scholarly journals Efficacy and Safety of Non-Operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta-Analyses

2022 ◽  
Author(s):  
Sameh Hany Emile ◽  
Ahmad Sakr ◽  
Mostafa Shalaby ◽  
Hossam Elfeki
Keyword(s):  
Acute Appendicitis ◽  
Systematic Reviews ◽  
Operative Management ◽  
Efficacy And Safety ◽  
Umbrella Review ◽  
Uncomplicated Acute Appendicitis ◽  
Meta Analyses ◽  
Non Operative Management

scholarly journals Efficacy and safety of levetiracetam in children with epilepsy: protocol for an umbrella review of systematic reviews and meta-analyses of randomised controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029811 ◽  
Author(s):  
Jing Gan ◽  
Dan Ma ◽  
Tao Xiong
Keyword(s):  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Assessment Tools ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Umbrella Review ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Paediatric Epilepsy

IntroductionEpilepsy causes serious suffering in children and is associated with high morbidity and increased mortality. It impairs children’s quality of life and places a heavy burden on healthcare resources. Levetiracetam has been used to prevent and treat paediatric epilepsy for years. To date, a number of systematic reviews have been performed to assess the efficacy and safety of levetiracetam in a variety of clinical settings. Conflicting outcomes have been reported for the same clinical issues. Our objective is to provide a comprehensive overview of the literature for clinicians and policymakers via an umbrella review that assesses the efficacy and safety of levetiracetam in children with epilepsy.Methods and analysisWe will follow the Joanna Briggs Institute’s guidelines for umbrella reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following seven databases will be searched from 1990 to February 2019: PubMed, Embase, Cochrane Database of Systematic Reviews, JBISRIR, EPPI, Epistemonikos and PROSPERO. We will provide evidence from existing systematic reviews and meta-analyses of randomised controlled trials regarding the use of levetiracetam in children with epilepsy. The intervention of interest is levetiracetam monotherapy and add-on therapies for prevention or treatment purposes. Studies will be individually selected and assessed by two reviewers. The primary outcomes of interest are epilepsy control, the efficacy of prophylaxis for provoked seizures and the mortality rate of children with epilepsy who received levetiracetam treatment. The secondary outcomes are adverse events and withdrawal rates due to adverse effects. The methodological quality of all reviews will be individually assessed by two reviewers using the ‘A Measurement Tool to Assess Systematic Reviews’ instrument. The Grading of Recommendations Assessment, Development and Evaluation assessment will be applied to evaluate the quality of evidence for each outcome of interest. A narrative description of an analysis of the systematic reviews will be tabulated to address objective and specific questions. Information from each review will be detailed in a table including the population, number of studies, total number of participants, year range of the trials, study designs of the primary trials, countries and settings of the trials, heterogeneity of results and assessment tools. Recommendations regarding each outcome of levetiracetam will be categorised based on a protocol.Ethics and disseminationThis umbrella review will inform clinical and policy decisions regarding the efficacy and safety of levetiracetam for preventing and treating paediatric epilepsy. The results will be disseminated through a peer-reviewed publication and conference presentations. Ethical approval is not required for this study.

scholarly journals Study of conservative treatment in uncomplicated acute appendicitis

2017 ◽  
Vol 4 (4) ◽  
pp. 1409 ◽  
Author(s):  
B. S. Gedam ◽  
Ajit Gujela ◽  
Prasad Y. Bansod ◽  
Murtaza Akhtar
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Treatment Failure ◽  
Tertiary Care ◽  
Operative Management ◽  
Care Hospital ◽  
Alvarado Score ◽  
Modified Alvarado Score ◽  
Uncomplicated Acute Appendicitis ◽  
Non Operative Management

Background: Management of acute appendicitis with antibiotics only, without surgery is currently evaluated. Non-operative management of uncomplicated acute diverticulitis and salpingitis has been well established but the non-operative management of acute appendicitis remains controversial. Growing evidence indicates that patients with acute uncomplicated appendicitis can be treated safely with an antibiotics- first approach.Methods: A tertiary care hospital based longitudinal study with duration of 26 month. Patients with clinical and radiological feature of acute appendicitis presenting within 48 hours of initiation of abdominal pain with Modified Alvarado Score ≥5 included. Various demographic, clinico-pathological, radiological factors were studied.Results: 71 patients evaluated, mean age of 30.45±9.71 years. Tenderness in RIF was the commonest finding followed by Fever and rebound tenderness. Leucocytosis seen in 74.65% Modified Alvarado score of 5-6 was present in 18.32% whereas 7-9 was present in 81.68% patients. USG was suggestive of appendicitis in 84.50% patients. Conservative treatment was successful in 74.65% patients with no treatment failure. 25.35% patients, conservative treatment failed. Overall recurrence was seen in 13.11% cases that were successfully managed during primary admission.Conclusions: Majority of cases of first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment requires monitoring and repeated re-evaluation to identify failure which needs to be treated promptly by surgery. Treatment failure on primary admission as well as the short- term recurrence after conservative treatment is low and acceptable. The outcome of conservative treatment does not depend on Modified Alvarado Score.

scholarly journals Surgical treatment for cryptoglandular and Crohn’s perianal fistulas: Protocol of an umbrella review

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251460
Author(s):  
Zubing Mei ◽  
Qin Feng ◽  
Peixin Du ◽  
Bin Li ◽  
Chenyang Fang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Efficacy And Safety ◽  
Umbrella Review ◽  
Perianal Fistulas ◽  
Surgical Options ◽  
Meta Analyses

Introduction A high prevalence of cryptoglandular and Crohn’s perianal fistulas has been reported worldwide, and several surgical options are available for the management of anal fistula, with varying clinical efficacy. However, currently, the available evidence for the effectiveness of these surgical approaches are lacking and of concern in terms of the credibility and strength. The purpose of this study is to evaluate the credibility of the published systematic reviews and meta-analyses that assess the efficacy and safety of the surgical options for cryptoglandular and Crohn’s perianal fistulas through an umbrella review. Methods and analysis A systematic search in PubMed, Embase and Cochrane library will be performed from inception to December 2020 without any language restriction. We will include systematic reviews and meta-analyses that investigate the efficacy and safety of surgical approaches in the management of cryptoglandular and Crohn’s perianal fistulas. Two reviewers will independently screen search results through reading the titles or abstracts. Relevant information will be extracted from each eligible systematic review or meta-analysis. Based on random effects model summary estimates along with their p values, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance, we will classify the evidence from convincing (class I) to weak (class IV). Findings will be summarized using quantitative synthesis combined with a narrative approach. Cryptoglandular and Crohn’s perianal fistulas will be summarized separately. Two authors will independently perform the literature search, data extraction, and quality assessment of each included systematic review and meta-analysis. Any unresolved conflicts or doubts will be resolved by discussion or by consulting a senior author. The risk of bias of the systematic reviews will be assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. The strength of evidence for the included systematic reviews will be classified as "high", "moderate", "low", or "critically low" quality. Ethics and dissemination Ethics approval is not required as we will collect data from the published systematic reviews and meta-analyses without using individual patient data. The results of this umbrella review will be published in a peer-reviewed journal and will be presented at an anorectal disease conference. PROSPERO registration number CRD42020200754.

scholarly journals Efficacy and safety of aliskiren combination therapy: a protocol for an umbrella review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043807
Author(s):  
Jiantong Shen ◽  
Wenming Feng ◽  
Yike Wang ◽  
Qiyuan Zhao ◽  
Billong Laura Flavorta ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Systematic Reviews ◽  
Cochrane Library ◽  
Umbrella Review ◽  
Quality Of Reporting ◽  
Ethical Approval ◽  
Registration Number ◽  
Third Person ◽  
Meta Analyses ◽  
The Impact

IntroductionEfficacy of aliskiren combination therapy with other antihypertensive has been evaluated in the treatment of patients with hypertension in recent systematic reviews. However, most previous reviews only focused on one single health outcome or one setting, none of them made a full summary that assessed the impact of aliskiren combination treatment comprehensively. As such, this umbrella review based on systematic reviews and meta-analyses is aimed to synthesise the evidences on efficacy, safety and tolerability of aliskiren-based therapy for hypertension and related comorbid patients.Methods and analysisA comprehensive search of PubMed, EMBASE, Cochrane Library, CNKI published from inception to August 2020 will be conducted. The selected articles are systematic reviews which evaluated efficacy, safety and tolerability of aliskiren combination therapy. Two reviewers will screen eligible articles, extract data and evaluate quality independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the Assessment of Multiple Systematic Reviews V.2 tool tool. We will take a mixed-methods approach to synthesising the review literatures, reporting summary of findings tables and iteratively mapping the results.Ethics and disseminationEthical approval is not required for the study, as we would only collect data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.PROSPERO registration numberCRD42020192131.

scholarly journals Frailty Status and All-Cause Mortality in the Community-Dwelling Older People: An Umbrella Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 488-489
Author(s):  
A R M Saifuddin Ekram ◽  
Joanne Ryan ◽  
Carlene Britt ◽  
Sara Espinoza ◽  
Robyn Woods
Keyword(s):  
Older People ◽  
Systematic Reviews ◽  
Community Dwelling ◽  
Umbrella Review ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Community Dwelling Older People ◽  
Meta Analyses

Abstract Frailty is increasingly recognised for its association with adverse health outcomes including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aimed to map which frailty scale could best predict the relationship between frailty and all-cause mortality among community-dwelling older people. According to the PRISMA guidelines, Medline, Embase, EBSCOhost and Web of Science databases were searched to identify eligible systematic reviews and meta-analyses which examined the association between frailty and all-cause mortality in the community-dwelling older people. Relevant data were extracted and summarised qualitatively. Methodological quality was assessed by AMSTAR-2 checklist. Five moderate-quality systematic reviews with a total of 374,529 participants were identified. Of these, two examined the frailty phenotype and its derivatives, two examined the cumulative deficit models and the other predominantly included studies assessing frailty with the FRAIL scale. All of the reviews found a significant association between frailty status and all-cause mortality. The magnitude of association varied between individual studies, with no consistent pattern related to the frailty measures that were used. In conclusion, regardless of the measure used to assess frailty status, it is associated with an increased risk of all-cause mortality.

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