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Purpose We aimed to provide clinicians with introductory guidance for interpreting and assessing confidence in on Network meta-analysis (NMA) results. Methods We reviewed current literature on NMA and summarized key points. Results Network meta-analysis (NMA) is a statistical method for comparing the efficacy of three or more interventions simultaneously in a single analysis by synthesizing both direct and indirect evidence across a network of randomized clinical trials. It has become increasingly popular in healthcare, since direct evidence (head-to-head randomized clinical trials) are not always available. NMA methods are categorized as either Bayesian or frequentist, and while the two mostly provide similar results, the two approaches are theoretically different and require different interpretations of the results. Conclusions We recommend a careful approach to interpreting NMA results and the validity of an NMA depends on its underlying statistical assumptions and the quality of the evidence used in the NMA., Author(s): Alan Yang [sup.1], Petros Pechlivanoglou [sup.1], Kazuyoshi Aoyama [sup.1] [sup.2] Author Affiliations: (1) grid.42327.30, 0000 0004 0473 9646, Program in Child Health Evaluative Sciences, The Hospital for Sick Children [...]

Author(s): Naohiro Shioji [sup.1] [sup.2], Tobias Everett [sup.3], Yasuyuki Suzuki [sup.4], Kazuyoshi Aoyama [sup.3] [sup.5] Author Affiliations: (1) grid.17063.33, 0000 0001 2157 2938, Department of Critical Care Medicine, The Hospital [...]

Author(s): Yusuke Mazda [sup.1], Kazuyoshi Aoyama [sup.2] [sup.3] Author Affiliations: (1) Division of Obstetric Anesthesia, Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, , Kawagoe, Japan (2) grid.17063.33, 0000 [...]

The current coronavirus disease of 2019 (COVID-19) pandemic has presented unique health challenges in the pediatric population. Compared to adults, the most significant change in viral disease manifestation is encompassed by the multisystem inflammatory syndrome in children (MIS-C). MIS-C is a new inflammatory syndrome which develops 2-4 weeks after COVID-19 exposure, with evidence suggesting it is a post-infectious immune reaction. We describe its epidemiology, pathophysiology, diagnosis (which varies based on definition used) and treatment options based on published recommendations. A systematic literature search we conducted through MEDLINE yielded 518 abstracts and identified five studies that reported more than 100 cases of MIS-C and their mortality. Most cases developed multiorgan dysfunction, including cardiovascular, dermatologic, neurological, renal, and respiratory issues, and required intensive care unit (ICU) admission. Many patients admitted to the ICU needed inotrope support and invasive mechanical ventilation, and the most severe cases required extracorporeal membrane oxygenation support. Most clinicians treated MIS-C with intravenous immunoglobulin, systemic steroids, and biological therapies. Overall mortality was low (2-3%) in all studies. Further research is needed to: understand if early intervention can prevent its progression; optimize its treatment; and improve outcomes of this new syndrome for the patients who develop MIS-C., Author(s): Naohiro Shioji [sup.1] [sup.2], Kazuyoshi Aoyama [sup.3] [sup.4], Marina Englesakis [sup.5], Gail Annich [sup.1], Jason T. Maynes [sup.3] [sup.6] Author Affiliations: (1) grid.17063.33, 0000 0001 2157 2938, Department of [...]

Coronavirus disease 2019 (COVID-19) has affected anesthetic care worldwide, including the provision of anesthesia for pediatric patients. Hospitals have balanced the risks associated with the potential surges of resource-intensive COVID-19 patients against the probable morbidity of delaying elective surgical procedures. These decisions are complicated by the unclear influence that COVID-19 has on the perioperative risk for disease-positive pediatric patients. We conducted a comprehensive literature search on MEDLINE for publications involving pediatric patients with COVID-19 who underwent general anesthesia. A total of eight publications met inclusion criteria, and together described 20 patients. Nine patients had documented preoperative COVID-19 symptoms and one perioperative death was reported. Overall, further studies are needed to increase patient numbers and properly assess the perioperative risk. As we continue to provide care without clear guiding data, we present a discussion of modified anesthetic techniques for pediatric patients with suspected or confirmed COVID-19., Author(s): Nan Gai [sup.1], Jason T. Maynes [sup.1] [sup.2], Kazuyoshi Aoyama [sup.1] [sup.3] Author Affiliations: (1) grid.42327.30, 0000 0004 0473 9646, Department of Anesthesia and Pain Medicine, The Hospital for [...]

In the pediatric population, pain is frequently under-recognized and inadequately treated. Improved education and training of health care providers can positively impact the management of pain in children. The purpose of this review is to provide a practical clinical approach to the management of acute pain in the pediatric inpatient population. This will include an overview of commonly used pain management modalities and their potential pitfalls. For institutions that have a pediatric acute pain service or are considering initiating one, it is our hope to provide a useful tool to aid clinicians in the safe and effective treatment of pain in children., Author(s): Nan Gai [sup.1], Basem Naser [sup.1], Jacqueline Hanley [sup.1], Arie Peliowski [sup.1], Jason Hayes [sup.1], Kazuyoshi Aoyama [sup.1] [sup.2] Author Affiliations: (1) grid.42327.30, 0000 0004 0473 9646, Department of [...]

Background The relation between prepregnancy average glucose concentration and a woman's risk of severe maternal morbidity (SMM) is unknown. The current study evaluated whether an elevated preconception hemoglobin A1c (A1c) is associated with SMM or maternal death among women with and without known prepregnancy diabetes mellitus (DM). Methods and findings A population-based cohort study was completed in Ontario, Canada, where there is universal healthcare. The main cohort included 31,225 women aged 16-50 years with a hospital live birth or stillbirth from 2007 to 2015, and who had an A1c measured within 90 days before conception, including 28,075 women (90%) without known prepregnancy DM. The main outcome was SMM or maternal mortality from 23 weeks' gestation up to 42 days postpartum. Relative risks (RRs) were generated using modified Poisson regression, adjusting for the main covariates of maternal age, multifetal pregnancy, world region of origin, and tobacco/drug dependence. The mean maternal age was 31.1 years. Overall, SMM or death arose among 682 births (2.2%). The RR of SMM or death was 1.16 (95% CI 1.14-1.19; p < 0.001) per 0.5% increase in A1c and 1.16 (95% CI 1.13-1.18; p < 0.001) after adjusting for the main covariates. The adjusted relative risk (aRR) was increased among those with (1.11, 95% CI 1.07-1.14; p < 0.001) and without (1.15, 95% CI 1.02-1.29; p < 0.001) known prepregnancy diabetes, and upon further adjusting for body mass index (BMI) (1.15, 95% CI 1.11-1.20; p < 0.001), or chronic hypertension and prepregnancy serum creatinine (1.11, 95% CI 1.04-1.18; p = 0.002). The aRR of SMM or death was 1.31 (95% CI 1.06-1.62; p = 0.01) in those with a preconception A1c of 5.8%-6.4%, and 2.84 (95% CI 2.31-3.49; p 6.4%, each relative to an A1c 6.4%, the aRR of SMM or death was 3.25 (95% CI 1.76-6.00; p < 0.001). Study limitations include that selection bias may have incorporated less healthy women tested for A1c, and BMI was unknown for many women. Conclusions Our findings indicate that women with an elevated A1c preconception may be at higher risk of SMM or death in pregnancy or postpartum, including those without known prepregnancy DM., Author(s): Alexander J. F. Davidson 1, Alison L. Park 1,2, Howard Berger 1,3,4, Kazuyoshi Aoyama 1,5, Ziv Harel 1,2,3, Jocelynn L. Cook 6,7, Joel G. Ray 1,2,3,4,* Introduction The prevalence [...]