[Physical activity and activities of daily living of nursing homes residents: A systematic review and meta-analysis]. / Körperliche Aktivität und Aktivitäten des täglichen Lebens bei Bewohnerinnen und Bewohnern in der stationären Pflege - eine systematische Übersicht und Metaanalyse.

BACKGROUND: Interventions to promote physical activity in nursing homes are among the priorities of German long-term care insurance funds. We summarized the evidence on the effectiveness of such interventions. METHODS: We conducted a systematic literature search in five electronic databases in November 2019, which was complemented by searching reference lists and trials registries. Eligible studies included individually (RCTs) or cluster randomized trials or non-randomized comparative studies that investigated the effectiveness of interventions to promote physical activity in nursing home residents and their impact on the ability to perform activities of daily living. Results were synthesized using random effects meta-analysis. RESULTS: Meta-analysis of 19 included studies with high risk of bias showed a small yet statistically significant effect on activities of daily living (SMD = 0.40, 95 % CI 0.08-0.72); heterogeneity was substantial (I2 = 77 %, p < 0.0001). Sensitivity analysis excluding two non-randomized comparative studies did not alter the results (SMD = 0.40, 95 % CI 0.03-0.76). The effect attenuated but was still statistically significant in a meta-analysis which excluded five studies that were largely responsible for the heterogeneity (SMD = 0.27, 95 % CI 0.12-0.43, I2=34 %, p = 0.10). Subgroup analyses did not demonstrate any statistically significant results in favour of physical activity. DISCUSSION: We found evidence for a beneficial effect on activities of daily living in favour of interventions that aim to promote physical activity. Due to the high overall risk of bias and substantial heterogeneity of the included studies the results should be interpreted with caution, though. CONCLUSION: Methodologically sound studies are needed to strengthen the evidence base on the topic.

[Violent behavior of staff towards nursing home residents: A systematic review of instruments to measure prevalence]. / Personale Gewalt in der stationären Altenpflege: Eine systematische Übersicht über Instrumente zur Erfassung der Prävalenz.

BACKGROUND: Reduction or prevention of violence is one of the fields of preventive interventions in nursing homes. To prove the effectiveness of appropriate interventions, valid instruments are crucial to measure violence. METHODS: Between November 2019 and May 2020, a systematic search for studies and instruments was conducted in relevant databases and reference directories assessing violent behaviour by employees towards residents, by residents towards employees and resident-to-resident abuse. RESULTS: 24 instruments were identified. 8 instruments capture staff-to-resident violence, 14 capture resident-to-staff violence, 3 resident-to-resident aggression, and 5 instruments are not exactly attributable to the constellation of violence. No instrument covers all three situations of violence. Four of the instruments used to capture violence by staff cover all forms of personal violence. Validity and reliability data are inadequate. DISCUSSION: At present, there is no tool that fully depicts violence in resident homes and is suitable for measuring the effectiveness of interventions. There are sufficient tools for the individual constellations of violence that represent all forms of violence. Not all instruments could be procured in their original form, and even available instruments did not always provide information on the development of the instruments and a possible review of their quality. CONCLUSION: There is a lack of an internationally comparable instrument representing elder abuse in the inpatient setting with sufficient validity and reliability.

[Monitoring heat-related mortality in Hesse]. / Monitoring hitzebedingter Sterblichkeit in Hessen.

BACKGROUND: Continuous monitoring of the mortality phenomenon is given high priority in the current recommendations for the preparation of heat action plans in Germany with respect to problem detection and evaluation of interventions. International monitoring systems are heterogeneous concerning the procedures used. In Germany, such monitoring systems are rarely established. OBJECTIVES: Under what circumstances can a mortality monitoring system be operated on a regional basis using routine data? MATERIALS AND METHODS: Summer mortality data from Hesse from 2000 to 2018 and their associations with climate variables were analyzed. Different approaches regarding spatial analyses, definition of excess criteria, and adjusting procedures were explored. RESULTS: In Hesse, daily mean temperatures averaged over all operating weather stations proved appropriate as a climate parameter. The expected daily number of deaths was estimated by a moving average based on 25 daily mortality datasets from reference periods of five years adjusted for mortality peaks using data from three previous years. Mortality excess was defined as twice the value of the standard deviation of the expected values including an empirically determined temperature threshold. This threshold was derived from analyzing relative frequencies of observed excess number of deaths per 1 ℃ temperature interval. Based on this approach, 49 mortality excesses with a total of 889 excess deaths were estimated in Hesse during days with a daily mean temperature of more than 23.0 ℃ during summer from 2005 to 2018. CONCLUSIONS: The system described in this article turned out to be practicable for systematically monitoring mortality during summer. Timely availability of mortality and climate data is crucial.

Adverse effects of biologics: a network meta-analysis and Cochrane overview.

BACKGROUND: Biologics are used for the treatment of rheumatoid arthritis and many other conditions. While the efficacy of biologics has been established, there is uncertainty regarding the adverse effects of this treatment. Since serious risks such as tuberculosis (TB) reactivation, serious infections, and lymphomas may be common to the biologics but occur in small numbers across the various indications, we planned to combine the results from biologics used in many conditions to obtain the much needed risk estimates. OBJECTIVES: To compare the adverse effects of tumor necrosis factor blocker (etanercept, adalimumab, infliximab, golimumab, certolizumab), interleukin (IL)-1 antagonist (anakinra), IL-6 antagonist (tocilizumab), anti-CD28 (abatacept), and anti-B cell (rituximab) therapy in patients with any disease condition except human immunodeficiency disease (HIV/AIDS). METHODS: Randomized controlled trials (RCTs), controlled clinical trials (CCTs) and open-label extension (OLE) studies that studied one of the nine biologics for use in any indication (with the exception of HIV/AIDS) and that reported our pre-specified adverse outcomes were considered for inclusion. We searched The Cochrane Library, MEDLINE, and EMBASE (to January 2010). Identifying search results and data extraction were performed independently and in duplicate. For the network meta-analysis, we performed mixed-effects logistic regression using an arm-based, random-effects model within an empirical Bayes framework. MAIN RESULTS: We included 163 RCTs with 50,010 participants and 46 extension studies with 11,954 participants. The median duration of RCTs was six months and 13 months for OLEs. Data were limited for tuberculosis (TB) reactivation, lymphoma, and congestive heart failure. Adjusted for dose, biologics as a group were associated with a statistically significant higher rate of total adverse events (odds ratio (OR) 1.19, 95% CI 1.09 to 1.30; number needed to treat to harm (NNTH) = 30, 95% CI 21 to 60) and withdrawals due to adverse events (OR 1.32, 95% CI 1.06 to 1.64; NNTH = 37, 95% CI 19 to 190) and an increased risk of TB reactivation (OR 4.68, 95% CI 1.18 to 18.60; NNTH = 681, 95% CI 143 to 14706) compared to control.The rate of serious adverse events, serious infections, lymphoma, and congestive heart failure were not statistically significantly different between biologics and control treatment. Certolizumab pegol was associated with significantly higher risk of serious infections compared to control treatment (OR 3.51, 95% CI 1.59 to 7.79; NNTH = 17, 95% CI 7 to 68). Infliximab was associated with significantly higher risk of withdrawals due to adverse events compared to control (OR 2.04, 95% CI 1.43 to 2.91; NNTH = 12, 95% CI 8 to 28). Indirect comparisons revealed that abatacept and anakinra were associated with a significantly lower risk of serious adverse events compared to most other biologics.  Although the overall numbers are relatively small, certolizumab pegol was associated with significantly higher odds of serious infections compared to etanercept, adalimumab, abatacept, anakinra, golimumab, infliximab, and rituximab; abatacept was significantly less likely than infliximab and tocilizumab to be associated with serious infections.  Abatacept, adalimumab, etanercept and golimumab were significantly less likely than infliximab to result in withdrawals due to adverse events. AUTHORS' CONCLUSIONS: Overall, in the short term biologics were associated with significantly higher rates of total adverse events, withdrawals due to adverse events and TB reactivation. Some biologics had a statistically higher association with certain adverse outcomes compared to control, but there was no consistency across the outcomes so caution is needed in interpreting these results.There is an urgent need for more research regarding the long-term safety of biologics and the comparative safety of different biologics. National and international registries and other types of large databases are relevant sources for providing complementary evidence regarding the short- and longer-term safety of biologics. 

Twelfth biannual report of the Cochrane Haematological Malignancies Group--focus on tyrosine kinase inhibitors.

This 12th biannual report of the Cochrane Haematological Malignancies Group highlights recently published randomized controlled trials in the field of hemato-oncology, covering the publication period from September 1, 2009, through June 30, 2010. Implication for clinical practice and methodological aspects are the main principles used to select trials for this report. Studies on tyrosine kinase inhibitors for patients with chronic myeloid leukemia were identified through electronic search of MEDLINE with a broad search filter that covered all topics in hemato-oncology combined with a highly sensitive search filter for randomized studies as described in the Cochrane Handbook for Systematic Reviews of Interventions.