scholarly journals Pharmacological interventions for preventing post-operative atrial fibrillation in patients undergoing cardiac surgery: a network meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018544 ◽  
Author(s):  
Xiaoqin Wang ◽  
Liang Yao ◽  
Long Ge ◽  
Lun Li ◽  
Fuxiang Liang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Systematic Reviews ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Pharmacological Interventions ◽  
Patient Consent ◽  
Meta Analyses

IntroductionPostoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, and randomised clinical trials (RCTs) and systematic reviews have been conducted to compare and evaluate different pharmacological interventions for preventing POAF. This study aimed to explore the effect of different pharmacological interventions for prophylaxis against POAF after cardiac surgery using network meta-analysis (NMA).Methods and analysisA systematic search will be performed in PubMed, EMBASE and the Cochrane Library to identify RCTs, systematic reviews, meta-analyses or NMA of different pharmacological interventions for POAF. We will evaluate the risk of bias of the included RCTs according to the Cochrane Handbook V.5.1.0, and use GRADE to assess the quality of evidence. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be used to compare the efficacy of different pharmacological interventions.Ethics and disseminationEthics approval and patient consent are not required as this study is a meta-analysis based on published studies. The results of this NMA and trial sequential analysis will be submitted to a peer-reviewed journal for publication.Protocol registration numberCRD42017067492.

scholarly journals Trial sequential analysis: novel approach for meta-analysis

2021 ◽  
Vol 16 (2) ◽  
pp. 138-150
Author(s):  
Hyun Kang
Keyword(s):  
Systematic Reviews ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Novel Approach ◽  
Meta Analyses ◽  
Spurious Results

Systematic reviews and meta-analyses rank the highest in the evidence hierarchy. However, they still have the risk of spurious results because they include too few studies and participants. The use of trial sequential analysis (TSA) has increased recently, providing more information on the precision and uncertainty of meta-analysis results. This makes it a powerful tool for clinicians to assess the conclusiveness of meta-analysis. TSA provides monitoring boundaries or futility boundaries, helping clinicians prevent unnecessary trials. The use and interpretation of TSA should be based on an understanding of the principles and assumptions behind TSA, which may provide more accurate, precise, and unbiased information to clinicians, patients, and policymakers. In this article, the history, background, principles, and assumptions behind TSA are described, which would lead to its better understanding, implementation, and interpretation.

scholarly journals Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254271
Author(s):  
Min Shui ◽  
Ziyi Xue ◽  
Xiaolei Miao ◽  
Changwei Wei ◽  
Anshi Wu
Keyword(s):  
Cardiac Surgery ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Type I ◽  
Quality Of Recovery ◽  
Significant Difference

Background Intravenous and inhalational agents are commonly used in general anesthesia. However, it is still controversial which technique is superior for the quality of postoperative recovery. This meta-analysis aimed at comparing impact of total intravenous anesthesia (TIVA) versus inhalational maintenance of anesthesia on the quality of recovery in patients undergoing non-cardiac surgery. Methods We systematically searched EMBASE, PubMed, and Cochrane library for randomized controlled trials (RCTs), with no language or publication status restriction. Two authors independently performed data extraction and assessed risk of bias. The outcomes were expressed as mean difference (MD) with 95% confidence interval (CI) based on a random-effect model. We performed trial sequential analysis (TSA) for total QoR-40 scores and calculated the required information size (RIS) to correct the increased type I error. Results A total of 156 records were identified, and 9 RCTs consisting of 922 patients were reviewed and included in the meta-analysis. It revealed a significant increase in total QoR-40 score on the day of surgery with TIVA (MD, 5.91 points; 95% CI, 2.14 to 9.68 points; P = 0.002; I2 = 0.0%). The main improvement was in four dimensions, including “physical comfort”, “emotional status”, “psychological support” and “physical independence”. There was no significant difference between groups in total QoR-40 score (P = 0.120) or scores of each dimension on POD1. The TSA showed that the estimated required information size for total QoR-40 scores was not surpassed by recovered evidence in our meta-analysis. And the adjusted Z-curves did not cross the conventional boundary and the TSA monitoring boundary. Conclusion Low-certainty evidence suggests that propofol-based TIVA may improve the QoR-40 score on the day of surgery. But more evidence is needed for a firm conclusion and clinical significance.

What Is the Impact of Different Glucose-lowering Agents for Atrial Fibrillation Risk: A Systematic Review and a Network Meta-analysis 

2020 ◽  
Author(s):  
Wence Shi ◽  
Zhang Wenchang ◽  
Gao Lihua ◽  
Ding Chunhua
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Clinical Endpoints ◽  
Meta Analyses ◽  
The Impact ◽  
Diabetes Patients

Abstract Background: The emergence of new glucose-lowering agents has brought revolutionary changes to the treatment of cardiovascular diseases. Diabetes is associated with atrial fibrillation (AF) and atrial flutter (AFL) progression, while whether or not glucose-lowering agents would bring a reduction of AF/AFL is not clear. We therefore evaluate the effect of different glucose-lowering agents on AF/AFL and made this network meta-analysis to identify the optimal treatment for diabetes patients to reduce AF/AFL events.Methods: We searched PubMed, Embase, and the Cochrane Library until September 30 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in this network meta-analysis. The primary endpoint for our study was AF or AFL events. Only studies with a follow-up period of at least 12 months and reporting AF/AFL as clinical endpoints were included. Results from trials were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled using a bayesian random-effects model.Results: 5 eligible studies (9 glucose-lowering agents were analyzed including thiazolidinedione[TZD], metformin[Met], sulfonylurea[SU], insulin[Insu], dipeptidyl peptidase-4 inhibitor[DPP-4i], glucagon-like peptide-1 receptor agonist[GLP-1RA], sodium-glucose cotransporter 2 inhibitor[SGLT2i], alpha glucosidase inhibitor[AGI], and non-sulfonylurea[nSU]) consisting of 263583 patients with type 2 diabetes mellitus were included. Pooled results show that GLP1-RA, when compared to Met (OR 0.17, 95% CI 0.04-0.61), SU (OR 0.23, 95% CI 0.07-0.73), Insu (OR 0.20, 95% CI 0.07-0.86), and nSU (OR 0.18, 95% CI 0.04-0.66) significantly reduce AF/AFL events. In addition, DPP-4i could also reduce AF/AFL events when compared with nSU (OR 0.33, 95% CI 0.12-0.92).Conclusion: The finding of our study indicated that GLP1-RA could be optimal glucose-lowering agent for diabetes patients to prevents AF/AFL. Met and insulin-providing therapy (insulin, sulfonylurea, or non- sulfonylurea) should be avoided to patients with high risk of AF/AFL.Trial registration: We have registered in PROSPERO (international prospective register of systematic reviews (CRD42020212994) for this network meta-analysis

scholarly journals A systematic review of pharmacist-led audit and feedback interventions to influence prescribing behaviour in general practice settings

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i34-i35
Author(s):  
M Carter ◽  
N Abutheraa ◽  
N Ivers ◽  
J Grimshaw ◽  
S Chapman ◽  
...  
Keyword(s):  
General Practice ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Audit And Feedback ◽  
Cochrane Library ◽  
Randomised Trials ◽  
Prescribing Behaviour ◽  
Meta Analyses

Abstract Introduction Audit and Feedback (A&F) involves measuring data about practice, comparing it with clinical guidelines, professional standards or peer performance, and then feeding back the data to individuals/groups of health professionals to encourage change in practice (if required). A 2012 Cochrane review (1) found A&F was effective in changing health professionals’ behaviour and suggested that the person who delivers the A&F intervention influences its effect. Increasingly, pharmacists work in general practice and often have responsibility for medication review and repeat prescriptions. The effectiveness of pharmacist-led A&F in influencing prescribing behaviour is uncertain. Aim This secondary analysis from an ongoing update of the original Cochrane review aims to identify and describe pharmacist-led A&F interventions and evaluate their impact on prescribing behaviour in general practice compared with no intervention. Methods This sub-review is registered with PROSPERO: CRD42020194355 and complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (2). For the updated Cochrane review, the Cochrane Effective Practice and Organization of Care Group searched MEDLINE (1946 to present), EMBASE, CINAHL and Cochrane Library (March 2019) to identify randomised trials featuring A&F interventions. For this sub-review, authors screened titles and abstracts (May 2020) to identify trials involving pharmacist-led A&F interventions in primary care, extracted data, and assessed risk of bias (RoB) in eligible studies. Review results are summarised descriptively. Heterogeneity will be assessed and a random-effects meta-analysis is planned. Publication bias for selected outcomes and the certainty of the body of evidence will be evaluated and presented. Sub-group analyses will be conducted. Results Titles and abstracts of 295 studies identified for inclusion in the Cochrane A&F review update were screened. Eleven studies (all cluster-randomised trials) conducted in 9 countries (Denmark, Italy, Netherlands, Norway, Republic of Ireland, UK, Australia, Malaysia, USA) were identified for inclusion (Figure 1). Six studies had low RoB, two had high risk due to dissimilarities between trial arms at baseline and/or insufficient detail about randomisation, and three studies had unclear RoB. Studies examined the effect of A&F on prescribing for specific conditions (e.g. hypertension), medications (e.g. antibiotics), populations (e.g. patients >70), and prescribing errors (e.g. inappropriate dose). The pharmacist delivering A&F was a colleague of intervention participants in five studies. Pharmacists’ levels of skill and experience varied; seven studies reported details of pharmacist training undertaken for trial purposes. A&F interventions in nine studies demonstrated changes in prescribing, including reductions in errors or inappropriate prescribing according to the study aims and smaller increases in unwanted prescribing compared with the control group. Data analyses are ongoing (results will be available for the conference). Conclusion The preliminary results demonstrate the effectiveness of pharmacist-led A&F interventions in different countries and health systems with influencing prescribing practice to align more closely with guidance. Studies measured different prescribing behaviours; meta-analysis is unlikely to include all 11 studies. Further detailed analysis including feedback format/content/frequency and pharmacist skill level/experience, work-base (external/internal to recipients), will examine the impact of specific features on intervention effectiveness. References 1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012(6):CD000259. 2. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

scholarly journals Clinical Considerations for Return to Driving a Car following a Total Knee or Hip Arthroplasty: A Systematic Review

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Annalisa Na ◽  
Kacy Richburg ◽  
Zbigniew Gugala
Keyword(s):  
Systematic Reviews ◽  
Hip Arthroplasty ◽  
Response Times ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Postoperative Management ◽  
Cochrane Library ◽  
Clinical Factors ◽  
Study Results ◽  
Meta Analyses

Aim. The purpose of this study is to systematically review patient characteristics and clinical determinants that may influence return to driving status and time frames following a primary TKA or THA and provide an update of the current literature. Methods. This review was completed per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Final electronic database searches were completed in October 2019 in Medline/PubMed, Medline/OVID, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library using preselected search terms. Manuscripts of prospective and nonrandomized studies that examined the return to driving a car after a primary knee or hip arthroplasty patients were included. The Methodological Index for Non-Randomized Studies was used to measure study quality. Two authors selected studies and assessed their qualities. All disagreements were resolved through discussion and, as needed, a third reviewer. Data on study title, author(s), country, year, study design, sample size, inclusion and exclusion criteria, age, BMI, gender, statistical analyses, driving measure, follow-up time, surgical approach, laterality, and postoperative management were extracted from each study. Results. A total of 23 studies were eligible, including 12 TKA studies (n=654) with mean ages between 43 and 82 years, 9 THA studies (n=922) with mean ages between 34 and 85 years, and 2 combined TKA and THA (TKA, n=815; THA, n=685), yielded MINORS scores between 6 and 12. Most patients achieved or exceeded preoperative response times between 1 and 8 weeks following a TKA and 2 days to 8 weeks following a THA, and/or self-reported return to driving between 1 week and 6 months. Influences on return to driving time included laterality and pain, but gender was mixed. Discussion/Conclusions. Study results were consistent with previous systematic reviews in that return to driving a car after a primary TKA or THA is highly variable, and most commonly occurs around 4 weeks, but can range between 2 and 8 weeks. While various patient and clinical factors can influence return to driving for a TKA or THA, the most common contributing facts were pain and laterality. The heterogeneous nature of the studies prevented a meta-analysis for determining contributions of return to driving following a primary TKA or THA. Regardless, this study updates previous systematic reviews and presents insight on patient and clinical factors beyond generalized timeframes for return to driving a car. This information and results from future studies are essential to guide clinical recommendations and patient and clinician expectations for return to driving a car after a primary TKA or THA.

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