scholarly journals 470 Could Covid-19 Change the Way We Do Clinics for The Better? A Comparison of Remote Versus Outpatient Clinic Follow-Up for Surgical Patients: A Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Emily Oates ◽  
Grace Hui Chin Lim ◽  
Edward J Nevins ◽  
Venkatesh Kanakala
Keyword(s):  
Outpatient Clinic ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Controlled Trials ◽  
Randomised Controlled ◽  
The Uk ◽  
The Way

Abstract Introduction As the Covid-19 pandemic hit the UK, the way the NHS operates changed overnight. One change was the move to remote appointments (RA) by video or telephone. This meta-analysis (MA) of randomised controlled trials (RCTs) looks at existing evidence on RA and aims to discover if surgical patients are satisfied with them. Method A literature search of RCTs of surgical patient satisfaction of RA versus conventional outpatient clinic (OPC) was performed. The PubMed, EMBASE and Google Scholar databases were searched to include articles from January 2000 to 2020. A random effects MA model was used to compare outcomes. Results All 5 RCTs showed that patients were as satisfied with RA as OPC (RR = 1.00, [0.97-1.03] p = 0.96). Furthermore, both patient cohorts would prefer RA for future follow-up (RR = 2.28 [1.85-2.82] p < 0.00001). 1 RCT performed a cost analysis and found the cost to institutions was less in the RA group ($19.05 vs $52.76). All other RCTs suggested cost to patients and institutions would be less for RA. Conclusions Surgical patients are satisfied with RA and in fact would prefer them, thus indicating that out with the Covid-19 pandemic RAs could be continued, and in doing so may well save money for patients and the NHS.

scholarly journals The impact of a run-in period on treatment effects in cardiovascular prevention randomised control trials: A protocol for a comprehensive review and meta-analysis

2020 ◽  
Vol 3 ◽  
pp. 82
Author(s):  
Robert Murphy ◽  
Emer McGrath ◽  
Aoife Nolan ◽  
Andrew Smyth ◽  
Michelle Canavan ◽  
...  
Keyword(s):  
Randomised Controlled Trials ◽  
Treatment Effects ◽  
Meta Analysis ◽  
Cardiovascular Prevention ◽  
Controlled Trials ◽  
Loss To Follow Up ◽  
Relative Risks ◽  
Prevention Trials ◽  
Randomised Controlled

Background: A run-in period is often employed in randomised controlled trials to increase adherence to the intervention and reduce participant loss to follow-up in the trial population. However, it is uncertain whether use of a run-in period affects the magnitude of treatment effect. Methods: We will conduct a sensitive search for systematic reviews of cardiovascular preventative trials and a complete meta-analysis of treatment effects comparing cardiovascular prevention trials using a run-in period (“run-in trials”) with matched cardiovascular prevention trials that did not use a run-in period (“non-run-in trials”). We describe a comprehensive matching process which will match run-in trials with non-run-in trials by patient populations, interventions, and outcomes. For each pair of run-in trial and matched non-run-in trial(s), we will estimate the ratio of relative risks and 95% confidence interval. We will evaluate differences in treatment effect between run-in and non-run-in trials and our and our priamry outcome will be the ratio of relative risks for matched run-in and non-run-in trials for their reported cardiovascular composite outcome. Our secondary outcomes are comparisons of mortality, loss to follow up, frequency of adverse events and methodological quality of trials. Conclusions: This study will answer a key question about what influence a run-in period has on the magnitude of treatment effects in randomised controlled trials for cardiovascular prevention therapies.

Effect of action observation therapy on motor function in children with cerebral palsy: a systematic review of randomized controlled trials with meta-analysis

2020 ◽  
pp. 026921552095434
Author(s):  
Naglaa Abdelhaleem ◽  
Samar Taher ◽  
Menna Mahmoud ◽  
Ahmad Hendawy ◽  
Maged Hamed ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Methodological Quality ◽  
Randomised Controlled Trials ◽  
Action Observation ◽  
Meta Analysis ◽  
Post Treatment ◽  
Controlled Trials ◽  
Children With Cerebral Palsy ◽  
Randomised Controlled

Objective: To evaluate the evidence of using Action Observation Therapy in the rehabilitation of children with Cerebral Palsy. Study design: Systematic review with meta-analysis of Randomised Controlled Trials. Methods: For the purpose of identifying relevant studies, six databases were searched from inception until July 2020. The methodological quality was assessed by Physiotherapy Evidence Database scale. The outcomes were classified within the framework of the International Classification of Functioning. A pooled meta-analysis was performed on studies that demonstrated homogeneity. Results: Twelve randomised controlled trials with 307 participants were included with six of them were included in the meta-analysis. Non-significant difference between the groups was demonstrated by meta-analysis. Results of capacity assessed in post treatment and follow up evaluation were (0.06, –0.22 to 0.34, 95% (CI); P = 0.69 and (–0.35, –0.96 to 0.27, 95% (CI); P = 0.27); respectively. Actual performance in post-treatment and follow up were (0.10, –0.22 to 0.48, 95% (CI); P = 0.62) and (0.01, –0.40 to 0.41, 95% (CI); P = 0.97); respectively. Perceived performance evaluated using (ABILHAND-KIDS) were (0.30, –0.28 to 0.89, 95% (CI); P = 0.31) and (0.15, –0.43 to 0.73, 95% (CI); P = 0.61) for post treatment and follow up; respectively. Overall effect on activity domain was (0.08, –0.11 to 0.28, 95% (CI); P = 0.86) immediately and (0.04, –0.33 to 0.26, 95% (CI); P = 0.49) at follow-up; respectively. Conclusion: No evidence of benefit had been found to draw a firm conclusion regarding the effectiveness of action observation therapy in the rehabilitation of children with cerebral palsy due to limitations in methodological quality and variations between studies.

scholarly journals Are Surgical Patients Satisfied With Remote Consultations? A Comparison of Remote Versus Conventional Outpatient Clinic Follow-Up for Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
pp. 237437352110359
Author(s):  
Emily V Oates ◽  
Grace H C Lim ◽  
Edward J Nevins ◽  
Venkatesh Kanakala
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Cochrane Library ◽  
Surgical Patient ◽  
Controlled Trials ◽  
Analysis Model ◽  
Randomized Controlled ◽  
The Cost

Access to remote appointments (RA) by telephone or video is increasing as technology advances and becomes more available to patients. This meta-analysis of randomized controlled trials (RCTs) aims to discover whether surgical patients are satisfied with RAs when compared with conventional outpatient clinics (OPC). A literature search of RCTs of surgical patient satisfaction of RAs versus OPC appointments was performed. The PubMed, EMBASE, OVID, Cochrane Library, and Google Scholar databases were searched to include articles from January 2000 to 2020. A random-effects meta-analysis model was used to compare outcomes. All 7 RCTs showed that patients were as satisfied with RAs as OPC appointments (RR = 1.00, [0.98-1.02]; P = .73). Furthermore, both patient cohorts would prefer RAs for future follow-up (RR = 2.29, [1.96-2.97]; P < .00001). One RCT found the cost to institutions was less in the RA group ($19.05 vs $52.76) and another found the patients would save $9.96 on transportation costs. The majority of RCTs suggested cost to patients and or institutions would be less for RA. In conclusion, surgical patients are satisfied with RAs and in fact would prefer them.

scholarly journals New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-Analysis of Randomised Controlled Trials (Preprint)

2021 ◽  
Author(s):  
Marion Sommers-Spijkerman ◽  
Judith Austin ◽  
Ernst Bohlmeijer ◽  
Wendy Pots
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Well Being ◽  
Evidence Base ◽  
Effect Sizes ◽  
Controlled Trials ◽  
Long Term Follow Up ◽  
Randomised Controlled

BACKGROUND There is a need for regularly updating the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. OBJECTIVE The current study presents an updated meta-analysis of randomised controlled trials assessing the effects of online MBIs on mental health, as well as the potential moderators of those effects. METHODS A systematic literature search was conducted in PsycINFO, PubMed and Web of Science up to July 19th, 2019. Seventy trials totalling 91 comparisons were included. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges’ g) were calculated for depression, anxiety, stress, well-being and mindfulness, using a random effects model. RESULTS The findings revealed statistically significant moderate pre-to-post effects on stress (g=0.41) and mindfulness (g=0.43) and small effects on depression (g=0.31) and anxiety (g=0.23). For well-being, a significant effect was found only when omitting low quality studies (g=0.34). Significant but small follow-up effects were found for depression (g=0.25), anxiety (g=0.17) and stress (g=-0.11). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. For stress and mindfulness, studies that used an inactive control condition yielded larger effects. CONCLUSIONS Our findings do not only demonstrate that the field of online MBIs is booming, but also corroborate previous evidence that online MBIs are beneficial for improving mental health outcomes in a broad range of samples. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence and long-term follow-up measurements.

scholarly journals Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials

2020 ◽  
pp. bjsports-2019-101872 ◽  
Author(s):  
Arco C van der Vlist ◽  
Marinus Winters ◽  
Adam Weir ◽  
Clare L Ardern ◽  
Nicky J Welton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Exercise Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Achilles Tendinopathy ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Wait And See ◽  
Randomised Controlled

ObjectiveTo provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy.DesignLiving systematic review and network meta-analysis.Data sourcesMultiple databases including grey literature sources were searched up to February 2019.Study eligibility criteriaRandomised controlled trials examining the effectiveness of any treatment in patients with both insertional and/or midportion Achilles tendinopathy. We excluded trials with 10 or fewer participants per treatment arm or trials investigating tendon ruptures.Data extraction and synthesisReviewers independently extracted data and assessed the risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of evidence.Primary outcome measureThe validated patient-reported Victorian Institute of Sport Assessment-Achilles questionnaire.Results29 trials investigating 42 different treatments were included. 22 trials (76%) were at high risk of bias and 7 (24%) had some concerns. Most trials included patients with midportion tendinopathy (86%). Any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months (very low to low certainty of evidence). At 12 months, exercise therapy, exercise+injection therapy and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy (very low to low certainty). No network meta-analysis could be performed for insertional Achilles tendinopathy.Summary/conclusionIn our living network meta-analysis no trials were at low risk of bias and there was large uncertainty in the comparative estimates. For midportion Achilles tendinopathy, wait-and-see is not recommended as all active treatments seemed superior at 3-month follow-up. There seems to be no clinically relevant difference in effectiveness between different active treatments at either 3-month or 12-month follow-up. As exercise therapy is easy to prescribe, can be of low cost and has few harms, clinicians could consider starting treatment with a calf-muscle exercise programme.PROSPERO registration numberCRD42018086467.

scholarly journals Asthma in children treated with paracetamol versus ibuprofen: A systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Author(s):  
Mohamed Sherbash ◽  
Luis Furuya-Kanamori ◽  
Joanne Daghfal Nader ◽  
Lukman Thalib
Keyword(s):  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Inverse Variance ◽  
Comprehensive Search ◽  
Asthma In Children ◽  
Definition Of ◽  
Randomised Controlled

Abstract Background: Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of asthma among children taking paracetamol compared to ibuprofen, remain unsettled. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) that compared asthma in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of asthma in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the inverse variance heterogeneity model. Results: Five RCTs with 85095 children were included in the analysis. The pooled estimate (RR 1.04; 95%CI 0.84-1.29) revealed no difference in the risk of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma, the pooled estimate remained similar (RR 1.03; 95%CI 0.64-1.67). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84-1.28). Conclusion: Although, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive finding.

scholarly journals Risk of asthma in children treated with paracetamol versus ibuprofen: A systematic review and meta-analysis of randomised controlled trials

2020 ◽  
Author(s):  
Mohamed Sherbash ◽  
Luis Furuya-Kanamori ◽  
Joanne Daghfal Nader ◽  
Lukman Thalib
Keyword(s):  
Odds Ratio ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Comprehensive Search ◽  
Asthma In Children ◽  
Definition Of ◽  
Randomised Controlled

Abstract Background: Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of asthma among children taking paracetamol compared to ibuprofen, remain unsettled. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) that compared asthma in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of asthma in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the Peto’s odds ratio. Results: Five RCTs with 85095 children were included in the analysis. The pooled estimate (29OR 1.05; 95%CI 0.76-1.46) revealed no difference in the odds of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma, the pooled estimate remained similar ( OR 1.01; 95%CI 0.63-1.64). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84-1.28). Conclusion: Although, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive finding

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