scholarly journals 165 A Review of The Current Literature on LMWH Administered at Different Times in Relation to MOS (Major Orthopaedic Surgery): Assessment of The Safety and Efficacy of The Different Proposed Strategies

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Placella ◽  
V Pace ◽  
P Antinolfi ◽  
V Salini
Keyword(s):  
Meta Analysis ◽  
Convincing Evidence ◽  
Just In Time ◽  
Medical Complications ◽  
Randomized Controlled ◽  
The Past ◽  
Cochrane Database ◽  
Major Orthopedic Surgery ◽  
Major Orthopaedic Surgery ◽  
The One

Abstract Nowadays venous VTE represents an important perioperative and postoperative complication in patients undergoing elective Major Orthopedic Surgery (MOS). There are significant discrepancies between clinical practice, international recommendations, and published guidelines. Although thromboembolic events may be less common these days than in the past, they can still lead to serious medical complications. Therefore, most patients undergoing MOS procedures are provided with one of the thromboprophylactic treatments. The optimum timing of LMWH administrations remains debated. Customized structured electronic searches in PubMed and Cochrane database. Meta-Analysis, Randomized Controlled Trials, Systematic Reviews on different strategies of the use of LMWH for MOS. Studies on prophylactic regimens showed that subcutaneous LMWH plays a key role in the management of thromboprophylaxis in MOS. However, some controversies still stand. Among those most relevant, it remains unclear whether to start thromboprophylaxis before or after MOS to better balance the risks of clotting and bleeding. With regards to different times of LMWH administration, there is no convincing evidence that starting prophylaxis 12 hours preoperatively is associated with lower risks of VTE compared to prophylaxis started 12 to 24 hours postoperatively. Furthermore, it seems that the most safe and efficient LMWH regimen is the one called “Just-in-time” (LMWH started 6 hours post-op).

A perspective on role of calcium and vitamin D in cardiovascular outcomes and lipid profile

2015 ◽  
Vol 26 (5) ◽  
Author(s):  
Tarun Arora ◽  
Harmeet Singh Rehan
Keyword(s):  
Vitamin D ◽  
Calcium Supplementation ◽  
Meta Analysis ◽  
Disease Status ◽  
Controlled Trials ◽  
Lipid Levels ◽  
Randomized Controlled ◽  
The Past ◽  
Vitamin D Supplements

AbstractRecent concerns on increased incidence of myocardial infarction and stroke on administration of calcium and vitamin D supplements have alarmed the physicians about safety of these drugs. Although both calcium and vitamin D have been shown in the past to have beneficial effect on cardiovascular disease status through lowering of harmful lipids, these findings have been contradicted by some recent meta-analysis and randomized controlled trials that have shown no beneficial or in some cases a deteriorating effect of these supplements on lipid levels. In particular, calcium supplementation has been associated more with increased incidence of cardiovascular morbidity than vitamin D, but the convincing proof is still lacking. Here we have highlighted the results of some significant studies that might impact the prescription of these drugs.

Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-Analysis

2007 ◽  
Vol 16 (1) ◽  
pp. 50-61 ◽  
Author(s):  
David R. Goldhill ◽  
Michael Imhoff ◽  
Barbara McLean ◽  
Carl Waldmann
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Controlled Trials ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Convincing Evidence ◽  
Controlled Trials ◽  
Respiratory Complications ◽  
Randomized Controlled ◽  
Meta Analyses

• Background Immobility is associated with complications involving many body systems. • Objective To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. • Methods Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. • Results A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. • Conclusions Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

scholarly journals Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis

2019 ◽  
Vol 33 (2) ◽  
pp. 112-129 ◽  
Author(s):  
Martina Maier ◽  
Belén Rubio Ballester ◽  
Armin Duff ◽  
Esther Duarte Oller ◽  
Paul F. M. J. Verschure
Keyword(s):  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Meta Analysis ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
The Past ◽  
Upper Limb Function ◽  
Activity Measures ◽  
Recovery Mechanisms ◽  
Positive Effect

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming. Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT). Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures. Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.

scholarly journals Análise da Revisão Cochrane: Cromoscopia Versus Colonoscopia Convencional na Deteção de Pólipos ColoRetais. Cochrane Database Syst Rev. 2016;4:CD006439

2016 ◽  
Vol 29 (10) ◽  
pp. 583
Author(s):  
Diogo Libânio ◽  
Luís Filipe Azevedo
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Colorectal Polyps ◽  
Control Group ◽  
Controlled Trials ◽  
Polyp Detection ◽  
High Definition ◽  
Screening Programs ◽  
Randomized Controlled ◽  
Cochrane Database

Although colonoscopy is considered the most accurate test for the investigation of colorectal polyps, lesions ≤ 10 mm may be missed in approximately 10%. Chromoscopy may increase the detection of colorectal polyps. A systematic review and meta-analysis was performed to investigate the benefit of cromoscopy in colorectal polyps detection. Seven randomized controlled trials were included (incuding 2,727 participants) comparing polyp detection (both neoplastic and non- neoplastic polyps) in patients submitted to conventional colonoscopy or colonoscopy with chromoscopy. Chromoscopy was associated with a significant improvement in all detection endpoints (number of polyps, number of neoplastic polyps, number of diminutive polyps, number of neoplastic diminutive polyps, proportion of patients with at least one polyp and proportion of patients with at least one neoplastic polyp). However, when highdefinition colonoscopes were used in the control group, chromoscopy benefit does not seem to be significant. Besides, routine use of chromoscopy may have implications in the accessibility of colonoscopy and in the effectiveness of screening programs. Moreover, the benefit of chromoscopy in the era of high-definition colonoscopy is questionable.

scholarly journals A Meta-Analysis of Arsenic Trioxide Combined with Transcatheter Arterial Chemoembolization for Treatment of Primary Hepatic Carcinoma

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Ling He ◽  
Qingyun Xu ◽  
Liguo Chen ◽  
Ruixue Chen
Keyword(s):  
Meta Analysis ◽  
Efficacy Rate ◽  
Malignant Tumours ◽  
Hepatic Carcinoma ◽  
Randomized Controlled ◽  
Primary Hepatic Carcinoma ◽  
One Year ◽  
The One ◽  
Arterial Chemoembolization

Primary hepatic carcinoma (PHC) is one of the most common malignant tumours in the world. More and more research has shown that As2O3combined with TACE has a good curative effect in treating PHC. The objectives of this study were to evaluate the therapeutic efficacy and safety of As2O3combined with TACE in treating PHC. The CNKI, VIP, Wanfang, PubMed, and Cochrane databases were searched from their inception until December 2015. Randomized controlled trials (RCTs) comparing As2O3combined with TACE versus TACE alone in treating PHC were identified. Stata SE 12.0 was used for data analysis. 17 RCTs with 1055 patients were included. Meta-analysis showed that, compared with TACE alone, As2O3combined with TACE showed significant effects in improving the clinical efficacy rate (P<0.01), decreasing the value of alpha-fetoprotein (P<0.01), increasing the one-year survival rate (P<0.01), and improving the quality of life of PHC patients (P<0.01). Fifteen studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, As2O3combined with TACE therapy appears to be potentially effective in treating PHC and is generally safe. However, further studies with rigorous designs trials and multiregional cooperation trials are needed.

Reduction in Mortality following Elective Major Hip and Knee Surgery: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 119 (04) ◽  
pp. 668-674 ◽  
Author(s):  
Ke Xu ◽  
Noel Chan ◽  
Quazi Ibrahim ◽  
Paul Kruger ◽  
Smita Sinha ◽  
...  
Keyword(s):  
Study Design ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Relative Reduction ◽  
Mortality Reduction ◽  
Mortality Risks ◽  
The Past ◽  
Operative Care ◽  
Major Orthopaedic Surgery ◽  
Hip And Knee Surgery

Background Systematic reviews reporting time trends in mortality following major orthopaedic surgery are few and have limitations. They reported on only a fraction (< 15%) of the available data and did not investigate potential causes of the reduction in mortality. Methods We searched PubMed for randomized trials and observational studies, published between 1950 and 2016, reporting on mortality within 3 months of elective total hip and knee replacement (THR/TKR). Mortality risks were estimated for each 5-year interval using a Poisson regression model and presented by study design and mode of prophylaxis. To estimate the mortality reduction unrelated to anti-thrombotic use, we performed a pooled analysis of four thromboprophylaxis strategies for which data spanned five decades. Results We identified 255 eligible studies, which documented 31,604 deaths among 6,293,954 patients, and found a consistent decline in mortality irrespective of study design and mode of prophylaxis. Mortality declined from 1.15% pre-1980 to 0.24% post-2000, a 78.7% relative risk reduction (95% confidence interval [CI]: 74.7–82.1%) in randomized and cohort studies. Furthermore, our data showed a 74.4% (95% CI: 68.7–79.0%) relative reduction in mortality independent of the methods of prophylaxis, thereby indicating that improvements in peri-operative care unrelated to anti-thrombotic prophylaxis played a major role in such reduction. Conclusion Mortality following elective THR/TKR has markedly declined over the past 50 years and is now low irrespective of which prophylactic agent is being used. Although anti-thrombotic prophylaxis may have contributed, other improvements in peri-operative care played a major role in the mortality reduction.

scholarly journals The Bayesian New Statistics (Public)

2017 ◽  
Author(s):  
John K. Kruschke ◽  
Torrin Liddell
Keyword(s):  
Hypothesis Testing ◽  
Bayesian Methods ◽  
Meta Analysis ◽  
Bayesian Approaches ◽  
Randomized Controlled ◽  
Credible Intervals ◽  
Conceptual Distinction ◽  
The One ◽  
New Statistics ◽  
Better Than

In the practice of data analysis, there is a conceptual distinction between hypothesis testing, on the one hand, and estimation with quantified uncertainty, on the other hand. Among frequentists in psychology a shift of emphasis from hypothesis testing to estimation has been dubbed "the New Statistics" (Cumming, 2014). A second conceptual distinction is between frequentist methods and Bayesian methods. Our main goal in this article is to explain how Bayesian methods achieve the goals of the New Statistics better than frequentist methods. The article reviews frequentist and Bayesian approaches to hypothesis testing and to estimation with confidence or credible intervals. The article also describes Bayesian approaches to meta-analysis, randomized controlled trials, and power analysis.

scholarly journals Effect of different types of statins on kidney function decline and proteinuria: a network meta-analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
K. Esmeijer ◽  
Olaf M. Dekkers ◽  
Johan W. de Fijter ◽  
Friedo W. Dekker ◽  
Ellen K. Hoogeveen
Keyword(s):  
Kidney Function ◽  
Meta Analysis ◽  
Renal Outcome ◽  
Randomized Controlled ◽  
Individual Comparison ◽  
Cochrane Database ◽  
Different Types ◽  
Meta Analyses ◽  
Reduced Kidney Function ◽  
Kidney Function Decline

Abstract Previous studies showed that statins reduce the progression of kidney function decline and proteinuria, but whether specific types of statins are more beneficial than others remains unclear. We performed a network meta-analysis of randomized controlled trials (RCT) to investigate which statin most effectively reduces kidney function decline and proteinuria. We searched MEDLINE, Embase, Web of Science, and the Cochrane database until July 13, 2018, and included 43 RCTs (>110,000 patients). We performed a pairwise random-effects meta-analysis and a network meta-analysis according to a frequentist approach. We assessed network inconsistency, publication bias, and estimated for each statin the probability of being the best treatment. Considerable heterogeneity was present among the included studies. In pairwise meta-analyses, 1-year use of statins versus control reduced kidney function decline by 0.61 (95%-CI: 0.27; 0.95) mL/min/1.73 m2 and proteinuria with a standardized mean difference of −0.58 (95%-CI:−0.88; −0.29). The network meta-analysis for the separate endpoints showed broad confidence intervals due to the small number available RCTs for each individual comparison. In conclusion, 1-year statin use versus control attenuated the progression of kidney function decline and proteinuria. Due to the imprecision of individual comparisons, results were inconclusive as to which statin performs best with regard to renal outcome.

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