scholarly journals Preoperative opioid use and complications following total joint replacement: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035377
Author(s):  
Cade Shadbolt ◽  
Daniel Gould ◽  
Ximena Camacho ◽  
Josh Knight ◽  
Siddharth Rele ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Assessment Tools ◽  
Study Quality ◽  
Opioid Use ◽  
Meta Analyses

IntroductionMounting evidence now indicates that preoperative opioid use is associated with an array of complications following total joint replacement (TJR). However, evidence of these risks remains fragmented. A comprehensive and well-integrated understanding of this body of evidence is necessary to appropriately inform treatment decisions, the allocation of limited healthcare resources, and the direction of future clinical research. The proposed systematic review and meta-analysis aims to identify and synthesise the available evidence of an association between opioid use prior to TJR and postoperative complications, categorised by complication type.Methods and analysisWe will search MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from inception to April 2020. Observational and experimental studies that compare preoperative opioid users who have undergone elective TJR to opioid naïve TJR patients will be included. The primary outcomes will be postoperative complications, which will be categorised as either mortality, morbidity, or joint-related complications. The secondary outcomes will be persistent postoperative opioid use, readmission, and length of stay. Individual study quality will be assessed using the relevant NIH–NHLBI study quality assessment tools. Findings will be reported in narrative and tabular form, and, where possible, odds ratios (dichotomous outcomes) or standardised mean differences (continuous outcomes) will be reported with 95% confidence intervals. Where appropriate, random effect meta-analyses will be conducted for each outcome, and heterogeneity will be quantified using the I2 statistic and Cochran’s Q test. This study will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines.Ethics and disseminationEthics approval will not be required as no primary or private data are being collected. Findings will be disseminated through peer-reviewed publication and presentation at academic conferences.PROSPERO registration numberCRD42020153047.

scholarly journals Influence of Coronal Preflaring on the Accuracy of Electronic Working Length Determination: Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (13) ◽  
pp. 2760
Author(s):  
María León-López ◽  
Daniel Cabanillas-Balsera ◽  
Victoria Areal-Quecuty ◽  
Jenifer Martín-González ◽  
María C. Jiménez-Sánchez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Science Studies ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Risk Of Bias ◽  
Permanent Teeth ◽  
Total Risk ◽  
Human Teeth ◽  
Working Length ◽  
Meta Analyses

Aim. To conduct a systematic review and meta-analysis according to the following PICO question: in extracted human permanent teeth, does preflaring, compared with unflared canals, influence the accuracy of WL determination with EAL? Material and Methods. A systematic review was conducted according to the PRISMA checklist, using the following databases: PubMed, Science Direct, Scopus, and Web of Science. Studies related to WL determination using EAL both in preflared and unflared root canals of extracted human teeth were included. The outcome of interest was the accuracy of the electronic WL determination. A quality assessment of the included studies was performed, determining the risk of bias. The meta-analyses were calculated with the 5.4 RevMan software using the inverse variance method with random effects. PROSPERO registration: CRD42021243412. Results. Ten experimental studies fulfilled the inclusion criteria, and most of them found that preflaring increases the accuracy of the EALs in WL determination. The calculated OR was 1.98 (95% CI = 1.65–2.37; p < 0.00001; I2 = 10%), indicating that the determination of WL by EALs is almost twice as accurate in preflared canals. The accuracy of Root ZX in WL determination increases more than three times (OR = 3.25; p < 0.00001). Preflaring with Protaper files significantly increases the accuracy of EALs (OR = 1.76; p < 0.00001). The total risk of bias of the included studies was low. No obvious publication bias was observed. Conclusions. The results indicate a significant increase in the accuracy of WL determination with EAL after preflaring, doubling the percentage of exact measurements. Preflaring should be recommended as an important step during mechanical enlargement of the root canal, not only because it improves the access of the files to the canal, but also because it allows one to obtain more accurate electronic determinations of WL.

scholarly journals Stepped care treatment delivery for depression: a systematic review and meta-analysis

2014 ◽  
Vol 45 (2) ◽  
pp. 231-246 ◽  
Author(s):  
A. van Straten ◽  
J. Hill ◽  
D. A. Richards ◽  
P. Cuijpers
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Subsequent Treatment ◽  
Stepped Care ◽  
Study Quality ◽  
Duration Of Treatment ◽  
Treatment Delivery ◽  
Treatment Organization ◽  
Care Models ◽  
Meta Analyses

BackgroundIn stepped care models patients typically start with a low-intensity evidence-based treatment. Progress is monitored systematically and those patients who do not respond adequately step up to a subsequent treatment of higher intensity. Despite the fact that many guidelines have endorsed this stepped care principle it is not clear if stepped care really delivers similar or better patient outcomes against lower costs compared with other systems. We performed a systematic review and meta-analysis of all randomized trials on stepped care for depression.MethodWe carried out a comprehensive literature search. Selection of studies, evaluation of study quality and extraction of data were performed independently by two authors.ResultsA total of 14 studies were included and 10 were used in the meta-analyses (4580 patients). All studies used screening to identify possible patients and care as usual as a comparator. Study quality was relatively high. Stepped care had a moderate effect on depression (pooled 6-month between-group effect size Cohen'sdwas 0.34; 95% confidence interval 0.20–0.48). The stepped care interventions varied greatly in number and duration of treatment steps, treatments offered, professionals involved, and criteria to step up.ConclusionsThere is currently only limited evidence to suggest that stepped care should be the dominant model of treatment organization. Evidence on (cost-) effectiveness compared with high-intensity psychological therapy alone, as well as with matched care, is required.

Systematic review and meta-analysis of opioid use at 3, 6 and 12 months post-operatively by opioid naïve orthopaedic surgery patients

2021 ◽  
Vol 17 (6) ◽  
pp. 517-529
Author(s):  
Karen-leigh Edward, PhD, BN, GDipPsychology ◽  
Beata Stanley, BPharm ◽  
Lisa Collins, PhD ◽  
Amanda Norman, BA ◽  
Yvonne Bonomo, MBBS, FRACP, PhD, FAChAM ◽  
...  
Keyword(s):  
Systematic Review ◽  
Strong Evidence ◽  
Meta Analysis ◽  
Significant Proportion ◽  
Opioid Use ◽  
Time Points ◽  
Post Surgery ◽  
Potential Factors ◽  
Meta Analyses ◽  
Orthopedic Patients

Background and objective: There is evidence that opioid initiation post-surgery is contributing to the problem of chronic misuse and/or abuse of over the counter medications in the community, and that orthopedic patients may be particularly at risk. The aim of the systematic review with meta-analysis was to identify research that examined opioid use at 3, 6, and 12 months post-operatively by previously opioid naïve orthopedic surgery patients.Design, databases, and data treatment: A searched review with meta-analysis was undertaken. Eight databases were search. Meta-analyses conducted at all three time points (3 months, 6 months, and 12 months).Results: The search yielded 779 records, and after screening, 13 papers were included in meta-analysis. Results provide strong evidence that post-operative opioid use amongst the opioid naïve is a real effect (7 percent at 3 months, 4 percent at 6 months, and 2 percent at 12 months). A Z-test for overall effect revealed strong evidence that this proportion was nonzero for opioid use at 3, 6, and 12 months (p 0.001 for all time points). A small but significant proportion of opioid naïve patients who are prescribed opioids remain on these medications up to 12 months post-operatively.Conclusions: The nature of the studies included in the meta-analysis were varied, hence subanalyses regarding surgery type, characteristics of the patient group or other potential factors that might influence the progression to longer term opioid use after these surgeries could not be explored. Given this, further research in this area should explore such specific orthopedic subgroups.

The Effect of Plantago major on Wound Healing in Preclinical Studies: A Systematic Review

2021 ◽  
Vol 67 (1) ◽  
pp. 27-34
Author(s):  
Fernanda Cardoso ◽  
Jéssica Breder ◽  
Priscila Apolinário ◽  
Henrique Oliveia ◽  
Maria Saidel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Wound Healing ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Risk Of Bias ◽  
Preclinical Studies ◽  
Plantago Major ◽  
Best Response ◽  
Meta Analyses

BACKGROUND: Plantago major is a medicinal plant that has been used for centuries to treat various health conditions including wounds. PURPOSE: To investigate the effectiveness of the topical use of P major in healing skin wounds in animal models. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted. Seven (7) electronic databases (Virtual Health Library, Public/Publisher MEDLINE, Scopus, Web of Science, Embase, Cumulative Index of Nursing and Allied Health Literature, and CAB Direct) were searched for controlled studies published in English from January 2006 to March 2020. The Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies tools guided the evaluation of the studies and determined their quality. The Systematic Review Center for Laboratory Animal Experimentation was used to assess the risk of bias. RESULTS: Of the 176 publications identified, 4 met the inclusion criteria. Studies included 20 to 100 animals and varying concentrations of P major. There were no reports of losses during research. Wound healing was assessed between 17 and 21 days following wounding. The best response in terms of wound contraction rate occurred with 10%, 20%, and 50% concentrations when compared with control groups. One (1) study did not have an animal ethics committee review. All studies had a high risk of bias and a lack of methodological rigor. CONCLUSION: The results of this review did not find evidence about the in vivo effectiveness of P major for wound healing. More rigorous preclinical studies with adequate sample sizes are required to identify the best concentrations and formulations as well as increase understanding about the mechanisms of action of P major in wound healing.

scholarly journals The Efficacy of Recasts in Language Intervention: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 24 (2) ◽  
pp. 237-255 ◽  
Author(s):  
Patricia L. Cleave ◽  
Stephanie D. Becker ◽  
Maura K. Curran ◽  
Amanda J. Owen Van Horne ◽  
Marc E. Fey
Keyword(s):  
Systematic Review ◽  
Research Evidence ◽  
Meta Analysis ◽  
Language Intervention ◽  
Effect Sizes ◽  
Study Quality ◽  
Average Effect ◽  
Grammatical Development ◽  
Meta Analyses ◽  
Study Designs

Purpose This systematic review and meta-analysis critically evaluated the research evidence on the effectiveness of conversational recasts in grammatical development for children with language impairments. Method Two different but complementary reviews were conducted and then integrated. Systematic searches of the literature resulted in 35 articles for the systematic review. Studies that employed a wide variety of study designs were involved, but all examined interventions where recasts were the key component. The meta-analysis only included studies that allowed the calculation of effect sizes, but it did include package interventions in which recasts were a major part. Fourteen studies were included, 7 of which were also in the systematic review. Studies were grouped according to research phase and were rated for quality. Results Study quality and thus strength of evidence varied substantially. Nevertheless, across all phases, the vast majority of studies provided support for the use of recasts. Meta-analyses found average effect sizes of .96 for proximal measures and .76 for distal measures, reflecting a positive benefit of about 0.75 to 1.00 standard deviation. Conclusion The available evidence is limited, but it is supportive of the use of recasts in grammatical intervention. Critical features of recasts in grammatical interventions are discussed.

scholarly journals Risk of behaviour suggestive of opioid abuse: a protocol for a systematic review of validated assessment tools

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021948
Author(s):  
Sheila Raposo Galindo ◽  
Tatiana de Paula Santana da Silva ◽  
Manoel Henrique da Nóbrega Marinho ◽  
Carlos Eduardo de Souza Leão Ribeiro ◽  
Murilo Duarte da Costa Lima ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Meta Analysis ◽  
Opioid Abuse ◽  
Assessment Tools ◽  
Measurement Instruments ◽  
Opioid Use ◽  
Health Measurement ◽  
Registration Number ◽  
The Individual

IntroductionOpioid use patterns of individuals with non-cancer pain are influenced by the behavioural dynamics of the individual in managing and properly following the prescription. The use of assessment tools for measuring the risk of behaviour suggestive of opioid abuse is important for health professionals who provide care to individuals with non-cancer pain. The aim of the proposed review is to analyse the psychometric properties of tools for measuring the risk of behaviour suggestive of opioid abuse in adults with non-cancer pain.Methods and analysisThe review process will be based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The Consensus-Based Standards for the Selection of Health Measurement Instruments will be used to analyse the assessment tools. Two independent reviewers will perform the literature search and analysis procedures. Searches will be performed on PubMed, Web of Science, Cochrane, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases, and the ‘snowball’ strategy will be employed. The inclusion criteria will be (1) validation studies, (2) assessment tools designed exclusively for measuring the risk of behaviour suggestive of opioid abuse and (3) assessment tools designed for evaluation of adults with chronic non-cancer pain. The titles and abstracts of the studies retrieved from the databases will be analysed for the preselection of articles, which will be submitted to a full-text analysis to define the final sample. Divergence of opinion between two reviewers will be resolved by consulting a third reviewer.Ethics and disseminationThe review will offer an overview of assessment tools available for measuring the risk of behaviour suggestive of opioid abuse, which is relevant to reducing the risk of deaths due to abusive consumption and for clinical management of adults with chronic non-cancer pain.PROSPERO registration numberCRD42018081577.

scholarly journals Comparison of complications of early and delayed open reduction and internal fixation for treating pilon fracture: A protocol of systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258962
Author(s):  
Yang Chen ◽  
Xiaoyu Huang ◽  
Yili Chen ◽  
Changlong Shi ◽  
Hao Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
Open Reduction ◽  
Meta Analysis ◽  
Assessment Tools ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Statistical Heterogeneity ◽  
Pilon Fractures

Background Tibial Pilon fractures are severe fractures accompanied by soft tissue injury. Although open reduction and internal fixation (ORIF) are effective in treating Pilon fractures, there is a controversy over time to surgery due to reported postoperative complications. However, there is no systematic review evaluating the difference of postoperative complications between early and delayed ORIF for treating pilon fractures. Methods Relevant literature written in English will be searched through PubMed, Cochrane Library, Embase, MEDLINE, and Web of Science. The study aims to compare the effects and complications of early and delayed ORIF for treating fresh pilon fractures in adult patients. The primary outcome will be infection rate, fracture union time, nonunion and malunion rate. And the secondary outcome will be metalwork removal, amputation, and ankle function grade. Two reviewers will independently assess the eligibility of the studies according to the pre-defined inclusion and exclusion criteria. A meta-analysis for the available data will be conducted using Revman 5.3. To measure effect size, odds ratios (ORs) and mean difference will be used for dichotomous and continuous data, respectively. Statistical heterogeneity will be explored. And a random-effects model or a fixed-effects will be used in pooled data on the basis of the existence or absence of heterogeneity. Subgroup analysis will be conducted to identify sources of heterogeneity and sensitivity analysis to test the results’ robustness. We will assess the risk of bias by four different quality assessment tools according to the study design. Publication bias will be evaluated by funnel plot. The study data will be stored in the Open Science Framework website. PROSPERO registration number CRD42020207465

scholarly journals Beta-lactam vs Fluoroquinolone Monotherapy for Pseudomonas aeruginosa Infection: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Eric Reid ◽  
Ryan Walters ◽  
Christopher Destache
Keyword(s):  
Systematic Review ◽  
Pseudomonas Aeruginosa ◽  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Tissue Infection ◽  
Assessment Tools ◽  
Bacteriological Eradication ◽  
Meta Analyses

Abstract Introduction: Pseudomonas aeruginosa (PA) is a leading cause of healthcare-associated infections. A variety of antibiotic classes are used in the treatment of PA infections, including beta-lactams (BLs) and fluoroquinolones (FQs), given either together in combination therapy or alone in monotherapy. A systematic review and meta-analysis were performed to evaluate the therapeutic efficacy of BL agents versus FQ agents as active, definitive monotherapy in PA infections in adults.Methods: Comprehensive literature searches of Medline and Scopus electronic databases, alongside hand searches of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar, were performed without time restriction to identify studies published in English comparing BL and FQ agents given as monotherapy for PA infection in hospitalized adults for which mortality, bacteriological eradication, or clinical response was evaluated. One reviewer screened search results based on pre-defined selection criteria. Two reviewers independently assessed included studies for methodological quality using NIH assessment tools. Two fixed-effects meta-analyses were performed.Results: A total of 368 articles were screened, and 6 studies involving 338 total patients were included in the meta-analysis. Upon evaluation of methodological quality, 2 studies were rated good, 3 fair, and 1 poor. A meta-analysis of 3 studies demonstrates FQ monotherapy is associated with significantly improved survival compared to BL monotherapy for patients with PA bacteremia (OR, 3.65; 95% CI, 1.27-10.44; p=.02). A meta-analysis of 3 studies demonstrates FQ monotherapy is associated with equivalent bacteriological eradication compared to BL monotherapy for PA pneumonia or skin and soft tissue infection (RD, 0.07; 95% CI, -0.09 to 0.24; p=.39).Conclusion: The meta-analyses demonstrate FQ monotherapy significantly improves survival in PA bacteremia and is associated with similar rates of bacteriological eradication in pneumonia and skin and soft tissue infection caused by PA compared to BL monotherapy. However, more research is needed to make meaningful clinical recommendations.

Abstract P541: High Allostatic Load is Associated With Increased Risk of All-cause Mortality - A Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Haley W Parker ◽  
Alyssa M Abreu ◽  
Mary Sullivan ◽  
Maya K Vadiveloo
Keyword(s):  
Systematic Review ◽  
Allostatic Load ◽  
Meta Analysis ◽  
Study Quality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Meta Analyses ◽  
Sample Age ◽  
The Relationship ◽  
Cvd Mortality

Introduction: Allostatic load (AL) is a measure of physiological damage from chronic stress, quantified using a variety of neuroendocrine, metabolic, cardiovascular, and immune biomarkers. While AL has been associated with several mortality risk factors (e.g., metabolic disorders, inflammation, cardiovascular disease (CVD), frailty), to date, no meta-analyses have examined the relationship between AL and mortality. This systematic review and meta-analysis examines the relationship between AL and mortality (CVD and all-cause). Hypothesis: Higher AL (i.e., increased dysregulation) will be associated with an increased risk of all-cause and CVD mortality. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided this review. Two databases (PubMed and EMBASE) were searched in Feb 2019 with the terms: ((mortality) OR survival) AND ((allostatic load) OR allostasis); references of included studies were also screened. Included studies met the a priori inclusion criteria (i.e. compared mortality (all-cause and/or CVD) in high vs. low AL (defined by study) in adults). Study quality was assessed with the Newcastle Ottawa Criteria. Findings were qualitatively synthesized then the meta-analysis was completed in Review Manager 5.3. Subgroups were examined by design and sample age. Results: Database searches and references identified 400 studies; after removing duplicates, 266 abstracts were screened and 32 full texts were reviewed. The systematic review included 12 observational studies (2001-18) examining all-cause mortality; half were also included in meta-analyses. Of the 12 included studies, most examined CVD mortality (n=7), were longitudinal (n=7), from the US (n=7), and had a balanced sex distribution. In the qualitative review, high AL was consistently associated with increased risk of all-cause mortality (n=11 of 12 studies, hazard ratio (HR) range=1.13-2.98), however, the association was less consistent for CVD mortality (n=4 of 7 studies, HR=1.12-3.06). In meta-analyses, high AL was associated with increased risk of all-cause (HR= 1.46 [1.24, 1.72], n=6) and CVD mortality (HR= 1.18 [1.02, 1.38], n=4). High AL was associated with all-cause mortality in subgroup analyses stratified by design (cross-sectional HR=1.44 [1.14, 1.81], n=3; longitudinal HR=1.61 [1.11, 2.33], n=3) and sample age (older adults HR=1.17 [1.10, 1.24], n=3; all adults HR=1.94 [1.45, 2.60], n=3). Heterogeneity was high (I 2 =85-96%) in analyses except for the older adults subgroup (I 2 =18%). Study quality was good in 7 studies (including all studies in the meta-analysis), fair in 3 studies, and poor in 2 studies. Conclusions: In this review of relatively high-quality studies, high AL was associated with a 46% increased risk of all-cause mortality and may also be associated with CVD mortality. Thus, AL shows promise as a prognostic indicator for mortality.

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