scholarly journals Endoscopic versus surgical treatment for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 34 (6) ◽  
pp. 2429-2444 ◽  
Author(s):  
C. M. Haney ◽  
K. F. Kowalewski ◽  
M. W. Schmidt ◽  
R. Koschny ◽  
E. A. Felinska ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Necrotizing Pancreatitis ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals SURGERY VERSUS CONSERVATIVE STRATEGIES IN PATIENTS WITH ROTATOR CUFF TEAR OF THE SHOULDER: A SYSTEMATIC REVIEW WITH META-ANALYSIS

2020 ◽  
Author(s):  
Fabrizio Brindisino ◽  
Mattia Salomon ◽  
Silvia Giagio ◽  
Chiara Pastore ◽  
Tiziano Innocenti
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Rotator Cuff ◽  
Conservative Treatment ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Optimal Management ◽  
Related Disorder ◽  
Randomized Controlled

Shoulder pain (SP) is one of the most common musculoskeletal complaints 1 and it can negatively affect the correct movement of the upper limb, night rest, daily life activity, work and sports performances and autonomy 2-4. Rotator cuff (RC) disease represents the most common cause of SP and it is responsible for up to 70% of all shoulder related visits to clinicians 5. RC tears are generally considered to be a normal imaging result and a age related disorder 6, when we consider patients over 5th decade. Infact, RC tears are present between 20% to 54% of subjects aged between 60 and 80 years 7; moreover full-thickness RC tears can be evident in approximately 20% of patients over 65 years old 8. RC tears have been widely studied and a lot of management strategies of patients with RC tears are actually available in literature 9,10; even if successful results have been achieved for both conservative and surgical treatment of RC tears, optimal management and best choice treatments for patient with RC tears are still unknown and debated 11,12. Generally, conservative treatments were often administered in partial thickness RC tear, while surgery was judged as better option for massive tear 13. Furthermore, conservative treatment has often been advocated for older patients with comorbidities, while surgery is suggested for younger people 14,15. Lastly, physiotherapy did not reach structural healing of the tear, however successful rate was reported also after conservative treatment of massive tears: nevertheless, some concerns persist about the enlargement of the anatomical lesion and following loss of strength and pain persistence 7. In the USA, in 2006, the annual incidence of surgery for RC tear was 98 procedures per 100,000 inhabitants and the incidence was increased form the application of the arthroscopic strategies 16,17, moreover, despite being considered as a successful treatment option, surgical treatment is estimated to cause from 20 to 90% rate of re-tear after surgery 18,19. In such a framework of uncertainty on optimal management, several randomized controlled trials (RCTs) have been structured to compare the efficacy of surgical and conservative treatments for patient with any type of RC tears; results coming from different studies are often contradictory and substantially influenced by the recruited sample characteristics. The aim of this systematic review is to analyze the results of randomized controlled trials which compare surgical and conservative treatments for patient with any type of RC tear through meta-analysis. Furthermore, this study also aims to know which are the most common indication to surgery: authors would like to understand if the presence of structural failure at the imaging assessment, the presence of pain refractory to conservative treatment, the presence of strength deficit or the combination of this mentioned elements are considered as decision criteria for choosing a surgery approach.

Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

2018 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Middle Income ◽  
Brief Motivational Intervention ◽  
Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

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