scholarly journals The Value of Systematic Reviews and Meta-Analyses in Surgery

2021 ◽  
pp. 1-8
Author(s):  
Simon R. Knight
Keyword(s):  
Clinical Trials ◽  
Systematic Reviews ◽  
Practice Guidelines ◽  
Statistical Power ◽  
Clinical Decision Making ◽  
Learning Curves ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Surgical Interventions ◽  
Meta Analyses

<b><i>Background:</i></b> Systematic reviews and meta-analyses are generally regarded as sitting atop the hierarchy of clinical evidence. The unbiased summary of current evidence that a systematic review provides, along with the increased statistical power from larger numbers of patients, is invaluable in guiding clinical decision-making and development of practice guidelines. Surgical specialties have historically lagged behind other areas of medicine in the application of evidence-based medicine, perhaps due to the unique challenges faced in the conduct of surgical clinical trials. These challenges extend to the conduct of systematic reviews, due to issues with the quality and heterogeneity of the underlying literature. <b><i>Summary:</i></b> Recent years have seen an improvement in the quality of randomized controlled trials in surgical topics and an explosion in the publication of systematic reviews. This review explores recent trends in systematic reviews in surgery and discussed some of the aspects in conducting and interpreting reviews that are unique to surgical topics, including blinding, surgical heterogeneity and learning curves, patient and clinician preference, and industry involvement. <b><i>Key Messages:</i></b> Clinical trials, and therefore systematic reviews, of surgical interventions pose unique challenges which are important to consider when conducting them or applying the findings to clinical practice. Despite the challenges, systematic reviews still represent the best level of evidence for development of surgical practice guidelines.

scholarly journals Analysis of the evidence of efficacy and safety of over-the-counter cough medications registered in Brazil

2010 ◽  
Vol 46 (1) ◽  
pp. 135-145
Author(s):  
Adriano Max Moreira Reis ◽  
Albert Figueras
Keyword(s):  
Clinical Trials ◽  
Systematic Reviews ◽  
Randomized Clinical Trials ◽  
Fixed Dose ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Over The Counter ◽  
Essential Information ◽  
Health Database ◽  
Meta Analyses

The objective of this study was to analyze the level of evidence regarding the efficacy, effectiveness and safety of over-the-counter (OTC) cough medications registered in Brazil. The National Health Surveillance Agency database was used to identify the drugs. Clinical trials, systematic reviews, meta-analyses, and studies on safety were searched on the Medline baseline, the Cochrane Library and SIETES (System of Essential Information in Therapeutics and Health; database in Spanish). Most drugs (62.5%) were sold as a fixed-dose combination of two or more drugs. Randomized clinical trials were found for only three drugs: bromhexine, dextromethorphan and guaifenesin. No clinical trials were found for fixed-dose combinations. Systematic reviews on Cochrane did not report any evidence in favor of or against the effectiveness of cough drugs. Efficacy is also unclear, especially regarding fixed-dose combinations. The evidence for the efficacy of OTC cough medications available in Brazil is poor due to the lack of quality studies. Pharmacovigilance of OTC cough medications should be encouraged.

scholarly journals An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095030
Author(s):  
Jason B. Smoak ◽  
John R. Matthews ◽  
Amrit V. Vinod ◽  
Melissa A. Kluczynski ◽  
Leslie J. Bisson
Keyword(s):  
Systematic Reviews ◽  
Meniscal Repair ◽  
Patient Reported Outcome Measures ◽  
Current Evidence ◽  
Postoperative Rehabilitation ◽  
Level Of Evidence ◽  
Meniscal Allograft ◽  
Study Protocols ◽  
Patient Reported ◽  
Meta Analyses

Background: A large number of systematic reviews and meta-analyses regarding the meniscus have been published. Purpose: To provide a qualitative summary of the published systematic reviews and meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the meniscus and published between July 2009 and July 2019 was performed with PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts, narrative reviews, articles not written in English, commentaries, study protocols, and topics that were not focused on the meniscus were excluded. The most pertinent results were extracted and summarized from each study. Results: A total of 332 articles were found, of which 142 were included. Included articles were summarized and divided into 16 topics: epidemiology, diagnosis, histology, biomechanics, comorbid pathology, animal models, arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root repairs, meniscal allograft transplantation (MAT), meniscal implants and scaffolds, mesenchymal stem cells and growth factors, postoperative rehabilitation, postoperative imaging assessment, patient-reported outcome measures, and cost-effectiveness. The majority of articles focused on APM (20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a single source of the current evidence regarding the meniscus.

scholarly journals Platelet-rich plasma in osteoarthritis treatment: review of current evidence

2019 ◽  
Vol 10 ◽  
pp. 204062231982556 ◽  
Author(s):  
Lucía Gato-Calvo ◽  
Joana Magalhaes ◽  
Cristina Ruiz-Romero ◽  
Francisco J. Blanco ◽  
Elena F. Burguera
Keyword(s):  
Knee Osteoarthritis ◽  
Systematic Reviews ◽  
Platelet Rich Plasma ◽  
Clinical Effectiveness ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Relevant Evidence ◽  
Osteoarthritis Treatment ◽  
Clinical Case Studies ◽  
Meta Analyses

Platelet-rich plasma (PRP) is defined as a volume of plasma with a platelet concentration higher than the average in peripheral blood. Many basic, preclinical and even clinical case studies and trials report PRP’s ability to improve musculoskeletal conditions including osteoarthritis, but paradoxically, just as many conclude it has no effect. The purpose of this narrative review is to discuss the available relevant evidence that supports the clinical use of PRP in osteoarthritis, highlighting those variables we perceive as critical. Here, recent systematic reviews and meta-analyses were used to identify the latest randomized controlled trials (RCTs) testing a PRP product as an intra-articular treatment for knee osteoarthritis, compared with an intra-articular control (mostly hyaluronic acid). Conclusions in the identified RCTs are examined and compared. In total, five recent meta-analyses and systematic reviews were found meeting the above criteria. A total of 19 individual trials were identified in the five reviews but only 9 were level of evidence I RCTs, and many had moderate or high risks of bias. At present, results from these RCTs seem to favor PRP use over other intra-articular treatments to improve pain scales in the short and medium term (6–12 months), but the overall level of evidence is low. As a result, clinical effectiveness of PRP for knee osteoarthritis treatment is still under debate. This is, prominently, the result of a lack of standardization of PRP products, scarceness of high quality RCTs not showing high risks of bias, and poor patient stratification for inclusion in the RCTs.

scholarly journals Consequences of the COVID-19 Syndemic for Nutritional Health: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1168
Author(s):  
Cristian Neira ◽  
Rejane Godinho ◽  
Fabio Rincón ◽  
Rodrigo Mardones ◽  
Janari Pedroso
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Preventive Measures ◽  
Physical Contact ◽  
Current Evidence ◽  
Study Objective ◽  
Eating Style ◽  
Healthy Nutrition ◽  
Meta Analyses ◽  
The Impact

Confinement at home, quarantine, and social distancing are some measures adopted worldwide to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), which has been generating an important alteration in the routines and qualities of life of people. The impact on health is still being evaluated, and consequences in the nutritional field are not entirely clear. The study objective was to evaluate the current evidence about the impact that preventive measures of physical contact restriction causes in healthy nutrition. A systematic review was carried out according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” PRISMA Group and Cochrane method for rapid systematic reviews. Searching was performed in six electronic databases and evaluated articles published between 2010 and 2020, including among their participants adult subjects who had been exposed to the preventive measures of physical contact restriction. Seven studies met the selection criteria and reported an overall increase in food consumption, weight, Body Mass Index (BMI), and a change in eating style. Findings suggest that healthy nutrition is affected by preventive measures to restrict physical contact as a result of the COVID-19 syndemic.

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

scholarly journals Stroke and food groups: an overview of systematic reviews and meta-analyses

2017 ◽  
Vol 21 (4) ◽  
pp. 766-776 ◽  
Author(s):  
Cuiyu Deng ◽  
Qi Lu ◽  
Bingyan Gong ◽  
Liya Li ◽  
Lianxia Chang ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Prospective Studies ◽  
Stroke Risk ◽  
Cochrane Library ◽  
Processed Meat ◽  
Stroke Outcome ◽  
Food Groups ◽  
Level Of Evidence ◽  
High Consumption ◽  
Meta Analyses

AbstractObjectiveNumerous systematic reviews of prospective studies on the association of stroke risk with the consumption of various food groups have been published. A review of the evidence across the existing systematic reviews and meta-analyses of prospective studies was conducted to provide an overview of the range and validity of the reported associations of food groups with stroke risk.DesignThe PubMed, EMBASE and Cochrane Library databases were searched for articles published up to September 2015 to identify systematic reviews of prospective studies.ResultsA total of eighteen studies published from 2008 to 2015 were eligible for analysis. Overall, thirteen specific foods were studied for an association with stroke outcome, including nuts, legumes, fruits and vegetables, refined grains, whole grains, dairy products, eggs, chocolate, red and/or processed meat, fish, tea, sugar-sweetened beverages and coffee. Whereas a high consumption of nuts, fruits, vegetables, dairy foods, fish and tea, and moderate consumption of coffee and chocolate demonstrated a protective effect, a high consumption of red and/or processed meat was associated with increased stroke risk. Refined grain, sugar-sweetened beverage, legume, egg and whole grain intake showed no effect on stroke outcome.ConclusionsThe current overview provided a high level of evidence to support the beneficial effect of specific foods on stroke outcome. Clinicians and policy makers could inform clinical practice and policy based on this overview.

scholarly journals (Protocol) Preferred Reporting Items for Resistance Exercise Studies (PRIRES): An Umbrella Review of Systematic Reviews, Guidelines, and Position Stands for Item Extraction

2021 ◽  
Author(s):  
Ting-Yu Lin ◽  
Ting-Yu Chueh ◽  
Tsung-Min Hung
Keyword(s):  
Resistance Exercise ◽  
Systematic Reviews ◽  
Reporting Quality ◽  
Science Research ◽  
Plain Language ◽  
Letters To The Editor ◽  
Level Of Evidence ◽  
Sports Science ◽  
Animal Research Ethics ◽  
Meta Analyses

Abstract BackgroundThe issues of replication and scientific transparency have been raised in exercise and sports science research. A potential means to address the replication crisis and enhance research reliability is to improve reporting quality and transparency. This study aims to formulate a reporting checklist as a supplement to the existing reporting guidelines, specifically for resistance exercise studies.MethodsSystematic reviews/meta-analyses, guidelines, and position stands related to resistance exercise since inception will be searched in PubMed and Scopus. Only studies published in English will be included. Two authors will independently screen titles/abstracts and then full-text articles against the inclusion criteria. Basic data will be extracted by the same two authors independently. The same two authors will independently extract items from systematic reviews, guidelines, and position stands that could potentially influence training efficiency, physiological/psychological functions, other health-related variables, or replication. Summaries of the findings and items extracted from the included systematic reviews/meta-analyses and included position stands or guidelines will be presented as tables. Using items adapted from the existing checklist Consensus on Exercise Reporting Template (CERT), a preferred reporting checklist for resistance exercise studies will be formulated. The protocol for this study was developed according to the reporting checklist for umbrella reviews published by Onishi and Furukawa in 2016.DiscussionThe proposed study is expected to build a reporting checklist with a high level of evidence, which can improve the reporting quality of future resistance exercise studies.Ethics and disseminationApproval from a human/animal research ethics committee is not required. The findings of the proposed study will be disseminated through conference presentations, our lab’s website in plain language, and, if possible, letters to the editor in peer-reviewed journals related to sport and exercise science.RegistrationThis study is registered with the EQUATOR Network under the title “Preferred Reporting Items for Resistance Exercise Studies (PRIRES).” PROSPERO registration number: CRD42021235259.

scholarly journals Manipulative and Manual Therapies in the Management of Patients with Prior Lumbar Surgery: A Systematic Review

2020 ◽  
Author(s):  
Clinton J Daniels ◽  
Zachary A. Cupler ◽  
Jordan A Gliedt ◽  
Sheryl Walters ◽  
Alec L Schielke ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Clinical Decision ◽  
Manual Therapies ◽  
Lumbar Surgery ◽  
Pilot Studies ◽  
Surgical Interventions

Abstract BackgroundThe purpose was to identify, summarize, and rate scholarly literature that describes manipulative and manual therapy following lumbar surgery.MethodsThe review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. PubMed, Cochrane Database of Systematic Reviews, ICL, CINAHL, and PEDro were searched through July 2019. Articles were screened independently by at least two reviewers for inclusion. Articles included described the practice, utilization, and/or clinical decision making to post surgical intervention with manipulative and/or manual therapies. Data extraction consisted of principal findings, pain and function/disability, patient satisfaction, opioid/medication consumption, and adverse events. Scottish Intercollegiate Guidelines Network critical appraisal checklists were utilized to assess study quality.ResultsLiterature search yielded 1916 articles, 348 duplicates were removed, 109 full-text articles were screened and 50 citations met inclusion criteria. There were 37 case reports/case series, 3 randomized controlled trials, 3 pilot studies, 5 systematic/scoping/narrative reviews, and 2 commentaries. ConclusionThe findings of this review may help inform practitioners who utilize manipulative and/or manual therapies regarding levels of evidence for patients with prior lumbar surgery. Following lumbar surgery, the evidence indicated inpatient neural mobilization does not improve outcomes. There is inconclusive evidence to recommend for or against most manual therapies after most surgical interventions.Trial registrationProspectively registered with PROSPERO (#CRD42020137314). Registered 24 January 2020.

Factors associated with neck pain in fighter aircrew: a systematic review and meta-analysis

2021 ◽  
pp. oemed-2020-107103
Author(s):  
James B Wallace ◽  
Phil M Newman ◽  
Aoife McGarvey ◽  
Peter G Osmotherly ◽  
Wayne Spratford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neck Pain ◽  
Data Availability ◽  
Computer Work ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Operational Capability ◽  
Factors Associated ◽  
Common Complaint ◽  
Meta Analyses

Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew. Six electronic databases were searched in June 2019 and updated in June 2020 utilising the maximum date ranges. Included studies were appraised for methodological quality, ranked according to level of evidence and relevant data extracted. Where methods were homogeneous and data availability allowed, meta-analyses were performed. A total of 20 studies (16 cross sectional, one case–control, one retrospective cohort and two prospective cohort) were eligible for inclusion. Of the 44 factors investigated, consistent evidence was reported for greater occurrence of neck pain among aircrew operating more advanced aircraft and those exposed to more desk/computer work, while another 12 factors reported consistent evidence for no association. Of the 20 factors where meta-analyses could be performed, greater occurrence of neck pain was indicated for aircrew: flying more advanced aircraft, undertaking warm-up stretching and not placing their head against the seat under greater +Gz. Despite many studies investigating factors associated with neck pain among fighter aircrew, methodological limitations limited the ability to identify those factors that are most important to future preventive programmes. High-quality prospective studies with consistent use of definitions are required before we can implement efficient and effective programmes to reduce the prevalence and impact of neck pain in fighter aircrew. PROSPERO registration number: CRD42019128952.Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew.

Auriculoterapia para o tratamento da ansiedade em estudantes universitários: revisão sistemática

2021 ◽  
Author(s):  
◽  
Lara dos Santos Silva
Keyword(s):  
Clinical Trials ◽  
Systematic Reviews ◽  
Ad Hoc ◽  
Cochrane Collaboration ◽  
Risk Of Bias ◽  
Meta Analyses ◽  
Tecnología Educativa

A ansiedade está entre os transtornos mentais de maior prevalência na população mundial, sendo a segunda causa de incapacidade mental no mundo. Dentre a população suscetível à ansiedade, destacam-se os estudantes universitários, em decorrência das situações vivenciadas no âmbito acadêmico. Os tratamentos da ansiedade podem estar pautados em recursos medicamentosos e não medicamentosos. Dentre os não medicamentosos, destacam-se as Práticas Integrativas e Complementares em Saúde e, dentre estas, a auriculoterapia. O objetivo geral deste estudo foi s intetizar as evidências disponíveis na literatura científica sobre o uso da auriculoterapia no tratamento da ansiedade em estudantes universitários. Trata-se de uma revisão sistemática da literatura, realizada em 16 bases de dados, com início em 20 de janeiro e revisão até 27 de março de 2021. Todo o processo de busca e seleção dos artigos foi feito de modo independente e pareado, e, quando necessário, um terceiro pesquisador com experiência na temática auxiliava como ad hoc na resolução dos conflitos. O relato da revisão pautou-se na diretriz Preferred Reporting Items for Systematic Reviews and Meta-Analyses, e o protocolo da revisão foi cadastrado na plataforma International Prospective Register of Systematic Reviews (registro No CRD42020205968). Utilizou-se as diretrizes Standards for Reporting Interventions in Clinical Trials of Acupuncture, Cochrane Collaboration Risk of Bias Tool, e escala de JADAD para avaliação dos artigos. A amostra final foi composta por cinco artigos. A análise dos mesmos mostrou que a auriculoterapia contribuiu para tratar a ansiedade de estudantes universitários. O uso desta intervenção deve ser considerado pelas instituições formadoras para promoção da saúde mental nesta população, e pode contribuir para a melhora do desempenho acadêmico, redução das taxas de evasão, e melhora da qualidade de vida aos universitários. O estudo também possibilitou a elaboração de uma tecnologia educativa no formato de cartilha, com o objetivo de esclarecer aos estudantes universitários sobre a ansiedade como um problema de saúde relevante na população, bem como apresentar a auriculoterapia como uma possibilidade terapêutica. Pretende-se que, em momento oportuno, a mesma seja divulgada em formato eletrônico para toda a comunidade acadêmica. Palavras-chave: Auriculoterapia. Terapia auricular. Ansiedade. Estudantes.

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