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Background: Community-acquired pneumonia (CAP) triggers inflammatory and thrombotic host responses driving morbidity and mortality. Antiplatelet agents may favorably modulate these pathways; however, their role in non–COVID-19 CAP remains uncertain. Objectives: To evaluate the association of antiplatelet agents with mortality in hospitalized patients with non–COVID-19 CAP. Methods: We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) of adult patients hospitalized for non–COVID-19 CAP exposed to antiplatelet agents (acetylsalicylic acid or P2Y12 inhibitors). We searched MEDLINE, Embase, and CENTRAL from inception to August 2023. Our primary outcome was all-cause mortality: meta-analyzed (random-effects models) separately for observational studies and RCTs. For observational studies, we used adjusted mortality estimates. Results: We included 13 observational studies (123,012 patients; 6 reported adjusted mortality estimates) and 2 RCTs (225 patients; both high risk of bias). In observational studies reporting hazard ratio, antiplatelet agents were associated with lower mortality (hazard ratio, 0.65; 95% CI, 0.46-0.91; I2 = 85%; 4 studies, 91,430 patients). In studies reporting adjusted odds ratio, antiplatelet agent exposure was associated with reduced odds of mortality (odds ratio, 0.67; 95% CI, 0.45-1.00; I2 = 0%; 2 studies, 24,889 patients). Among RCTs, there was a nonsignificant association with mortality (risk ratio, 0.66; 95% CI, 0.20-2.25; I2 = 54%; 2 studies, 225 patients). By the Grading of Recommendations, Assessment, Development, and Evaluation criteria, the certainty of the evidence was low, primarily due to risk of bias. Conclusion: In hospitalized patients with non–COVID-19 CAP, antiplatelet agents may be associated with reduced mortality compared with usual care or placebo, but the certainty of evidence is low.

Abstract Background It has long been believed that the patulous eustachian tube is a unique but uncommon condition, with an estimated incidence ranging from 0.3 to 6.6% in the general population. Hearing one’s own voice and breathing, or autophony and aerophony, are the most common symptoms of PET, along with frequent auditory fullness. Aim This study is to establish a standardized protocol for the audiological evaluation of patulous Eustachian tube using acoustic reflex decay test during different breathing tasks. Methods Between January 2022 and December 2022, the ENT department at Suez Canal University Hospitals undertook an observational case-control study. Fifty-two adult patients who present to the Suez Canal University ENT department with complaints of autophony, auditory fullness, or aerophony are diagnosed with patulous eustachian tube dysfunction through endoscopic examination of the tympanic membrane’s synchronized movement with respiration. Results The incidence rate of PET among adults was approximately 3 patients/1000 patients/year. The age of the whole studied group ranged from 20 to 60 years with mean ± SD of 37.4 ± 12.6 years. They included 23 males (44.2%) and 29 females (55.8%). The most common symptom among the studied group was aural fullness (46%), while the least common symptom was aerophony (12%); the most common risk factor among the studied patients was allergy (46.2%), while the least common was radiotherapy (3.9%); 66.7% of the patients with GERD were males, while 66.7% of the patients who lost weight were females; 58.3% of the patients with allergies were females, and also 60% of the patients with thin built were females. In the case group, there is a significant higher change of middle ear compliance in ipsilateral nostril breathing than the mouth breathing and nasal breathing. The sensitivity of the acoustic reflex decay test to diagnose PET with reference to the gold standard test is 88.5% (23/26*100), the specificity is 100% (26/26*100), and the positive predictive value is 100% (23/23*100). Conclusion The sensitivity of the acoustic reflex decay test to diagnose PET with reference to the gold standard test is high, and the specificity is very high with very good diagnostic accuracy.

Background: Preoperative treatment with oral neomycin combined with erythromycin or metronidazole is recommended to decrease the risk of surgical site infections (SSIs) in elective colorectal surgery. However, oral neomycin is not commercially available in Canada, and therefore it is not routinely used. Fluoroquinolones are widely available and have excellent activity against aerobic Gram-negative bacteria. The aim of this systematic review was to identify, critically appraise and summarize the evidence on the efficacy and safety of preoperative use of oral fluoroquinolone antibiotics for the prevention of SSIs in adult patients undergoing elective colorectal resection. Methods: Following Cochrane guidelines, we included English-language randomized controlled trials (RCTs) comparing oral fluoroquinolones plus routine preoperative intravenous antibiotics against intravenous antibiotics alone from MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials (Ovid) and ClinicalTrials.gov. Results: We included 3 RCTs (1136 patients). Risk of bias was uncertain in 2 trials and high in 1 trial. Preoperative oral fluoroquinolones led to significantly decreased total SSIs (risk ratio [RR] 0.43, 95% confidence interval [CI] 0.32-0.57, [I.sup.2] = 0%), superficial incisional (RR 0.38, 95% CI 0.22-0.68, [I.sup.2] = 32%), deep incisional (RR 0.19, 95% CI 0.06-0.65, [I.sup.2] = 0%) and organ/space SSIs (RR 0.34, 95% CI 0.12-0.90, [I.sup.2] = 33%). There was also a significant reduction in anastomotic leaks (RR 0.22, 95% CI 0.06-0.87, [I.sup.2] = 0%). No antibiotic-related adverse events were reported. Conclusion: This review suggests that preoperative oral fluoroquinolones with intravenous antibiotics are superior to intravenous antibiotics alone for preventing SSIs after colorectal surgery. If neomycin is unavailable, oral fluoroquinolones should be considered as a reasonable alternative. Future trials are required to further compare the relative efficacy of oral antibiotic regimens. Contexte : Un traitement préopératoire par néomycine orale associée à de l'érythromycine ou du métronidazole est recommandé pour réduire le risque d'infection du site opératoire (ISO) lors de la chirurgie colorectale non urgente. Or, la néomycine orale n'est pas disponible sur le marché au Canada et par conséquent, n'est pas utilisée. Les fluoroquinolones sont facilement accessibles et exercent une excellente activité contre les bactéries aérobies à Gram négatif. Le but de cette revue systématique était d'identifier, d'évaluer de façon critique et de résumer les données probantes sur l'efficacité et l'innocuité de l'administration préopératoire de fluoroquinolones orales pour la prévention des ISO chez des adultes soumis à une résection colorectale élective. Méthodes : Conformément aux lignes directrices Cochrane, nous avons inclus les essais randomisés et contrôlés (ERC) de langue anglaise ayant comparé des fluoroquinolones orales en association avec les antibiotiques intraveineux préopératoires habituels et aux antibiotiques intraveineux seuls, recensés dans les bases de données MEDLINE (Ovid), Embase (Ovid), le Registre central Cochrane des essais contrôlés (Ovid) et ClinicalTrials.gov. Résultats : Nous avons inclus 3 ERC (1136 patients). Le risque de biais était incertain pour 2 essais et élevé pour 1 essai. Les fluoroquinolones orales préopératoires ont donné lieu à une diminution significative du nombre total d'ISO (risque relatif [RR] 0,43, intervalle de confiance [IC] de 95 % 0,32-0,7, [I.sup.2] = 0 %), superficielles (RR 0,38, IC de 95 % 0,22-0,68, [I.sup.2] =32 %), profondes (RR 0,19, IC de 95 % 0,06-0,65, [I.sup.2] = 0 %) et des cavités/organes (RR 0,34, IC de 95 % 0,12-0,90, [I.sup.2] = 33 %). On a aussi noté une réduction significative des fuites anastomotiques (RR 0,22, IC de 95 % 0,06-0,87, [I.sup.2] = 0 %). Aucun effet indésirable lié à l'antibiothérapie n'a été signalé. Conclusion : Selon cette revue, les fluoroquinolones orales préopératoires avec antibiothérapie intraveineuse sont supérieures aux antibiotiques intraveineux seuls pour la prévention des ISO après la chirurgie colorectale. En l'absence de néomycine, les fluoroquinolones orales représentent une solution de rechange acceptable. Il faudra procéder à d'autres essais pour mieux comparer l'efficacité relative des différents schémas d'antibiothérapie orale., Colorectal surgical procedures are associated with some of the highest rates of surgical site infections (SSIs) of any intra-abdominal procedures, which are frequently caused by anaerobic bacterial flora and Gram-negative [...]

Abstract Purpose To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening for prostate cancer in adults aged 18 years and older in primary care. This protocol outlines the planned scope and methods for a series of systematic reviews. Methods Updates of two systematic reviews and a de novo review will be conducted to synthesize the evidence on the benefits and harms of screening for prostate cancer with a prostate-specific antigen (PSA) and/or digital rectal examination (DRE) (with or without additional information) and patient values and preferences. Outcomes for the benefits of screening include reduced prostate cancer mortality, all-cause mortality, and incidence of metastatic prostate cancer. Outcomes for the harms of screening include false-positive screening tests, overdiagnosis, complications due to biopsy, and complications of treatment including incontinence (urinary or bowel), and erectile dysfunction. The quality of life or functioning (overall and disease-specific) and psychological effects outcomes are considered as a possible benefit or harm. Outcomes for the values and preferences review include quantitative or qualitative information regarding the choice to screen or intention to undergo screening. For the reviews on benefits or harms, we will search for randomized controlled trials, quasi-randomized, and controlled studies in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. For the review on values and preferences, we will search for experimental or observational studies in MEDLINE, Embase, and PsycInfo. For all reviews, we will also search websites of relevant organizations, gray literature, and reference lists of included studies. Title and abstract screening, full-text review, data extraction, and risk of bias assessments will be completed independently by pairs of reviewers with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of the evidence for each outcome. Discussion The series of systematic reviews will be used by the Canadian Task Force on Preventive Health Care to update their 2014 guideline on screening for prostate cancer in adults aged 18 years and older. Systematic review registration This review has been registered with PROSPERO (CRD42022314407) and is available on the Open Science Framework (osf.io/dm32k).

This is the introductory paper in a collection of four papers on the Strategy for Patient-Oriented Research (SPOR) Evidence Alliance, a pan-Canadian research initiative that was funded by the Canadian Institutes of Health Research in September of 2017. Here, we introduce the SPOR enterprise in Canada, provide a rationale for the creation of the SPOR Evidence Alliance, provide information on the mandate and approach, and describe how the SPOR Evidence Alliance adds to the health research ecosystem in Canada and beyond.

Background: COVID-19 has proven to be challenging to manage for many reasons, including its high infection rate. One of the potential ways to limit its spread is by limiting international travel. The objective of this systematic review was to identify, critically appraise and summarise evidence on international air travel-related control measures for COVID-19. Methods: This review is based on the Cochrane review: International travel-related control measures to contain the COVID-19 pandemic and followed the same methods. In brief, we searched for clinical and modelling studies in general health and COVID-19-specific bibliographic databases. The primary outcome categories were (i) cases avoided, (ii) a shift in epidemic development and, (iii) cases detected. Results: From 6,202 citations identified by the search strategy, we included 22 new studies (modelling = 9, observational = 13) in addition to the 62 studies identified in the Cochrane review. Studies suggest that quarantine or microbial detection or a combination may avoid further cases. Similarly, these interventions may produce a positive shift in epidemic development and case detection may improve. Most studies were evaluated as having a moderate to critical risk of bias. The studies did not change the main conclusions of the Cochrane review nor the quality of the evidence (very low certainty); however, they added to the evidence base for most outcomes. Conclusions: Weak evidence supports the use of international air travel-related control measures to limit the spread of COVID-19 via air travel. More real-world studies are required to support these conclusions.

Objectives To summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals.Design A scoping review following the Joanna Briggs Institute’s methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data sources MEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021.Eligibility and criteria Study participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis.Data extraction and synthesis We summarised findings graphically and descriptively.Results From 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator.Conclusions Multidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.

Considering the alterations in gait patterns and increase in metabolic demands during walking on an inclined surface, inclined treadmill training (ITT) may be an alternative treatment to non-inclined treadmill training (NITT) for improving gait and balance among people with chronic stroke. We searched eight electronic databases (August 2021), assessed risk of bias (Cochrane RoB 2.0 tool), and meta-analysed data (RevMan 3.5). Results were reported according to the PRISMA guidelines. Outcomes were gait parameters such as walking speed and balance-related outcome measures such as Berg Balance Scale scores. Risk of bias assessment was performed according to Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Of the screened citations, four met our inclusion criteria. Quantitative analysis showed ITT was significant in improving walking speed, stride length, paretic step length, Berg Balance Scale scores and Overall Stability Index (p < 0.05) but not in cadence, non-paretic step length, stance time on the non-paretic and paretic leg (p > 0.05). Only one study was rated low risk of bias. There was limited evidence for the superiority of ITT over NITT, in adjunct to other conventional intervention, for improving gait and balance among chronic stroke patients. [ABSTRACT FROM AUTHOR]