Surgical treatment for cryptoglandular and Crohn’s perianal fistulas: Protocol of an umbrella review

Introduction A high prevalence of cryptoglandular and Crohn’s perianal fistulas has been reported worldwide, and several surgical options are available for the management of anal fistula, with varying clinical efficacy. However, currently, the available evidence for the effectiveness of these surgical approaches are lacking and of concern in terms of the credibility and strength. The purpose of this study is to evaluate the credibility of the published systematic reviews and meta-analyses that assess the efficacy and safety of the surgical options for cryptoglandular and Crohn’s perianal fistulas through an umbrella review. Methods and analysis A systematic search in PubMed, Embase and Cochrane library will be performed from inception to December 2020 without any language restriction. We will include systematic reviews and meta-analyses that investigate the efficacy and safety of surgical approaches in the management of cryptoglandular and Crohn’s perianal fistulas. Two reviewers will independently screen search results through reading the titles or abstracts. Relevant information will be extracted from each eligible systematic review or meta-analysis. Based on random effects model summary estimates along with their p values, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance, we will classify the evidence from convincing (class I) to weak (class IV). Findings will be summarized using quantitative synthesis combined with a narrative approach. Cryptoglandular and Crohn’s perianal fistulas will be summarized separately. Two authors will independently perform the literature search, data extraction, and quality assessment of each included systematic review and meta-analysis. Any unresolved conflicts or doubts will be resolved by discussion or by consulting a senior author. The risk of bias of the systematic reviews will be assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. The strength of evidence for the included systematic reviews will be classified as "high", "moderate", "low", or "critically low" quality. Ethics and dissemination Ethics approval is not required as we will collect data from the published systematic reviews and meta-analyses without using individual patient data. The results of this umbrella review will be published in a peer-reviewed journal and will be presented at an anorectal disease conference. PROSPERO registration number CRD42020200754.

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Small-sided games: An umbrella review of systematic reviews and meta-analyses

PLoS ONE ◽

10.1371/journal.pone.0247067 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247067

Author(s):

Filipe Manuel Clemente ◽

José Afonso ◽

Hugo Sarmento

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Aerobic Capacity ◽

Methodological Quality ◽

Meta Analysis ◽

Cochrane Library ◽

Acute Effects ◽

Umbrella Review ◽

Positive Effects ◽

Meta Analyses

Objective This umbrella review was conducted to summarize the evidence and qualify the methodological quality of SR and SRMA published on small-sided games in team ball sports. Methods A systematic review of Web of Science, PubMed, Cochrane Library, Scopus, and SPORTDiscus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results From the 176 studies initially identified, 12 (eight SR and four SRMA) were fully reviewed, and their outcome measures were extracted and analyzed. Methodological quality (with the use of AMSTAR-2) revealed that seven reviews had low quality and five had critically low quality. Two major types of effects of SSGs were observed: (i) short-term acute effects and (ii) long-term adaptations. Four broad dimensions of analysis were found: (i) physiological demands (internal load); (ii) physical demands (external load) or fitness status; (iii) technical actions; and (iv) tactical behavior and collective organization. The psychological domain was reduced to an analysis of enjoyment. The main findings from this umbrella review revealed that SSGs present positive effects in improving aerobic capacity and tactical/technical behaviors, while neuromuscular adaptations present more heterogeneous findings. Factors such as sex, age group, expertise, skill level, or fitness status are also determinants of some acute effects and adaptations. Conclusion The current umbrella review allowed to identify that most of the systematic review and meta-analysis conducted in SSGs presents low methodological quality considering the standards. Most of the systematic reviews included in this umbrella revealed that task constraints significantly change the acute responses in exercise, while SSGs are effective in improving aerobic capacity. Future original studies in this topic should improve the methodological quality and improve the experimental study designs for assessing changes in tactical/technical skills.

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Management of haemorrhoids: protocol of an umbrella review of systematic reviews and meta-analyses

BMJ Open ◽

10.1136/bmjopen-2019-035287 ◽

2020 ◽

Vol 10 (3) ◽

pp. e035287

Author(s):

Min Chen ◽

Tai-Chun Tang ◽

Tao-Hong He ◽

Yong-Jun Du ◽

Di Qin ◽

...

Keyword(s):

Systematic Reviews ◽

Meta Analysis ◽

Random Effect Model ◽

Current Evidence ◽

Cochrane Library ◽

Final Report ◽

Umbrella Review ◽

Effect Model ◽

Meta Analyses ◽

The Impact

IntroductionThe prevalence of haemorrhoidal diseases was high in general population, and many treatments are proposed for the management of haemorrhoids. The treatments include conservative and surgical interventions; the credibility and strength of current evidence of their effectiveness are not comprehensively evaluated. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness of the treatments for haemorrhoidal diseases through an umbrella review.Methods and analysisWe will search Ovid Medline, Embase, Cochrane library and Web of Science from inception to March 2020 without any language restriction. We will include meta-analyses that examine the effectiveness of treatments in the management of haemorrhoids. Two reviewers will independently screen the titles and abstracts of retrieved articles, and they will extract data from the included meta-analyses. For each meta-analysis, we will estimate the effect size of a treatment through the random-effect model and the fixed-effect model, and we will evaluate between-study heterogeneity (Cochrane’s Q and I2statistics) and small-study effect (Egger’s test); we will also estimate the evidence of excess significance bias. Evidence of each treatment will be graded according to prespecified criteria. Methodological quality of each meta-analysis will be evaluated by using Assessment of Multiple Systematic Reviews 2. The corrected cover area method will be used to assess the impact of overlap in reviews on the findings of the umbrella review.Ethics and disseminationWe will present the results of the umbrella review at conferences and publish the final report in a peer-reviewed journal. The umbrella review does not require ethical approval.PROSPERO registration numberCRD42019140702.

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Efficacy and safety of Dabigatran vs. Rivaroxaban among Asians with non-valvular atrial fibrillation：Protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-895665/v1 ◽

2021 ◽

Author(s):

Li Jia ◽

Mingming Zhou ◽

Li Sun ◽

Luhai Yu ◽

Xiangyan He

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Cochrane Library ◽

Efficacy And Safety ◽

Systemic Embolism ◽

China National Knowledge Infrastructure ◽

Asian Patients ◽

Meta Analyses

Abstract Atrial fibrillation(AF) increases the risk of ischemic stroke and systemic embolism in patients. Moreover, Asian patients with AF are more likely to have ischemic stroke than non-Asian patients. Oral anticoagulants could effectively prevent thrombotic events. Dabigatran and Rivaroxaban are two most commonly used novel oral anticoagulants (NOACs) in Asia, but those clinicial studies in relation with them are mostly in American and European countries. Therefore, whether there are differences between Dabigatran and Rivaroxaban among Asian patients with AF in terms of efficacy and safety is still unknown. This systematic review and meta-analysis will mainly assess clinical efficacy and safety of Dabigatran versus Rivaroxaban in Asian patients with AF by a pooled analysis. We will follow the PRISMA (preferred reporting items for systematic reviews and meta-analyses) and the reporting MOOSE (Meta-analyses of Observational Studies in Epidemiology) when performing this study. Then Cochrane Library,Web of Science, PubMed and China national knowledge infrastructure will be searched for eligible retrospective investigation that report the efficacy and safety outcomes of AF patients who utilised Dabigatran or Rivaroxaban for stroke prevention in Asian countries. The abovementioned database will be comprehensively searched from inception to September 30, 2019 to locate all potentially eligible studies. Outcome measures will include safety and efficacy indicators. Safety indicators include intracranial hemorrhage, major bleeding and gastrointestinal bleeding. Efficacy indicators include systemic embolism and stroke. New evidence for clinical profile of Dabigatran versus Rivaroxaban in AF patients will be provided for decision-making of Asian patients.PROSPERO registration number: CRD42020156197

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Systematic review of laryngocele and pyolaryngocele management in the age of robotic surgery

Journal of International Medical Research ◽

10.1177/0300060520940441 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052094044

Author(s):

Ravjit Singh ◽

William Karantanis ◽

Matthew Fadhil ◽

Shivani Angelique Kumar ◽

Julia Crawford ◽

...

Keyword(s):

Systematic Review ◽

Robotic Surgery ◽

Meta Analysis ◽

Rare Condition ◽

Cochrane Library ◽

Surgical Approaches ◽

Randomized Controlled ◽

Initial Description ◽

Laryngeal Saccule ◽

Meta Analyses

Objective A laryngocele is a space that develops as a result of pathological dilatation of the laryngeal saccule. However, the reported management of laryngoceles varies. We conducted a systematic review of the literature regarding the surgical management of laryngoceles and pyolaryngoceles, to understand the evolving nature of treatment for this rare condition. Methods We searched for publications in the PubMed, Cochrane Library, JBI Library of Systematic Reviews, and Ovid databases using the terms “laryngocele”, “pyolaryngocele”, and “laryngopyocele”, and reviewed the identified articles. Results After removal of repeated studies and filtering for relevance and studies written in English, a total of 227 studies were included in this review. No meta-analyses or randomized controlled trials have been published. The identified studies have been summarized in 14 reviews conducted since 1946. The meta-analysis determined that endoscopy was the preferred approach for internal laryngoceles, while combined laryngoceles benefited from both internal and external surgical approaches. Conclusions Laryngocele management has progressed since its initial description, from open surgery to an endoscopic approach, and more recently to a robotic-assisted surgical approach. The uptake of robotic surgery as a possible treatment modality over the last decade shows much promise for the treatment of these conditions.

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The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression

Journal of Diabetes Science and Technology ◽

10.1177/19322968211064633 ◽

2021 ◽

pp. 193229682110646

Author(s):

Stine Hangaard ◽

Sisse H. Laursen ◽

Jonas D. Andersen ◽

Thomas Kronborg ◽

Peter Vestergaard ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Systematic Reviews ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Sufficient Information ◽

Meta Regression ◽

Meta Analyses

Background: Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of −0.415% (95% confidence interval [CI] = −0.482% to −0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. Conclusions: In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.

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Environmental assessment of cytotoxic drugs in healthcare settings: protocol for a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-020-01494-4 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Laila Al Alawi ◽

Elpidoforos S. Soteriades ◽

Marilia Silva Paulo ◽

Linda Östlundh ◽

Michal Grivna ◽

...

Keyword(s):

Systematic Review ◽

Occupational Exposure ◽

Health Outcomes ◽

Systematic Reviews ◽

Environmental Contamination ◽

Meta Analysis ◽

Cytotoxic Drugs ◽

Cochrane Library ◽

Healthcare Settings ◽

Meta Analyses

Abstract Background Occupational exposure to cytotoxic drugs is associated with various unfavorable health outcomes. This protocol reports a methodology for a systematic review and meta-analysis that aims to systematically review the published literature and quantify the level of environmental contamination of healthcare settings with cytotoxic drugs. Methods This protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol-2015 (PRISMA-P) guidelines. Six electronic databases (PubMed, Web of Science, Scopus, Cochrane Library, CINAHL, and EMBASE) will be searched with no restrictions on publication period. Eligible studies will be identified and data will be extracted using a predefined data extraction form by at least two independent reviewers following best practice. Eligible studies should report calculated or calculable estimates on the proportion of positive samples tested for cytotoxic drugs and/or estimates on the concentration of the cytotoxic drug(s) in the tested samples. Risk of bias (RoB) will be assessed by using the RoB in Studies estimating Prevalence of Exposure to Occupational risk factors (RoB-SPEO) tool, which developed by the World Health Organization (WHO) and International Labour Organization (ILO) for environmental and occupational health systematic reviews. The random-effects model will be used to perform meta-analyses. Discussion Occupational exposure to cytotoxic drugs is associated with short- and long-term adverse health outcomes. Following this protocol, the review to be carried out will be the first to fill an evidence gap on the environmental contamination of healthcare settings with cytotoxic drugs. The findings of this review will help in the understanding of the risk of occupational exposure of healthcare workers to cytotoxic drugs and facilitate the identification of priority areas for specific interventions. Ethics and dissemination The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available. Systematic review registration PROSPERO CRD42020162780, dated July 14, 2020

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Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella Review

Multiple Sclerosis International ◽

10.1155/2019/2027947 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Angela Salomè ◽

Tullia Sasso D’Elia ◽

Giorgia Franchini ◽

Valter Santilli ◽

Teresa Paolucci

Keyword(s):

Multiple Sclerosis ◽

Occupational Therapy ◽

Systematic Reviews ◽

Work Performance ◽

Positive Impact ◽

Meta Analysis ◽

Cochrane Library ◽

Umbrella Review ◽

Fatigue Management ◽

Meta Analyses

Background. Fatigue is one of the most invalidant symptoms of Multiple Sclerosis (MS) that negatively affects occupational and work performance and social participation. Occupational therapy (OT) assessment and treatment of impairments related to fatigue can have a significant and positive impact on the quality of life. Methods. An umbrella review has been carried out to provide rehabilitative decision makers in healthcare with insight into the role of OT in fatigue management in Multiple Sclerosis. The question is, what type of treatment provided by occupational therapist is more effective in reducing fatigue in Multiple Sclerosis? A search of literature published until June 2018 was undertaken by three independent reviewers using PubMed, PEDro, and Cochrane Library database including systematic reviews and meta-analyses of the last 10 years. Results. 10 studies were selected (5 systematic reviews, 1 meta-analysis, 3 reviews, and 1 guideline). Conclusions. Fatigue management programs have moderate evidence; other strategies such as OT strategies and telerehabilitation show low evidence.

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Efficacy and safety of aliskiren combination therapy: a protocol for an umbrella review

BMJ Open ◽

10.1136/bmjopen-2020-043807 ◽

2021 ◽

Vol 11 (3) ◽

pp. e043807

Author(s):

Jiantong Shen ◽

Wenming Feng ◽

Yike Wang ◽

Qiyuan Zhao ◽

Billong Laura Flavorta ◽

...

Keyword(s):

Combination Therapy ◽

Systematic Reviews ◽

Cochrane Library ◽

Umbrella Review ◽

Quality Of Reporting ◽

Ethical Approval ◽

Registration Number ◽

Third Person ◽

Meta Analyses ◽

The Impact

IntroductionEfficacy of aliskiren combination therapy with other antihypertensive has been evaluated in the treatment of patients with hypertension in recent systematic reviews. However, most previous reviews only focused on one single health outcome or one setting, none of them made a full summary that assessed the impact of aliskiren combination treatment comprehensively. As such, this umbrella review based on systematic reviews and meta-analyses is aimed to synthesise the evidences on efficacy, safety and tolerability of aliskiren-based therapy for hypertension and related comorbid patients.Methods and analysisA comprehensive search of PubMed, EMBASE, Cochrane Library, CNKI published from inception to August 2020 will be conducted. The selected articles are systematic reviews which evaluated efficacy, safety and tolerability of aliskiren combination therapy. Two reviewers will screen eligible articles, extract data and evaluate quality independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the Assessment of Multiple Systematic Reviews V.2 tool tool. We will take a mixed-methods approach to synthesising the review literatures, reporting summary of findings tables and iteratively mapping the results.Ethics and disseminationEthical approval is not required for the study, as we would only collect data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.PROSPERO registration numberCRD42020192131.

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Comparative efficacy and safety of interventions for treating head lice: a protocol for systematic review and network meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001129 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001129

Author(s):

Bill Stevenson ◽

Wubshet Tesfaye ◽

Julia Christenson ◽

Cynthia Mathew ◽

Solomon Abrha ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Controlled Trials ◽

Head Lice ◽

Efficacy And Safety ◽

Randomised Controlled ◽

Meta Analyses

BackgroundHead lice infestation is a major public health problem around the globe. Its treatment is challenging due to product failures resulting from rapidly emerging resistance to existing treatments, incorrect treatment applications and misdiagnosis. Various head lice treatments with different mechanism of action have been developed and explored over the years, with limited report on systematic assessments of their efficacy and safety. This work aims to present a robust evidence summarising the interventions used in head lice.MethodThis is a systematic review and network meta-analysis which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for network meta-analyses. Selected databases, including PubMed, Embase, MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials will be systematically searched for randomised controlled trials exploring head lice treatments. Searches will be limited to trials published in English from database inception till 2021. Grey literature will be identified through Open Grey, AHRQ, Grey Literature Report, Grey Matters, ClinicalTrials.gov, WHO International Clinical Trials Registry and International Standard Randomised Controlled Trials Number registry. Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two independent reviewers, with disagreements resolved via a third reviewer. The primary outcome measure is the relative risk of cure at 7 and 14 days postinitial treatment. Secondary outcome measures may include adverse drug events, ovicidal activity, treatment compliance and acceptability, and reinfestation. Information from direct and indirect evidence will be used to generate the effect sizes (relative risk) to compare the efficacy and safety of individual head lice treatments against a common comparator (placebo and/or permethrin). Risk of bias assessment will be undertaken by two independent reviewers using the Cochrane Risk of Bias tool and the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations guideline for network meta-analysis. All quantitative analyses will be conducted using STATA V.16.DiscussionThe evidence generated from this systematic review and meta-analysis is intended for use in evidence-driven treatment of head lice infestations and will be instrumental in informing health professionals, public health practitioners and policy-makers.PROSPERO registration numberCRD42017073375.

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Efficacy and safety of anti-epidermal growth factor receptor agents for the treatment of oesophageal cancer: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-046352 ◽

2021 ◽

Vol 11 (3) ◽

pp. e046352

Author(s):

Lijuan Zhang ◽

Yanli Song ◽

Nan Jiang ◽

Yaqi Huang ◽

Bo Dong ◽

...

Keyword(s):

Systematic Review ◽

Growth Factor ◽

Outcome Measures ◽

Oesophageal Cancer ◽

Meta Analysis ◽

Growth Factor Receptor ◽

Cochrane Library ◽

Secondary Outcome ◽

Efficacy And Safety ◽

Positive Effects

ObjectivesDespite remarkable advances in the treatment of oesophageal cancer (OC), the role of antiepidermal growth factor receptor (anti-EGFR) agents in treating OC remains controversial. Herein, a systematic review and meta-analysis were conducted to elucidate the efficacy and safety of anti-EGFR agents in patients with OC.DesignMeta-analysis of randomised controlled trials (RCTs) identified by searching the PubMed, Embase, Web of Science, ClinicalTrials.gov, Cochrane Library, Chinese Biology Medicine, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform databases from inception to December 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.SettingRCTs from any country and healthcare setting.ParticipantsPatients with OC.InterventionsCombination therapy with anti-EGFR agents and conventional treatments versus conventional treatments alone in patients with OC.Primary and secondary outcome measuresOverall survival (OS) and progression-free survival (PFS) were primary outcome measures, and objective response rate (ORR), disease control rate (DCR) and treatment toxicities were secondary outcome measures.ResultsIn total, 25 RCTs comprising 3406 patients with OC were included. Overall, anti-EGFR treatment significantly improved the OS (HR: 0.81, 95% CI 0.74 to 0.89, p<0.00001), ORR (relative risk (RR): 1.33, 95% CI 1.16 to 1.52, p<0.0001) and DCR (RR: 1.22, 95% CI 1.11 to 1.34, p<0.0001) but not PFS (HR: 0.91, 95% CI 0.76 to 1.08, p=0.26). Anti-EGFR treatment was significantly associated with higher incidences of myelosuppression, diarrhoea, acne-like rash and hypomagnesaemia.ConclusionsOverall, anti-EGFR agents have positive effects on OS, the ORR and DCR in OC. However, considering the high incidence of adverse effects, such as myelosuppression, diarrhoea, acne-like rashes and hypomagnesaemia, careful monitoring of patients with OC is recommended during anti-EGFR treatment.Trial registration numberCRD42020169230.

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