Ability of prophylactic clipping to reduce the incidence of delayed bleeding in patients undergoing endoscopic resection of colonic polyps: a rapid evidence assessment review

Background: Delayed bleeding is a recognised complicationf ollowing colonic endoscopic resection. Prophylactic clip application is often used to reduce this. However, there is a lack of guidelines to support this. Aims: This article aims to review the most recent evidence on the question: 'In patients undergoing endoscopic resection of colonic polyps, does prophylactic clipping of the resection, compared with not clipping, reduce the incidence of delayed bleeding?'. Methods: A rapid assessment was undertaken regarding prophylactic clipping efficacy to reduce delayed bleeding. A search of three databases (Medline, the University of Derby Library Plus and the Cochrane Library) was undertaken to identify articles from the past 4 years. Findings: Eight publications were reviewed: three meta-analyses and five randomised control trials. Five publications recommended against prophylactic clipping following colonic endoscopic resection and three, the most recent publications, strongly recommended it, specifically for those at high risk of delayed bleeding. Conclusion: Prophylactic clip application to reduce delayed bleeding is not effective across all colonic resections. However, there is evidence in favour of clipping for patients with high risk of delayed bleeding.

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Management of anticoagulants in delayed bleeding after endoscopic resection: A systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-1467-6068 ◽

2021 ◽

Vol 09 (07) ◽

pp. E1128-E1135

Author(s):

Xianhong Zhao ◽

Yangxue Huang ◽

Jiarong Li ◽

Aoqiang Zhou ◽

Gengxin Chen ◽

...

Keyword(s):

Endoscopic Resection ◽

Clinical Effect ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Delayed Bleeding ◽

Best Management ◽

Significant Difference ◽

Meta Analyses ◽

Bridge Therapy

Abstract Background and study aims Delayed bleeding and thrombotic events are uncontrolled adverse events that are hard to balance in patients receiving anticoagulants after endoscopic resection. The present study aims to assess the clinical effect of warfarin, when compared to direct oral anticoagulants (DOACs), in terms of delayed bleeding and thrombotic events. Methods A comprehensive electronic literature search was conducted for eligible literature. Pairwise meta-analyses were performed on outcomes of delayed bleeding and thrombotic events. Two networks within the Bayesian framework were established based on the management of anticoagulants and type of DOAC. Results Eight cohort studies with 2,046 patients were eligible for inclusion, including 1,176 patients treated with warfarin and 870 with DOACs. There was no significant difference between warfarin and DOACs, in terms of delayed bleeding (OR = 1.29, 95 % CI [0.99–1.69]) and thromboembolism (OR = 2.0, 95 % CI [0.32–12.39]). In the network meta-analyses for delayed bleeding, the rank probabilities revealed that the safest management was discontinuous warfarin without heparin bridge therapy (HBT). Rank probabilities for the types of DOACs demonstrated that the safest drug was dabigatran. Conclusions There was no significant difference in delayed bleeding and thromboembolism between warfarin and DOACs in patients receiving endoscopic treatment. In terms of delayed bleeding, discontinuous warfarin without HBT was suggested as the best management, and dabigatran was recommended as the best type of DOAC.

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Validated Finite Element Models of Premolars: A Scoping Review

Materials ◽

10.3390/ma13153280 ◽

2020 ◽

Vol 13 (15) ◽

pp. 3280

Author(s):

Raphaël Richert ◽

Jean-Christophe Farges ◽

Faleh Tamimi ◽

Naim Naouar ◽

Philippe Boisse ◽

...

Keyword(s):

Finite Element ◽

Construction Material ◽

Failure Criteria ◽

Model Construction ◽

Cochrane Library ◽

In Vitro Tests ◽

Periodontal Tissues ◽

Meta Analyses ◽

The Cochrane Library

Finite element (FE) models are widely used to investigate the biomechanics of reconstructed premolars. However, parameter identification is a complex step because experimental validation cannot always be conducted. The aim of this study was to collect the experimentally validated FE models of premolars, extract their parameters, and discuss trends. A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Records were identified in three electronic databases (MEDLINE [PubMed], Scopus, The Cochrane Library) by two independent reviewers. Twenty-seven parameters dealing with failure criteria, model construction, material laws, boundary conditions, and model validation were extracted from the included articles. From 1306 records, 214 were selected for eligibility and entirely read. Among them, 19 studies were included. A heterogeneity was observed for several parameters associated with failure criteria and model construction. Elasticity, linearity, and isotropy were more often chosen for dental and periodontal tissues with a Young’s modulus mostly set at 18–18.6 GPa for dentine. Loading was mainly simulated by an axial force, and FE models were mostly validated by in vitro tests evaluating tooth strains, but different conditions about experiment type, sample size, and tooth status (intact or restored) were reported. In conclusion, material laws identified herein could be applied to future premolar FE models. However, further investigations such as sensitivity analysis are required for several parameters to clarify their indication.

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Effect of Using a Safety Checklist on Patient Complications after Surgery

Anesthesiology ◽

10.1097/aln.0000000000000232 ◽

2014 ◽

Vol 120 (6) ◽

pp. 1380-1389 ◽

Cited By ~ 63

Author(s):

Brigid M. Gillespie ◽

Wendy Chaboyer ◽

Lukman Thalib ◽

Melinda John ◽

Nicole Fairweather ◽

...

Keyword(s):

Absolute Risk ◽

Absolute Risk Reduction ◽

Cochrane Library ◽

Number Needed To Treat ◽

Complication Rates ◽

Random Effects Models ◽

Fixed And Random Effects ◽

Before And After ◽

Meta Analyses ◽

The Cochrane Library

Abstract Background: Previous before-and-after studies indicate that the use of safety checklists in surgery reduces complication rates in patients. Methods: A systematic review of studies was undertaken using MEDLINE, CINAHL, Proquest, and the Cochrane Library to identify studies that evaluated the effects of checklist use in surgery on complication rates. Study quality was assessed using the Methodological Index for Nonrandomized Studies. The pooled risk ratio (RR) was estimated using both fixed and random effects models. For each outcome, the number needed to treat (NNT) and the absolute risk reduction (ARR) were also computed. Results: Of the 207 intervention studies identified, 7 representing 37,339 patients were included in meta-analyses, and all were cohort studies. Results indicated that the use of checklists in surgery compared with standard practice led to a reduction in any complication (RR, 0.63; 95% CI, 0.58 to 0.72; P < 0.0001; ARR, 3.7%; NNT, 27) and wound infection (RR, 0.54; 95% CI, 0.40 to 0.72; P = 0.0001; ARR, 2.9%; NNT, 34) and also reduction in blood loss (RR, 0.56; 95% CI, 0.45 to 0.70; P = 0.0001; ARR, 3.8%; NNT, 33). There were no significant reductions in mortality (RR, 0.79; 95% CI, 0.57 to 1.11; P = 0.191; ARR, 0.44%; NNT, 229), pneumonia (RR, 1.03; 95% CI, 0.73 to 1.4; P = 0.857; ARR, 0.04%; NNT, 2,512), or unplanned return to operating room (RR, 0.75; 95% CI, 0.56 to 1.02; P = 0.068; ARR, 0.52%; NNT, 192). Conclusion: Notwithstanding the lack of randomized controlled trials, synthesis of the existing body of evidence suggests a relationship between checklist use in surgery and fewer postoperative complications.

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Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence

Journal of Clinical Medicine ◽

10.3390/jcm9103369 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3369

Author(s):

Won-Seok Kim ◽

Sungmin Cho ◽

Jeonghun Ku ◽

Yuhee Kim ◽

Kiwon Lee ◽

...

Keyword(s):

Virtual Reality ◽

Clinical Application ◽

Upper Limb ◽

Stroke Rehabilitation ◽

Cochrane Library ◽

Motor Rehabilitation ◽

Novel Technologies ◽

Ovid Medline ◽

Meta Analyses ◽

The Cochrane Library

Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.

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Association between Atopic Dermatitis and the Metabolic Syndrome: A Systematic Review

Dermatology ◽

10.1159/000491593 ◽

2018 ◽

Vol 234 (3-4) ◽

pp. 79-85 ◽

Cited By ~ 10

Author(s):

Zarqa Ali ◽

Charlotte Suppli Ulrik ◽

Tove Agner ◽

Simon Francis Thomsen

Keyword(s):

Metabolic Syndrome ◽

Atopic Dermatitis ◽

Central Obesity ◽

Current Knowledge ◽

Positive Association ◽

Cochrane Library ◽

The Metabolic Syndrome ◽

Increased Risk ◽

Meta Analyses ◽

The Cochrane Library

Atopic dermatitis (AD) may be associated with the metabolic syndrome and by that carry an increased risk of cardiovascular disease. Our objective was to provide an update on current knowledge of the association between AD and metabolic syndrome, including each component of the metabolic syndrome. A systematic literature review was performed to identify studies investigating the association between metabolic syndrome and AD from PubMed, Embase, and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A total of 14 studies, investigating the association between AD and the metabolic syndrome or AD and components of metabolic syndrome fulfilled the inclusion criteria and were included. It seems unlikely that the association between AD and metabolic syndrome is causal. However, women with AD tended to have components of metabolic syndrome more often than women without AD. There was a positive association between AD and central obesity measured as waist circumference, and this association was stronger for women than men. Despite conflicting results regarding hypertension, the association between hypertension and AD also appeared stronger for women. On the other hand, the association between AD and hyperglycemia appears unlikely, and the association between AD and cholesterol levels was inconsistent. In conclusion, it remains unclear whether AD is a risk factor for metabolic syndrome and its components. However, data indicate that central obesity is associated with AD and that the association is stronger for women than men.

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The Effectiveness and Safety of Manual Acupuncture Therapy in Patients with Poststroke Cognitive Impairment: A Meta-analysis

Neural Plasticity ◽

10.1155/2020/8890521 ◽

2020 ◽

Vol 2020 ◽

pp. 1-15

Author(s):

Wei Liu ◽

Chang Rao ◽

Yuzheng Du ◽

Lili Zhang ◽

Jipeng Yang

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Barthel Index ◽

Daily Life ◽

Meta Analysis ◽

Cochrane Library ◽

Activities Of Daily Life ◽

Rigorous Study ◽

Meta Analyses ◽

The Cochrane Library

Background. Poststroke cognitive impairment (PSCI) is a common cause of disability among patients with stroke. Meanwhile, acupuncture has increasingly been used to improve motor and cognitive function for stroke patients. The aim of the present study was to summarize and evaluate the evidence on the effectiveness of acupuncture in treating PSCI. Methods. Eight databases (PubMed, The Cochrane Library, CNKI, WanFang Data, VIP, CBM, Medline, Embase databases) were searched from January 2010 to January 2020. Meta-analyses were conducted for the eligible randomized controlled trials (RCTs). Assessments were performed using Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Barthel Index (BI), or modified Barthel Index (MBI). Results. A total of 657 relevant RCTs were identified, and 22 RCTs with 1856 patients were eventually included. Meta-analysis showed that acupuncture appeared to be effective for improving cognitive function as assessed by MMSE ( mean difference MD = 1.73 , 95% confidence interval (CI) (1.39, 2.06), P < 0.00001 ) and MoCA ( MD = 2.32 , 95% CI (1.92, 2.73), P < 0.00001 ). Furthermore, it also suggested that acupuncture could improve the activities of daily life (ADL) for PSCI patients as assessed by BI or MBI ( SMD = 0.97 , 95% CI (0.57, 1.38), P < 0.00001 ). Conclusions. Compared with nonacupuncture group, acupuncture group showed better effects in improving the scores of MMSE, MoCA, BI, and MBI. This meta-analysis provided positive evidence that acupuncture may be effective in improving cognitive function and activities of daily life for PSCI patients. Meanwhile, long retention time of acupuncture may improve cognitive function and activities of daily life, and twist technique may be an important factor that could influence cognitive function. However, further studies using large samples and a rigorous study design are needed to confirm the role of acupuncture in the treatment of PSCI.

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Comparative efficacy, effectiveness and harms of second-generation antidepressants in the pharmacologic treatment of adult depression

European Psychiatry ◽

10.1016/s0924-9338(11)72971-6 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1266-1266

Author(s):

L. Morgan ◽

G. Gartlehner

Keyword(s):

Second Generation ◽

Healthcare Research ◽

Response To Treatment ◽

Cochrane Library ◽

Comparative Efficacy ◽

Onset Of Action ◽

Conflicting Evidence ◽

Treatment Comparisons ◽

Meta Analyses ◽

The Cochrane Library

IntroductionSecond-generation antidepressants dominate the medical management of major depressive disorder (MDD). Two published comparative effectiveness reviews (CER) provide conflicting evidence about the comparative efficacy and safety of second-generation antidepressants for treating MDD.ObjectivesTo compare the benefits and harms of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of MDD in adults.MethodsWe updated a CER published in 2007 by the Agency for Healthcare Research and Quality searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias. If data were sufficient, we conducted meta-analyses of head-to-head trials of the relative benefit of response to treatment. In addition, we conducted mixed treatment comparisons to derive indirect estimates of the comparative efficacy among all second-generation antidepressants.ResultsOverall, no substantial differences in efficacy could be detected among second-generation antidepressants. Statistically significant differences in response rates between some compared drugs are small and likely not clinically relevant. Differences exist in the incidence of specific adverse events and the onset of action. Venlafaxine leads to higher rates of nausea and vomiting, sertraline to higher rates of diarrhea, and mirtazapine to higher rates of weight gain than comparator drugs. Bupropion caused lower rates of sexual dysfunction than other antidepressants.ConclusionsOur findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy and effectiveness.

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Influence ofDPYDGenetic Polymorphisms on 5-Fluorouracil Toxicities in Patients with Colorectal Cancer: A Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2014/827989 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 9

Author(s):

Qiang Li ◽

Ying Liu ◽

Hong-Mei Zhang ◽

Yin-Peng Huang ◽

Tian-Yi Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Genetic Polymorphisms ◽

Web Of Science ◽

Meta Analysis ◽

Dihydropyrimidine Dehydrogenase ◽

Cochrane Library ◽

Inclusion Criteria ◽

Meta Analyses ◽

The Cochrane Library ◽

Stratified Analysis

Our meta-analysis aggregated existing results from relevant studies to comprehensively investigate the correlations between genetic polymorphisms in dihydropyrimidine dehydrogenase (DPYD) gene and 5-fluorouracil (5-FU) toxicities in patients with colorectal cancer (CRC). The MEDLINE (1966∼2013), the Cochrane Library Database (Issue 12, 2013), EMBASE (1980∼2013), CINAHL (1982∼2013), Web of Science (1945∼2013), and the Chinese Biomedical Database (CBM) (1982∼2013) were searched without language restrictions. Meta-analyses were conducted with the use of STATA software (Version 12.0, Stata Corporation, College Station, TX, USA). Seven clinical cohort studies with a total of 946 CRC patients met our inclusion criteria, and NOS scores of each of the included studies were ≥5. Our findings showed thatDPYDgenetic polymorphisms were significantly correlated with high incidences of 5-FU-related toxicity in CRC patients. SNP-stratified analysis indicated that there were remarkable connections of IVS14+1G>A, 464T>A, and 2194G>A polymorphisms with the incidence of marrow suppression in CRC patients receiving 5-FU chemotherapy. Furthermore, we found that IVS14+1G>A, 496A>G, and 2194G>A polymorphisms were correlated with the incidence of gastrointestinal reaction. Ethnicity-stratified analysis also revealed thatDPYDgenetic polymorphisms might contribute to the development of marrow suppression and gastrointestinal reaction among Asians, but not among Caucasians. The present meta-analysis suggests thatDPYDgenetic polymorphisms may be correlated with the incidence of 5-FU-related toxicity in CRC patients.

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418 SYSTEMATIC REVIEW OF LEARNING CURVES IN MINIMALLY INVASIVE PARAESOPHAGEAL HERNIA REPAIR: IS THERE ENOUGH EVIDENCE FOR MENTORSHIP IN SURGICAL RESIDENCY?

Diseases of the Esophagus ◽

10.1093/dote/doaa087.107 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

P Prasad ◽

M Navidi ◽

N Hayes ◽

S Wahed ◽

A Immanuel ◽

...

Keyword(s):

Minimally Invasive ◽

Learning Curve ◽

Paraesophageal Hernia ◽

Learning Curves ◽

Cochrane Library ◽

Surgical Residents ◽

Trainee Group ◽

Newcastle Ottawa Scale ◽

Meta Analyses ◽

The Cochrane Library

Abstract Laparoscopic repair remains the approach of choice for the surgical management of symptomatic paraesophageal hernia (PEH), although robotic techniques are becoming increasingly popular. The learning curve for minimally invasive PEH repair can be variable and little is known of its potential impact upon surgical residents’ training. The aim of this review is to appraise current literature on learning curves in PEH repair and its impact on training and mentorship of surgical residents. Methods Literature searches were performed in three databases: MEDLINE (1980-2020), EMBASE and the Cochrane Library. Search results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data quality was assessed in accordance with the Newcastle-Ottawa Scale for cohort studies. Results A total of 6 studies were identified; 4 laparoscopic and 2 robotic assisted with 2678 patients assessed in total. One study used a cumulative sum (CUSUM) analysis to define learning with the remainder of studies using between 3 and 11 parameters. 2 studies evaluated trainees’ performance in performing laparoscopic PEH repair when mentored by surgeons who had achieved competence on the learning curve. Both studies reported equivalent clinical outcomes for laparoscopic PEH repair performed by trainees versus consultants, although one study suggested 5-year outcomes were inferior in the trainee group despite mentorship. Conclusion Despite being commonly performed, little is known about the learning curves for minimally invasive PEH repair. Furthermore, whether prior laparoscopic experience confers any advantage to performing robotic PEH repair is not known at present. Further data to help evaluate the learning curve for those performing PEH is required in order to enhance training and permit quicker attainment of competency.

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Efficacy and safety of iron supplementation in patients with heart failure and iron deficiency: a meta-analysis

British Journal Of Nutrition ◽

10.1017/s000711451900014x ◽

2019 ◽

Vol 121 (8) ◽

pp. 841-848 ◽

Cited By ~ 1

Author(s):

Shuo Zhang ◽

Fengxiao Zhang ◽

Meng Du ◽

Kun Huang ◽

Cheng Wang

Keyword(s):

Heart Failure ◽

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Efficacy And Safety ◽

Fixed Effects Model ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Randomised Control Trials ◽

The Cochrane Library

AbstractFe therapy can be effective in heart failure patients both with and without anaemia. However, the role of Fe therapy in such patients is still uncertain. In this review, the aim was to evaluate the efficacy and safety of Fe therapy in adult patients with heart failure who have reduced ejection fraction (HFrEF). Multiple databases (PubMed, Medline, EMBASE, the Cochrane Library and Clinical Trials) were searched up to December 2017 and the reference lists of relevant articles obtained from the search were reviewed. Data extracted from randomised control trials (RCT) selected for the review were pooled using a fixed effects model or a random effects model, according to heterogeneity between trials. Nine RCT were included in this meta-analysis which included a total of 789 patients who received Fe therapy and who in turn were compared with 585 controls. There was significant improvement in the 6-min walk test (19·05 m, 95 % CI 10·48, 27·62) and peak VO2/kg (0·93 ml/kg per min, 95 % CI 0·16, 1·69) in the Fe supplementation arm. With Fe therapy, fewer patients were hospitalised for heart failure (OR: 0·42, 95 % CI 0·27, 0·65), but no relationship was found for total re-hospitalisation (OR: 0·70, 95 % CI 0·32, 1·51) or mortality (OR: 0·70, 95 % CI 0·38, 1·28). Fe therapy has the potential to improve exercise tolerance, reduce re-hospitalisations for patients with HFrEF having Fe deficiency. In addition, Fe supplementation was found to be safe, with no increased rate of adverse events.

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