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Since the early 1990s the number of systematic reviews (SR) of animal studies has steadily increased. There is, however, little guidance on when and how to conduct a meta‐analysis of human‐health‐related animal studies. To gain insight about the methods that are currently used we created an overview of the key characteristics of published meta‐analyses of animal studies, with a focus on the choice of effect size measures. An additional goal was to learn about the rationale behind the meta‐analysis methods used by the review authors. We show that important details of the meta‐analyses are not fully described, only a fraction of all human‐health‐related meta‐analyses provided rationales for their decision to use specific effect size measures. In addition, our data may suggest that authors make post‐hoc decisions to switch to another effect size measure during the course of their meta‐analysis, and possibly search for significant effects. Based on analyses in this paper we recommend that review teams: 1) publish a review protocol before starting the conduct of a SR, prespecifying all methodological details (providing special attention to the planned meta‐analysis including the effect size measure and the rational behind choosing a specific effect size, prespecifying subgroups and restricting the number of subgroup analyses), 2) always use the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) checklist to report your SR of animal studies, and 3) use the random effects model (REM) in human‐health‐related meta‐analysis of animal studies, unless the assumptions for using the fixed effect model (FEM) are all met. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Supporting evidence for diagnostic test recommendations in clinical practice guidelines (CPGs) should not only include diagnostic accuracy, but also downstream consequences of the test result on patient‐relevant outcomes. The aim of this study is to assess the extent to which evidence‐based CPGs about diagnostic tests cover all relevant test‐treatment pathway components. Methods: We performed a systematic document analysis and quality assessment of publicly accessible CPGs about three common diagnostic tests: C‐reactive protein, colonoscopy and fractional exhaled nitric oxide. Evaluation of the impact of the full test‐treatment pathway (diagnostic accuracy, burden of the test, natural course of target condition, treatment effectiveness, and link between test result and administration of treatment) on patient relevant outcomes was considered best practice for developing medical test recommendations. Results: We retrieved 15 recommendations in 15 CPGs. The methodological quality of the CPGs varied from poor to excellent. Ten recommendations considered diagnostic accuracy. Four of these were funded on a systematic review and rating of the certainty in the evidence. None of the CPGs evaluated all steps of the test‐treatment pathway. Burden of the test was considered in three CPGs, but without systematically reviewing the evidence. Natural course was considered in two CPGs, without a systematic review of the evidence. In three recommendations, treatment effectiveness was considered, supported with a systematic review and rating of the certainty in the evidence in one CPG. The link between test result and treatment administration was not considered in any CPG. Conclusions: The included CPGs hardly seem to consider evidence about test consequences on patient‐relevant outcomes. This might be explained by reporting issues and challenging methodology. Future research is needed to investigate how to facilitate guideline developers in explicit reliable consideration of all steps of a test‐treatment pathway when developing diagnostic test recommendations. [ABSTRACT FROM AUTHOR]

Background In infants, apneas can be centrally mediated, obstructive or both and have been proposed to be gastroesophageal reflux (GER) induced. Evidence for this possible association has never been systematically reviewed. Purpose To perform a systematic review using PubMed, EMBASE and Cochrane databases to determine whether an association between GER and apnea in infants exists. Studies with n ≥ 10 infants, aged <12 months, were included. GER had to be studied by pH-metry or pH-impedancemetry. GER episodes were defined as pH <4 for ≥5 s and/or a drop of >50% of baseline in impedance signal in distal channels. An apneic event was defined as a cessation of breathing for >20 s, or ≥10 s with hypoxemia or bradycardia. An epoch of ≤2 min was used to define temporal relation between GER and apnea. Methodological quality of studies was assessed with Newcastle Ottawa Scale (NOS). Of 1959 abstracts found, 6 articles met the inclusion criteria. All studies had poor methodological quality. A total of 289 infants were included. The temporal association of GER followed by apnea was assessed in all studies, with epochs varying from 10 s to 2 min. One study found an increase of apneic events after GER, the remaining 5 studies did not find an association. Two studies assessed apnea followed by GER as well, but did not find sufficient evidence for association. This systematic review showed insufficient evidence for an association between GER and apneas in infants. High quality studies using uniform inclusion criteria, definitions according to accepted guidelines, and patient relevant outcome measures are needed. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To assess the dose–effect relationship between self-reported drug intake and the concentration of drugs and/or their metabolites in hair and to examine factors that may mediate this relationship. Design and setting A cohort study among young drug users (YDU) in Amsterdam, the Netherlands, which began in July 2000. At intake, YDU were asked to report their average drug intake over a 2-month period. A hair sample was taken and then analysed for cocaine, benzoylecgonine (BE), morphine, 6-monoacetylmorphine and methadone. Weighted least-squares regression analysis was used to model hair-test results as a function of reported drug use. Participants Subjects were 95 YDU (using cocaine, heroin, methadone and/or amphetamines at least 3 days/week) aged 18–30 residing in Amsterdam in 2000–2001. Findings Of the 95 YDU, one-third were women; mean age was almost 26; 30% had black hair, 33% blond hair and 37% brown hair. Cocaine use was reported by 92%, heroin by 75% and methadone by 64% of participants. All hair samples contained one or more drugs. Crude correlation coefficients between reported drug doses and drug concentrations in hair ranged between 0.45 and 0.59. The multivariate regression analysis showed that, for one or more types of drug, black-haired people, women and non-western European people had relatively high drug concentrations in hair (significant slope effects). The corresponding multivariate correlation coefficients ranged between 0.63 and 0.87. Conclusions Hair testing can be used to quantify drug use in epidemiological studies, given that factors such as hair colour and sex are taken into account. [ABSTRACT FROM AUTHOR]

Aims. To assess relationships between characteristics of methadone maintenance treatment and long-term cessation of injecting (\>= 1 year). Design and participants. The incidence of cessation of injecting and relapse from non-injecting to injecting was estimated among 488 participants of the Amsterdam cohort study among drug users. We used a nested matched case–control design to identify methadone treatment characteristics significantly and independently related to cessation of injecting. To ensure detailed and valid assessment of methadone treatment, data of the Central Methadone Register were linked with cohort data. For 339 of 488 subjects of the initial study group methadone data were available. Findings. The incidence of cessation of injecting increased from 2.2 /100 person years in 1985–89 to 5.5 /100 per year in 1995–97 (p [sub trend] = 0.005). Relapse to injecting was high: 17.2 /100 person years (no trend). Methadone dosage and frequency of methadone programme attendance in themselves were not significantly related to cessation of injecting. However, an individual increase of 5 mg or more per year (OR 4.20, 95% CI 1.54–11.46) and receiving methadone mainly via the outpatient clinic for drug-abusing prostitutes and foreigners (OR 0.18, 95% CI 0.05–0.59) were independent predictors of cessation of injecting. After cessation of injecting, there were no HIV-seroconversions during the period of non-injecting (129 person years). After relapse to injecting there was one seroconverter; however, follow-up was small (23 person years). The HIV-incidence of those who continued injecting was 3.2 /100 per year. Conclusions. Steadily increasing the methadone dosage in a harm reduction setting may be useful in supporting injecting drug users in the process of cessation of injecting and reducing the spread of HIV-infection. [ABSTRACT FROM AUTHOR]

Aims. To give a detailed description of injection-related risk behaviours, and to estimate the relative importance of these behaviours with regard to HIV transmission. Design. The present study was part of the Amsterdam Cohort Study of drug users. Setting. In Amsterdam, a city with extensive preventive measures, large HIV-risk reductions have taken place, but no further decreases have occurred since 1991. Participants and measurements. A detailed questionnaire on injecting risk behaviour was completed by a cross-section of participants in 1992/93 (n = 168). Among 48 HIV-seroconverters, a questionnaire was completed concerning possible HIV-transmission route. Findings. Of 96 HIV-negative participants, 23% deliberately borrowed a used syringe, 18% reported possible "accidental" borrowing, 9% front/backloading, 4% simultaneous injection, and 32% possible sharing of ancillary equipment. Of deliberate borrowers, 64% borrowed from a person with unknown or positive HIV serostatus, and 81% did not appropriately clean the equipment; 79% borrowed in the absence of serious withdrawal symptoms. Risk factors differed for deliberate and 'accidental' borrowing. Among the HIV seroconverters, the most likely transmission route was borrowing in 29% of cases, front/backloading in 8%, borrowing or front/backloading in 21%, unprotected sexual contact in 23% (mainly with regular partner) and either injecting or sexual risk in 13%. Women were much more likely to report sexual transmission ( p = 0.016). Borrowing was admitted by 43% before, and 64% after awareness of HIV-seroconverion. Conclusions. As the injecting risk is high, usually deliberate, and often in the absence of withdrawal symptoms, further prevention seems difficult. Although deliberate borrowing is the main risk for HIV seroconversion, unprotected sexual contacts and front- and backloading may be more important than previously thought in Amsterdam. Under-reporting of borrowing is probably substantial, but does not alter the above conclusions. [ABSTRACT FROM AUTHOR]

Presents a study on the evaluation of the Methadone Dispensing Circuit in Amsterdam, Netherlands, where methadone programs are implemented according to the harm reduction approach. Participants used in the study; Method in which the study was conducted; Details on the findings; Conclusions reached.

Background: Pericardiectomy for postradiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction., Methods: A retrospective analysis of all patients (≥18 years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2 ± 10.1 years, 49% females) who met the inclusion criteria. Records were reviewed to look at the surgical approach, the extent of resection, early mortality, and late survival., Results: The overall operative mortality was 10.1% (n = 10). The rate of operative mortality decreased over the study period; however, the test of the trend was not statistically significant (p = .062). Hodgkin's disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% of patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery were performed in 46% of patients. Radical resection was performed in 50% of patients, whereas 47% of patients underwent subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%), and pleural effusion (16%) were the most common postoperative complications. The overall 1, 5-, and 10-years survival was 73.6%, 53.4%, and 32.1%, respectively. Increasing age (hazard ratio, 1.044, 95% confidence interval 1.017-1.073) appeared to have a significant negative effect on overall survival in the univariate model., Conclusion: Pericardiectomy performed for radiation-associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time., (© 2021 Wiley Periodicals LLC.)