scholarly journals Knowledge gaps in candidaemia/invasive candidiasis in haematological cancer patients

2020 ◽  
Author(s):  
Arnaldo Lopes Colombo ◽  
Caroline Agnelli ◽  
Dimitrios P Kontoyiannis
Keyword(s):  
Invasive Candidiasis ◽  
Research Agenda ◽  
Haematological Cancer ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Neutropenic Patients ◽  
Haematological Patients ◽  
Poor Outcomes ◽  
Opportunistic Mycosis

Abstract As neutropenic patients with haematological cancer are not typically included in randomized controlled trials (RCTs) of candidaemia, there is low quality of evidence regarding the management of this common opportunistic mycosis in this patient population, which is at high risk for poor outcomes. Herein we identify the gaps in knowledge that are not addressed by the modern RCTs and candidaemia guidelines, and outline some considerations for the future clinical research agenda in candidaemia/invasive candidiasis in haematological patients.

scholarly journals Concordance between systematic reviews of randomized controlled trials in assisted reproduction: an overview

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Mariano Mascarenhas ◽  
Theodoros Kalampokas ◽  
Sesh Kamal Sunkara ◽  
Mohan S Kamath
Keyword(s):  
Assisted Reproduction ◽  
Systematic Reviews ◽  
Selective Reporting ◽  
Methodological Issues ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Cochrane Reviews ◽  
Secondary Outcomes ◽  
Meta Analyses

Abstract STUDY QUESTION Are systematic reviews published within a 3-year period on interventions in ART concordant in their conclusions? SUMMARY ANSWER The majority of the systematic reviews published within a 3-year period in the field of assisted reproduction on the same topic had discordant conclusions. WHAT IS KNOWN ALREADY Systematic reviews and meta-analyses have now replaced individual randomized controlled trials (RCTs) at the top of the evidence pyramid. There has been a proliferation of systematic reviews and meta-analyses, many of which suffer from methodological issues and provide varying conclusions. STUDY DESIGN, SIZE, DURATION We assessed nine interventions in women undergoing ART with at least three systematic reviews each, published from January 2015 to December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS The systematic reviews which included RCTs were considered eligible for inclusion. The primary outcome was extent of concordance between systematic reviews on the same topic. Secondary outcomes included assessment of quality of systematic reviews, differences in included studies in meta-analyses covering the same search period, selective reporting and reporting the quality of evidence. MAIN RESULTS AND THE ROLE OF CHANCE Concordant results and conclusions were found in only one topic, with reviews in the remaining eight topics displaying partial discordance. The AMSTAR grading for the majority of the non-Cochrane reviews was critically low whilst it was categorized as high for all of the Cochrane reviews. For three of the nine topics, none of the included systematic reviews assessed the quality of evidence. We were unable to assess selective reporting as most of the reviews did not have a pre-specified published protocol. LIMITATIONS, REASONS FOR CAUTION We were limited by the high proportion of reviews lacking a pre-specified protocol, which made it impossible to assess for selective reporting. Furthermore, many reviews did not specify primary and secondary outcomes which made it difficult to assess reporting bias. All the authors of this review were Cochrane review authors which may introduce some assessment bias. The categorization of the review’s conclusions as beneficial, harmful or neutral was subjective, depending on the tone and wording of the conclusion section of the review. WIDER IMPLICATIONS OF THE FINDINGS The majority of the systematic reviews published within a 3-year period on the same topic in the field of assisted reproduction revealed discordant conclusions and suffered from serious methodological issues, hindering the process of informed healthcare decision-making. STUDY FUNDING/COMPETING INTEREST(S) All the authors are Cochrane authors. M.S.K. is an editorial board member of Cochrane Gynaecology and Fertility group. No grant from funding agencies in the public, commercial or not-for-profit sectors was obtained.

scholarly journals Changing gloves during cesarean section for prevention of postoperative infections: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Siwanon Rattanakanokchai ◽  
Nuntasiri Eamudomkarn ◽  
Nampet Jampathong ◽  
Bao-Yen Luong-Thanh ◽  
Chumnan Kietpeerakool
Keyword(s):  
Systematic Review ◽  
Cesarean Section ◽  
Meta Analysis ◽  
Postoperative Infections ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Incisional Surgical Site Infection ◽  
Grade Approach ◽  
Febrile Morbidity

AbstractThis systematic review and meta-analysis was conducted to assess associations between changing gloves during cesarean section (CS) and postoperative infection. A literature search was conducted using the major electronic databases MEDLINE, Scopus, ISI Web of Science, PubMed, CINAHL, and CENTRAL from their inception to September 2020. Randomized controlled trials (RCTs) comparing glove change during CS to no glove change were included. Outcomes of interest were endometritis, febrile morbidity, and incisional surgical site infection (SSI). GRADE approach was applied to assess the quality of evidence. Ten reports of six studies involving 1707 participants were included in the analyses. Glove change was associated with a reduction in the risk of incisional SSI following CS (pooled RR 0.49, 95% CI 0.30, 0.78; moderate quality of evidence). Compared to no glove change, glove change during CS did not reduce the risks of endometritis (pooled RR 1.00, 95% CI 0.80, 1.24; low quality of evidence) or febrile morbidity (pooled RR 0.85, 95% CI 0.43, 1.71; very low quality of evidence). Changing gloves during CS was associated with a decreased risk of incisional SSI. The risks of postoperative endometritis and febrile morbidity were not altered by changing gloves.

Tools to Assess the External Validity of Randomized Controlled Trials in Systematic Reviews: a Systematic Review of Measurement Properties

2021 ◽  
Author(s):  
Andres Jung ◽  
Julia Balzer ◽  
Tobias Braun ◽  
Kerstin Luedtke
Keyword(s):  
Randomized Controlled Trials ◽  
Systematic Reviews ◽  
External Validity ◽  
Measurement Properties ◽  
Controlled Trials ◽  
Measurement Instruments ◽  
Health Measurement ◽  
Quality Of Evidence ◽  
Randomized Controlled

Abstract Background: Internal and external validity are the most relevant components when critically appraising randomized controlled trials (RCTs) for systematic reviews. However, there is no gold standard to assess external validity. This might be related to the heterogeneity of terminology as well as to unclear evidence of the measurement properties of available tools. The aim of this review was to identify tools to assess the external validity of RCTs in systematic reviews and to evaluate the quality of evidence regarding their measurement properties.Methods: A two-phase systematic literature search was performed in four databases: MEDLINE via PubMed, Scopus, PsycINFO via OVID, and CINAHL via EBSCO. First, tools to assess the external validity of RCTs were identified. Second, studies aiming to investigate the measurement properties of these tools were selected. The measurement properties of each included tool were appraised using an adapted version of the COnsensus based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.Results: 34 publications reporting on the development or validation of 26 included tools were included. For 62% of the included tools, there was no evidence of any measurement property. For the remaining tools, reliability was assessed most frequently. Reliability was judged as “sufficient” for three tools (very low quality of evidence). Content validity was rated as “sufficient” for one tool (moderate quality of evidence).Conclusions: Based on these results, no available tool can be fully recommended to assess the external validity of RCTs in systematic reviews. Several steps are required to overcome the identified difficulties to either adapt and validate available tools or to develop a new one. There is a need for more research for this purpose.Trial registration: Prospective registration at Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/PTG4D

scholarly journals A brief introduction to propensity score for anesthesiologists

2020 ◽  
Vol 73 (4) ◽  
pp. 296-301 ◽  
Author(s):  
Alessandro De Cassai ◽  
Giulio Andreatta ◽  
Annalisa Boscolo ◽  
Marina Munari ◽  
Paolo Navalesi
Keyword(s):  
Propensity Score ◽  
Observational Studies ◽  
Retrospective Studies ◽  
Statistical Technique ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Balanced Distribution ◽  
Different Characteristics ◽  
Randomization Process

Intergroup comparability is of paramount importance in clinical research since it is impossible to draw conclusions on a treatment if populations with different characteristics are compared. While an adequate randomization process in randomized controlled trials (RCTs) ensures a balanced distribution of subjects between groups, the distribution in observational prospective and retrospective studies may be influenced by many confounders.<br/>Propensity score (PS) is a statistical technique that was developed more than 30 years ago with the purpose of estimating the probability to be assigned to a group. Once evaluated, the PS could be used to adjust and balance the groups using different methods such as matching, stratification, covariate adjustment, and weighting. The validity of PS is strictly related to the confounders used in the model, and confounders that are either not identified or not available will produce biases in the results. RCTs will therefore continue to provide the highest quality of evidence, but PS allows fine adjustments on otherwise unbalanced groups, which will increase the strength and quality of observational studies.

scholarly journals The Effects of Ascorbic Acid Over Sepsis: Meta-analysis With Trial Sequential Analysis

2020 ◽  
Author(s):  
Ying Wang ◽  
Hui-chang Zhuo ◽  
Jiandong Lin
Keyword(s):  
Odds Ratio ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Random Errors ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Registration Number ◽  
Summary Odds Ratio

Abstract Background: This meta-analysis is performed to evaluate the effects of AA on the mortality over sepsis patients, focusing on the courses and initiation of treatment as well as AA doses.Methods: Randomized controlled trials concerning sepsis patients treated with intravenous AA were included when searching the database. The meta-analysis was performed using the random (M-H heterogeneity) model to produce summary odds ratio with 95% CI. Trial sequential analysis was applied to evaluated the effect of random errors.Results: The included 12 trials enrolled a total of 1232 patients. Intravenously administration of AA could not lower 28-day mortality over sepsis patients (OR = 0.81; 95% CI (0.54-1.23); p = 0.326). Subgroup analysis demonstrated that when administrating AA alone, in a dose ≥ 10 g/d, or within 6 h of admission, the result may turn to positive (OR = 0.36; 95% CI (0.15-0.86); p = 0.020, OR = 0.50; 95% CI (0.27-0.92); p = 0.025, OR = 0.49; 95% CI (0.27-0.89); p = 0.019, relatively). The quality of evidence is moderate.Conclusion: IV AA may have no effects to lower mortality over sepsis patients. However, when administrating AA alone, in a dose ≥ 10 g/d, or within 6 h of admission, the result may turn to positive. Due to a moderate GRADE certainty of evidence, further studies are required to fully elaborate the effectiveness of AA during the management of the sepsis patients.PROSPERO registration number: CRD 42020170825. 24 Feb, 2020 retrospectively registered.

scholarly journals Reduced Intensity Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation of AML in CR and MDS-a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 14-15
Author(s):  
Yanzhi Song ◽  
Zhichao Yin ◽  
Erhui Yuan ◽  
Yajing Wang ◽  
Tong Wu
Keyword(s):  
P Value ◽  
Random Effects Model ◽  
Reduced Intensity Conditioning ◽  
Hematopoietic Stem ◽  
Quality Of Evidence ◽  
Graft Versus Host ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Reduced Intensity

Background Allogeneic hematopoietic stem cell transplantation is the most effective treatment that can cure acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). However, myeloablative conditioning (MAC) regimens cause high non-relapse mortality (NRM). Reduced intensity conditioning (RIC) regimens can reduce NRM but increase relapse incidence (RI) and as a result of it, has the similar overall survival (OS) to the MAC regimen according to the results of published clinical trials. Nevertheless, most of these clinical trials aren't high quality studies and the results of different studies are not consistent. To clarify whether RIC is as effective as MAC but safer than it for AML in CR and MDS we write the systematic review (SR). Methods Two reviewers independently comprehensively searched the related databases and websites and hand searched the reference lists. They also independently screened and evaluated the retrieved studies and then extracted data of included studies with the Cochrane Collaboration recommended tools. Only randomized controlled trials (RCTs) were included. Hazard ratio (HR) was used to compare the OS, RI, leakemia free survival (LFS), non-relapse mortality (NRM), the incidence of acute graft versus host disease (aGVHD) and chronic graft versus host disease (cGVHD) with the generic inverse variance method. The III-IV aGVHD and graft failure (GF) were compared with the Mantel-Haenszel method pooled risk ratio (RR). A two-sided P value of less than 0·05 was considered as significant difference. Heterogeneity was significant when the P value of the Chi-square test was less than 0·1 and/or the I2 value was more than 50%. Additionally we used the GRADE principles to evaluate the quality of evidence. The SR was registered on PROSPERO with ID of CRD42020185436. Results 7770 records were retrieved. We included 6 RCTs with 1413 participants comparing RIC with MAC. Our results showed there wasn't significant difference in OS (HR=0·95 95% confidence interval (CI, 0·64, 1·4), P=0·80) and RI (HR=1·18, CI (0·88, 1·59), P=0·28). Six RCTs and 1413 pariticipants were included of the two outcomes. The result of LFS was (HR=1·09, CI (0·69, 1·74), P=0·71) between RIC and MAC, three studies and 596 participants were included. The heterogeneity was significant in the OS, RI and LFS outcomes so we combined the three outcomes with the random effects model. RIC significantly reduced NRM than TBI/Bu based MAC (HR=0·53, CI (0·36, 0·80), P=0·002), four RCTs and 633 participants were included. On the other hand, RIC didn't reduce NRM than treosulfan based MAC with the results of (HR=1·67, CI (1·02, 2·02), P=0·04) compared with treosulfan 10 g/m2*3 days regimen and (HR=0·76, CI (0·45, 1·3), P=0·32) compared with treosulfan 14 g/m2*3 days regimen, both included only 1 RCT and 460 and 320 participants were included respectively. RIC had a trend to reduce the incidence of aGVHD compared to TBI/Bu based MAC (HR=0·79, CI (0·60, 1·03), P=0·08) and III-IV aGVHD (HR=0·61, CI (0·36, 1·04), P=0·07). RIC didn't show significant difference to treosulfan based MAC regimen on the two outcomes. The heterogeneity of the NRM, aGVHD, III-IV aGVHD was non-significant and we combined the three outcomes with the fixed effect model. The cGVHD was similar between RIC and MAC (HR=1·01, CI (0·79, 1·28), P=0·96), results of included results had significant heterogeneity and random effects model was used. GF was rare in both RIC (2·6%) and MAC (1·1%) arms. The quality of evidence on OS, RI and LFS was moderate and on NRM, aGVHD, cGVHD was high. Conclusions For AML in CR and MDS paitents, RIC don't increase OS and RI compared with MAC. RIC regimens reduce NRM than the TBI/Bu based MAC regimens. RIC regimens are also good choice of preparative regimens before HSCT for AML in CR and MDS. The treosulfan based MAC has a promising result in one RCT and even causes less NRM than RIC. Nevertheless, studies are scarce and more studies are needed to confirm the result. Disclosures No relevant conflicts of interest to declare.

scholarly journals Were Traditional Chinese Medicine Injections Efficacious for Angina Pectoris? A Frequentist Network Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Guoying Gao ◽  
Siu-wai Leung ◽  
Yongliang Jia
Keyword(s):  
Chinese Medicine ◽  
Angina Pectoris ◽  
Traditional Chinese Medicine ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Grade Approach

Abstract Background: The efficacy of traditional Chinese medicine injections (TCMIs) for angina pectoris has never been well investigated for lacking quality assessment of evidence. This study aimed to conduct a comprehensive and rigorous network meta-analysis and assess the quality of evidence according to the Grading of Recommendations and Assessment, Development, and Evaluation (GRADE) approach to compare the efficacy of all TCMIs in treating angina pectoris.Methods: Following the protocol (reference: CRD42018117720), randomized controlled trials (RCTs) which compared one TCMI with another TCMI or conventional treatments on anginal outcome measures (i.e. symptomatic improvement, electrocardiography improvement, symptomatic recovery, and electrocardiography recovery) were included. The risk of bias among included RCTs was assessed with the revised Cochrane’s risk of bias tool 2. Frequentist statistical analyses including subgroup analysis, sensitivity analysis, meta-regression and publication bias analysis were performed. The certainty of evidence was assessed with the GRADE approach.Results: Totally, 475 RCTs including all 24 TCMIs were identified, while the quality of all but two included RCTs was poor. According to the network meta-analysis, Honghua (Safflower) injection were preferable both in improving symptoms and electrocardiography. However, significant inconsistency showed the intransitivity among indirect comparisons, results in network meta-analysis seemed thus not trustworthy. The quality of evidence was assessed as low or very low.Conclusions: The low-quality evidence reduced the confidence in the efficacious results. Current evidence hardly supports the beneficial effects of TCMIs in treating angina pectoris.

scholarly journals Digital Health Professions Education in the Field of Pediatrics: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

2019 ◽  
Author(s):  
Serena Brusamento ◽  
Bhone Myint Kyaw ◽  
Penny Whiting ◽  
Li Li ◽  
Lorainne Tudor Car
Keyword(s):  
Health Professionals ◽  
Digital Health ◽  
Risk Of Bias ◽  
Traditional Learning ◽  
High Fidelity ◽  
Quality Of Evidence ◽  
Digital Education ◽  
Randomized Controlled ◽  
Computer Based

BACKGROUND Reducing childhood morbidity and mortality is challenging, particularly in countries with a shortage of qualified health care workers. Lack of trainers makes it difficult to provide the necessary continuing education in pediatrics for postregistration health professionals. Digital education, teaching and learning by means of digital technologies, has the potential to deliver medical education to a large audience while limiting the number of trainers needed. OBJECTIVE The goal of the research was to evaluate whether digital education can replace traditional learning to improve postregistration health professionals’ knowledge, skills, attitudes, and satisfaction and foster behavior change in the field of pediatrics. METHODS We completed a systematic review of the literature by following the Cochrane methodology. We searched 7 major electronic databases for articles published from January 1990 to August 2017. No language restrictions were applied. We independently selected studies, extracted data, and assessed risk of bias, and pairs of authors compared information. We contacted authors of studies for additional information if necessary. All pooled analyses were based on random effects models. We included individually or cluster randomized controlled trials that compared digital education with traditional learning, no intervention, or other forms of digital education. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. RESULTS Twenty studies (1382 participants) were included. Participants included pediatricians, physicians, nurses, and midwives. Digital education technologies were assessed including high-fidelity mannequins (6 studies), computer-based education (12 studies), mobile learning (1 study), and virtual reality (1 study). Most studies reported that digital education was either as effective as or more effective than the control intervention for outcomes including skill, knowledge, attitude, and satisfaction. High-fidelity mannequins were associated with higher postintervention skill scores compared with low-fidelity mannequins (standardized mean difference 0.62; 95% CI 0.17-1.06; moderate effect size, low-quality evidence). One study reported physician change in practicing behavior and found similar effects between offline plus online digital education and no intervention. The only study that assessed impact on patient outcome found no difference between intervention and control groups. None of the included studies reported adverse or untoward effects or economic outcomes of the digital education interventions. The risk of bias was mainly unclear or high. The quality of evidence was low due to study inconsistencies, limitations, or imprecision across the studies. CONCLUSIONS Digital education for postregistration health professions education in pediatrics is at least as effective as traditional learning and more effective than no learning. High-fidelity mannequins were found to be more effective at improving skills than traditional learning with low-fidelity mannequins. Computer-based offline/online digital education was better than no intervention for knowledge and skill outcomes and as good as traditional face-to-face learning. This review highlights evidence gaps calling for more methodologically rigorous randomized controlled trials on the topic.

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