scholarly journals Effect of pretreatment with midazolam on etomidate-induced myoclonus: A meta-analysis

2017 ◽  
Vol 45 (2) ◽  
pp. 399-406 ◽  
Author(s):  
Chengmao Zhou ◽  
Yu Zhu ◽  
Zhen Liu ◽  
Lin Ruan
Keyword(s):  
Incidence Rate ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Group Versus ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Fixed Effects Model ◽  
Control Groups ◽  
Randomized Controlled ◽  
Review Manager

Objective To investigate the effect of pretreatment with midazolam on myoclonus induced by etomidate injection. Methods A meta-analysis was performed using Review Manager software, version 5.2. Two researchers independently searched PubMed, Cochrane Library, and Embase® databases for randomized controlled trials involving patients who underwent etomidate induced general anaesthesia with or without midazolam pretreatment, published between 1990 and 2016. Outcome measures comprised overall myoclonus incidence rate and incidence rate classified by degree of myoclonus following etomidate injection. Data were assessed using a fixed effects model. Results Five studies, comprising 302 patients, were included for analysis. Overall incidence rate of etomidate injection-induced myoclonus was significantly lower in the pooled midazolam group versus controls (relative risk [RR] 0.34, 95% confidence interval [CI] 0.26, 0.44); Results subgrouped by degree of myoclonus showed significantly lower incidence in midazolam groups versus control groups for mild myoclonus (RR 0.56, 95% CI 0.39, 0.80); moderate myoclonus (RR 0.20, 95% CI 0.10, 0.41); and severe myoclonus (RR 0.12, 95% CI 0.04, 0.39). Conclusion Midazolam can effectively prevent etomidate-induced myoclonus, and alleviate the degree of etomidate-induced myoclonus.

scholarly journals Poly(ADP-Ribose) Polymerase Inhibitors (PARPi) for Patients With Advanced Breast Cancer: a Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
YongCheng Su ◽  
XiaoGang Zheng
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Parp Inhibitors ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Grade 3

Abstract BACKGROUND: Poly(ADP–ribose) polymerase (PARP) inhibitors are new class of drugs that are currently being studied in several malignancies. However, datas about the efficacy and safety of the PARP inhibitors are limited. Therefore, we conducted a meta-analysis of randomized controlled trials (RCT) in patients with breast cancer.METHODS: Pubmed/Medline, Embase, Cochrane Library, and abstracts presented at the annual meeting of the American Society of Clinical Oncology (ASCO) were searched for articles published from 2000 to June 2018.Summary incidences and the RR, HR with 95% confidence intervals, were calculated by using a random-effects or fixed-effects model.RESULTS: The summary HR indicated PARPi was not associated with OS (HR=0.83, 95%CI 0.66–1.06, Z=1.49, P=0.14), while it could significantly improve PFS ande time to deterioration (TTD) of global health status/quality of life(GHS/QoL) as compared with traditional standard therapy, the HR was 0.60(95%CI 0.50-0.72; Z=5.52, P＜0.00001) and 0.4 (95%CI 0.29–0.54,z=5.80 ,p=0.000),respectively.The RR of grade 3 or more anemia ,fatigue and headache was 3.02 (95% CI, 0.69–13.17;p = 0.14,,I2=90%),0.77 (95%CI, 0.34–1.73;p=0.52,I2=7%) and 1.13 (95% CI,0.30–4.18;p=0.86,I2=0%),respectively.CONCLUSION: The findings of this meta-analysis showed that PARPi has no significant effect on OS, while it could significantly improve in PFS and TTD of GHS/QoL for patients with advanced or metastatic breast cancer.Furthermore,our findings also demonstrated that the PARPi treatment is connected with an increased risk of grade 3 or more anemia adverse events.

Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer: A systematic review and meta-analysis

2020 ◽  
pp. 112972982095099
Author(s):  
Xiaohong Wu ◽  
Tiantian Zhang ◽  
Lichan Chen ◽  
Xisui Chen
Keyword(s):  
Fixed Effects ◽  
Meta Analysis ◽  
Monthly Interval ◽  
Cochrane Library ◽  
Fixed Effects Model ◽  
Eligibility Criteria ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Statistical Heterogeneity ◽  
Significant Difference

Background: Recently, some studies have shown that prolonging flush interval is safe and feasible for patients who complete chemotherapy. However, there is no consensus about the optimal flush interval for those patients. Objective: The purpose of this review was to evaluate whether the flush interval could be prolonged based on monthly interval for regular maintenance and to explore the optimal flush interval. Data sources: We searched the following databases for articles published between 1 January 1982 and 21 February 2020: PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and Ovid. Study eligibility criteria: Randomized controlled trials, retrospective and prospective cohort studies of flush interval less than 4 weeks versus longer than 4 weeks for patients who completed chemotherapy, were included. Results: Two reviewers extracted information and assessed the quality of the articles independently. In total, 389 articles were retrieved, and 4 studies including 862 cases fulfilled the inclusion criteria. There was no statistical heterogeneity ( I2 = 0, p > 0.05) among the included studies. Hence, the fixed-effects model was used for the meta-analysis. The meta-analysis showed that the total complication rate associated with longer than 4-week interval was higher than that associated with less than 4-week interval. Nevertheless, there was no significant difference between the two groups (7.2% vs 7.6%, p = 0.83). Moreover, the meta-analysis showed that the total complication and catheter occlusion rates associated with the 4-week interval were higher than those associated with the 8-week interval. However, there was no significant difference between the two groups (total complications: 11.4% vs 9.5%, p = 0.68; catheter occlusions: 4.9% vs 4.1%, p = 0.89). Limitations: Only four non-randomized controlled studies were included, and the outcomes of the included studies were reported incompletely. Conclusion: Extending the flush interval to longer than 4 weeks is safe and feasible. Based on previous studies, extending the flush interval to 8 weeks might not increase the incidence of total complications and catheter occlusions. However, there is no conclusion on whether the flush interval could be extended to 3 months or longer.

scholarly journals Qigong-Based Therapy for Treating Adults with Major Depressive Disorder: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 16 (5) ◽  
pp. 826 ◽  
Author(s):  
Lijuan Guo ◽  
Zhaowei Kong ◽  
Yanjie Zhang
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Depression Symptoms ◽  
Controlled Trials ◽  
Control Groups ◽  
Major Depressive ◽  
Randomized Controlled

This current meta-analysis review was conducted to examine the effectiveness of Qigong-based therapy on individuals with major depressive disorder. Six electronic databases (PubMed, PsycINFO, Cochrane Library, and Web of Science, Chinese National Knowledge Infrastructure, and Wangfang) were employed to retrieve potential articles that were randomized controlled trials. The synthesized effect sizes (Hedges’ g) were computerized to explore the effectiveness of Qigong-based therapy. Additionally, a moderator analysis was performed based on the control type. The pooled results indicated that Qigong-based therapy has a significant benefit on depression severity (Hedges’ g = −0.64, 95% CI −0.92 to −0.35, p < 0. 001, I2 = 41.73%). Specifically, Qigong led to significantly reduced depression as compared to the active control groups (Hedges’ g = −0.47, 95% CI −0.81 to −0.12, p = 0.01, I2 = 22.75%) and the passive control groups (Hedges’ g = −0.80, 95% CI −1.23 to −0.37, p < 0.01, I2 = 48.07%), respectively. For studies which reported categorical outcomes, Qigong intervention showed significantly improved treatment response rates (OR = 4.38, 95% CI 1.26 to 15.23, p = 0.02) and remission rates (OR = 8.52, 95% CI 1.91 to 37.98, p = 0.005) in comparison to the waitlist control group. Conclusions: Qigong-based exercises may be effective for alleviating depression symptoms in individuals with major depressive disorder. Future well-designed, randomized, controlled trials with large sample sizes are needed to confirm these findings.

scholarly journals Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Guangjie Liu ◽  
Xingyu Yang ◽  
Tao Xue ◽  
Shujun Chen ◽  
Xin Wu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Compulsive Disorder ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Subacute Stroke

Background and Purpose: Fluoxetine is a drug commonly used to treat mental disorders, such as depression and obsessive–compulsive disorder, and some studies have shown that fluoxetine can improve motor and function recovery after stroke. Therefore, we performed a meta-analysis to investigate the efficacy and safety of fluoxetine in the treatment of post-stroke neurological recovery.Methods: PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) that were performed to assess the efficacy and safety of fluoxetine for functional and motor recovery in subacute stroke patients up to October 2020. Review Manager 5.3 software was used to assess the data. The risk ratio (RR) and standardized mean difference (SMD) were analyzed and calculated with a fixed effects model.Results: We pooled 6,788 patients from nine RCTs. The primary endpoint was modified Rankin Scale (mRS). Fluoxetine did not change the proportion of mRS ≤ 2 (P = 0.47). The secondary endpoints were Fugl-Meyer Motor Scale (FMMS), Barthel Index (BI), and National Institutes of Health Stroke Scale (NIHSS). Fluoxetine improved the FMMS (P &lt; 0.00001) and BI(P &lt; 0.0001) and showed a tendency of improving NIHSS (P = 0.08). In addition, we found that fluoxetine reduced the rate of new-onset depression (P &lt; 0.0001) and new antidepressants (P &lt; 0.0001).Conclusion: In post-stroke treatment, fluoxetine did not improve participants' mRS and NIHSS but improved FMMS and BI. This difference could result from heterogeneities between the trials: different treatment duration, clinical scales sensitivity, patient age, delay of inclusion, and severity of the deficit.

scholarly journals Efficacy and Safety of Cerebrolysin for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Danfeng Zhang ◽  
Yan Dong ◽  
Ya Li ◽  
Jigang Chen ◽  
Junyu Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Randomized Controlled Trials ◽  
Acute Ischemic Stroke ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Safety Outcomes

Cerebrolysin was reported to be effective in the neurological improvement of patients with acute ischemic stroke (AIS) in experimental models, while data from clinical trials were inconsistent. We performed a meta-analysis to explore the efficacy and safety of cerebrolysin for AIS. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials, which intervened within 72 hours after the stroke onset. We investigated the efficacy and safety outcomes, respectively. Risk ratios and mean differences were pooled with fixed-effects model or random-effects model. Seven studies were identified, involving 1779 patients with AIS. The summary results failed to demonstrate significant superiority of cerebrolysin in the assessment of efficacy outcomes of mRS and BI. Similarly, administration of cerebrolysin had neutral effects on safety outcomes compared with placebo, including mortality and SAE. However, the number of included studies was small, especially in the analysis of efficacy outcomes, which might cause publication bias and inaccurate between-studies variance in the meta-analysis. Conclusively, although it seemed to be safe, routine use of cerebrolysin to improve the long-term rehabilitation after stroke could not be supported by available evidence.

scholarly journals Evaluating the Efficacy of Massage Intervention for the Treatment of Poststroke Constipation: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Qiu-Shuang Wang ◽  
Ya Liu ◽  
Xiang-Ni Zou ◽  
Yan-Ling Ma ◽  
Gen-Li Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Control Groups ◽  
Stroke Event ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Massage Group

Background. It is essential to determine a safe and effective method for treating constipation after stroke. Massage has been widely used in recent years. However, meta-analysis data on the efficacy of massage for the treatment of constipation experienced after stroke are almost nonexistent. Objective. This review aimed to examine the effectiveness of using massage therapy to treat constipation in patients who suffered a stroke event. Methods. This systematic review adhered to the reporting guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science, China Biology Medicine, Wan Fang Data, VIP Database for Chinese Technical Periodicals, and National Knowledge Infrastructure, were searched for relevant studies on the efficacy of massage for the treatment of poststroke constipation. Rev-Man 5.3 software was used to analyze the study data. Results. A total of 11 randomized controlled trials with 1045 patients were included. A statistically significant difference in the total effective rates was found between the massage and control groups (OR = 4.96; 95% confidence interval (CI): 2.81, 8.76; P<0.001). Compared with the control groups, the massage group had markedly reduced incidences of constipation (OR = 0.34; 95% CI: 0.25, 0.47; P<0.001) and of four symptoms of discomfort (P<0.001). The frequency of defecation on day two and day three in the massage group was significantly higher than that in the control group (P<0.001). Conclusion. Our results strongly suggest that massage can effectively reduce the incidence and severity of constipation after stroke. However, large, multicenter, long-term, and high-quality randomized controlled trials need to be conducted to establish a definitive conclusion.

scholarly journals Routine Prophylactic Endoscopic Clipping Is Not Efficacious in the Prevention of Delayed Post-Polypectomy Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 2 (3) ◽  
pp. 105-117 ◽  
Author(s):  
Nauzer Forbes ◽  
Levi Frehlich ◽  
Matthew T James ◽  
Robert J Hilsden ◽  
Gilaad G Kaplan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Risk Groups ◽  
Controlled Trials ◽  
Fixed Effects Model ◽  
Randomized Controlled ◽  
Subgroup Analyses

Abstract Background and Aims Colorectal cancer (CRC) can be prevented through colonoscopic polypectomy, but this exposes patients to risks, including delayed post-polypectomy bleeding (DPPB). Endoscopists increasingly use clips prophylactically with the aim of preventing DPPB. However, clips are costly, and data to support their efficacy in this context are inconsistent. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of prophylactic clipping for preventing DPPB. Methods We searched electronic databases and other relevant sources for randomized controlled trials assessing the efficacy of prophylactic clipping versus no clipping for the prevention of DPPB. Pooled relative risks were determined using a fixed-effects model. Subgroup analyses were also performed. Results A total of 2305 citations were initially screened. Seven randomized controlled trials satisfied all criteria for inclusion. The quality of included studies was generally low to moderate. A total of 2851 patients underwent 5405 polypectomies. Delayed post-polypectomy bleeding occurred at an overall pooled rate of 2.5%. No overall benefit of clipping for preventing DPPB was observed, with a pooled relative risk of 0.86 (95% confidence interval [CI], 0.55 to 1.36). No significant patient or polyp factors predicting DPPB were found through subgroup analyses. No publication bias was identified. Conclusions Randomized trials to date do not demonstrate a protective effect of prophylactic clipping for the prevention of DPPB, and therefore, the practice of routine prophylactic clipping appears unjustified. Additional high quality randomized trials are required to identify higher-risk groups that may benefit from prophylactic clipping.

scholarly journals Clinical Efficacy of Perioperative Immunonutrition Containing Omega-3-Fatty Acids in Patients Undergoing Hepatectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
pp. 1-12
Author(s):  
Benjian Gao ◽  
Jia Luo ◽  
Ying Liu ◽  
Furui Zhong ◽  
Xiaoli Yang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Impact

<b><i>Background:</i></b> The effect of immunonutrition in patients undergoing hepatectomy remains unclear. This meta-analysis aimed to assess the impact of immunonutrition on postoperative clinical outcomes in patients undergoing hepatectomy. <b><i>Methods:</i></b> A literature search of PubMed, Cochrane Library, Web of Science, and Embase databases was performed to identify all randomized controlled trials (RCTs) exploring the effect of perioperative immunonutrition in patients undergoing hepatectomy until the end of March 10, 2020. Quality assessment and data extraction of RCTs were conducted independently by 3 reviewers. Mean difference (MD) and odds ratio (OR) with 95% confidence interval (CI) were calculated using a fixed-effects or random-effects model. The meta-analysis was performed with RevMan 5.3 software. <b><i>Results:</i></b> Nine RCTs involving a total of 966 patients were finally included. This meta-analysis showed that immunonutrition significantly reduced the incidences of overall postoperative complications (OR = 0.57, 95% CI: 0.34–0.95; <i>p</i> = 0.03), overall postoperative infectious complications (OR = 0.53, 95% CI: 0.37–0.75; <i>p</i> = 0.0003), and incision infection (OR = 0.50, 95% CI: 0.28–0.89; <i>p</i> = 0.02), and it shortened the length of hospital stay (MD = −3.80, 95% CI: −6.59 to −1.02; <i>p</i> = 0.007). There were no significant differences in the incidences of pulmonary infection (OR = 0.60, 95% CI: 0.32–1.12; <i>p</i> = 0.11), urinary tract infection (OR = 1.30, 95% CI: 0.55–3.08; <i>p</i> = 0.55), liver failure (OR = 0.54, 95% CI: 0.23–1.24; <i>p</i> = 0.15), and postoperative mortality (OR = 0.69, 95% CI: 0.26–1.83; <i>p</i> = 0.46). <b><i>Conclusion:</i></b> Given its positive impact on postoperative complications and the tendency to shorten the length of hospital stay, perioperative immunonutrition should be encouraged in patients undergoing hepatectomy.

The efficacy of systemic lymphadenectomy for overall survival in epithelial ovarian cancer: A systematic review and meta-analysis by KOGYMAG

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16509-e16509
Author(s):  
H. Kim ◽  
W. Ju ◽  
B. Jee ◽  
J. Kim ◽  
Y. Song ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Epithelial Ovarian Cancer ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Figo Stage ◽  
Study Endpoint ◽  
Controlled Trials ◽  
Fixed Effects Model ◽  
Randomized Controlled

e16509 Background: The role of systemic lymphadenectomy remains unclear for improving overall survival in epithelial ovarian cancer (EOC) till now. To evaluate the efficacy of systemic lymphadenectomy for survival in EOC, Korean Gynecologic Meta-analysis Group (KOGYMAG) performed a meta-analysis of all studies which compared systemic lymphadenectomy versus non-systemic lymphadenectomy (not performed or lymph node sampling). Methods: Studies were retrieved by searching PubMed, Embase, and Cochrane Controlled Trials Register (CENTRAL) electronic database. The literature search was conducted between 1995 and 2008. The meta-analysis was carried out on 11 studies (2 randomized controlled and 9 retrospective studies) and a total of 30,534 patients with EOC who underwent staging laparotomy including systemic lymphadenectomy or nonsystemic lymphadenectomy. The study endpoint was overall survival, and we extracted adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival from all studies and obtained pooled estimates using an inverse-variance model. Results: In all studies, systemic lymphadenectomy was a favorable factor for overall survival as compared to non-systemic lymphadenectomy (HR, 0.76, 95% CI, 0.65 to 0.88; random-effects model). When we performed sub-analysis according to disease status, patients treated with systemic lymphadenectomy showed improved overall survival compared to those with non-systemic lymphadenectomy in 3 studies where only patients with early-stage EOC (FIGO stage I-II) were included (HR, 0.70; 95% CI, 0.63 to 0.77; fixed-effects model). Furthermore, systemic lymphadenectomy was also a significant factor for improved overall survival in 5 studies where only patients with advanced-stage EOC (FIGO stage III-IV) were enrolled (HR, 0.91; 95% CI, 0.85–0.96; fixed-effects model). Conclusions: These results support that systemic lymphadnectomy may improve overall survival in patients with EOC. However, there are some limitaions including few randomized controlled studies and the deviation of weight in this meta-analysis. Thus, large-scale randomized controlled trials are required to evaluate the efficacy of systemic lymphadenectomy in EOC. No significant financial relationships to disclose.

scholarly journals Does surfactant nebulization prevent early intubation in preterm infants? A protocol for a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Vincent D. Gaertner ◽  
Dirk Bassler ◽  
Christoph M. Rüegger
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Preterm Infants ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Exogenous Surfactant ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Surfactant Administration

Abstract Background Respiratory distress syndrome (RDS) is the most common cause of respiratory failure in preterm infants. Treatment consists of respiratory support and exogenous surfactant administration. Commonly, surfactant is administered intratracheally. However, this requires airway instrumentation and subsequent fluid instillation which may be harmful. Surfactant nebulization (SN) may offer a safe and effective alternative for surfactant administration, but the clinical efficacy is not yet established. Thus, this systematic review and meta-analysis of randomized controlled trials will summarize the available evidence to determine the effectiveness and safety of SN for the prevention of intubation and subsequent mechanical ventilation at 72 h after birth. Methods A systematic literature search in Medline, Embase, and The Cochrane Library will be performed, and all randomized controlled trials (RCTs) and quasi-RCTs from published articles, presentations, and trial registries will be included in this meta-analysis. Titles and abstracts of all records identified in the search will be screened by two reviewers independently. Data on preterm infants (≤ 37 weeks) receiving nebulized surfactant in the first 72 h after birth for the treatment or prevention of RDS will be evaluated. Primary outcome is the intubation rate by 72 h after birth, and secondary outcomes include peridosing safety effects as well as major neonatal morbidities. Risk of bias will be assessed using the revised Cochrane ROB tool, and subgroup analyses will be performed to evaluate potential confounding factors. Publication bias will be assessed by examining a funnel plot. The meta-analysis will be performed using a fixed-effects model. Discussion This review will provide an evidence-based tool for information about surfactant nebulization, illustrating the current knowledge and hopefully revealing potential novel avenues for researchers and clinicians alike. Systematic review registration This review is registered with the publicly available resource PROSPERO (CRD42020175625).

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