Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials

Background Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. Aims To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis. Method We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258). Results We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive–behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = −0.67, 95% CI −0.95 to −0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI −0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = −0.61, 95% CI −1.15 to −0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54–1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU. Conclusions CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.

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Abstract 16401: Duration of Dual Antiplatelet Therapy in Coronary Heart Disease: A 60,000-patient Meta-analysis of Randomised Controlled Trials

Circulation ◽

10.1161/circ.142.suppl_3.16401 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anda Bularga ◽

Mohammed Meah ◽

Dimitrios Doudesis ◽

Anoop S Shah ◽

Nicholas L Mills ◽

...

Keyword(s):

Myocardial Infarction ◽

Major Bleeding ◽

Randomised Controlled Trials ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Controlled Trials ◽

Short Term ◽

All Cause Mortality ◽

Standard Duration ◽

Randomised Controlled

Introduction: Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological treatment for patients with acute coronary syndrome (ACS) and in those undergoing percutaneous coronary intervention for stable coronary disease. Despite widespread use, the optimal duration of DAPT remains uncertain. We present an updated meta-analysis comparing outcomes in short-term DAPT (≤ 6 months) versus long-term DAPT (≥ 12 months). Methods: Four major databases were searched for randomised controlled trials of interest. The primary outcome was all-cause mortality. Secondary safety outcomes included any bleeding and major bleeding. Efficacy outcomes included cardiovascular death, myocardial infarction, stent thrombosis, coronary revascularization and thrombotic stroke. Further subgroup analysis stratified by index presentation and a sensitivity analysis to evaluate shorter duration DAPT (≤3 months) was performed. Results: Nineteen randomised controlled trials were included (n=60,879) of which 8 compared shorter duration DAPT (≤3 months) with standard duration (12 months) (n=38,036). Short-term DAPT was associated with an apparent modest increase in myocardial infarction (risk ratio [RR] 1.09; 95% confidence interval [CI], 0.98-1.22) with a major reduction in bleeding (RR 0.68; 95% CI, 0.55-0.83) for major bleeding and (RR 0.66; 95% CI, 0.56-0.77 for any bleeding) and an overall apparent reduction in all-cause mortality (RR 0.90; 95% CI 0.81-1.01). These associations persisted when comparing shorter duration DAPT to standard duration. Subgroup analysis of patients with stable disease or ACS identified no significant heterogenicity in efficacy, safety or mortality outcomes. Conclusion: In the largest meta-analysis to date comparing duration of DAPT, we show that short (≤ 6 months) and shorter (≤ 3 months) DAPT is associated with continuing trends for small reductions in all-cause mortality irrespective of index presentation.

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Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials

BMJ ◽

10.1136/bmj.l689 ◽

2019 ◽

pp. l689 ◽

Cited By ~ 29

Author(s):

Sidney M Rubinstein ◽

Annemarie de Zoete ◽

Marienke van Middelkoop ◽

Willem J J Assendelft ◽

Michiel R de Boer ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Adverse Events ◽

Confidence Interval ◽

Chronic Low Back Pain ◽

Randomised Controlled Trials ◽

Controlled Trials ◽

Low Back ◽

Short Term ◽

Randomised Controlled

Abstract Objective To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews. Eligibility criteria for selecting studies Randomised controlled trials examining the effect of spinal manipulation or mobilisation in adults (≥18 years) with chronic low back pain with or without referred pain. Studies that exclusively examined sciatica were excluded, as was grey literature. No restrictions were applied to language or setting. Review methods Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence. The effect of SMT was compared with recommended therapies, non-recommended therapies, sham (placebo) SMT, and SMT as an adjuvant therapy. Main outcomes were pain and back specific functional status, examined as mean differences and standardised mean differences (SMD), respectively. Outcomes were examined at 1, 6, and 12 months. Quality of evidence was assessed using GRADE. A random effects model was used and statistical heterogeneity explored. Results 47 randomised controlled trials including a total of 9211 participants were identified, who were on average middle aged (35-60 years). Most trials compared SMT with recommended therapies. Moderate quality evidence suggested that SMT has similar effects to other recommended therapies for short term pain relief (mean difference −3.17, 95% confidence interval −7.85 to 1.51) and a small, clinically better improvement in function (SMD −0.25, 95% confidence interval −0.41 to −0.09). High quality evidence suggested that compared with non-recommended therapies SMT results in small, not clinically better effects for short term pain relief (mean difference −7.48, −11.50 to −3.47) and small to moderate clinically better improvement in function (SMD −0.41, −0.67 to −0.15). In general, these results were similar for the intermediate and long term outcomes as were the effects of SMT as an adjuvant therapy. Evidence for sham SMT was low to very low quality; therefore these effects should be considered uncertain. Statistical heterogeneity could not be explained. About half of the studies examined adverse and serious adverse events, but in most of these it was unclear how and whether these events were registered systematically. Most of the observed adverse events were musculoskeletal related, transient in nature, and of mild to moderate severity. One study with a low risk of selection bias and powered to examine risk (n=183) found no increased risk of an adverse event (relative risk 1.24, 95% confidence interval 0.85 to 1.81) or duration of the event (1.13, 0.59 to 2.18) compared with sham SMT. In one study, the Data Safety Monitoring Board judged one serious adverse event to be possibly related to SMT. Conclusion SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.

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Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials

The Lancet ◽

10.1016/s0140-6736(12)60209-8 ◽

2012 ◽

Vol 379 (9826) ◽

pp. 1591-1601 ◽

Cited By ~ 575

Author(s):

Peter M Rothwell ◽

Michelle Wilson ◽

Jacqueline F Price ◽

Jill FF Belch ◽

Tom W Meade ◽

...

Keyword(s):

Randomised Controlled Trials ◽

Cancer Metastasis ◽

Controlled Trials ◽

Daily Aspirin ◽

Randomised Controlled ◽

Risk Of Cancer

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Animal-Assisted Interventions for the Improvement of Mental Health Outcomes in Higher Education Students: A Systematic Review of Randomised Controlled Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010768 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10768

Author(s):

Charlotte Parbery-Clark ◽

Marvellas Lubamba ◽

Louise Tanner ◽

Elaine McColl

Keyword(s):

Mental Health ◽

Higher Education ◽

Systematic Review ◽

Health Outcomes ◽

Randomised Controlled Trials ◽

Mental Health Outcomes ◽

Cochrane Library ◽

Controlled Trials ◽

Short Term ◽

Randomised Controlled

Background: The aim of this systematic review was to evaluate the effectiveness of Animal-Assisted Interventions (AAIs), particularly Animal-Assisted Therapy (AAT) and Animal-Assisted Activity (AAA), in improving mental health outcomes for students in higher education. The number of students in higher education reporting mental health problems and seeking support from universities’ student support services has risen over recent years. Therefore, providing engaging interventions, such as AAIs, that are accessible to large groups of students are attractive. Methods: MEDLINE, PsycINFO, Embase and Cochrane Library were searched from relative inception to end of April 2020. Additionally, a grey literature search was undertaken. Independent screening, data extraction and risk of bias assessment were completed, with varying percentages, by two reviewers. Results: After de-duplication, 6248 articles were identified of which 11 studies were included in the narrative synthesis. The evidence from randomised controlled trials suggests that AAIs could provide short-term beneficial results for anxiety in students attending higher education but with limited evidence for stress, and inconclusive evidence for depression, well-being and mood. For the non-statistically significant results, the studies either did not include a power calculation or were under-powered. Conclusions: Potential emerging evidence for the short-term benefits of AAI for anxiety, and possibly stress, for students in higher education was found.

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Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: a systematic review of randomised controlled trials

10.21203/rs.3.rs-389691/v1 ◽

2021 ◽

Author(s):

Yue Chang ◽

Zhezhe Cui ◽

Guanghong Yang ◽

Xun He ◽

Lei Wang ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Respiratory Diseases ◽

Antibiotic Prescription ◽

Educational Interventions ◽

Controlled Trials ◽

Short Term ◽

Prescription Rates ◽

Multifaceted Interventions ◽

Randomised Controlled

Abstract Background The global health system is improperly using antibiotics, particularly in the treatment of respiratory diseases. We aimed to examine the effectiveness of implementing a unifaceted and multifaceted intervention for unreasonable antibiotic prescriptions. Methods Relevant literature published in the databases of Pubmed, Embase, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Journal Full-text (CNKI) and Wanfang was searched. Data were independently filtered and extracted by two reviewers based on a pre-designed inclusion and exclusion criteria. The Cochrane collaborative bias risk tool was used to evaluate the quality of the included randomised controlled trials studies. Results A total of 1,074 studies were obtained of which 58 were included in the systematic review. Fifty-one studies reported positive results, that is, the primary results in the intervention groups were superior to those in the control groups. The remaining 7 studies had negative or partially negative results. In 19 studies the outcome variable was the antibiotic prescription rate with detailed reports of the number of prescriptions being further analyzed, of which 17 involved educational interventions for doctors, including: (1) Online training using email, web pages and webinar, (2) Antibiotic guidelines for information dissemination measures by email, postal or telephone reminder, (3) Training doctors in communication skills, (4) Short-term interactive educational seminars, and (5) Short-term field training sessions. Seventeen studies of interventions for health care workers also included: (6) Regular or irregular assessment/audit of antibiotic prescriptions, (7) Prescription recommendations from experts and peers delivered at a meeting or online, (8) Publicly reporting on doctors' antibiotic usage to patients, hospital administrators, and health authorities, (9) Monitoring/feedback prescribing behavior to general practices by email or poster, and (10) Studies involving patients and their families (n = 9). Seventeen randomised controlled trials were rated as having a low risk of bias while 2 randomised controlled trials were rated as having a high risk of bias. Conclusion The combination of education, prescription audit, prescription recommendations from experts, public reporting, prescription feedback and patient or family member multifaceted interventions can effectively reduce antibiotic prescription rates in health care institutions. Moreover, adding multifaceted interventions to educational interventions can control antibiotic prescription rates and may be a more reasonable method. Registrations: This systematic review was registered in PROSPERO, registration number: CRD42020192560.

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Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials

Yearbook of Oncology ◽

10.1016/j.yonc.2012.08.035 ◽

2012 ◽

Vol 2012 ◽

pp. 5-6

Author(s):

J.T. Thigpen

Keyword(s):

Randomised Controlled Trials ◽

Cancer Metastasis ◽

Controlled Trials ◽

Daily Aspirin ◽

Randomised Controlled ◽

Risk Of Cancer

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Pharmacological treatment for unipolar psychotic depression

The British Journal of Psychiatry ◽

10.1192/bjp.bp.105.010470 ◽

2006 ◽

Vol 188 (5) ◽

pp. 410-415 ◽

Cited By ~ 59

Author(s):

Jaap Wijkstra ◽

Jeroen Lijmer ◽

Ferdi J. Balk ◽

John R. Geddes ◽

Willem A. Nolen

Keyword(s):

Systematic Review ◽

Pharmacological Treatment ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Controlled Trials ◽

Psychotic Depression ◽

Pharmacological Treatments ◽

Risks And Benefits ◽

Randomised Controlled

BackgroundThe optimal pharmacological treatment of unipolar psychotic depression is uncertain.AimsTo compare the clinical effectiveness of pharmacological treatments for patients with unipolar psychotic depression.MethodSystematic review and meta-analysis of randomised controlled trials.ResultsTen trials were included in the review. We found no evidence that the combination of an antidepressant with an antipsychotic is more effective than an antidepressant alone. This combination was statistically more effective than an antipsychotic alone.ConclusionsAntidepressant mono-therapy and adding an antipsychotic if the patient does not respond, or starting with the combination of an antidepressant and an antipsychotic, both appear to be appropriate options for patients with unipolar psychotic depression. However, clinically the balance between risks and benefits may suggest the first option should be preferred for many patients. Starting with an antipsychotic alone appears to be inadequate.

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Short-term risk of major adverse cardiovascular events or congestive heart failure in patients with psoriatic arthritis or psoriasis initiating a biological therapy: a meta–analysis of randomised controlled trials

RMD Open ◽

10.1136/rmdopen-2018-000763 ◽

2019 ◽

Vol 5 (1) ◽

pp. e000763 ◽

Cited By ~ 6

Author(s):

Bénédicte Champs ◽

Yannick Degboé ◽

Thomas Barnetche ◽

Alain Cantagrel ◽

Adeline Ruyssen-Witrand ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Events ◽

Randomised Controlled Trials ◽

Biological Therapy ◽

Meta Analysis ◽

Major Adverse Cardiovascular Events ◽

Controlled Trials ◽

Short Term ◽

Significant Difference ◽

Randomised Controlled

ObjectiveThe objective was to investigate the short-term risk of major adverse cardiovascular events (MACEs) or congestive heart failure (CHF) in patients with psoriatic arthritis (PsA) or psoriasis initiating a biological therapy.MethodsScreening for the study was carried out using MEDLINE, Cochrane and Embase, from the inception of the database to December 2017. Randomised controlled trials (RCTs) of anti-tumour necrosis factor (TNF), anti-interleukin (IL)12/23, anti-IL23 and anti-IL17 agents for the treatment of PsA or psoriasis were included. Two investigators independently extracted MACEs or CHF data reported during the placebo-controlled phase. The primary outcome measures were the incidence of MACEs or CHF.ResultsOf 753 references screened, 62 articles were selected, and 12 articles were added by manual searches. Accordingly 77 RCTs were included in the meta-analysis (MA) (10 174 patient-years (P-Y)). No significant difference was observed in MACE incidences in patients receiving anti-TNF, anti-IL12/23, anti-IL23 or anti-IL17 agents in comparison to the placebo. However, 10 MACEs were observed in the anti-IL12/23 group (1150 P-Y) compared with 1 in the placebo group (652 P-Y), with 0.01 −0.00 to 0.02 event/P-Y risk difference, which is not statistically significant. This trend was not observed in the anti-IL23 group. No significant difference was observed in CHF incidence in patients receiving biological agents in comparison to placebo.ConclusionThis MA of 77 RCTs did not reveal any significant change in the short-term risk of MACE or CHF in patients with PsA or psoriasis initiating a biological therapy.

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