Sameer K. Gunukula

The effects of waterpipe tobacco smoking on health outcomes: a systematic review

BACKGROUND There is a need for a comprehensive and critical review of the literature to inform scientific debates about the public health effects of waterpipe smoking. The objective of this study was therefore to systematically review the medical literature for the effects of waterpipe tobacco smoking on health outcomes. METHODS We conducted a systematic review using the Cochrane Collaboration methodology for conducting systematic reviews. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS Twenty-four studies were eligible for this review. Based on the available evidence, waterpipe tobacco smoking was significantly associated with lung cancer [odds ratio (OR) = 2.12; 95% confidence interval (CI) 1.32-3.42], respiratory illness (OR = 2.3; 95% CI 1.1-5.1), low birth-weight (OR = 2.12; 95% CI 1.08-4.18) and periodontal disease (OR = 3-5). It was not significantly associated with bladder cancer (OR = 0.8; 95% CI 0.2-4.0), nasopharyngeal cancer (OR = 0.49; 95% CI 0.20-1.23), oesophageal cancer (OR = 1.85; 95% CI 0.95-3.58), oral dysplasia (OR = 8.33; 95% CI 0.78-9.47) or infertility (OR = 2.5; 95% CI 1.0-6.3) but the CIs did not exclude important associations. Smoking waterpipe in groups was not significantly associated with hepatitis C infection (OR = 0.98; 95% CI 0.80-1.21). The quality of evidence for the different outcomes varied from very low to low. CONCLUSION Waterpipe tobacco smoking is possibly associated with a number of deleterious health outcomes. There is a need for high-quality studies to identify and quantify with confidence all the health effects of this form of smoking.

The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review

BackgroundThe objective of this study was to systematically review the medical literature for the prevalence of waterpipe tobacco use among the general and specific populations.MethodsWe electronically searched MEDLINE, EMBASE, and the ISI the Web of Science. We selected studies using a two-stage duplicate and independent screening process. We included cohort studies and cross sectional studies assessing the prevalence of use of waterpipe in either the general population or a specific population of interest. Two reviewers used a standardized and pilot tested form to collect data from each eligible study using a duplicate and independent screening process. We stratified the data analysis by country and by age group. The study was not restricted to a specific context.ResultsOf a total of 38 studies, only 4 were national surveys; the rest assessed specific populations. The highest prevalence of current waterpipe smoking was among school students across countries: the United States, especially among Arab Americans (12%-15%) the Arabic Gulf region (9%-16%), Estonia (21%), and Lebanon (25%). Similarly, the prevalence of current waterpipe smoking among university students was high in the Arabic Gulf region (6%), the United Kingdom (8%), the United States (10%), Syria (15%), Lebanon (28%), and Pakistan (33%). The prevalence of current waterpipe smoking among adults was the following: Pakistan (6%), Arabic Gulf region (4%-12%), Australia (11% in Arab speaking adults), Syria (9%-12%), and Lebanon (15%). Group waterpipe smoking was high in Lebanon (5%), and Egypt (11%-15%). In Lebanon, 5%-6% pregnant women reported smoking waterpipe during pregnancy. The studies were all cross-sectional and varied by how they reported waterpipe smoking.ConclusionWhile very few national surveys have been conducted, the prevalence of waterpipe smoking appears to be alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries.

Attitudes of healthcare students and professionals toward patients with physical disability: a systematic review

Objective Negative healthcare provider attitudes toward patients with physical disabilities may challenge the delivery of quality care to patients. The objective of this study was to systematically review published studies examining the attitudes of healthcare students and professionals toward patients with physical disabilities. Design In October 2011, we searched four electronic databases using the OVID platform. In addition, we screened citation lists. Independent reviewers completed the selection of articles and data abstraction by triplicate review using standardized and pilot tested forms. They resolved disagreements by discussion or with the help of an additional reviewer when necessary. Articles were included if they examined healthcare professionals’ and students’ attitudes toward patients with physical disabilities. We did not perform a meta-analysis because of the variation in instruments used and variables examined. We used a qualitative approach to identifying and reporting common findings across the studies. Results Results indicate that healthcare students and professionals have favorable attitudes toward persons with physical disabilities. More experience with persons with physical disabilities, both professionally and socially, was associated with more favorable attitudes. In addition, female healthcare students and professionals were found to have more positive attitudes toward patients with physical disabilities than do their male colleagues. Limited evidence exists examining the influence of age, race or ethnicity, and rank of student or professional on attitudes toward patients with physical disabilities. Finally, it was found that healthcare students and professionals reported overall more favorable attitudes than did individuals in non-healthcare professions. Conclusions Overall, healthcare students’ and professionals’ attitudes toward persons with physical disabilities were favorable. However, some studies revealed the possibility that some healthcare providers demonstrate fear and anxiety with the challenge of caring for a patient with physical disabilities. Some of the factors associated with providers’ attitudes toward patients with physical disabilities are potentially modifiable (e.g., experience) and could be the target of educational interventions to ameliorate this fear and facilitate higher quality care.

Validated instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability: a systematic review

BackgroundInstruments to detect changes in attitudes towards people with disabilities are important for evaluation of training programs and for research. While we were interested in instruments specific for medical students, we aimed to systematically review the medical literature for validated survey instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability.MethodsWe electronically searched Medline, EMBASE, PsycINFO, Health and Psychosocial Instruments. We included papers reporting on the development and/or validation of survey instruments to measure attitudes of healthcare students and professionals towards patients with physical disability. We excluded papers in which the attitudes were not measured in a provider-patient context. Two reviewers carried out titles and abstracts screening, full texts screening, and data abstraction in a duplicate and independent manner using standardized and pilot tested forms.ResultsWe identified seven validated survey instruments used for healthcare students and professionals. These instruments were originally developed for the following target populations: general population (n = 4); dental students (n = 1); nursing students (n = 1); and rehabilitation professionals (n = 1). The types of validity reported for these instruments were content validity (n = 3), criterion-related validity (n = 1), construct validity (n = 2), face validity (n = 1), discriminant validity (n = 1), and responsiveness (n = 1). The most widely validated and used tool (ATDP) was developed in the late 1960s while the most recent instrument was developed in the early 1990s.ConclusionOf the seven identified validated instruments, less than half were specifically designed for healthcare students and professionals and none for medical students. There is a need to develop and validate a contemporary instrument specifically for medical students.

Support for and aspects of use of educational games in family medicine and internal medicine residency programs in the US: a survey

BackgroundThe evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States.MethodsWe conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use.ResultsOf 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively.ConclusionsGiven a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.

Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: a systematic review

BackgroundThe primary objective was to systematically review the medical literature for instruments validated for use in epidemiological and clinical research on waterpipe smoking.MethodsWe searched the following databases: MEDLINE, EMBASE, and ISI the Web of Science. We selected studies using a two-stage duplicate and independent screening process. We included papers reporting on the development and/or validation of survey instruments to measure waterpipe tobacco consumption or related concepts. Two reviewers used a standardized and pilot tested data abstraction form to collect data from each eligible study using a duplicate and independent screening process. We also determined the percentage of observational studies assessing the health effects of waterpipe tobacco smoking and the percentage of studies of prevalence of waterpipe tobacco smoking that have used validated survey instruments.ResultsWe identified a total of five survey instruments. One instrument was designed to measure knowledge, attitudes, and waterpipe use among pregnant women and was shown to have internal consistency and content validity. Three instruments were designed to measure waterpipe tobacco consumption, two of which were reported to have face validity. The fifth instrument was designed to measure waterpipe dependence and was rigorously developed and validated. One of the studies of prevalence and none of the studies of health effects of waterpipe smoking used validated instruments.ConclusionsA number of instruments for measuring the use of and dependence on waterpipe smoking exist. Future research should study content validity and cross cultural adaptation of these instruments.

Prevalence of chronic kidney disease in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

BackgroundThe incidence and prevalence of chronic kidney disease (CKD) continue to rise worldwide. Increasing age, diabetes, hypertension, and cigarette smoking are well-recognized risk factors for CKD. Chronic obstructive pulmonary disease (COPD) is characterized by chronic airway inflammation leading to airway obstruction and parenchymal lung destruction. Due to some of the common pathogenic mechanisms, COPD has been associated with increased prevalence of CKD.MethodsSystematic review of medical literature reporting the incidence and prevalence of CKD in patients with COPD using the Cochrane Collaboration Methodology, and conduct meta-analysis to study the cumulative effect of the eligible studies. We searched Medline via Ovid, PubMed, EMBASE and ISI Web of Science databases from 1950 through May, 2016. We included prospective and retrospective observational studies that reported the prevalence of CKD in patients with COPD.ResultsOur search resulted in 19 eligible studies of which 9 have been included in the meta-analysis. The definition of CKD was uniform across all the studies included in analysis. COPD was found to be associated with CKD in the included epidemiological studies conducted in many countries. Our meta-analysis showed that COPD was found to be associated with a significantly increased prevalence of CKD (Odds Ratio [OR] = 2.20; 95% Confidence Interval [CI] 1.83, 2.65). Study limitations: Studies included are observational studies. However, given the nature of our research question there is no possibility to perform a randomized control trial.ConclusionsPatients with COPD have increased odds of developing CKD. Future research should investigate the pathophysiological mechanism behind this association, which may lead to better outcomes.

Whole brain CT perfusion deficits using 320-detector-row CT scanner in TIA patients are associated with ABCD2 score

Background: Transient ischemic attacks (TIA) are cerebral ischemic events without infarction. The uses of CT perfusion (CTP) techniques such as cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT) and cerebral blood flow (CBF) provide real time data about ischemia. It has been shown that CTP changes occur in less sensitive CTP scanners in patients with TIA. Larger detector row CTP (whole brain perfusion studies) may show that CTP abnormalities are more prevalent than previously noted. It is also unclear if these changes are associated with TIA severity. Objective: To demonstrate that TIA patients are associated with perfusion deficits using whole brain 320-detector-row CT perfusion, and to determine an association between ABCD2 score and perfusion deficit using whole brain perfusion. Methods: We retrospectively reviewed all TIA patients for CTP deficits from 2008–2010. Perfusion imaging was reviewed at admission; and it was determined if a perfusion deficit was present along with vascular territory involved. Results: Of 364 TIA patients, 62 patients had CTP deficits. The largest group of patients had MCA territory involved with 48 of 62 patients (77.42%). The most common perfusion abnormality was increased TTP with 46 patients (74.19%). The ABCD2 score was reviewed in association with perfusion deficit. Increased age >60, severe hypertension (>180/100 mmHg), patients with speech abnormalities, and duration of symptoms >10 min were associated with a perfusion deficit but history of diabetes or minimal/moderate hypertension (140/90–179/99 mmHg) was not. There was no association between motor deficit and perfusion abnormality. Conclusion: Perfusion deficits are found in TIA patients using whole brain CTP and associated with components of the ABCD2 score.

Post-gastrointestinal endoscopy complications in patients with obstructive sleep apnea or at high risk for sleep apnea: a systematic review and meta-analysis

BackgroundObstructive sleep apnea (OSA) is becoming increasingly more prevalent with the rise in obesity. Complications from gastrointestinal (GI) endoscopy in this patient population have been reported in several studies, but the modest complication rates from these procedures make it difficult to come to definitive conclusions based on single studies. The objective of our study was to systematically review these studies reporting the incidence of post-procedure complications in patients with OSA undergoing endoscopy to determine whether the presence of OSA increases post-procedure complications.MethodsWe conducted a systematic review using the Cochrane Collaboration Methodology. We searched Medline via Ovid, PubMed, Embase, and Evidence Based Medicine Reviews databases from 1950 to August 2013. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Meta-analysis was done using Review Manager Version 5.0.20.ResultsOur search resulted in seven eligible studies. There was no significant association between diagnosis of OSA and post-GI endoscopy complications including hypoxemia, respiratory distress, variations in blood pressure or heart rate, bradypnea, or need for significant interventions. Subgroup analysis based on the type of GI endoscopy or the type of anesthesia used did not show any significant associations either.ConclusionsObstructive sleep apnea patients and/or patients at high risk for obstructive sleep apnea do not appear to be at increased risk of adverse outcomes from GI endoscopy.