scholarly journals Antidepressants on trial: how valid is the evidence?

2009 ◽  
Vol 194 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Gordon Parker
Keyword(s):  
Clinical Practice ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Antidepressant Drugs ◽  
Clinical Effectiveness ◽  
Controlled Trials ◽  
Contributing Factors ◽  
Current Trial ◽  
Randomised Controlled ◽  
Better Than

SummaryA recent meta-analysis concluded that newer antidepressant drugs are equivalent to or no better than placebos, a conclusion at some variance with their commonly judged clinical effectiveness. The ‘disconnect’ between randomised controlled trials and clinical practice would benefit from dissection of contributing factors, and redressing limitations to current trial procedures.

scholarly journals Quadruple versus triple combination antiretroviral therapies for treatment naive people with HIV: systematic review and meta-analysis of randomised controlled trials

BMJ ◽  
2019 ◽  
pp. l4179 ◽  
Author(s):  
Qi Feng ◽  
Aoshuang Zhou ◽  
Huachun Zou ◽  
Suzanne Ingle ◽  
Margaret T May ◽  
...  
Keyword(s):  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Triple Combination ◽  
Antiretroviral Therapies ◽  
Treatment Naïve ◽  
Randomised Controlled ◽  
Hiv 1 ◽  
Cd4 T Cell Count ◽  
Better Than

AbstractObjectiveTo evaluate the effects of four drug (quadruple) versus three drug (triple) combination antiretroviral therapies in treatment naive people with HIV, and explore the implications of existing trials for clinical practice and research.DesignSystematic review and meta-analysis of randomised controlled trials.Data sourcesPubMed, EMBASE, CENTRAL, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature from March 2001 to December 2016 (updated search in PubMed and EMBASE up to June 2018); and reference lists of eligible studies and related reviews.Study selectionRandomised controlled trials comparing quadruple with triple combination antiretroviral therapies in treatment naive people with HIV and evaluating at least one effectiveness or safety outcome.Review methodsOutcomes of interest included undetectable HIV-1 RNA, CD4 T cell count, virological failure, new AIDS defining events, death, and severe adverse effects. Random effects meta-analyses were conducted.ResultsTwelve trials (including 4251 people with HIV) were eligible. Quadruple and triple combination antiretroviral therapies had similar effects on all relevant effectiveness and safety outcomes, with no point estimates favouring quadruple therapy. With the triple therapy as the reference group, the risk ratio was 0.99 (95% confidence interval 0.93 to 1.05) for undetectable HIV-1 RNA, 1.00 (0.90 to 1.11) for virological failure, 1.17 (0.84 to 1.63) for new AIDS defining events, 1.23 (0.74 to 2.05) for death, and 1.09 (0.89 to 1.33) for severe adverse effects. The mean difference in CD4 T cell count increase between the two groups was −19.55 cells/μL (−43.02 to 3.92). In general, the results were similar, regardless of the specific regimens of combination antiretroviral therapies, and were robust in all subgroup and sensitivity analyses.ConclusionIn this study, effects of quadruple combination antiretroviral therapy were not better than triple combination antiretroviral therapy in treatment naive people with HIV. This finding lends support to current guidelines recommending the triple regimen as first line treatment. Further trials on this topic should be conducted only when new research is justified by adequate systematic reviews of the existing evidence. However, this study cannot exclude the possibility that quadruple cART would be better than triple cART when new classes of antiretroviral drugs are made available.

scholarly journals Pharmacological treatment for unipolar psychotic depression

2006 ◽  
Vol 188 (5) ◽  
pp. 410-415 ◽  
Author(s):  
Jaap Wijkstra ◽  
Jeroen Lijmer ◽  
Ferdi J. Balk ◽  
John R. Geddes ◽  
Willem A. Nolen
Keyword(s):  
Systematic Review ◽  
Pharmacological Treatment ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Controlled Trials ◽  
Psychotic Depression ◽  
Pharmacological Treatments ◽  
Risks And Benefits ◽  
Randomised Controlled

BackgroundThe optimal pharmacological treatment of unipolar psychotic depression is uncertain.AimsTo compare the clinical effectiveness of pharmacological treatments for patients with unipolar psychotic depression.MethodSystematic review and meta-analysis of randomised controlled trials.ResultsTen trials were included in the review. We found no evidence that the combination of an antidepressant with an antipsychotic is more effective than an antidepressant alone. This combination was statistically more effective than an antipsychotic alone.ConclusionsAntidepressant mono-therapy and adding an antipsychotic if the patient does not respond, or starting with the combination of an antidepressant and an antipsychotic, both appear to be appropriate options for patients with unipolar psychotic depression. However, clinically the balance between risks and benefits may suggest the first option should be preferred for many patients. Starting with an antipsychotic alone appears to be inadequate.

A Comparison of Traditional Digital Blocks and Single Subcutaneous Palmar Injection Blocks at the Base of the Finger and a Meta-Analysis of the Digital Block Trials

2006 ◽  
Vol 31 (5) ◽  
pp. 547-555 ◽  
Author(s):  
Z. G. YIN ◽  
J. B. ZHANG ◽  
S. L. KAN ◽  
P. WANG
Keyword(s):  
Randomised Controlled Trials ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Proximal Phalanx ◽  
Injection Pain ◽  
Controlled Trials ◽  
Current Trial ◽  
Randomised Controlled ◽  
Double Blinded ◽  
Digital Block

A randomised, double-blinded, controlled trial was performed to compare traditional digital blocks with single subcutaneous palmar injection blocks at the base of the finger. A search for randomised controlled trials of digital blocks through MEDLINE, EMBASE, Cochrane Controlled Trials Register and CBM was conducted and a meta-analysis including the current trial was performed. The current trial showed no difference between traditional digital blocks and single subcutaneous palmar injection bocks at the base of the finger in respect of injection pain and time to anaesthesia. The meta-analysis suggests that traditional digital blocks and single subcutaneous palmar injection blocks are similar with regard to injection pain and are less painful than the transthecal digital block. The palmar techniques, including single subcutaneous palmar block and transthecal block, carry a risk of not anaesthetising the dorsum of the digit adequately, particularly the dorsum of the thumb and the proximal phalanx of the fingers.

scholarly journals Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence

BMJ ◽  
2021 ◽  
pp. n1511
Author(s):  
Ashley W Blom ◽  
Richard L Donovan ◽  
Andrew D Beswick ◽  
Michael R Whitehouse ◽  
Setor K Kunutsor
Keyword(s):  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Meniscal Repair ◽  
Clinical Effectiveness ◽  
Controlled Trials ◽  
Operative Care ◽  
Total Knee ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Study Designs

AbstractObjectiveTo determine the clinical effectiveness of common elective orthopaedic procedures compared with no treatment, placebo, or non-operative care and assess the impact on clinical guidelines.DesignUmbrella review of meta-analyses of randomised controlled trials or other study designs in the absence of meta-analyses of randomised controlled trials.Data sourcesTen of the most common elective orthopaedic procedures—arthroscopic anterior cruciate ligament reconstruction, arthroscopic meniscal repair of the knee, arthroscopic partial meniscectomy of the knee, arthroscopic rotator cuff repair, arthroscopic subacromial decompression, carpal tunnel decompression, lumbar spine decompression, lumbar spine fusion, total hip replacement, and total knee replacement—were studied. Medline, Embase, Cochrane Library, and bibliographies were searched until September 2020.Eligibility criteria for selecting studiesMeta-analyses of randomised controlled trials (or in the absence of meta-analysis other study designs) that compared the clinical effectiveness of any of the 10 orthopaedic procedures with no treatment, placebo, or non-operative care.Data extraction and synthesisSummary data were extracted by two independent investigators, and a consensus was reached with the involvement of a third. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews instrument. The Jadad decision algorithm was used to ascertain which meta-analysis represented the best evidence. The National Institute for Health and Care Excellence Evidence search was used to check whether recommendations for each procedure reflected the body of evidence.Main outcome measuresQuality and quantity of evidence behind common elective orthopaedic interventions and comparisons with the strength of recommendations in relevant national clinical guidelines.ResultsRandomised controlled trial evidence supports the superiority of carpal tunnel decompression and total knee replacement over non-operative care. No randomised controlled trials specifically compared total hip replacement or meniscal repair with non-operative care. Trial evidence for the other six procedures showed no benefit over non-operative care.ConclusionsAlthough they may be effective overall or in certain subgroups, no strong, high quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives. Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations.Systematic review registrationPROSPERO CRD42018115917.

The effectiveness of telemedicine on body mass index: A systematic review and meta-analysis

2018 ◽  
Vol 25 (7) ◽  
pp. 389-401 ◽  
Author(s):  
Jen-Wu Huang ◽  
Yi-Ying Lin ◽  
Nai-Yuan Wu
Keyword(s):  
Systematic Review ◽  
Body Mass Index ◽  
Body Mass ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Obese People ◽  
Randomised Controlled

Object The purpose of this study was to evaluate the clinical effectiveness of telemedicine on changes in body mass index for overweight and obese people as well as for diabetes and hypertension patients. Methods A systematic review of articles published before 31 August 2014, was conducted using searches of Medline, Cochrane Library, EMBASE, and CINAHL Plus. The inclusion criteria were randomised controlled trials that compared telemedicine interventions with usual care or standard treatment in adults and reported a change in body mass index. A meta-analysis was conducted for eligible studies, and the primary outcome was a change in body mass index. Subgroup analysis was performed for the type of telemedicine, main purpose of intervention, and length of intervention. Results Twenty-five randomised controlled trials comprising 6253 people were included in the qualitative and quantitative analyses. The length of intervention ranged from nine weeks to two years. The meta-analysis revealed significant differences in body mass index changes (pooled difference in means = –0.49, 95% confidence interval –0.63 to –0.34, p < 0.001) between the telemedicine and control groups. The subgroup analyses found that either Internet-based or telephone-based intervention was associated with greater changes in body mass index than in controls. Telemedicine intervention was effective in improving body mass index whether it was used for diabetes control, hypertension control, weight loss, or increasing physical activity and was also effective for people with and without diabetes or hypertension. However, only interventions with a duration ≥ 6 months significantly decreased body mass index compared to controls. Conclusion Both patients with chronic disease and overweight/obese people could benefit from telemedicine interventions. We suggest that an effective telemedicine approach should be longer than six months and emphasise the importance of post-interventional follow-ups.

scholarly journals Evidence into practice

2002 ◽  
Vol 181 (2) ◽  
pp. 99-101 ◽  
Author(s):  
Rupatharshini Chilvers ◽  
Glynn Harrison ◽  
Attila Sipos ◽  
Madeline Barley
Keyword(s):  
Clinical Practice ◽  
Social Workers ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Routine Clinical Practice ◽  
Controlled Trials ◽  
External Evidence ◽  
Randomised Controlled ◽  
Health Field

Psychiatrists have long recognised that routine clinical practice needs to be shaped and informed by external evidence (Lewis, 1958). Psychiatric researchers were among the first to utilise multi-centre randomised controlled trials (demonstrating the effectiveness of antipsychotics), and psychologists were among the first in the health field to develop techniques of meta-analysis. Social workers, too, point to their tradition with the publication of one of the earliest controlled trials (Lehrman, 1949).

scholarly journals Evidence into practice

2002 ◽  
Vol 181 (02) ◽  
pp. 99-101 ◽  
Author(s):  
Rupatharshini Chilvers ◽  
Glynn Harrison ◽  
Attila Sipos ◽  
Madeline Barley
Keyword(s):  
Clinical Practice ◽  
Social Workers ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Routine Clinical Practice ◽  
Controlled Trials ◽  
External Evidence ◽  
Randomised Controlled ◽  
Health Field

Psychiatrists have long recognised that routine clinical practice needs to be shaped and informed by external evidence (Lewis, 1958). Psychiatric researchers were among the first to utilise multi-centre randomised controlled trials (demonstrating the effectiveness of antipsychotics), and psychologists were among the first in the health field to develop techniques of meta-analysis. Social workers, too, point to their tradition with the publication of one of the earliest controlled trials (Lehrman, 1949).

Sign in / Sign up

Export Citation Format

Share Document