Critical appraisal of gastric conduit ischaemic conditioning (GIC) prior to oesophagectomy: A systematic review and meta-analysis

2020 ◽  
Vol 77 ◽  
pp. 77-82 ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
Charlie Boyle ◽  
James R. Bundred ◽  
Benjamin HL. Tan
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Gastric Conduit ◽  
Ischaemic Conditioning

P60 CRITICAL APPRAISAL OF GASTRIC CONDUIT ISCHAEMIC CONDITIONING PRIOR TO OESOPHAGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Boyle Charlie ◽  
R Bundred, James ◽  
HL Tan Benjamin
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Major Complication ◽  
Gastric Conduit ◽  
High Morbidity ◽  
Anastomotic Strictures ◽  
Meta Analyses ◽  
The Impact ◽  
Ischaemic Conditioning

Abstract Aim Anastomotic leaks remain a major complication following oesophagectomy, accounting for high morbidity and mortality. Recently, gastric ischaemic conditioning (GIC) has been proposed to improve anastomotic integrity through neovascularisation of the gastric conduit. This systematic review aims to determine the impact of GIC on postoperative outcomes after oesophagectomy. Background & Methods A systematic literature search was performed to identify studies reporting GIC for any indication of oesophageal resection. Random-effects meta-analyses were conducted for main outcomes. Results Nineteen studies were included reporting GIC, of which 13 were comparative studies. GIC were performed through ligation in 13 studies and embolisation in six studies. GIC did not appear reduce anastomotic leakages (OR 0.80, CI95: 0.51 - 1.24, p=0.3), anastomotic strictures (OR 0.75, CI95: 0.35 - 1.60, p=0.5), overall complications (OR 1.02, CI95: 0.48 - 2.16, p=0.9), major complications (OR 1.06, CI95: 0.53 - 2.11, p=0.9), or in-hospital mortality (OR 0.70, CI95: 0.32 - 1.53, p=0.4). However, preconditioning reduced the rates of conduit necrosis (OR 0.30, CI95: 0.11 - 0.77, p=0.013). Conclusion Gastric preconditioning through does not appear to reduce overall rates of anastomotic leakage after oesophagectomy but seems to reduce severity of leakages. More in depth studies are recommended.

scholarly journals Optimal Application of Forced Air Warming to Prevent Peri-Operative Hypothermia during Abdominal Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (5) ◽  
pp. 2517
Author(s):  
Yoonyoung Lee ◽  
Kisook Kim
Keyword(s):  
Systematic Review ◽  
Abdominal Surgery ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Upper Body ◽  
Cochrane Library ◽  
Randomized Controlled ◽  
Forced Air Warming ◽  
Forced Air ◽  
Full Body

Patients who undergo abdominal surgery under general anesthesia develop hypothermia in 80–90% of the cases within an hour after induction of anesthesia. Side effects include shivering, bleeding, and infection at the surgical site. However, the surgical team applies forced air warming to prevent peri-operative hypothermia, but these methods are insufficient. This study aimed to confirm the optimal application method of forced air warming (FAW) intervention for the prevention of peri-operative hypothermia during abdominal surgery. A systematic review and meta-analysis were conducted to provide a synthesized and critical appraisal of the studies included. We used PubMed, EMBASE, CINAHL, and Cochrane Library CENTRAL to systematically search for randomized controlled trials published through March 2020. Twelve studies were systematically reviewed for FAW intervention. FAW intervention effectively prevented peri-operative hypothermia among patients undergoing both open abdominal and laparoscopic surgery. Statistically significant effect size could not be confirmed in cases of only pre- or peri-operative application. The upper body was the primary application area, rather than the lower or full body. These findings could contribute detailed standards and criteria that can be effectively applied in the clinical field performing abdominal surgery.

scholarly journals Effects of ischaemic conditioning on major clinical outcomes in people undergoing invasive procedures: systematic review and meta-analysis

BMJ ◽  
2016 ◽  
pp. i5599 ◽  
Author(s):  
Louisa Sukkar ◽  
Daqing Hong ◽  
Muh Geot Wong ◽  
Sunil V Badve ◽  
Kris Rogers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Invasive Procedures ◽  
Ischaemic Conditioning

scholarly journals Validity of ultrasonography to diagnosing pneumothorax: a critical appraisal of two meta-analyses

CJEM ◽  
2015 ◽  
Vol 17 (2) ◽  
pp. 199-201 ◽  
Author(s):  
Aftab Azad ◽  
Saad Al Juma ◽  
Junaid A. Bhatti ◽  
Jerrald Dankoff
Keyword(s):  
Systematic Review ◽  
Chest Radiography ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Clinical Question ◽  
Test Characteristics ◽  
Meta Analyses

Clinical questionCan ultrasonography be used in lieu of chest radiography to diagnose pneumothorax?Articles chosen1. Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a metaanalysis. Chest 2011;140:859-66. [Epub 2011 May 5]2. Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 2012; 141:703-8.

scholarly journals Anxiety disorders and risk of stroke: A systematic review and meta-analysis

2017 ◽  
Vol 41 (1) ◽  
pp. 102-108 ◽  
Author(s):  
M. Pérez-Piñar ◽  
L. Ayerbe ◽  
E. González ◽  
R. Mathur ◽  
Q. Foguet-Boreu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Critical Appraisal ◽  
Web Of Science ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Explanatory Factors ◽  
Increased Risk ◽  
Severe Anxiety

AbstractBackgroundAnxiety disorders are the most common mental health problem worldwide. However, the evidence on the association between anxiety disorders and risk of stroke is limited. This systematic review and meta-analysis presents a critical appraisal and summary of the available evidence on the association between anxiety disorders and risk of stroke.MethodsCohort studies reporting risk of stroke among patients with anxiety disorders were searched in PubMed, Embase, PsycINFO, Scopus, and the Web of Science, from database inception to June 2016. The quality of the studies was assessed using standard criteria. A meta-analysis was undertaken to obtain pooled estimates of the risk of stroke among patients with anxiety disorders.ResultsEight studies, including 950,759 patients, from the 11,764 references initially identified, were included in this review. A significantly increased risk of stroke for patients with anxiety disorders was observed, with an overall hazard ratio: 1.24 (1.09–1.41), P = 0.001. No significant heterogeneity between studies was detected and the funnel plot suggested that publication bias was unlikely. Limited evidence suggests that the risk of stroke is increased shortly after the diagnosis of anxiety and that risk of stroke may be higher for patients with severe anxiety.ConclusionsAnxiety disorders are a very prevalent modifiable condition associated with risk of stroke increased by 24%. This evidence could inform the development of interventions for the management of anxiety and the prevention of stroke. Further studies on the risk of stroke in patients with anxiety, and the explanatory factors for this association, are required.

scholarly journals Systematic Review and Meta-Analysis of the Effect of Statins on Circulating E-Selectin, L-Selectin, and P-Selectin

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1707
Author(s):  
Angelo Zinellu ◽  
Arduino A Mangoni
Keyword(s):  
Systematic Review ◽  
Cell Adhesion ◽  
Critical Appraisal ◽  
Inflammatory Cell ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Cardiovascular Risk Reduction ◽  
Standard Mean Difference ◽  
Registration Number ◽  
Selectin L

The pleiotropic effects of statins might involve preventing inflammatory cell adhesion to the endothelium, which is a critical step in the pathogenesis of atherosclerosis. We conducted a systematic review and meta-analysis of the effects of statins on the circulating cell adhesion molecules E-Selectin, L-Selectin, and P-Selectin. A literature search was conducted in PubMed, Web of Science, and Scopus, from inception to July 2021. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 61 studies, statins significantly reduced P-selectin (standard mean difference, SMD = −0.39, 95% CI −0.55 to −0.22, p < 0.001; moderate certainty of evidence), L-selectin (SMD = −0.49, 95% CI −0.89 to −0.10, p = 0.014; very low certainty of evidence), and E-Selectin (SMD = −0.73, 95% CI −1.02 to −0.43, p < 0.001; moderate certainty of evidence), independently of baseline lipid profile and other study and patient characteristics. The corresponding pooled SMD values in sensitivity analysis were not substantially altered when individual studies were sequentially removed. Simvastatin had a significant lowering effect on both P-selectin and E-selectin. Therefore, statins significantly reduce circulating selectins. Further studies are required to investigate whether selectin lowering mediates cardiovascular risk reduction with these agents. (PROSPERO registration number: CRD42021282778).

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