scholarly journals Systematic review and meta-analysis of outcomes in patients with suspected pulmonary embolism

2021 ◽  
Vol 5 (8) ◽  
pp. 2237-2244
Author(s):  
Parth Patel ◽  
Payal Patel ◽  
Meha Bhatt ◽  
Cody Braun ◽  
Housne Begum ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Ct Scan ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Suspected Pulmonary Embolism ◽  
Central Register ◽  
Mortality Incidence ◽  
D Dimer

Abstract Prompt evaluation and therapeutic intervention of suspected pulmonary embolism (PE) are of paramount importance for improvement in outcomes. We systematically reviewed outcomes in patients with suspected PE, including mortality, incidence of recurrent PE, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included 22 studies with 15 865 patients. Among patients who were diagnosed with PE and discharged with anticoagulation, 3-month follow-up revealed that all-cause mortality was 5.69% (91/1599; 95% confidence interval [CI], 4.56-6.83), mortality from PE was 1.19% (19/1597; 95% CI, 0.66-1.72), recurrent venous thromboembolism (VTE) occurred in 1.38% (22/1597; 95% CI: 0.81-1.95), and major bleeding occurred in 0.90% (2/221%; 95% CI, 0-2.15). In patients with a low pretest probability (PTP) and negative D-dimer, 3-month follow-up revealed mortality from PE was 0% (0/808) and incidence of VTE was 0.37% (4/1094; 95% CI: 0.007-0.72). In patients with intermediate PTP and negative D-dimer, 3-month follow-up revealed that mortality from PE was 0% (0/2747) and incidence of VTE was 0.46% (14/3015; 95% CI: 0.22-0.71). In patients with high PTP and negative computed tomography (CT) scan, 3-month follow-up revealed mortality from PE was 0% (0/651) and incidence of VTE was 0.84% (11/1302; 95% CI: 0.35-1.34). We further summarize outcomes evaluated by various diagnostic tests and diagnostic pathways (ie, D-dimer followed by CT scan).

scholarly journals Effectiveness of rigorously evaluated behavior change interventions delivered via mobile application: Systematic review and meta-analysis (Preprint)

2020 ◽  
Author(s):  
Sarah J Iribarren ◽  
Tokunbo O Akande ◽  
Kendra J Kamp ◽  
Dwight Barry ◽  
Yazan G Kader ◽  
...  
Keyword(s):  
Behavior Change ◽  
Health Outcomes ◽  
Meta Analysis ◽  
Outcome Data ◽  
Cochrane Central Register ◽  
Pilot Studies ◽  
Behavior Change Interventions ◽  
Cochrane Database ◽  
Central Register

BACKGROUND Background: Mobile applications can deliver more efficiently behavior change interventions that are traditionally resource-intensive and difficult to scale. OBJECTIVE Objectives: To summarize the evidence of app-driven behavior change interventions on health outcomes and identify whether certain features contribute to improved outcomes. METHODS Methods: We conducted a literature search in seven databases (MEDLINE; Scopus; PsycINFO, CINAHL, Global Index Medicus; Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews). Five reviewers independently screened and extracted sample characteristics. We used a random-effects model to calculate pooled effect size estimates for meta-analysis. Sensitivity analysis was conducted based on follow-up time, stand-alone app interventions, level of personalization, and pilot studies. Logistic regression was used to examine the structure of app features. RESULTS Results: From the database searches, 8230 records were initially identified. Of these, 172 met inclusion criteria. Studies were predominantly conducted in high-income countries (164, 94.3%). The majority had follow-up periods of six months or less (143, 83.1%). Over half of the interventions were delivered by a standalone app (106, 61.6%). Static/one size fits all (97,56. 4.0%) was the most common level of personalization. Intervention frequency was mostly at least daily (123, 71.5%). A total of 156 studies involving 21,422 participants reported continuous health outcome data. The use of a behavior change app (either as a stand-alone or as part of a larger intervention) confers a slight/weak advantage over standard care in health interventions [standardized mean difference = 0.38 (95% CI: 0.31-0.45), I2 = 80%] though heterogeneity is high. CONCLUSIONS Conclusion: Rigorous evaluation of behavior-change related intervention apps is increasing substantially. The evidence that behavior change apps improve health outcomes is weak, which may reflect the need for improved methodological and evaluative approaches to assessment of healthcare improvement apps. CLINICALTRIAL PROSPERO, CRD42018106868

scholarly journals Conjoined versus separate technique: a meta-analysis of anastomosis techniques for urinary diversion after bladder cancer

2019 ◽  
Author(s):  
Liu Daqian ◽  
Wang Yonghua ◽  
Zhao Yang ◽  
Yang Xuecheng ◽  
wang xinsheng ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urinary Diversion ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Anastomosis Group ◽  
Separate Group ◽  
Cochrane Central Register ◽  
Central Register ◽  
The Difference

Abstract Introduction: This was a meta-analysis of studies on conjoined and separate anastomosis for urinary diversion after radical cystectomy due to bladder cancer. Methods: We searched databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials) for studies regarding anastomosis for urinary diversion due to bladder cancer. The meta-analysis was designed to determine the difference between conjoined and separate anastomosis. Six studies including 1601 patients were considered in the meta-analysis (654 in the separate group and 947 in the conjoined group). Results: There were no significant differences with respect to age, gender or duration of follow-up. There were seven studies that compared the rate of stricture and the rate of hydronephrosis. For overall stricture, there were 186 of 1163 ureters in the separate group and 64 of 1718 ureters in the conjoined group (odds ratio, 4.53; 95% CI, 2.01-10.22; P = 0.0003). For overall hydronephrosis patients, there were 55 of 205 ureters in the separate group and 51 of 254 ureters in the conjoined group (odds ratio, 1.48; 95% CI, 0.95-2.29; P = 0.08). Conclusion: The separate anastomosis had a higher ratio of strictures than did the conjoined group. The separate anastomosis group experienced hydronephrosis more often than did the conjoined anastomosis group. The separate anastomosis is the better choice for surgery during the operation.

scholarly journals Systematic Review of Treatment for Massive and Submassive Pulmonary Embolism

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2612-2612
Author(s):  
Shipa Gupta ◽  
Esteban Gandara ◽  
Marc Carrier ◽  
Lana A Castellucci
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Research Funding ◽  
Randomized Trials ◽  
Treatment Strategies ◽  
Cochrane Central Register ◽  
Central Register ◽  
Submassive Pulmonary Embolism ◽  
Rheolytic Thrombectomy ◽  
Ultrasound Assisted

Abstract Introduction: Anticoagulation is the standard treatment for pulmonary embolism (PE). In patients presenting with massive or submassive PE, the addition of systemic thrombolytics (STL) and catheter directed therapies (CDT) may also be considered. However, there is uncertainty about the benefits and risks of these treatments, and no randomized trials have compared STL to CDT. Aim: We reviewed the risks and benefits of STL and CDT in the management of patients with massive or submassive PE. Methods: A systematic literature search was conducted using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and bibliographies of relevant studies and reviews. Randomized trials and cohort studies were eligible. Registries and studies with fewer than 10 patients were ineligible. Pooled proportions and their associated 95% confidence intervals (CI) for mortality, major bleeding, intracranial hemorrhage (ICH), recurrent PE, and fatal recurrent PE were calculated. Results: A total of 52 studies were included in the analyses: 19 studies evaluating STL; 18 studies using CDT; 5 studies using the AngioJet rheolytic thrombectomy system; and 10 studies using ultrasound-assisted CDT. The pooled proportion of outcomes for patients receiving STL were: 4.46% (95% CI: 3.04-6.13%) for mortality; 11.70% (95% CI: 7.78-16.90%) for major bleeding; 1.99% (95% CI: 1.06-3.20%) for ICH; 3.92% (95% CI: 2.56-5.55%) for recurrent PE; and 1.04% (95% CI: 0.42-1.94%) for fatal recurrent PE. For patients receiving CDT, the pooled proportion of outcomes were: 9.64% (95% CI: 5.93-14.13%) for mortality; 5.17% (95% CI: 2.18-9.33%) for major bleeding; 1.29% (95% CI: 0.48-2.48%) for ICH; 2.76% (95% CI: 1.36-4.63%) for recurrent PE; and 1.56% (95% CI: 0.53-3.12%) for fatal recurrent PE. For patients receiving AngioJet CDT, the pooled proportion of outcomes were: 10.18% (95% CI: 3.68-19.42%) for mortality; 9.14% (95% CI: 0.88-24.70%) for major bleeding; 2.30% (95% CI: 0.34-5.96%) for ICH; 4.84% (95% CI: 1.62-9.66%) for recurrent PE; and 4.84% (95% CI: 1.62-9.66%) for fatal recurrent PE. In patients receiving ultrasound-assisted CDT, the pooled proportion of outcomes were: 4.17% (95% CI: 1.64-7.79%) for mortality; 4.88% (95% CI: 2.48-8.05%) for major bleeding; 0.63% (95% CI: 0.10-1.59%) for ICH; 1.39% (95% CI: 0.48-2.77%) for recurrent PE; and 1.21% (95% CI: 0.35-2.56%) for fatal recurrent PE. Conclusions: Our results suggest that all-cause mortality rates in patients with massive or submassive PE are similar between STL and ultrasound-assisted CDT and are lower than other types of CDT. In general, major bleeding rates were lower in CDT based groups than in STL. Importantly, ICH rates in CDT based treatment strategies were also lower than STL therapy. Randomized trials comparing STL and CDT would help solidify the role of these treatment strategies in patients with massive and submassive PE. Disclosures Carrier: BMS: Research Funding; Leo Pharma: Research Funding.

Does Thromboprophylaxis Reduce Mortality in Medical Patients? A Systematic Review and Meta-Analysis of Randomized Cntrolled Tials.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 905-905
Author(s):  
Francesco Dentali ◽  
Monica Gianni ◽  
Wendy Lim ◽  
James D. Douketis
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Good Evidence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Medical Patients ◽  
Central Register ◽  
Increased Risk ◽  
Patients At Risk

Abstract Background: Despite good evidence that anticoagulants are effective in preventing venous thromboembolism in medical patients at risk for this disease, only one-third of such patients are receiving thromboprophylaxis. Underutilization of thromboprophylaxis in medical patients may be due to lack of evidence that thromboprophylaxis reduces mortality, concerns about anticoagulant-related bleeding, and questions about the clinical significance of surrogate (venographic) outcomes to assess efficacy in these trials. We performed a meta-analysis of randomized, placebo-controlled trials of anticoagulant thromboprophylaxis in medical patients to assess effects on mortality and bleeding. Methods: The MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched until June 2005. Studies were included that were randomized, placebo-controlled trials investigated a prophylactic dose of unfractionated heparin, low-molecular-weight heparin, or fondaparinux in medical patients. Meta-analysis was done to obtain pooled estimates of the effects of anticoagulant thromboprophylaxis on mortality and clinically important (major) bleeding. The effect of treatment on venous thromboembolism was not pooled because of across-study difference in methods used to diagnose this, and use of asymptomatic (venographic) outcomes in some studies. Results: There were 8 studies of 20,631 patients in the assessment of mortality and 4 studies of 5,428 patients in the assessment of major bleeding. Death occurred in 536 of 10,321 (5.2%) patients who received thromboprophylaxis, and in 608 of 10,510 (5.8%) who received placebo. Thromboprophylaxis was associated with 10% decreased risk for all-cause mortality, although this effect was not quite statistically significant (odds ratio [OR] = 0.90; 95% confidence interval [CI]: 0.81, 1.01). Major bleeding occurred in 22 of 2,726 (0.8%) patients who received thromboprophylaxis, and in 11 of 2,702 (0.4%) patients who received placebo. Thromboprophylaxis was associated with 2-fold increased risk for major bleeding, although this effect was not quite statistically significant (OR = 2.04; 95% CI: 0.98, 4.23). Conclusion: In medical patients who are at increased risk for venous thromboembolism, anticoagulant thromboprophylaxis appears to confer a small reduction in mortality; this benefit should be balanced against an increased risk for major bleeding.

scholarly journals Early Effects of Unfractionated Heparin on Clinical and Radiological Signs and D-dimer Levels in Patients With COVID-19 Associated Pulmonary Embolism: an Observational Cohort Study

2020 ◽  
Author(s):  
Lea Imeen van der Wal
Keyword(s):  
Pulmonary Embolism ◽  
Ct Scan ◽  
Unfractionated Heparin ◽  
Clinical Success ◽  
Ct Scanning ◽  
Observational Cohort Study ◽  
Anticoagulant Treatment ◽  
Observational Cohort ◽  
D Dimer

Abstract Background: Pulmonary embolism is a frequent complication in patients with Coronavirus disease 2019 (COVID-19). The pathogenesis of COVID-associated activation of coagulation is not fully understood and appears to be different from disseminated intravascular coagulation (DIC) in patients with sepsis. As the pathophysiology of coagulation in COVID-patients is unknown, it is uncertain whether unfractionated heparin (UFH), or anticoagulation in general, is effective in the attenuation of the procoagulant state. The aim of this study is to determine the effects of intravenous unfractionated heparin on clinical, radiological and laboratory parameters in patients with COVID-19 and acute pulmonary embolism (PE). Methods: We conducted an observational cohort study in 19 Intensive Care Unit (ICU) patients with COVID-19 and computed tomography (CT) scanning proven pulmonary embolism. According to the local protocol, repeated CT-scanning was indicated if no pulmonary improvement was present after a minimum of 7 days following start of anticoagulant treatment. We defined three endpoints: Laboratory markers (d-dimer at day 0 vs day 2), clinical success (resolution of PE at follow up CT scan or discharged alive from ICU) and radiological response (Qanadli index at follow up CT scan vs CT scan at diagnosis PE). Statistical tests used for analysis were a T-test and Wilcoxon Signed Rank test.Results: Unfractionated heparin resulted in clinical success in at least 14 out of 19 patients. Pulmonary emboli were completely resolved on the follow up computed tomography scans in 5 out of 6 patients and partly resolved in the 6th patient. D-dimer levels decreased on average from 7074 ng/mL to 4347 ng/mL (p=0.001) within 48 hours after start of heparin. Conclusion: In this observational study, we showed a rapid clinical, laboratory and radiological improvement in patients with COVID-19 and proven pulmonary embolism. Standard anticoagulant treatment was effective in this setting, supporting current guideline recommendations.

scholarly journals Comparison of Standard and Transepithelial Corneal Cross-Linking for the Treatment of Keratoconus: A Meta-analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Yu Di ◽  
Jingyi Wang ◽  
Ying Li ◽  
Yang Jiang
Keyword(s):  
Visual Acuity ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Corneal Thickness ◽  
Clinical Results ◽  
Cross Linking ◽  
Cochrane Central Register ◽  
Distance Visual Acuity ◽  
Central Register

Purpose. To compare the clinical results of standard corneal cross-linking (SCXL) with transepithelial corneal cross-linking (TECXL) in progressive keratoconus using a meta-analysis. Methods. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched up to June 2020 to identify relevant studies. The PRISMA guidelines were followed. Primary outcomes were change in uncorrected distance visual acuity and maximum keratometry (Kmax) after CXL. Secondary outcomes were change in corrected distance visual acuity, mean refractive spherical equivalent (MRSE), spherical and cylindrical error, endothelial cells density (ECD), and central corneal thickness (CCT). Results. Sixteen studies with a total of 690 eyes (SCXL: 332 eyes; TECXL: 358 eyes) were included. At the last follow-up, SCXL provided a greater decrease in maximum keratometry (Kmax) than TECXL (weighted mean difference (WMD) −1.12; 95% confidence interval (CI) −1.96, −0.29). For the other outcomes, there were no statistically significant differences. Conclusions. Except for a greater decrease in Kmax with SCXL group, both groups have a comparable effect on visual, pachymetric, and endothelial parameters at 24 months after surgery. Larger studies with a longer follow-up time are necessary to determine whether these techniques are comparable in the long term.

Clinical efficacy of chlorhexidine as an adjunct to mechanical therapy of peri-implant disease: a systematic review and meta-analysis.

2020 ◽  
Author(s):  
Pengfei Zhao ◽  
Qian Wang ◽  
Peng Zhang ◽  
Xinyi Zhou ◽  
Lulingxiao Nie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Clinical Results ◽  
Cochrane Central Register ◽  
Clinical Attachment Level ◽  
Probing Depth ◽  
Central Register ◽  
Mechanical Therapy ◽  
Attachment Level

The aim of this systematic review and meta-analysis was to determine the efficacy of chlorhexidine (CHX) as an adjunctive therapy to mechanical debridement in the treatment of peri-implant diseases. Five databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trails, Web of Science, and ClinicalTrials.gov) were searched. Randomized controlled trials (RCTs) comparing mechanical debridement combined with CHX to mechanical debridement alone for patients with peri-implant disease were identified. The trial investigators evaluated factors indicating inflammatory levels, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Six RCTs with 207 patients were ultimately included in this review. Low- to moderate-quality evidence demonstrated that the adjunctive CHX therapy had no significant effect on BOP reduction within 1 month (mean difference [MD], 0.10; 95% confidence interval [CI], -0.06 to 0.25), 3 to 4 months (MD, 0.06; 95% CI, -0.03 to 0.15), and 6 to 8 months (MD, 0.06; 95% CI, -0.03 to 0.14) follow-up. Significant differences in PD reduction and CAL gain were also not found. However, one subgroup analysis revealed a significant result for the use of CHX solution, but it was clinically slight (MD, 0.09; 95%CI, 0.01 to 0.18). Based on available evidence, adding CHX to mechanical debridement, compared to mechanical debridement alone, did not significantly enhance the clinical results. Therefore, clinicians should consider the negligible effect of adjunctive CHX.

scholarly journals Comparison of Diagnostic Accuracies in Outpatients and Hospitalized Patients of D-Dimer Testing for the Evaluation of Suspected Pulmonary Embolism

2003 ◽  
Vol 49 (9) ◽  
pp. 1483-1490 ◽  
Author(s):  
John E Schrecengost ◽  
Robin D LeGallo ◽  
James C Boyd ◽  
Karel G M Moons ◽  
Steven L Gonias ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Tertiary Care ◽  
Roc Curves ◽  
Hospitalized Patients ◽  
Assay Method ◽  
Suspected Pulmonary Embolism ◽  
Predictive Values ◽  
D Dimer

Abstract Background: The ability of various D-dimer assays to exclude the diagnosis of thromboembolic diseases is controversial. We examined the diagnostic accuracy of two D-dimer methods in hospitalized patients and outpatients. Methods: We studied consecutive patients for whom D-dimer testing was ordered for investigation of suspected pulmonary embolism. We measured D-dimer by an ELISA (VIDAS D-dimer) and an enhanced microlatex immunoassay method (Diagnostica Stago STA Liatest D-di). Patient diagnoses were based on imaging studies or, when these were not performed, on follow-up by review of medical records 3 months later. Results: We examined 233 hospitalized patients and 234 outpatients with a mean age of 58 years (range, 1–92 years) and a female-to-male ratio of 1.4 to 1. Thromboembolism was present in 8% of outpatients and 12% of hospitalized patients. In outpatients, the negative predictive values were 98% [95% confidence interval (CI), 93–100%] and 99% (94–100%) for the microlatex and ELISA methods, respectively, at the recommended cutoffs. Areas under the ROC curves were similar for the two methods [0.77 (95% CI, 0.67–0.87) and 0.81 (0.73–0.89), respectively]. By contrast, in hospitalized patients, the confidence intervals for the areas under the ROC curves included 0.5 [0.60 (95% CI, 0.50–0.71) and 0.56 (0.44–0.67)]. Conclusions: For hospitalized patients, in contrast to outpatients, the diagnostic accuracy of D-dimer testing for pulmonary embolism is poor in a tertiary care setting, presumably reflecting thrombosis and comorbidities, other than pulmonary embolism, that increase the D-dimer concentrations in these patients. The patient population studied appears more important than assay method in studies of the diagnostic accuracy of D-dimer testing.

Computerized Tomographic Pulmonary Angiography Compared with Ventilation-Perfusion Lung Scanning as Inital Diagnostic Modality for Patients with Suspected Pulmonary Embolism: A Randomized Controlled Trial.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1619-1619 ◽  
Author(s):  
David R. Anderson ◽  
Philip S. Wells ◽  
Susan Kahn ◽  
Marc Rodger ◽  
Michael J. Kovacs ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Pulmonary Angiography ◽  
Suspected Pulmonary Embolism ◽  
Cancer Management ◽  
Randomized Controlled ◽  
Lung Scanning ◽  
D Dimer

Abstract Ventilation-perfusion (VQ) lung scanning and computerized tomographic pulmonary angiography (CTPA) have been validated as imaging procedures for the evaluation of patients with suspected pulmonary embolism and are used widely. To compare the safety and utility of VQ scanning and CTPA we performed a multi-centre randomized controlled trial in patients presenting with clinically suspected acute pulmonary embolism. All patients were evaluated using an explicit clinical model to determine pretest probability (Wells score) and with D-dimer. Patients considered at low likelihood of pulmonary embolism (score < 4.5 and negative D-dimer) did not undergo further testing and were followed as a separate cohort. The remaining patients were randomized to undergo either VQ scanning or CTPA. Patients diagnosed with pulmonary embolism on the basis of a high probability VQ scan or a positive CTPA were treated. Other patients underwent bilateral venous ultrasound imaging of the proximal veins of lower extremities and those confirmed to have DVT were treated. Physicians were able to refer patients for traditional pulmonary angiography or serial ultrasonography after initial testing but switching of patients to have the alternative pulmonary imaging procedure was not permitted by the protocol. Patients in whom pulmonary embolism was considered excluded did not receive antithrombotic therapy and were followed for a three month period. The primary outcome was the development of symptomatic pulmonary embolism or proximal deep vein thrombosis in the follow-up period in patients in whom the diagnosis of pulmonary embolism had initially been excluded. 1577 patients were enrolled in the study of whom 172 entered the low risk cohort. 1405 patients were randomized, 694 to CTPA and 711 to VQ scanning. 19.2% (133) of patients in the CTPA versus 14.2% (101) were diagnosed with pulmonary embolism in the initial evaluation period (difference 5.0%, 95% CI 1.1% to 8.9%). Of those in whom pulmonary embolism was considered excluded 0.4% (2/561) patients undergoing CTPA versus 1.0% (6/610) patients undergoing VQ scanning developed venous thromboembolism in follow-up (difference −0.6%, 95% CI −1.6% to 0.3%) including one with fatal pulmonary embolism in the VQ group. All cause mortality was higher in the three month follow-up for patients undergoing VQ scanning (30/610, 4.9%) than for CTPA (17/694, 2.4%) in whom pulmonary embolism was considered excluded. Most of these deaths were from cancer. Management practices using bilateral ultrasonography with either VQ scanning or CTPA to exclude the diagnosis of pulmonary embolism resulted in low rates of venous thromboembolic complications. More patients were diagnosed intitally with pulmonary embolism using the CTPA approach and fewer patients died in this cohort in the three month follow-up period.

scholarly journals The Effect of Functional Mandibular Advancement for Adolecent Patients with Skeletal Class Ⅱ Malocclusion on the TMJ——a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Lan Ding ◽  
Rui Chen ◽  
Jiaxin Liu ◽  
Yuan Wang ◽  
Qian Chang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Oral Appliance ◽  
Temporomandibular Joint Disorders ◽  
Mandibular Advancement ◽  
Cochrane Central Register ◽  
Skeletal Class ◽  
Period 2 ◽  
Central Register

Abstract Objectives: This study aimed to assess whether functional mandibular advancement will induce or aggravate temporomandibular joint disorders.Methods: All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails directly observe the condition of patients’ TMJ after finishing treatment will be considered to include in our study. Cochrane Collaboration risk of bias tool was used to assess the quality of included studies according to the established inclusion criteria.Result:Finally 13 researches were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 285 individuals ,there were 142 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients recieved FMA didn’t show more tendency to develop temporomandibular symptoms[I²=25%, OR=0.39, 95%CI (0.22 ,0.68), p=0.001].Conclusion: (1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear during follow-up period. (2) Less convinced evidence indicate that slightly previous TMD will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not induce or aggravate TMD.

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