scholarly journals Suture choice to reduce occurrence of surgical site infection, hernia, wound dehiscence and sinus/fistula: a network meta-analysis

2019 ◽  
Vol 101 (3) ◽  
pp. 150-161 ◽  
Author(s):  
BE Zucker ◽  
C Simillis ◽  
P Tekkis ◽  
C Kontovounisios
Keyword(s):  
Surgical Site Infection ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Wound Dehiscence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Site Infection ◽  
Suture Materials ◽  
Absorbable Sutures

Background There are many options and little guiding evidence when choosing suture types with which to close the abdominal wall fascia. This network meta-analysis investigated the effect of suture materials on surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence after abdominal surgery. The aim was to provide clarity on whether previous recommendations on suture choice could be followed with confidence. Methods and methods In February 2017, the Cochrane Central Register of Controlled Trials, Medline, EMBASE and Science Citation Index Expanded were searched for randomised controlled trials investigating the effect of suture choice on these four complications in closing the abdomen. A reference search of identified trials was performed. Prisma guidelines and the Cochrane risk of bias tool were followed in the data extraction and synthesis. Two review authors screened titles and abstracts of trials identified. A random effect model was used for the surgical site infection network based on the deviance information criterion statistics. Results Thirty-one trials were included (11,533 participants). No suture material reached the predetermined 90% probability threshold for determination of ‘best treatment’ for any outcome. Pairwise comparisons largely showed no differences between suture types for all outcomes measured. However, nylon demonstrated a reduction in the occurrence of incisional hernias with respect to two commonly used absorbable sutures: polyglycolic acid (odds ratio, OR 1.91; 95% confidence interval, CI, 1.01–3.63) and polyglyconate (OR 2.18; 95% CI 1.17–4.07). Conclusions No suture type can be considered the ‘best treatment’ for the prevention of surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence.

scholarly journals Effects of music therapy on depression: A meta-analysis of randomized controlled trials

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0240862
Author(s):  
Qishou Tang ◽  
Zhaohui Huang ◽  
Huan Zhou ◽  
Peijie Ye
Keyword(s):  
Depressive Symptom ◽  
Music Therapy ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Music Medicine ◽  
Effect Model

Background We aimed to determine and compare the effects of music therapy and music medicine on depression, and explore the potential factors associated with the effect. Methods PubMed (MEDLINE), Ovid-Embase, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Clinical Evidence were searched to identify studies evaluating the effectiveness of music-based intervention on depression from inception to May 2020. Standardized mean differences (SMDs) were estimated with random-effect model and fixed-effect model. Results A total of 55 RCTs were included in our meta-analysis. Music therapy exhibited a significant reduction in depressive symptom (SMD = −0.66; 95% CI = -0.86 to -0.46; P<0.001) compared with the control group; while, music medicine exhibited a stronger effect in reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P<0.001). Among the specific music therapy methods, recreative music therapy (SMD = -1.41; 95% CI = -2.63 to -0.20; P<0.001), guided imagery and music (SMD = -1.08; 95% CI = -1.72 to -0.43; P<0.001), music-assisted relaxation (SMD = -0.81; 95% CI = -1.24 to -0.38; P<0.001), music and imagery (SMD = -0.38; 95% CI = -0.81 to 0.06; P = 0.312), improvisational music therapy (SMD = -0.27; 95% CI = -0.49 to -0.05; P = 0.001), music and discuss (SMD = -0.26; 95% CI = -1.12 to 0.60; P = 0.225) exhibited a different effect respectively. Music therapy and music medicine both exhibited a stronger effects of short and medium length compared with long intervention periods. Conclusions A different effect of music therapy and music medicine on depression was observed in our present meta-analysis, and the effect might be affected by the therapy process.

scholarly journals Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034266 ◽  
Author(s):  
Celestin Danwang ◽  
Jean Joel Bigna ◽  
Joel Noutakdie Tochie ◽  
Aimé Mbonda ◽  
Clarence Mvalo Mbanga ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Site Infection ◽  
Low Income ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Open Appendectomy ◽  
Risk Of Bias ◽  
Low Income Countries ◽  
Site Infection

BackgroundAlthough surgical site infection (SSI) is one of the most studied healthcare-associated infections, the global burden of SSI after appendectomy remains unknown.ObjectiveWe estimated the incidence of SSI after appendectomy at global and regional levels.DesignSystematic review and meta-analysis.ParticipantsAppendectomy patients.Data sourcesEMBASE, PubMed and Web of Science were searched, with no language restrictions, to identify observational studies and clinical trials published between 1 January 2000 and 30 December 2018 and reporting on the incidence of SSI after appendectomy. A random-effect model meta-analysis served to obtain the pooled incidence of SSI after appendectomy.ResultsIn total, 226 studies (729 434 participants from 49 countries) were included in the meta-analysis. With regard to methodological quality, 59 (26.1%) studies had low risk of bias, 147 (65.0%) had moderate risk of bias and 20 (8.8%) had high risk of bias. We found an overall incidence of SSI of 7.0 per 100 appendectomies (95% prediction interval: 1.0–17.6), varying from 0 to 37.4 per 100 appendectomies. A subgroup analysis to identify sources of heterogeneity showed that the incidence varied from 5.8 in Europe to 12.6 per 100 appendectomies in Africa (p<0.0001). The incidence of SSI after appendectomy increased when the level of income decreased, from 6.2 in high-income countries to 11.1 per 100 appendectomies in low-income countries (p=0.015). Open appendectomy (11.0 per 100 surgical procedures) was found to have a higher incidence of SSI compared with laparoscopy (4.6 per 100 appendectomies) (p=0.0002).ConclusionThis study suggests a high burden of SSI after appendectomy in some regions (especially Africa) and in low-income countries. Strategies are needed to implement and disseminate the WHO guidelines to decrease the burden of SSI after appendectomy in these regions.Prospero registration numberCRD42017075257.

scholarly journals Cerebrospinal Fluid and Serum d-Serine Levels in Patients with Alzheimer’s Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (12) ◽  
pp. 3840
Author(s):  
Chun-Hung Chang ◽  
Hsiao-Lun Kuo ◽  
Wei-Fen Ma ◽  
Hsin-Chi Tsai
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cerebrospinal Fluid ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Cochrane Database

Objective: Alzheimer’s disease (AD) is a complex and severe neurodegenerative disease and still lacks effective methods of diagnosis. Dysfunction of the N-methyl-D-aspartate receptor (NMDAR) has been found to be involved in synapse dysfunction and neurotoxicity of AD mechanisms. d-Serine, an NMDAR receptor coagonist, is reported as a potential new biomarker for AD. However, the results of serum and cerebrospinal fluid (CSF) d-serine levels are conflicting. We conducted a meta-analysis to investigate the serum and CSF d-serine levels in patients with AD. Methods: We searched PubMed, the Cochrane central register of controlled trials, and the Cochrane database of systematic reviews for trials that measured d-serine levels both in patients with AD and in controls. We included controlled trials that analyzed d-serine levels in human samples (e.g., serum and CSF). Studies were pooled using a random-effect model for comparisons between AD and control group. We used effect size (ES; expressed as d-serine levels) in each selected meta-analysis to calculate standardized mean difference (SMD). Positive values indicated increased d-serine levels in AD group. We presented results with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through visually inspecting funnel plots and using the I2 statistic. Moderators of effects were explored using metaregression. Results: Seven trials with more than 1186 participants were included in this meta-analysis. d-serine levels in patients with AD were significantly higher than those in controls (SMD = 0.679, 95% CI = 0.335 to 1.022, p < 0.001). Subgroup analyses showed that the AD group had significantly higher d-serine levels in serum and CSF compared with the control group (SMD = 0.566 (serum) and 1.008 (CSF); 95% CI = 0.183 to 0.948 (serum) and 0.168 to 1.849 (CSF)). Moreover, a metaregression revealed a significant negative association between ES and mean mini-mental state examination score in AD group (slope = −0.1203, p = 0.0004). Conclusions: Our results revealed higher d-serine levels in the serum and CSF of patients with AD relative to the controls. Further studies with a larger sample size and longer follow-up are recommended to clarify this association.

scholarly journals Effect of restrictive versus liberal red cell transfusion strategies on haemostasis: systematic review and meta-analysis

2017 ◽  
Vol 117 (05) ◽  
pp. 889-898 ◽  
Author(s):  
Katherine Colman ◽  
Babette Prick ◽  
Johannes Duvekot ◽  
Connor Sweeney ◽  
Ayodele Odutayo ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Red Cells ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Red Cell ◽  
Risk Of Bleeding ◽  
Red Cell Transfusion ◽  
Liberal Transfusion

SummaryRed cells play a key role in normal haemostasis in vitro but their importance clinically is less clear. The objective of this meta-analysis was to assess if correction of anaemia by transfusing red cells at a high haemoglobin threshold (liberal transfusion) is superior to transfusion at a lower haemoglobin threshold (restrictive transfusion) for reducing the risk of bleeding or thrombotic events. We searched for randomised controlled trials in any clinical setting that compared two red cell transfusion thresholds and investigated the risk of bleeding. We searched for studies published up to October 19, 2016 in The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, and the Transfusion Evidence Library and ISI Web of Science. Relative risks (RR) or Peto Odds Ratios (pOR) were pooled using a random-effect model. Nineteen randomised trials with 9852 participants were eligible for inclusion in this review. Overall there was no difference in the risk of any bleeding between transfusion strategies (RR 0.91, 95 % confidence interval [CI] 0.74 to 1.12). The risk of severe or life-threatening bleeding was lower with a restrictive strategy (RR 0.75, 95 % CI 0.57 to 0.99). There was no difference in the risk of thrombotic events (RR 0.83, 95 % CI 0.61 to 1.13). The risk of any bleeding was not reduced with liberal transfusion and there was no overall difference in the risk of thrombotic events. Data from the included trials do not support aiming for a high haemoglobin threshold to improve haemostasis. PROSPERO registration number CRD42016035519.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Inflammatory blood parameters as prognostic factors for surgical site infection after primary hip or knee arthroplasty: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046027
Author(s):  
Petr Domecky ◽  
Anna Rejman Patkova ◽  
Katerina Mala-Ladova ◽  
Josef Maly
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Diagnostic Accuracy ◽  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Blood Parameters ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Site Infection

IntroductionSurgical site infection (SSI) is a potential complication of surgical procedure. SSI after implant surgery is a disaster both for patients and surgeons. Although predictive tools for SSI are available, none of them estimate early infection based on inflammatory blood parameters. The inflammatory process can be measured using several parameters including interleukin-6, C reactive protein, neutrophil to lymphocyte ratio, white cell count, erythrocyte sedimentation rate or procalcitonin. This systematic review aims to determine whether inflammatory blood parameters could be used as significant predictive factors for SSI after primary hip or knee arthroplasty.Methods and analysisA systematic review of randomised controlled trials, cross-sectional studies, case–control studies and cohort studies, published in English, will be searched in the following electronic bibliographic databases: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials and Web of Science. Studies performed in adult patients of all ages who underwent knee or hip arthroplasty, studies containing data on the risk/prognostic factors for preknee or postknee or hip arthroplasty SSI and studies with a minimum follow-up of 30 days after surgery will be included. A standardised form will be used to extract data from the included studies comprising study characteristics, participant characteristics, details of the intervention, study methodology and outcomes. Quality Assessment of Diagnostic Accuracy tool, second version, and Standards for Reporting of Diagnostic Accuracy Studies checklist will be used to assess risk of bias. Heterogeneity will be assessed using Cochran χ² statistic and I2 statistics where applicable. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be used to report findings.Ethics and disseminationNo ethics approval is required. The findings will be disseminated at national and international scientific sessions, also to be published in a peer-reviewed journal.PROSPERO registration numberCRD42020147925.

scholarly journals Adhesive precoated bracket systems and operator coated bracket systems: Is there any difference? A systematic review and meta-analysis

2018 ◽  
Vol 89 (3) ◽  
pp. 495-504
Author(s):  
Ahmed Mohamed Alakttash ◽  
Mohamed Fawzi ◽  
David Bearn
Keyword(s):  
Failure Rate ◽  
Meta Analysis ◽  
Random Effect ◽  
Bonding Time ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
White Spot Lesion ◽  
Operator Experience ◽  
Gingival Health ◽  
Clinically Significant

ABSTRACT Objectives: To investigate whether adhesive precoated brackets (APC) are more efficient than operator-coated brackets (OPC) regarding failure rate, bonding time, patient experience, gingival health, plaque accumulation, and white spot lesion formation. Materials and Methods: Five online databases: Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, PubMed, MEDLINE, and Web of Science were searched for potential eligible randomized controlled trials (RCTs). A Google Scholar and gray literature search was undertaken. References of included studies were screened for potential eligible studies. Results were collated from each database and modified Cochrane data extraction forms were completed. Quality assessment was performed using Cochrane RoB 2.0 tool for RCTs. Results: Five studies met the inclusion criteria. All reported failure rates using metal brackets for both APC and OPC systems except one that compared clear APC to clear OPC. Three studies reported bonding time differences between the bracket systems. A quantitative synthesis of four studies reporting failure and three reporting bonding time was undertaken. Random effect meta-analysis determined there were no statistically significant differences in bond failures between bracket systems with an odds ratio of 0.890 (P = .808). Bonding time showed a statistically significant (P = .01) but not clinically significant shorter bonding time with OPC. There was insufficient evidence to assess plaque accumulation, gingival health, and either patient or operator experience. Conclusions: There is no superiority of either bracket system regarding failure rate. OPC are statistically significantly superior over APC in bonding time although this is most likely not clinically significant.

scholarly journals Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials

2020 ◽  
Vol 109 (11) ◽  
pp. 1381-1391 ◽  
Author(s):  
Hans-Josef Feistritzer ◽  
Alexander Jobs ◽  
Suzanne de Waha-Thiele ◽  
Ingo Eitel ◽  
Anne Freund ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Randomized Controlled Trials ◽  
Primary Endpoint ◽  
Meta Analysis ◽  
Random Effect ◽  
Final Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Risk Of Death ◽  
Randomized Controlled

Abstract Aims To perform a pairwise meta-analysis of randomized controlled trials (RCTs) comparing multivessel percutaneous coronary intervention (PCI) and culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) patients without cardiogenic shock. Methods We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for RCTs comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models. Results Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43–0.93; p = 0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52–0.79; p = 0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44–1.35; p = 0.28) or cardiovascular death (HR 0.64, 95% CI 0.37–1.11; p = 0.09) was observed. Conclusions In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.

Abiraterone or docetaxel in men with metastatic castration-sensitive prostate cancer: A pooled analysis of castration resistance-free survival and toxicity.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 354-354 ◽  
Author(s):  
Joelle Helou ◽  
Charles N Catton ◽  
Glenn Bauman ◽  
Rouhi Fazelzad ◽  
Jacques Raphael
Keyword(s):  
Prostate Cancer ◽  
Meta Analysis ◽  
Random Effect ◽  
Initial Therapy ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Castration Resistance ◽  
Free Survival ◽  
Meta Analyses

354 Background: Recent meta-analyses suggested an improvement in overall survival (OS) with the addition of Abiraterone (A) vs Docetaxel (D) to androgen deprivation therapy (ADT) in the treatment of men with metastatic castration-sensitive prostate cancer. However, none have reported castration resistance-free survival (CFS) and toxicity data; two clinically relevant outcomes for physicians and patients. Methods: We conducted a systematic review and meta-analysis to assess CFS and toxicity of adding A or D to ADT in men with castration-sensitive prostate cancer. The electronic databases Ovid MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE, were searched for randomized controlled trials. Pooled hazard ratios (HR) for CFS, and pooled risk ratios (RR) for grade 3 or higher toxicity were analyzed using the Mantel-Haenszel method and generic inverse variance. To account for between-studies heterogeneity, random-effect models were used to compute pooled estimates. Subgroup analyses compared patients on A and D in terms of CFS. Results: Five studies were included. The addition of A or D to ADT decreased the risk of development of castration-resistance by 53% (5 studies, 4,462 participants, HR = 0.47, 95% CI 0.33-0.67). In a subgroup analysis, the addition of A seemed to be better than D for the outcome CFS (5 studies, HR = 0.31, 95% CI 0.27-0.34 versus HR = 0.62, 95% CI 0.56-0.69, test for subgroup difference, p< 0.001). Different profiles of toxicity were seen with A and D. While A increased the risk of hypokalemia (3,107 participants, HR = 6.63, 95% CI 3.5-12.5) and cardiac toxicity (3,107 participants, HR = 2.4, 95% CI 1.7-3.3), D increased the risk of neutropenia (2,151 participants, HR = 13, 95% CI 8.9-18.8) and neuropathy (2,151 participants, HR = 2.25, 95% CI 1.18-4.3). Conclusions: The addition of A and D to ADT increases CFS in men with castration-sensitive prostate cancer, with a longer CFS noted for A compared to D. Considering CFS and OS, A may be preferred to D as initial therapy. Toxicity profiles differed between A and D. Quality of life and cost differences between A and D are other important factors and were not considered in this analysis.

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