a scoping review protocol(2020-03-03) Aregbesola, Alex; Abou-Setta, Ahmed M; Jeyaraman, Maya M; Okoli, George; Lam, Otto; Sibley, Kathryn M; Klassen, Terry PAbstract Background Behavior change is not simple, and the introduction of guidelines or protocols does not mean that they will be followed. As such, implementation strategies are vital for the uptake and sustainability of changes in medical protocols. Medical or mental emergencies may be life-threatening, especially in children due to their unique physiological needs. In emergency departments (EDs), where timely decisions are often made, practice change requires thoughtful considerations regarding the best approaches to implementation. As there are many studies reporting on a wide variety of implementation strategies in the emergency management of children in EDs, we aim to identify and map the characteristics of these studies. Methods We will conduct a scoping review to identify various implementation strategies in the emergency management of children using the Arksey and O’Malley framework. We will search MEDLINE (Ovid), Embase (Ovid), Cochrane Central (Wiley), and CINAHL (Ebsco), from inception to May 29, 2019, for implementation studies among the pediatric population (≤ 21 years) in a pediatric emergency setting. Two pairs of reviewers will independently select studies for inclusion and extract the data. We will perform a descriptive, narrative analysis of the characteristics of the identified implementation strategies. Discussion We will present specific characteristics and outcome measures of all included studies in a tabular form. The results of this review are expected to help identify and characterize successful implementation strategies in the emergency management of children in EDs. Systematic review registration Open Science Framework https://osf.io/h6jv2
- ItemOpen AccessInter-rater reliability and concurrent validity of ROBINS-I: protocol for a cross-sectional study(2020-01-13) Jeyaraman, Maya M; Rabbani, Rasheda; Al-Yousif, Nameer; Robson, Reid C; Copstein, Leslie; Xia, Jun; Pollock, Michelle; Mansour, Samer; Ansari, Mohammed T; Tricco, Andrea C; Abou-Setta, Ahmed MAbstract Background The Cochrane Bias Methods Group recently developed the “Risk of Bias (ROB) in Non-randomized Studies of Interventions” (ROBINS-I) tool to assess ROB for non-randomized studies of interventions (NRSI). It is important to establish consistency in its application and interpretation across review teams. In addition, it is important to understand if specialized training and guidance will improve the reliability of the results of the assessments. Therefore, the objective of this cross-sectional study is to establish the inter-rater reliability (IRR), inter-consensus reliability (ICR), and concurrent validity of ROBINS-I. Furthermore, as this is a relatively new tool, it is important to understand the barriers to using this tool (e.g., time to conduct assessments and reach consensus—evaluator burden). Methods Reviewers from four participating centers will appraise the ROB of a sample of NRSI publications using the ROBINS-I tool in two stages. For IRR and ICR, two pairs of reviewers will assess the ROB for each NRSI publication. In the first stage, reviewers will assess the ROB without any formal guidance. In the second stage, reviewers will be provided customized training and guidance. At each stage, each pair of reviewers will resolve conflicts and arrive at a consensus. To calculate the IRR and ICR, we will use Gwet’s AC1 statistic. For concurrent validity, reviewers will appraise a sample of NRSI publications using both the New-castle Ottawa Scale (NOS) and ROBINS-I. We will analyze the concordance between the two tools for similar domains and for the overall judgments using Kendall’s tau coefficient. To measure the evaluator burden, we will assess the time taken to apply the ROBINS-I (without and with guidance), and the NOS. To assess the impact of customized training and guidance on the evaluator burden, we will use the generalized linear models. We will use Microsoft Excel and SAS 9.4 to manage and analyze study data, respectively. Discussion The quality of evidence from systematic reviews that include NRS depends partly on the study-level ROB assessments. The findings of this study will contribute to an improved understanding of the ROBINS-I tool and how best to use it.
- ItemOpen AccessInter-rater reliability and validity of risk of bias instrument for non-randomized studies of exposures: a study protocol(2020-02-12) Jeyaraman, Maya M; Al-Yousif, Nameer; Robson, Reid C; Copstein, Leslie; Balijepalli, Chakrapani; Hofer, Kimberly; Fazeli, Mir S; Ansari, Mohammed T; Tricco, Andrea C; Rabbani, Rasheda; Abou-Setta, Ahmed MAbstract Background A new tool, “risk of bias (ROB) instrument for non-randomized studies of exposures (ROB-NRSE),” was recently developed. It is important to establish consistency in its application and interpretation across review teams. In addition, it is important to understand if specialized training and guidance will improve the reliability in the results of the assessments. Therefore, the objective of this cross-sectional study is to establish the inter-rater reliability (IRR), inter-consensus reliability (ICR), and concurrent validity of the new ROB-NRSE tool. Furthermore, as this is a relatively new tool, it is important to understand the barriers to using this tool (e.g., time to conduct assessments and reach consensus—evaluator burden). Methods Reviewers from four participating centers will apprise the ROB of a sample of NRSE publications using ROB-NRSE tool in two stages. For IRR and ICR, two pairs of reviewers will assess the ROB for each NRSE publication. In the first stage, reviewers will assess the ROB without any formal guidance. In the second stage, reviewers will be provided customized training and guidance. At each stage, each pair of reviewers will resolve conflicts and arrive at a consensus. To calculate the IRR and ICR, we will use Gwet’s AC1 statistic. For concurrent validity, reviewers will appraise a sample of NRSE publications using both the Newcastle-Ottawa Scale (NOS) and ROB-NRSE tool. We will analyze the concordance between the two tools for similar domains and for the overall judgments using Kendall’s tau coefficient. To measure evaluator burden, we will assess the time taken to apply ROB-NRSE tool (without and with guidance), and the NOS. To assess the impact of customized training and guidance on the evaluator burden, we will use the generalized linear models. We will use Microsoft Excel and SAS 9.4, to manage and analyze study data, respectively. Discussion The quality of evidence from systematic reviews that include NRSE depends partly on the study-level ROB assessments. The findings of this study will contribute to an improved understanding of ROB-NRSE and how best to use it.
- ItemOpen AccessIs reusing text from a protocol in the completed systematic review acceptable?(2021-05-03) Pieper, Dawid; Ge, Long; Abou-Setta, AhmedAbstract Published protocols have the potential to reduce bias in the conduct and reporting of systematic reviews (SR). When reporting the results of a completed SR, the question might arise whether text used in the protocol can also be used in the completed SR? Does this constitute text recycling, plagiarism, or even copyright infringement? In theory, no major changes to the protocol will be expected for the introduction and methods sections if the SR is completed in time. The benefits of maintaining the introduction and methods section of a protocol in the published SR are straightforward. Authors will require less time for writing up the completed SR. Potential benefits can also be expected for peer reviewers and editors. However, reusing text can be described as self-plagiarism. The question to be answered is whether this type of self-plagiarism is acceptable when copying text used previously (as would be the case when copying text from the protocol and pasting it into the subsequent completed SR)? The “traditional answer” to this question is “yes” because authors should not get credit for one piece of work for more than one time unless the work is cited appropriately. In contrast, we propose that in this context, it seems to be fully acceptable from a scientific and ethical perspective. As such, authors should not be accused of plagiarism in this case, but rather be encouraged to be efficient. However, legal issues need to be taken into consideration (e.g., copyright). We hope to stimulate a discussion on this topic among authors, readers, editors, and publishers.
- ItemOpen AccessPain management with acupuncture in osteoarthritis: a systematic review and meta-analysis(2014-08-23) Manyanga, Taru; Froese, Maria; Zarychanski, Ryan; Abou-Setta, Ahmed; Friesen, Carol; Tennenhouse, Michael; Shay, Barbara LAbstract Background The utility of acupuncture in managing osteoarthritis symptoms is uncertain. Trial results are conflicting and previous systematic reviews may have overestimated the benefits of acupuncture. Methods Two reviewers independently identified randomized controlled trials (up to May 2014) from multiple electronic sources (including PubMed/Medline, EMBASE, and CENTRAL) and reference lists of relevant articles, extracted data and assessed risk of bias (Cochrane’s Risk of Bias tool). Pooled data are expressed as mean differences (MD), with 95% confidence intervals (CI) (random-effects model). Results We included 12 trials (1763 participants) comparing acupuncture to sham acupuncture, no treatment or usual care. We adjudicated most trials to be unclear (64%) or high (9%) risk of bias. Acupuncture use was associated with significant reductions in pain intensity (MD -0.29, 95% CI -0.55 to -0.02, I 2 0%, 10 trials, 1699 participants), functional mobility (standardized MD -0.34, 95% CI -0.55 to -0.14, I 2 70%, 9 trials, 1543 participants), health-related quality of life (standardized MD -0.36, 95% CI -0.58 to -0.14, I 2 50%, 3 trials, 958 participants). Subgroup analysis of pain intensity by intervention duration suggested greater pain intensity reduction with intervention periods greater than 4 weeks (MD -0.38, 95% CI -0.69 to -0.06, I 2 0%, 6 trials, 1239 participants). Conclusions The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis. Systematic review registration CRD42013005405.
- ItemOpen AccessProbiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: a systematic review and meta-analysis(2014-03-03) Azad, Meghan B; Coneys, J G; Kozyrskyj, Anita L; Field, Catherine J; Ramsey, Clare D; Becker, Allan B; Friesen, Carol; Abou-Setta, Ahmed M; Zarychanski, Ryan
- ItemOpen AccessRapid review programs to support health care and policy decision making: a descriptive analysis of processes and methods(2015-03-14) Polisena, Julie; Garritty, Chantelle; Kamel, Chris; Stevens, Adrienne; Abou-Setta, Ahmed MAbstract Background Health care decision makers often need to make decisions in limited timeframes and cannot await the completion of a full evidence review. Rapid reviews (RRs), utilizing streamlined systematic review methods, are increasingly being used to synthesize the evidence with a shorter turnaround time. Our primary objective was to describe the processes and methods used internationally to produce RRs. In addition, we sought to understand the underlying themes associated with these programs. Methods We contacted representatives of international RR programs from a broad realm in health care to gather information about the methods and processes used to produce RRs. The responses were summarized narratively to understand the characteristics associated with their processes and methods. The summaries were compared and contrasted to highlight potential themes and trends related to the different RR programs. Results Twenty-nine international RR programs were included in our sample with a broad organizational representation from academia, government, research institutions, and non-for-profit organizations. Responses revealed that the main objectives for RRs were to inform decision making with regards to funding health care technologies, services and policy, and program development. Central themes that influenced the methods used by RR programs, and report type and dissemination were the imposed turnaround time to complete a report, resources available, the complexity and sensitivity of the research topics, and permission from the requestor. Conclusions Our study confirmed that there is no standard approach to conduct RRs. Differences in processes and methods across programs may be the result of the novelty of RR methods versus other types of evidence syntheses, customization of RRs for various decision makers, and definition of ‘rapid’ by organizations, since it impacts both the timelines and the evidence synthesis methods. Future research should investigate the impact of current RR methods and reporting to support informed health care decision making, the effects of potential biases that may be introduced with streamlined methods, and the effectiveness of RR reporting guidelines on transparency.
- ItemOpen AccessSystematic review of interventions for depression and anxiety in persons with inflammatory bowel disease(2016-08-12) Fiest, Kirsten M; Bernstein, Charles N; Walker, John R; Graff, Lesley A; Hitchon, Carol A; Peschken, Christine A; Zarychanski, Ryan; Abou-Setta, Ahmed; Patten, Scott B; Sareen, Jitender; Bolton, James; Singer, Alexander; Marrie, Ruth AAbstract Background Depression and anxiety are common in inflammatory bowel disease (IBD) and can affect disease outcomes, including quality of life and success of disease treatment. Successful management of psychiatric comorbidities may improve outcomes, though the effectiveness of existing treatments in IBD is unknown. Methods We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled clinical trials conducted in persons with IBD and depression or anxiety. Two independent reviewers reviewed all abstracts and full-text articles and extracted information including trial and participant characteristics. We also assessed the risk of bias. Results Of 768 unique abstracts, we included one trial of pharmacological anxiety treatment in IBD (48 participants), which found an improvement in anxiety symptoms (p < 0.001). There was a high risk of bias in this trial. We found no controlled clinical trials on the treatment of depression in persons with IBD and depression and no controlled clinical trials reporting on psychological interventions for anxiety or depression in IBD. Conclusions Only one trial examined an intervention for anxiety in adults with IBD and no trials studied depression in adults with IBD. The level of evidence is low because of the risk of bias and limited evidence.
- ItemOpen AccessThe impact of omega-3 polyunsaturated fatty acid supplementation on the incidence of cardiovascular events and complications in peripheral arterial disease: a systematic review and meta-analysis(2014-05-31) Enns, Jennifer E; Yeganeh, Azadeh; Zarychanski, Ryan; Abou-Setta, Ahmed M; Friesen, Carol; Zahradka, Peter; Taylor, Carla GAbstract Background Individuals with peripheral arterial disease are at higher risk for cardiovascular events than the general population. While supplementation with omega-3 polyunsaturated fatty acids (PUFA) has been shown to improve vascular function, it remains unclear if supplementation decreases serious clinical outcomes. We conducted a systematic review and meta-analysis to determine whether omega-3 PUFA supplementation reduces the incidence of cardiovascular events and complications in adults with peripheral arterial disease. Methods We searched five electronic databases (MEDLINE, EMBASE, CENTRAL, Scopus and the International Clinical Trials Registry Platform) from inception to 6 December 2013 to identify randomized trials of omega-3 PUFA supplementation (from fish or plant oils) that lasted ≥12 weeks in adults with peripheral arterial disease. No language filters were applied. Data on trial design, population characteristics, and health outcomes were extracted. The primary outcome was major adverse cardiac events; secondary outcomes included myocardial infarction, cardiovascular death, stroke, angina, amputation, revascularization procedures, maximum and pain-free walking distance, adverse effects of the intervention, and quality of life. Trial quality was assessed using the Cochrane Risk of Bias tool. Results Of 741 citations reviewed, we included five trials enrolling 396 individuals. All included trials were of unclear or high risk of bias. There was no evidence of a protective association of omega-3 PUFA supplementation against major adverse cardiac events (pooled risk ratio 0.73, 95% CI 0.22 to 2.41, I 2 75%, 2 trials, 288 individuals) or other serious clinical outcomes. Adverse events and compliance were poorly reported. Conclusions Our results showed that insufficient evidence exists to suggest a beneficial effect of omega-3 PUFA supplementation in adults with peripheral arterial disease with regard to cardiovascular events and other serious clinical outcomes.