Acupuncture for the Treatment of Hiccups following Stroke: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 35 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Jinhuan Yue ◽  
Ming Liu ◽  
Jun Li ◽  
Yuming Wang ◽  
E-Sing Hung ◽  
...  

Objectives To assess the effectiveness and safety of acupuncture for hiccups following stroke. Methods Medline, Embase, CENTRAL, CINAHL, and four Chinese medical databases were searched from their inception to 1 June 2015. The dataset included randomised controlled trials (RCTs) with no language restrictions that compared acupuncture as an adjunct to medical treatment (effectiveness) or acupuncture versus medical treatment (comparative effectiveness) in stroke patients with hiccups. The Cochrane risk of bias tool was used to assess the methodological quality of the trials. Results Out of 436 potentially relevant studies, five met the inclusion criteria. When acupuncture was compared with other interventions (as sole or adjunctive treatment), meta-analysis revealed a significant difference in favour of cessation of hiccups within a specified time period (CHWST) following intervention when used as an adjunct (risk ratio (RR) 1.59, 95% CI 1.16 to 2.19, I2=0%), but not when used alone (RR 1.40, 95% CI 0.79 to 2.47, I2=65%, ie, high heterogeneity). No safety information was reported in these studies. Conclusions Our systematic review and meta-analysis suggests that acupuncture may be an effective treatment for patients suffering from hiccups following stroke when used as an adjunct to medical treatment. However, due to the limited number of RCTs and poor methodology quality, we cannot reach a definitive conclusion, hence further large, rigorously designed trials are needed.

2019 ◽  
Vol 17 (2) ◽  
pp. 191-203
Author(s):  
Oliver Brown ◽  
Jennifer Rossington ◽  
Gill Louise Buchanan ◽  
Giuseppe Patti ◽  
Angela Hoye

Background and Objectives: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. </P><P> Methods: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. </P><P> Results: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. </P><P> Conclusion: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.


2021 ◽  
Vol 10 (17) ◽  
pp. 3978
Author(s):  
Yee Sin Seak ◽  
Junainah Nor ◽  
Tuan Hairulnizam Tuan Kamauzaman ◽  
Ariff Arithra ◽  
Md Asiful Islam

Due to overcrowding, personnel shortages, or problematic intravenous (IV) cannulation, acute pain management is often sub-optimal in emergency departments (EDs). The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of intranasal (IN) ketamine for adult acute pain in the emergency setting. We searched and identified studies up to 21 May 2021 via PubMed, Scopus, Web of Science, Cochrane Database, and Google Scholar. The random-effects model with 95% confidence intervals (CIs) was used to estimate mean differences (MDs) and odds ratios (ORs). The I2 statistic and Cochran’s Q test were used to determine heterogeneity. The protocol was registered in PROSPERO (CRD42020213391). Seven randomised controlled trials were included with a total of 1760 patients. There was no significant difference in pain scores comparing IN ketamine with IV analgesics or placebo at 5 (MD 0.94, p = 0.26), 15 (MD 0.15, p = 0.74), 25 (MD 0.24, p = 0.62), 30 (MD −0.05, p = 0.87), and 60 (MD −0.42, p = 0.53) minutes. There was also no significant difference in the need for rescue analgesics between IN ketamine and IV analgesics (OR 1.66, 95% CI: 0.57−4.86, p = 0.35, I2 = 70%). Only mild adverse effects were observed in patients who received IN ketamine. Our results suggest that IN ketamine is non-inferior to IV analgesics and may have a role in acute pain management among adults in the ED.


BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040726
Author(s):  
Yuxuan Wu ◽  
Cheng Lei ◽  
Zhimin Huangfu ◽  
Kejimu Sunzi ◽  
Changmei Yang

IntroductionBackward walking (BW) is otherwise known as retrowalking. As opposed to forward walking, BW is a countersequential exercise and is a common method of rehabilitation training and disease-assisted treatment. Studies have shown that BW has a helpful effect on improving lower limb proprioception, gait synergy and improving limb balance. Many studies have concluded that BW can improve the symptoms of patients with knee osteoarthritis (KOA) and can be used for rehabilitation and adjunctive treatment of KOA, but there is a lack of evidence-based medical evidence.This research aims to provide an update to the most recent available evidence on the effect of BW on patients with KOA .Methods and analysesElectronic databases, such as Ovid/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and PubMed, will be searched by us. We will include studies identified from citation until 12 May 2020 and will not be restricted by geographical setting. The search will not be limited to the language of the publication, but the study of human subjects. Randomised controlled trials (RCTs) on the BW training of KOA will be included, with outcome measures including pain, knee function or balance function. The quality of included RCTs will be evaluated according to the Cochrane Collaboration’s risk of bias tool. A meta-analysis or systematic review will be performed to summarise the effects of BW training. We will perform sensitivity analysis on the sample size of RCTs, meta-regression analysis of the follow-up periods, dosages and baselines of outcome measures, and publication bias analysis.Ethics and disseminationEthical approval is not required as this study will not involve confidential personal data. The results of this study will be disseminated through a peer-reviewed journal.PROSPERO registration numberCRD42020185694.


BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028855 ◽  
Author(s):  
Shicong Lai ◽  
Panxin Peng ◽  
Tongxiang Diao ◽  
Huimin Hou ◽  
Xuan Wang ◽  
...  

ObjectiveTo assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).DesignSystematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.Data sourcesPubMed, EMBASE, the Cochrane Library until October 2018.Eligibility criteriaRandomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH.Data extraction and synthesisPerioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF).Results22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=−0.08; 95% CI −0.13 to −0.02; p=0.007), and IPSS (MD = −0.10; 95% CI −0.15 to −0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant.ConclusionPVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.


BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043751
Author(s):  
Lorraine Lau ◽  
Jamie L Benham ◽  
Patricia Lemieux ◽  
Jennifer Yamamoto ◽  
Lois E Donovan

ObjectiveTo evaluate the effect of levothyroxine therapy on pregnancy outcomes compared with placebo or no treatment in women without overt hypothyroidism with presence of thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb).DesignSystematic review and meta-analysis of randomised controlled trialsStudy eligibility criteriaPrespecified criteria for inclusion were: randomised trials of levothyroxine versus control (placebo or no treatment) among women with positive TPOAb or TgAb who were pregnant or considering conception.Data sourcesOvid MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched from 1980 to 5 November 2020.Outcome measuresPrespecified data elements were extracted and where appropriate, meta-analyses were conducted. Main outcomes include pregnancy achieved, miscarriage, preterm delivery and live birth.Risk of bias assessmentCochrane Risk of Bias Tool for Quality Assessment of Randomised Controlled Trials.ResultsFrom 3023 citations, 79 citations were identified for full-text review. Of these, six trials (total of 2263 women) were included for qualitative and quantitative analyses. Risk of bias was deemed low for only one trial. There was no significant difference in the relative risk (RR) of pregnancy achieved (RR 1.03; 95% CI 0.93 to 1.13), miscarriage (RR 0.93; 95% CI 0.76 to 1.14), preterm delivery (RR 0.66; 95% CI 0.39 to 1.10) or live births (RR 1.01; 95% CI 0.89 to 1.16) in thyroid autoimmune women treated with levothyroxine compared with controls. Sensitivity analyses of preterm birth identified study quality and timing of levothyroxine initiation as sources of heterogeneity.ConclusionsAmong pregnant women or women planning conception, with thyroid autoimmunity, there is a lack of evidence of benefit for levothyroxine use (moderate to high Grading of Recommendations, Assessment, Development and Evaluations). Recommendations to use levothyroxine in this setting need to be reconsidered.PROSPERO registration numberCRD42019130459.


2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S168-S168
Author(s):  
Dan Siskind ◽  
Brian Wu ◽  
Tommy Wong ◽  
Steve Kisely

Abstract Background People living with schizophrenia are 3 times more likely to smoke than the general population, and have fewer and less successful quitting attempts. In concert with psychosocial quit interventions, there is a need for evidence based pharmacological interventions to assist people living with schizophrenia achieve smoking abstinence. Methods We systematically searched PubMed, PsycInfo, EMBASE and Cochrane for randomised controlled trials of pharmacological interventions for reducing smoking among people living with schizophrenia. We conducted pairwise and network meta-analyses of effectiveness of interventions for achieving abstinence and reduction in smoking. We also examined psychiatric and physical adverse events of interventions. Results Nineteen studies were included in the systematic review. Data was available for buproprion, varenicline and nicotine replacement therapy (NRT). Buproprion (RR 3.4, 95%CI 1.6–7.3, p=0.002), varenicline (RR 3.8, 95%CI 2.0–7.2, p&lt;0.001) and NRT (RR 4.3, 95%CI 1.7–10.7, p=0.002) were all associated with increased rates of abstinence in pairwise meta-analyses. In a network meta-analysis varenicline was superior to buproprion (RR 2.0, 95%CI 1.0–3.9), however there was no statistically significant difference between varenicline and NRT or buproprion and NRT. Varenicline was associated with higher rates of nausea than placebo. Discussion Buproprion, varenicline and NRT were all superior to placebo for achieving abstinence. Varenicline appears to be superior to buproprion for achieving abstinence, however varenicline is associated with higher rates of nausea.


2011 ◽  
Vol 198 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Corrado Barbui ◽  
Andrea Cipriani ◽  
Vikram Patel ◽  
José L. Ayuso-Mateos ◽  
Mark van Ommeren

BackgroundDepression is a common condition that has been frequently treated with psychotropics.AimsTo review systematically the evidence of efficacy and acceptability of antidepressant and benzodiazepine treatments for patients with minor depression.MethodA systematic review and meta-analysis of double-blind randomised controlled trials comparing antidepressants or benzodiazepines v. placebo in adults with minor depression. Data were obtained from MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Controlled Trials Register and pharmaceutical company websites. Risk of bias was assessed for the generation of the allocation sequence, allocation concealment, masking, incomplete outcome data, and sponsorship bias.ResultsSix studies met inclusion criteria. Three studies compared paroxetine with placebo; fluoxetine, amitriptyline and isocarboxazid were studied in one study each. No studies compared benzodiazepines with placebo. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found (relative risk (RR) 0.94, 95% CI 0.81–1.08). In terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo (RR = 1.06, 95% CI 0.65–1.73). There was no statistically significant between-study heterogeneity for any of the reported analyses.ConclusionsThere is evidence showing there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression. For benzodiazepines, no evidence is available, and thus it is not possible to determine their potential therapeutic role in this condition.


2010 ◽  
Vol 196 (5) ◽  
pp. 346-353 ◽  
Author(s):  
Daniel Tai-yin Tsoi ◽  
Mamta Porwal ◽  
Angela Claire Webster

BackgroundThe benefits and harms of bupropion as an aid for smoking cessation in schizophrenia remain uncertain.AimsTo summarise the current evidence for efficacy and safety of bupropion as treatment for nicotine dependence in schizophrenia.MethodSystematic review and random-effects meta-analysis of randomised controlled trials (RCTs) comparing bupropion with placebo or alternative therapeutic control in adult smokers with schizophrenia.ResultsTwenty-one reports from seven RCTs were included. Biochemically verified self-reported smoking cessation rates after bupropion were significantly higher than placebo at the end of treatment (risk ratio (RR) = 2.57, P = 0.004) and at 6 months (RR = 2.78, P = 0.05). Expired carbon monoxide level was significantly lower with bupropion at the end of therapy (P = 0.002) but not at 6 months (P = 0.37). There was no significant difference in positive (P = 0.28) or negative symptoms (P = 0.49) between the bupropion and the placebo group.ConclusionsBupropion increases the rates of smoking abstinence in smokers with schizophrenia, without jeopardising their mental state.


2016 ◽  
Vol 31 (3) ◽  
pp. 95-102
Author(s):  
Ahmad M. Yakasai ◽  
Hamza Muhammad ◽  
Garba Iliyasu ◽  
Aisha M. Nalado ◽  
Mahmood M. Dalhat ◽  
...  

Background: Catheter-related blood stream infection (CRBSI) contributes to morbidity and mortality among patients on haemodialysis (HD). We carried out a systematic review and meta-analysis to assess the efficacy of antimicrobial lock solutions (ALS) in preventing CRBSI.Method: Electronic search of randomised controlled trials (RCTs) comparing ALS with other agents was performed up to January 2013. DerSimonian and Laird meta-analysis was performed to obtain pooled relative risk (RR) from which efficacy of ALS and numbers needed to treat (NNT) were calculated. In a restricted analysis, pooled RRs where compared using a test of interaction to calculate ratio of relative risks (RRR). Meta-regression analysis was employed to explore sources of heterogeneity.Results: Sixteen RCTs involving 2016 individuals met the inclusion criteria. The efficacy of ALS in preventing CRBSI was 80% with NNT of 3 patients to prevent one CRBSI. The RR of CRBSI was significantly lower with ALS compared with heparin-only lock solution [RR {95% confidence interval (CI)} = 0.20 (0.13-0.31)]. With low dose (≤ 5 mg/ml) and high dose (40 mg/ ml) gentamicin-containing ALS, the RR (95% CI) of developing CRBSI was 0.03 (0.01-0.13) and 0.18 (0.03-0.98), respectively, with no significant difference [RRR (95% CI) = 0.2 (0.02-1.61), p = 0.126]. Heterogeneity was explained by a statistically significant association between rate of CRBSI and catheter days (p = 0.037). Conclusion: ALS are effective in preventing CRBSI. Low dose gentamicin should be preferred over high dose gentamicin as an ALS because it offers similar benefit in preventing CRBSI with lesser risk of toxicity from systemic leakage and subsequent development of drug resistance.


Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1584 ◽  
Author(s):  
Omorogieva Ojo ◽  
Osarhumwese Osaretin Ojo ◽  
Xiao-Hua Wang ◽  
Amanda Rodrigues Amorim Adegboye

The prevalence of diabetes is increasing globally, and its effect on patients and the healthcare system can be significant. Gestational diabetes mellitus (GDM) and type 2 diabetes are well established risk factors for cardiovascular disease, and strategies for managing these conditions include dietary interventions, such as the use of a low glycemic index (GI) diet. Aims: This review aimed to evaluate the effects of a low GI diet on the cardio-metabolic and inflammatory parameters in patients with type 2 diabetes and women with GDM and assess whether the effects are different in these conditions. Methods: This review was based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Three databases (EMBASE, Pubmed, and PsycINFO) were searched from inception to 20 February 2019 using search terms that included synonyms and Medical Subject Headings (MeSH) in line with the population, intervention, comparator, outcomes, and studies (PICOS) framework. Studies were evaluated for the quality and risk of bias. Results: 10 randomised controlled studies were included in the systematic review, while 9 were selected for the meta-analysis. Two distinct areas were identified: the effect of a low GI diet on lipid profile and the effect of a low GI diet on inflammatory parameters. The results of the meta-analysis showed that there were no significant differences (p > 0.05) between the low GI and higher GI diets with respect to total cholesterol, HDL, and LDL cholesterol in patients with type 2 diabetes. However, there was a significant difference (p = 0.027) with respect to triglyceride which increased by a mean of 0.06 mmol/L (0.01, 0.11) in patients with type 2 diabetes on higher GI diet. With respect to the women with GDM, the findings from the systematic review were not consistent in terms of the effect of a low GI diet on the lipid profile. The results of the meta-analysis did not show significant differences (p > 0.05) between low GI and higher GI diets with respect to adiponectin and C-reactive proteins in patients with type 2 diabetes, but a significant difference (p < 0.001) was observed between the two groups in relation to interleukin–6. Conclusion: This systematic review and meta-analysis have demonstrated that there were no significant differences (p > 0.05) between the low GI and higher GI diets in relation to total cholesterol—HDL and LDL cholesterol—in patients with type 2 diabetes. However, a significant difference (p < 0.05) was observed between the two groups with respect to triglyceride in patients with type 2 diabetes. The results of the effect of a low GI diet on the lipid profile in patients with GDM were not consistent. With respect to the inflammatory parameters, the low GI diet significantly decreased interleukin–6 in patients with type 2 diabetes compared to the higher GI diet. More studies are needed in this area of research.


Sign in / Sign up

Export Citation Format

Share Document