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 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.

scholarly journals Platelet-Rich Fibrin in Coverage of Gingival Recession: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 14 (02) ◽  
pp. 315-326
Author(s):  
Miguel Augusto Riquelme Rodas ◽  
Bruna Luísa de Paula ◽  
Victor Fabrizio Cabrera Pazmiño ◽  
Flávia Ferraz dos Santos Lot Vieira ◽  
Joel Ferreira Santiago Junior ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Gingival Recession ◽  
Class I ◽  
Clinical Attachment Level ◽  
Platelet Rich Fibrin ◽  
Probing Depth ◽  
Significant Difference ◽  
Keratinized Mucosa ◽  
Attachment Level

AbstractThis systematic review and meta-analysis sought to evaluate the efficacy of platelet-rich fibrin (PRF) membranes versus subepithelial connective tissue grafts (SCTGs) in the coverage of Miller class I and II gingival recessions. After the inclusion and exclusion criteria were applied, the quality of seven articles (Cohen’s Kappa = 0.9) was evaluated using the Jadad scale. The MEDLINE/PubMed, Cochrane, and Web of Science databases were consulted, and manual searches were performed in the most popular periodontics journals. The studies included considered a total of 122 patients, 203 surgical fields on which SCTGs were used, and 205 surgical fields on which PRF was used. The parameters analyzed were probing depth, clinical attachment level, gingival recession, and keratinized mucosa. The minimum follow-up period accepted was 6 months. A statistically significant difference between the SCTG and PRF groups was found only in the case of keratinized mucosa. However, gingival recession, clinical attachment level, and probing depth parameters in the PRF group were found to be statistically equal to those of the SCTG group (the gold standard) (p ≥0.05). PRF membranes were determined to be a promising alternative to autogenous gingival grafts in the treatment of Miller class I and II gingival recessions.

scholarly journals Regeneration of the Periodontal Apparatus in Aggressive Periodontitis Patients

2019 ◽  
Author(s):  
Zvi Artzi ◽  
Shiran Sudri ◽  
Ori Platner ◽  
Avital Kozlovsky
Keyword(s):  
Gingival Recession ◽  
Clinical Results ◽  
Aggressive Periodontitis ◽  
Clinical Attachment Level ◽  
Probing Depth ◽  
Group 12 ◽  
Enamel Matrix Derivatives ◽  
Pre Treatment ◽  
Attachment Level

The aim of this article is to evaluate and compare, retrospectively, the efficacy of two regenerative periodontal procedures in patients suffering from aggressive periodontitis (AgP). Twenty-eight patients were diagnosed with AgP, suffering from multiple intra-bony defects (IBD); that were treated by one of two regenerative modalities of periodontal therapy randomly assigned to each patient: a. guided tissue regeneration (GTR) or b. an application of enamel matrix derivatives (EMD) combined with DBX. The monitoring of the treated sites included recordings of probing depth (PD), clinical attachment level (CAL), and gingival recession. Pre-treatment and follow-up (up to 10 years from the surgery) recordings were analyzed statistically within and between groups. A significant reduction was shown at time on PD and CAL values, however, not between subject groups. CAL values decreased in all sites. At EMD group (44 sites) CAL gain was 1.92 mm (±1.68) from pre-treatment to follow-up (p<0.001) and at the GTR group (12 sites) CAL gain of 2.27 (±1.82) mm. In conclusion, 1-10 years observations have shown that surgical treatment of AgP patients by either GTR or by application of EMD/DBX results in similar successful clinical results.

Use of opioids in patients with cancer with hepatic impairment—a systematic review

2021 ◽  
pp. bmjspcare-2021-003065
Author(s):  
Lewis Thomas Hughes ◽  
David Raftery ◽  
Paul Coulter ◽  
Barry Laird ◽  
Marie Fallon
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Hepatic Impairment ◽  
Evaluation System ◽  
Meta Analysis ◽  
Hepatic Function ◽  
Cochrane Central Register ◽  
Assessment Development ◽  
Patients With Cancer ◽  
Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

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).

Safety of Cochlear Implantation in Children 12 Months or Younger: Systematic Review and Meta-analysis

2022 ◽  
pp. 019459982110677
Author(s):  
Firas Sbeih ◽  
Malek H. Bouzaher ◽  
Swathi Appachi ◽  
Seth Schwartz ◽  
Michael S. Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochlear Implants ◽  
Cochlear Implantation ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Ovid Medline ◽  
Central Register ◽  
Data Source ◽  
Anesthetic Complications ◽  
Full Text Screening

Objective To systematically review the literature to determine safety of cochlear implantation in pediatric patients 12 months and younger. Data Source Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to March 20, 2021. Review Methods Studies that involved patients 12 months and younger with report of intraoperative or postoperative complication outcomes were included. Studies selected were reviewed for complications, explants, readmissions, and prolonged hospitalizations. Two independent reviewers screened all studies that were selected for the systematic review and meta-analysis. All studies included were assessed for quality and risk of bias. Results The literature search yielded 269 studies, of which 53 studies underwent full-text screening, and 18 studies were selected for the systematic review and meta-analysis. A total of 449 patients and 625 cochlear implants were assessed. Across all included studies, major complications were noted in 3.1% of patients (95% CI, 0.8-7.1) and 2.3% of cochlear implantations (95% CI, 0.6-5.2), whereas minor complications were noted in 2.4% of patients (95% CI, 0.4-6.0) and 1.8% of cochlear implantations (95% CI, 0.4-4.3). There were no anesthetic complications reported across all included studies. Conclusion The results of this systematic review and meta-analysis suggest that cochlear implantation in patients 12 months and younger is safe with similar rates of complications to older cohorts.

scholarly journals Mesothelin as a biomarker for ovarian carcinoma: a meta-analysis

2016 ◽  
Vol 88 (2) ◽  
pp. 923-932 ◽  
Author(s):  
KRISTIAN MADEIRA ◽  
EDUARDO R. DONDOSSOLA ◽  
BRUNA F. DE FARIAS ◽  
CARLA S. SIMON ◽  
MARIA C.M. ALEXANDRE ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ovarian Cancer ◽  
Ovarian Tissue ◽  
Meta Analysis ◽  
Diagnostic Odds Ratio ◽  
Cochrane Central Register ◽  
Central Register ◽  
Quantitative Systematic Review ◽  
Comprehensive Search ◽  
Sensitivity Specificity

The objective of this work was to estimate the accuracy of mesothelin as a biomarker for ovarian cancer. A quantitative systematic review was performed. A comprehensive search of the Medline, LILACS, SCOPUS, Embase, Cochrane Central Register of Controlled Trials, Biomed Central, and ISI Web of Science databases was conducted from January 1990 to June 2015. For inclusion in this systematic review, the papers must have measured mesothelin levels in at least two histological diagnoses; ovarian cancer (borderline or ovarian tumor) vs. benign or normal ovarian tissue. For each study, 2 x 2 contingency tables were constructed. We calculated the sensitivity, specificity and diagnostic odds ratio. The verification bias was performed according to QUADAS-2. Statistical analysis was performed with the software Stata 11, Meta-DiSc(r) and RevMan 5.2. Twelve studies were analyzed, which included 1,561 women. The pooled sensitivity was 0.62 (CI 95% 0.58 - 0.66) and specificity was 0.94 (CI 95% 0.92 - 0.95). The DOR was 38.92 (CI 95% 17.82 - 84.99). Our systematic review shows that mesothelin cannot serve alone as a biomarker for the detection of ovarian cancer.

scholarly journals Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e014611 ◽  
Author(s):  
Caio Chaves Guimaraes ◽  
Rogério Heládio Lopes Motta ◽  
Cristiane de Cássia Bergamaschi ◽  
Jimmy de Oliveira Araújo ◽  
Natalia Karol de Andrade ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Data Extraction ◽  
Meta Analysis ◽  
Local Anaesthetics ◽  
Cochrane Central Register ◽  
Assessment Development ◽  
Dental Procedures ◽  
Central Register ◽  
Registration Number

IntroductionThe use of vasoconstrictors combined with local anaesthetics (LAs) in dentistry for patients with cardiovascular disease (CVD) is still controversial in the scientific literature. It raises concerns regarding the possibility of transient episodes, triggering negative cardiovascular outcomes.Method/designTrials eligible for our systematic review will enrol patients with CVD who have undergone dental treatments carried out with the use of LAs by comparing two arms: LAs with vasoconstrictors and LAs without vasoconstrictors. The research will be conducted in the electronic databases, namely Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Healthstar (via Ovid), Cumulative Index to Nursing and Allied Health Literature and Web of Science, from their inception to December 2017, without any restrictions in terms of language and status of publication. A team of reviewers will independently assess titles, abstracts and complete text to determine eligibility. For eligible studies, the same reviewers will perform data extraction and evaluate the risk of bias in the selected articles. The selected outcomes comprise death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding, arrhythmias, ischaemic episodes, anxiety, adverse effects, changes in blood pressure, changes in heart rate, anxiety and results obtained via oximetry. Whenever possible, we will conduct a meta-analysis to establish the effects of LAs with and without vasoconstrictors in the patients with CVD, and the overall quality of evidence for each outcome will be determined using the Grading of Recommendations Assessment, Development and Evaluation classification system.Ethics and disseminationEthics committee approval was not necessary because this is a protocol of systematic review. This systematic review will be submitted for presentation at conferences and for publication in a peer-reviewed journal. Our review will assess the risks of cardiovascular events when using LAs with and without vasoconstrictors in patients with CVD, focusing on important clinical outcomes.PROSPERO registration numberCRD42016045421.

scholarly journals Acupuncture in oncological pain relief: A systematic review of randomized clinical trials

2021 ◽  
Vol 34 ◽  
Author(s):  
Michel Marcos Dalmedico ◽  
Caroline Machado de Toledo ◽  
Paula Karina Hembecker ◽  
Juliana Londero Silva Ávila ◽  
Chayane Karla Lucena de Carvalho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Cancer Pain ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Opioid Use ◽  
Central Register ◽  
Considerable Impact ◽  
Analgesic Use

Abstract Introduction: Cancer pain has a considerable impact on patients’ health and quality of life, and its treatment is essentially based on opioid use. Objective: To report the effectiveness of acupuncture in relieving cancer pain (secondary to the disease or to the corresponding therapy) or in decreasing opioid use compared to other interventions. Methods: A systematic review of randomized clinical trials was conducted following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The trials were selected from the PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Results: The search strategy resulted in the inclusion of eight trials, of which five compared acupuncture and drug therapy and three compared acupuncture and placebo. Seven trials reported decreased pain and analgesic use. The trials showed clinical heterogeneity, making a meta-analysis unfeasible. Conclusion: The findings herein provided no robust evidence to support the routine use of acupuncture as an adjuvant therapy in the treatment of cancer pain. However, its use is promising since the results showed a trend toward decreased pain and analgesic use, thus justifying further studies in the future.

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

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