Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Evans, Corinne V; Rushkin, Megan C.

doi:10.1001/jama.2018.17847

Cited by 72 publications

(198 citation statements)

References 6 publications

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“…These include old age, female sex, fear of falling, impaired cognition, mobility, and gait. [5][6][7][8] One of the potentially modifiable risk factors is sarcopenia, that is, age-related low skeletal muscle mass, strength, and physical performance. 9 Sarcopenia is prevalent between 2% and 37% in community-dwelling older adults, depending on the sarcopenia definition applied [10][11][12] and associated with decreased mobility, impaired standing balance, functional decline, hospitalization, and mortality.…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta‐analysis

Yeung

Reijnierse

Pham

et al. 2019

J cachexia sarcopenia muscle

616

463

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Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures is unclear. This study aims to systematically assess the literature and perform a meta‐analysis of the association between sarcopenia with falls and fractures among older adults. A literature search was performed using MEDLINE, EMBASE, Cochrane, and CINAHL from inception to May 2018. Inclusion criteria were the following: published in English, mean/median age ≥ 65 years, sarcopenia diagnosis (based on definitions used by the original studies' authors), falls and/or fractures outcomes, and any study population. Pooled analyses were conducted of the associations of sarcopenia with falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent, and study quality. Heterogeneity was assessed using the I 2 statistics. The search identified 2771 studies. Thirty‐six studies (52 838 individuals, 48.8% females, and mean age of the study populations ranging from 65.0 to 86.7 years) were included in the systematic review. Four studies reported on both falls and fractures. Ten out of 22 studies reported a significantly higher risk of falls in sarcopenic compared with non‐sarcopenic individuals; 11 out of 19 studies showed a significant positive association with fractures. Thirty‐three studies (45 926 individuals) were included in the meta‐analysis. Sarcopenic individuals had a significant higher risk of falls (cross‐sectional studies: OR 1.60; 95% CI 1.37–1.86, P < 0.001, I 2 = 34%; prospective studies: OR 1.89; 95% CI 1.33–2.68, P < 0.001, I 2 = 37%) and fractures (cross‐sectional studies: OR 1.84; 95% CI 1.30–2.62, P = 0.001, I 2 = 91%; prospective studies: OR 1.71; 95% CI 1.44–2.03, P = 0.011, I 2 = 0%) compared with non‐sarcopenic individuals. This was independent of study design, population, sex, sarcopenia definition, continent, and study quality. The positive association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarcopenia prevention and interventions to evaluate its effect on falls and fractures.

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Section: Introductionmentioning

confidence: 99%

Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta‐analysis

Yeung

Reijnierse

Pham

et al. 2019

J cachexia sarcopenia muscle

616

463

View full text Add to dashboard Cite

show abstract

“…10 Other medications, such as tetracycline ophthalmic ointment and silver nitrate, have been evaluated for the prevention of gonococcal ophthalmia neonatorum but are no longer available in the United States. 3 Gentamicin was used during a period of erythromycin shortage, although its use was associated with ocular reactions (chemical conjunctivitis). 11 Povidone-iodine has been proposed for prophylaxis, but there are limited data on its benefits and harms.…”

Section: Preventive Medicationmentioning

confidence: 99%

“…11 Povidone-iodine has been proposed for prophylaxis, but there are limited data on its benefits and harms. 3 Currently, erythromycin is the only drug approved by the US Food and Drug Administration for the prophylaxis of gonococcal ophthalmia neonatorum. 11 Ocular prophylaxis of newborns is mandated in most states 6 and is considered standard neonatal care.…”

Section: Preventive Medicationmentioning

confidence: 99%

“…The rates of gonococcal ophthalmia neonatorum are related to gonococcal infection rates in women of reproductive age. 3 Accordingly, screening for and treatment of gonococcal infection in pregnant women is an important strategy for reducing the sexual transmission of gonorrhea and subsequent vertical transmission leading to gonococcal ophthalmia neonatorum. While screening and treatment programs have reduced the rates of gonorrhea in pregnant women, there are large disparities in access to prenatal care in the United States.…”

Section: Additional Approaches To Preventionmentioning

confidence: 99%

“…10 The rates of gonococcal conjunctivitis in infants are directly related to the rates of gonorrhea among women of reproductive age. 3 In the United States, adolescents and young adult women have the highest rates of gonorrhea, with rates peaking at age 19 years (872.2 cases per 100 000 women); among women aged 20 to 24 years, there were 648.8 cases per 100 000 women in 2017. 1 Estimated rates of gonorrhea among pregnant women in the US primary care…”

Section: Burden Of Diseasementioning

confidence: 99%

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Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum

Force¹,

Curry

Krist

et al. 2019

JAMA

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US Preventive Services Task Force T he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and Evidence The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum (A recommendation) (Figure 1). Rationale Importance In the United States, the rate of gonococcal ophthalmia neonatorum was an estimated 0.4 cases per 100 000 live births per year from 2013 to 2017. 1-4 Gonococcal ophthalmia neonatorum can cause corneal scarring, ocular perforation, and blindness as early as 24 hours after birth. 5-7 In the absence of ocular prophylaxis, transmission rates of gonococcal infection from mother to newborn are 30% to 50%. 8 Reaffirmation In 2011, the USPSTF reviewed the evidence on prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum and issued an A recommendation. 5 The USPSTF has decided to use a reaffirmation deliberation process to update this recommendation. The USPSTF uses the reaffirmation process for well-established, evidence-based standards of practice in current primary care practice for which only a very high level of evidence would justify a change in the grade of the recommendation. 9 In its deliberation of the evidence, the USPSTF considers whether IMPORTANCE In the United States, the rate of gonococcal ophthalmia neonatorum was an estimated 0.4 cases per 100 000 live births per year from 2013 to 2017. Gonococcal ophthalmia neonatorum can cause corneal scarring, ocular perforation, and blindness as early as 24 hours after birth. In the absence of ocular prophylaxis, transmission rates of gonococcal infection from mother to newborn are 30% to 50%. OBJECTIVE To reaffirm the US Preventive Services Task Force (USPSTF) 2011 recommendation on ocular prophylaxis for gonococcal ophthalmia neonatorum. EVIDENCE REVIEW The USPSTF commissioned a reaffirmation evidence update to identify new and substantial evidence sufficient enough to change its prior recommendation. FINDINGS Using a reaffirmation process, the USPSTF found no new data that would change its previous conclusion that topical ocular prophylaxis is effective in preventing gonococcal ophthalmia neonatorum and related ocular conditions. The USPSTF found no new data that would change its previous conclusion that there is convincing evidence that topi...

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Screening for Gynecologic Conditions With Pelvic Examination

Bibbins‐Domingo

Grossman

Curry

et al. 2017

JAMA

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he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms.It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and EvidenceThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women (I statement) (Figure 1).This statement does not apply to specific disorders for which the USPSTF already recommends screening (ie, screening for cervical cancer with a Papanicolaou ["Pap"] smear, screening for gonorrhea and chlamydia). See the eTable in the Supplement. RationaleImportance Many conditions that can affect women's health are often evaluated through pelvic examination. These conditions include but are not limited to malignant diseases, such as ovarian, uterine, vaginal, and cervical cancer; infectious diseases, such as bacterial vaginosis, candidiasis, genital warts, genital herpes, trichomoniasis, and pelvic inflammatory disease; and other benign conditions, such as cervical polyps, endometriosis, ovarian cysts, dysfunction of the pelvic wall and floor, and uterine fibroids. Pelvic examination is a common part of the physical examination; in 2012, an IMPORTANCE Many conditions that can affect women's health are often evaluated through pelvic examination. Although the pelvic examination is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality.OBJECTIVE ToissueanewUSPreventiveServicesTaskForce(USPSTF)recommendationonscreening forgynecologicconditionswithpelvicexaminationforconditionsotherthancervicalcancer,gonorrhea, and chlamydia, for which the USPSTF has already made specific recommendations. EVIDENCE REVIEWThe USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women 18 years and older who are not at increased risk for any specific gynecologic condition.FINDINGS Overall, the USPSTF found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women. CONCLUSIONS AND RECOMMENDATIONThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screen...

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Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Cited by 72 publications

References 6 publications

Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta‐analysis

Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta‐analysis

Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum

Screening for Gynecologic Conditions With Pelvic Examination

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