scholarly journals Comparison of Hand Therapy with or without Splinting Postfasciectomy for Dupuytren’s Contracture: Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Mohammad Karam ◽  
Narvair Kahlar ◽  
Ahmad Abul ◽  
Shafiq Rahman ◽  
Richard Pinder
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Dupuytren’S Contracture ◽  
Hand Therapy ◽  
Extension Deficit ◽  
Dupuytren's Contracture ◽  
Active Flexion ◽  
Functional Benefit

AbstractThis study aimed to compare the outcomes of hand therapy alone versus additional splinting post fasciectomy for Dupuytren’s contracture patients. A systematic review and meta-analysis were conducted, and a search was performed identifying all relevant studies comparing the two groups. Primary outcome measures included Total active flexion and extension (TAF and TAE) and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary outcome measures included pain intensity, grip strength, and global perceived effect and patients’ satisfaction. A random effects model was used for the analysis. Four RCTs were identified enrolling 295 patients. There were no significant differences between hand therapy and splintage groups in terms of all outcomes (both primary and secondary). Splintage offers no added functional benefit to hand therapy alone for post fasciectomy patients with Dupuytren’s contracture, however, orthotic regimes may still be applied on an intention to treat basis in those patients who develop an extension deficit postoperatively.

scholarly journals Efficacy and safety of anti-epidermal growth factor receptor agents for the treatment of oesophageal cancer: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046352
Author(s):  
Lijuan Zhang ◽  
Yanli Song ◽  
Nan Jiang ◽  
Yaqi Huang ◽  
Bo Dong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Growth Factor ◽  
Outcome Measures ◽  
Oesophageal Cancer ◽  
Meta Analysis ◽  
Growth Factor Receptor ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Positive Effects

ObjectivesDespite remarkable advances in the treatment of oesophageal cancer (OC), the role of antiepidermal growth factor receptor (anti-EGFR) agents in treating OC remains controversial. Herein, a systematic review and meta-analysis were conducted to elucidate the efficacy and safety of anti-EGFR agents in patients with OC.DesignMeta-analysis of randomised controlled trials (RCTs) identified by searching the PubMed, Embase, Web of Science, ClinicalTrials.gov, Cochrane Library, Chinese Biology Medicine, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform databases from inception to December 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.SettingRCTs from any country and healthcare setting.ParticipantsPatients with OC.InterventionsCombination therapy with anti-EGFR agents and conventional treatments versus conventional treatments alone in patients with OC.Primary and secondary outcome measuresOverall survival (OS) and progression-free survival (PFS) were primary outcome measures, and objective response rate (ORR), disease control rate (DCR) and treatment toxicities were secondary outcome measures.ResultsIn total, 25 RCTs comprising 3406 patients with OC were included. Overall, anti-EGFR treatment significantly improved the OS (HR: 0.81, 95% CI 0.74 to 0.89, p<0.00001), ORR (relative risk (RR): 1.33, 95% CI 1.16 to 1.52, p<0.0001) and DCR (RR: 1.22, 95% CI 1.11 to 1.34, p<0.0001) but not PFS (HR: 0.91, 95% CI 0.76 to 1.08, p=0.26). Anti-EGFR treatment was significantly associated with higher incidences of myelosuppression, diarrhoea, acne-like rash and hypomagnesaemia.ConclusionsOverall, anti-EGFR agents have positive effects on OS, the ORR and DCR in OC. However, considering the high incidence of adverse effects, such as myelosuppression, diarrhoea, acne-like rashes and hypomagnesaemia, careful monitoring of patients with OC is recommended during anti-EGFR treatment.Trial registration numberCRD42020169230.

scholarly journals Effect of PTH treatment on bone healing in insufficiency fractures of the pelvis: a systematic review

2021 ◽  
Vol 6 (1) ◽  
pp. 9-14
Author(s):  
Pernille Bovbjerg ◽  
Ditte Høgh ◽  
Lonnie Froberg ◽  
Hagen Schmal ◽  
Moustapha Kassem
Keyword(s):  
Systematic Review ◽  
Fracture Healing ◽  
Outcome Measures ◽  
Bone Healing ◽  
Meta Analysis ◽  
Insufficiency Fracture ◽  
Secondary Outcome ◽  
Insufficiency Fractures ◽  
Patient Reported ◽  
Positive Effect

The aging of our society is associated with an increasing number of insufficiency fractures of the pelvis and the current standard of care is pain control and early mobilization. The aim of this study was to explore whether parathyroid hormone (PTH) treatment can support bone healing in these patients. We conducted a systematic review searching the databases PubMed, Embase and Cochrane. Our primary outcome was fracture healing, secondary outcome measures comprised pain, mobility and patient-reported outcome measures (PROMs). Eight articles were included in the qualitative synthesis, of which two were included in a meta-analysis. However, only three studies were comparative including one randomized controlled trial. Fracture healing and reported pain were assessed after eight weeks, and were significantly improved in the group being treated with PTH (p < 0.01) in the meta-analysis. All articles described a positive effect for PTH on fracture healing and pain. Our systematic review indicates that there is a positive effect of PTH treatment on healing and pain in patients with insufficiency fracture in the pelvic ring, but further research is necessary. Cite this article: EFORT Open Rev 2021;6:9-14. DOI: 10.1302/2058-5241.6.200029

scholarly journals Coblation versus Bipolar Diathermy Hemostasis in Pediatric Tonsillectomy Patients: Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Mohammad Karam ◽  
Ahmad Abul ◽  
Abdulwahab Althuwaini ◽  
Talal Alenezi ◽  
Ali Aljadi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Operation Time ◽  
Secondary Outcome ◽  
Intraoperative Bleeding ◽  
Post Operative Pain ◽  
Delayed Hemorrhage ◽  
Significant Difference

Objective To compare the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and an electronic search of information was conducted to identify all Randomized Controlled Trials (RCTs) comparing the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Intraoperative bleeding, reactionary hemorrhage, delayed hemorrhage and post-operative pain were primary outcome measures. Secondary outcome measures included return to normal diet, effects on tonsillar bed, operation time and administration of analgesia. Fixed and random effects models were used for the analysis. Results Seven studies enrolling 1328 patients were identified. There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.25, P = 0.0007) and post-operative pain (standardized mean difference [MD] = -2.13, P = 0.0007). Intraoperative bleeding (MD = -43.26, P = 0.11) and reactionary hemorrhage did not show any significant difference. For secondary outcomes, coblation group had improved outcomes in terms of administration of analgesia, diet and tonsillar tissue recovery and thermal damage. No significant difference was reported in terms of operation time. Conclusions Coblation is a superior option when compared to bipolar technique for pediatric patients undergoing tonsillectomy as it improves post-operative pain and delayed hemorrhage and does not worsen intraoperative bleeding and reactionary hemorrhage.

A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren’s disease

2012 ◽  
Vol 37 (8) ◽  
pp. 733-737 ◽  
Author(s):  
M. A. Kemler ◽  
P. Houpt ◽  
C.M.A.M. van der Horst
Keyword(s):  
Primary Outcome Measure ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Hand Therapy ◽  
Extension Deficit ◽  
Intention To Treat ◽  
Flexion Contractures ◽  
Dupuytren's Contracture ◽  
Pip Joint ◽  
Postoperative Flexion

Before surgery for Dupuytren’s contracture, 54 patients with a proximal interphalangeal (PIP) joint flexion contractures of at least 30° were randomized to receive either a 3-month splinting protocol together with hand therapy under the direct supervision of hand therapists, or the same hand therapy alone. Extension deficit of the PIP joint (primary outcome measure), global perceived effect, pain intensity, comfort and complications were assessed at baseline and 1 year after surgery. In an intention-to-treat analysis, the group assigned to splint-plus-hand therapy had a mean reduction of 21° in flexion contracture after 1 year, compared with 29° in the group receiving hand therapy alone ( p = 0.1). There was no difference between the groups regarding other parameters. After operative release of a Dupuytren’s contracture, a postoperative protocol using a splint and hand therapy was no better than hand therapy alone in minimizing postoperative flexion contractures.

scholarly journals Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047576
Author(s):  
Bastiaan Van Grootven ◽  
Patricia Jepma ◽  
Corinne Rijpkema ◽  
Lotte Verweij ◽  
Mariska Leeflang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Outcome Measures ◽  
Hospital Readmission ◽  
Prediction Models ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Secondary Outcome ◽  
C Statistic ◽  
Data Source

ObjectiveTo describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions.DesignSystematic review and meta-analysis.Data sourceMedline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020.Eligibility criteria for selecting studiesStudies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months.Primary and secondary outcome measuresModel discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled.ResultsSixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was <0.7 in 72 models, between 0.7 and 0.8 in 16 models and >0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled.ConclusionSome promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability.PROSPERO registration numberCRD42020159839.

scholarly journals Which treatment is most effective for patients with patellofemoral pain? A protocol for a living systematic review including network meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022920 ◽  
Author(s):  
Marinus Winters ◽  
Sinead Holden ◽  
Bill Vicenzino ◽  
Nicky J Welton ◽  
Deborah M Caldwell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Patellofemoral Pain ◽  
Risk Of Bias ◽  
Secondary Outcome ◽  
Published Data ◽  
Global Rating ◽  
Meta Analyses

IntroductionPatellofemoral pain (PFP) affects 1 in every 14 adults. Many treatments for PFP have been evaluated, but the comparative effectiveness of all available treatments has never been examined. Network meta-analysis is the only design to study the comparative effectiveness of all available treatments in one synthesis. This protocol describes the methods for a systematic review including network meta-analysis to assess which treatment is most likely to be effective for patients with PFP.Methods and analysisThe primary outcome measures of this network meta-analysis are the global rating of change scale at 6–12 weeks, 13–52 weeks and >52 weeks. The secondary outcome measures are patient-rated pain scales at 6–12 weeks, 13–52 weeks and >52 weeks. Completed published and unpublished randomised controlled trials with full-text reports are eligible for inclusion. We will search Embase, PubMed (including MEDLINE), CENTRAL, Scopus, Web of Science, and CINAHL, SPORTDiscus, OpenGrey, WorldCat, conference Proceedings and multiple trial registers for relevant reports. Two researchers will appraise the study eligibility and perform data extraction. Risk of bias will be assessed with the Cochrane Risk of Bias Tool V.2.0.Bayesian network meta-analyses will be constructed for global rating of change scale and patient-rated pain. Consistency between direct and indirect comparisons will be assessed. Between study variability will be explored, and a threshold analysis for the credibility of the network meta-analyses’ conclusions will be performed.Ethics and disseminationEthical approval is not required, as this study will be based on published data. The study commenced at 1 February 2018, and its expected completion date is 15 January 2019. Full publication of the work will be sought in an international peer-reviewed journal, as well as translational articles to disseminate the work to clinical practitioners.PROSPERO registration numberCRD42018079502.

scholarly journals Tonsillectomy Outcomes for Coblation versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Abdulmalik Alsaif ◽  
Mohammad Alazemi ◽  
Narvair Kahlar ◽  
Mohammad Karam ◽  
Ahmad Abul ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Operation Time ◽  
Adult Patients ◽  
Secondary Outcome ◽  
Bipolar Diathermy ◽  
Post Operative Pain ◽  
Randomised Controlled

Introduction There is no consensus on the most superior tonsillectomy technique in adult patients. Recent trials involving coblation technique have shown promising results. Aim The study aims to compare the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs) as well as non-randomised studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Reactionary haemorrhage, delayed haemorrhage and postoperative pain were primary outcome measures. Secondary outcome measures included a return to theatre, administration of analgesia, intraoperative bleeding, diet, the effect on tonsils (degree of healing of tonsillar fossae) and operation time. Fixed effects modelling was used for the analysis. Results Four RCTs and two non-randomised studies were identified enrolling a total of 1824 patients. There were no significant differences between the coblation and bipolar groups in terms of reactionary haemorrhage (Odds Ratio [OR] = 1.81, P = 0.51), delayed haemorrhage (OR = 0.72, P = 0.20) or post-operative pain by day 7 (standardised Mean Difference [MD] = -0.15, P = 0.45). For secondary outcomes, there were no differences noted in terms of intraoperative blood loss, diet and the number of cases returned to theatre. Administration of analgesia was reported to be either insignificant between the two groups or higher in the coblation group Also, the coblation group had longer operation time and greater healing effect on tonsillar tissue. Conclusions Coblation is neither a superior or inferior option when compared to bipolar diathermy used in the current clinical practice for adult patients undergoing tonsillectomy as both techniques have similar haemorrhage rates and post-operative pain whilst also lengthening the operative time in coblation.

scholarly journals 402 A Systematic Review and Meta-Analysis of Autologous vs Titanium Cranioplasty Implants

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Capitelli-McMahon ◽  
N Kahlar ◽  
S Rahman
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Titanium Implants ◽  
Secondary Outcome ◽  
Infection Rates ◽  
Optimal Method ◽  
Operation Rate ◽  
Significant Difference

Abstract Aim: There is currently no gold standard reconstructive material for cranioplasty, with autologous and numerous synthetic materials currently in use. The emerging role of titanium due to its strength and biocompatibility has made it a good option. Titanium has been compared in numerous studies with autologous bone for cranioplasty however there is currently no meta-analysis within the literature to guide craniofacial surgeons on the optimal method. Method A systematic review and meta-analysis was performed as per the PRISMA guidelines and a search of electronic information was conducted to identify all randomised control trials and observational studies comparing autologous implants vs. titanium implants in cranioplasty following craniectomy. Re-operation rates and cosmesis were the primary outcome measures and incidence of complications such as bone resorption and infection were the secondary outcome measures. Results Six studies (n = 1909) were identified. Autologous cranioplasty using bone had a higher re-operation rate (p &gt; 0.007), due to higher bone reabsorption seen in this group. There was no significant difference between the two groups in cosmetic outcome. Both had comparable infection rates (p &gt; 0.18) and costs involved. Conclusions Titanium implants for cranioplasty offer lower re-operation rates compared to autologous based reconstruction without significantly increasing adverse outcomes such as post-operative infection rates or cost.

Three-Dimensional Printing in Cleft Care: A Systematic Review

2021 ◽  
pp. 105566562110131
Author(s):  
Farrukh R. Virani ◽  
Evan C. Chua ◽  
Mary Roz Timbang ◽  
Tsung-yen Hsieh ◽  
Craig W. Senders
Keyword(s):  
Systematic Review ◽  
3D Printing ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Secondary Outcome ◽  
Exclusion Criteria ◽  
3 Dimensional ◽  
Dimensional Printing

Objective: To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications. Design: Retrospective systematic review. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate. Main Outcome Measures: Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes. Results: Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles. Conclusion: 3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.

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