Intra-articular platelet-rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations

Abstract Multiple risk-assessment models (RAMs) for venous thromboembolism (VTE) in hospitalized medical patients have been developed. To inform the 2018 American Society of Hematology (ASH) guidelines on VTE, we conducted an overview of systematic reviews to identify and summarize evidence related to RAMs for VTE and bleeding in medical inpatients. We searched Epistemonikos, the Cochrane Database, Medline, and Embase from 2005 through June 2017 and then updated the search in January 2020 to identify systematic reviews that included RAMs for VTE and bleeding in medical inpatients. We conducted study selection, data abstraction and quality assessment (using the Risk of Bias in Systematic Reviews [ROBIS] tool) independently and in duplicate. We described the characteristics of the reviews and their included studies, and compared the identified RAMs using narrative synthesis. Of 15 348 citations, we included 2 systematic reviews, of which 1 had low risk of bias. The reviews included 19 unique studies reporting on 15 RAMs. Seven of the RAMs were derived using individual patient data in which risk factors were included based on their predictive ability in a regression analysis. The other 8 RAMs were empirically developed using consensus approaches, risk factors identified from a literature review, and clinical expertise. The RAMs that have been externally validated include the Caprini, Geneva, IMPROVE, Kucher, and Padua RAMs. The Padua, Geneva, and Kucher RAMs have been evaluated in impact studies that reported an increase in appropriate VTE prophylaxis rates. Our findings informed the ASH guidelines. They also aim to guide health care practitioners in their decision-making processes regarding appropriate individual prophylactic management.

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Clinical and pharmacokinetic/dynamic outcomes of prolonged infusions of beta-lactam antimicrobials: An overview of systematic reviews

PLoS ONE ◽

10.1371/journal.pone.0244966 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244966

Author(s):

Pierre Thabet ◽

Anchal Joshi ◽

Erika MacDonald ◽

Brian Hutton ◽

Wei Cheng ◽

...

Keyword(s):

Systematic Reviews ◽

Clinical Cure ◽

Search Strategy ◽

Data Extraction ◽

Risk Of Bias ◽

Hospitalized Patients ◽

Cochrane Library ◽

Beta Lactam ◽

Beta Lactams ◽

Overview Of Systematic Reviews

Objective This overview of reviews aims to map and compare of objectives, methods, and findings of existing systematic reviews to develop a greater understanding of the information available about prolonged beta-lactam infusions in hospitalized patients with infection. Design Overview of systematic reviews. Data sources Medline, Embase, PROSPERO and the Cochrane Library were systematically searched from January, 1990 to June, 2019 using a peer reviewed search strategy. Grey literature was also searched for relevant reviews. Eligibility criteria for selecting reviews Systematic reviews were sought that compared two or more infusion strategies for intravenous beta-lactam antimicrobials and report clinical cure or mortality. Populations of included reviews were restricted to hospitalized patients with infection, without restrictions on age, infection type, or disease. Data extraction and analysis Abstract screening, data extraction, quality and risk of bias assessment were conducted by two independent reviewers. Overlap between reviews was assessed using a modified corrected covered area. Overview findings are reported in accordance with Cochrane’s recommendation for overview conduct. Clinical outcomes extracted included survival, clinical cure, treatment failure, microbiological cure, length of stay, adverse events, cost, and emergence of resistance. Results The search strategy identified 3327 unique citations from which 21 eligible reviews were included. Reviews varied by population, intervention and outcomes studied. Between reviews, overlap of primary studies was generally high, methodologic quality generally low and risk of bias variable. Nine of 14 reviews that quantitatively evaluated mortality and clinical cure identified a benefit with prolonged infusions of beta lactams when compared with intermittent infusions. Evidence of mortality and clinical cure benefit was greater among critically ill patients when compared to less sick patients and lower in randomized controlled trials when compared with observational studies. Conclusions Findings from our review demonstrate a consistent and reproducible lack of harm with prolonged infusions of beta-lactam antibiotics with variability in effect size and significance of benefits. Despite 21 systematic reviews addressing prolonged infusions of beta-lactams, this overview supports the continued need for a definitive systematic review given variability in populations, interventions and outcomes in the current systematic reviews. Subsequent systematic reviews should have more rigorous and transparent methods, only include RCTs and evaluate the proposed benefits found in various subgroup-analyses—i.e. high risk of mortality. Trial registration Prospero registry, CRD42019117118.

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Intra-articular hyaluronic acid injection in treating knee osteoarthritis: assessing risk of bias in systematic reviews with ROBIS tool

International Journal of Rheumatic Diseases ◽

10.1111/1756-185x.13192 ◽

2017 ◽

Vol 20 (11) ◽

pp. 1658-1673 ◽

Cited By ~ 3

Author(s):

Dan Xing ◽

Bin Wang ◽

Wei Zhang ◽

Ziyi Yang ◽

Yunfei Hou ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Systematic Reviews ◽

Risk Of Bias ◽

Hyaluronic Acid Injection ◽

Acid Injection

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Surfactant therapy for meconium aspiration syndrome in neonates: a systematic overview of systematic reviews and recent clinical trials

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0018 ◽

2020 ◽

Vol 9 (8) ◽

pp. 527-536

Author(s):

Mohammed Ahmed Abdelaal ◽

Dina Abushanab ◽

Daoud Al-Badriyeh

Keyword(s):

Clinical Trials ◽

Systematic Reviews ◽

Lung Lavage ◽

Meconium Aspiration Syndrome ◽

Risk Of Bias ◽

Surfactant Therapy ◽

High Quality ◽

Meconium Aspiration ◽

Systematic Overview ◽

Overview Of Systematic Reviews

Aim: To conduct a systematic overview of systematic reviews (SRs) and randomized clinical trials (RCTs) on surfactant therapy in neonatal meconium aspiration syndrome. Methods: We searched EMBASE, PROQUEST and PubMed to summarize the different effects of surfactant lung lavage and bolus surfactant therapies in neonates with meconium aspiration syndrome. Results: With a total of 1377 patients, three SRs and two RCTs were included in analysis. Surfactant effectiveness was concluded by low-quality SRs, with high risk of bias, which was contradicted by high-quality SRs, with low risk of bias. In SRs, the surfactant lung lavage reduced mortality, need for extracorporeal membrane oxygenation and hospitalization, while the bolus surfactant did not. In recent high-quality RCTs, however, the two modalities did not significantly differ. Conclusion: The evidence on surfactant effectiveness and its method of administration is sparse and inconsistent.

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Do manual therapies have a specific autonomic effect? An overview of systematic reviews

PLoS ONE ◽

10.1371/journal.pone.0260642 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260642

Author(s):

Sonia Roura ◽

Gerard Álvarez ◽

Ivan Solà ◽

Francesco Cerritelli

Keyword(s):

Manual Therapy ◽

Systematic Reviews ◽

Risk Of Bias ◽

The Body ◽

Manual Therapies ◽

Body Region ◽

Future Research ◽

Overview Of Systematic Reviews ◽

Therapy Interventions ◽

The Impact

Background The impact of manual therapy interventions on the autonomic nervous system have been largely assessed, but with heterogeneous findings regarding the direction of these effects. We conducted an overview of systematic reviews to describe if there is a specific autonomic effect elicited by manual therapy interventions, its relation with the type of technique used and the body region where the intervention was applied. Methods We conducted an overview according to a publicly registered protocol. We searched the Cochrane Database of Systematic Reviews, MEDLINE, EPISTEMONIKOS and SCOPUS, from their inception to march 2021. We included systematic reviews for which the primary aim of the intervention was to assess the autonomic effect elicited by a manual therapy intervention in either healthy or symptomatic individuals. Two authors independently applied the selection criteria, assessed risk of bias from the included reviews and extracted data. An established model of generalisation guided the data analysis and interpretation. Results We included 12 reviews (5 rated as low risk of bias according the ROBIS tool). The findings showed that manual therapies may have an effect on both sympathetic and parasympathetic systems. However, the results from included reviews were inconsistent due to differences in their methodological rigour and how the effects were measured. The reviews with a lower risk of bias could not discriminate the effects depending on the body region to which the technique was applied. Conclusion The magnitude of the specific autonomic effect elicited by manual therapies and its clinical relevance is uncertain. We point out some specific recommendations in order to improve the quality and relevance of future research in this field.

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Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284818820438 ◽

2019 ◽

Vol 12 ◽

pp. 175628481882043 ◽

Cited By ~ 8

Author(s):

Irene X. Y. Wu ◽

Charlene H. L. Wong ◽

Robin S. T. Ho ◽

William K. W. Cheung ◽

Alexander C. Ford ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Systematic Reviews ◽

Comparative Effectiveness ◽

Meta Analysis ◽

Treatment Options ◽

Risk Of Bias ◽

Chinese Herbs ◽

Overview Of Systematic Reviews ◽

Irritable Bowel ◽

Needle Acupuncture

Background: An overview of systematic reviews (SRs) and a network meta-analysis (NMA) were conducted to evaluate the comparative effectiveness of acupuncture and related therapies used either alone, or as an add-on to other irritable bowel syndrome (IBS) treatments. Methods: A total of eight international and Chinese databases were searched for SRs of randomized controlled trials (RCTs). The methodological quality of SRs was appraised using the AMSTAR instrument. From the included SRs, data from RCTs were extracted for the random-effect pairwise meta-analyses. An NMA was used to evaluate the comparative effectiveness of different treatment options. The risk of bias among included RCTs was assessed using the Cochrane risk of bias tool. Results: From 15 SRs of mediocre quality, 27 eligible RCTs ( n = 2141) were included but none performed proper blinding. Results from pairwise meta-analysis showed that both needle acupuncture and electroacupuncture were superior in improving global IBS symptoms when compared with pinaverium bromide. NMA results showed needle acupuncture plus Geshanxiaoyao formula had the highest probability of being the best option for improving global IBS symptoms among 14 included treatment options, but a slight inconsistency exists. Conclusion: The risk of bias and NMA inconsistency among included trials limited the trustworthiness of the conclusion. Patients who did not respond well to first-line conventional therapies or antidepressants may consider acupuncture as an alternative. Future trials should investigate the potential of (1) acupuncture as an add-on to antidepressants and (2) the combined effect of Chinese herbs and acupuncture, which is the norm of routine Chinese medicine practice.

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Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04308-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Michael McLarnon ◽

Neil Heron

Keyword(s):

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Risk Of Bias ◽

Post Intervention ◽

Promising Alternative ◽

Knee Oa ◽

Sporting Activity ◽

Symptomatic Management ◽

Corticosteroid Injections

Abstract Background Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA platelet-rich plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA. Methods All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC/VAS score (or subscores), comparing IA PRP to CS injections across studies. Results Included were eight studies and 648 patients, 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. Overall, the studies were considered at low risk of bias. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3, 6 and 9 months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (− 0.78 (− 1.34 to − 0.23) standard mean deviations (SMD) and − 1.63 (− 2.14 to − 1.12) SMD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. At 6 months PRP allowed greater return to sporting activities than CS, measured by the KOOS subscale for sporting activity, of magnitude 9.7 (− 0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months follow-up (P < 0.01). Conclusions IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than 1 IA-PRP injection. Prospero trial registration number CRD42020181928.

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Periodontal Disease and Pregnancy Outcomes: Overview of Systematic Reviews

JDR Clinical & Translational Research ◽

10.1177/2380084417731097 ◽

2017 ◽

Vol 3 (1) ◽

pp. 10-27 ◽

Cited By ~ 24

Author(s):

L.A. Daalderop ◽

B.V. Wieland ◽

K. Tomsin ◽

L. Reyes ◽

B.W. Kramer ◽

...

Keyword(s):

Preterm Birth ◽

Relative Risk ◽

Periodontal Disease ◽

Perinatal Mortality ◽

Systematic Reviews ◽

Pregnancy Outcomes ◽

Risk Of Bias ◽

Adverse Pregnancy Outcomes ◽

Overview Of Systematic Reviews ◽

Adverse Pregnancy

Periodontal disease is very common during pregnancy. Although it has been linked to adverse pregnancy outcomes, systematic reviews have reached discrepant conclusions on these links. Therefore, we conducted a systematic overview of systematic reviews studying the association between periodontal disease and adverse pregnancy outcomes. We searched 6 online databases up to November 2016 and hand-searched references and citations of eligible papers. Systematic reviews of studies comparing pregnancy outcomes among women with and without periodontal disease were eligible for inclusion. Primary outcomes were maternal mortality, preterm birth, and perinatal mortality. Two reviewers extracted data and assessed risk of bias of individual systematic reviews. Findings are described in tabular and narrative form. Twenty-three systematic reviews (including between 3 and 45 studies) were included. None reported the association between periodontal disease and maternal or perinatal mortality. Systematic reviews with the lowest risk of bias consistently demonstrated positive associations between periodontal disease and preterm birth (relative risk, 1.6; 95% confidence interval, 1.3 to 2.0; 17 studies, 6,741 participants), low birth weight (LBW; relative risk, 1.7; 95% CI, 1.3 to 2.1; 10 studies, 5,693 participants), preeclampsia (odds ratio, 2.2; 95% CI, 1.4 to 3.4; 15 studies, 5,111 participants), and preterm LBW (relative risk 3.4; 95% CI, 1.3 to 8.8; 4 studies, 2,263 participants). Based on these figures, estimated population-attributable fractions for periodontal disease were 5% to 38% for preterm birth, 6% to 41% for LBW, and 10% to 55% for preeclampsia. In terms of limitations, as several primary studies did not adjust for confounding, meta-analyses may have overestimated the strength of the associations under study. Due to substantial overlap in included primary studies, we could not aggregate results across reviews. Consistent evidence from systematic reviews with low risk of bias indicates that pregnant women with periodontal disease are at increased risk of developing preeclampsia and delivering a preterm and/or LBW baby (PROSPERO: CRD42015030132). Knowledge Transfer Statement: This study highlights that periodontal disease is an important risk factor for several common adverse pregnancy outcomes. Clinicians should be aware of this link to guide risk selection. Research is needed to develop novel preventive and treatment strategies.

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