Limited Evidence Suggests Benefits of Single Visit Revascularization Endodontic Procedures - A Systematic Review

Abstract Revascularization endodontic procedures commonly require multiple treatment sessions. However, single visit procedures may be advantageous from the clinical and patient management standpoints. The purpose of this review was to evaluate the outcomes of single-visit revascularization endodontic procedures for the management of immature permanent teeth with non-vital pulp. Two electronic databases (Scopus and PubMed) were searched, from their inception to July 2018, for studies that assessed clinical and/or radiographic and/or histologic outcomes of single-visit revascularization endodontic procedures performed in immature permanent teeth with non-vital pulp. Case reports, animal studies and clinical trials were included. The quality of case reports was appraised by Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. The quality of randomized clinical trials was assessed by the revised Cochrane risk of bias tool for randomized trials. The risk of bias for animal studies was assessed using SYRCLE’s risk of bias tool. Tabulation followed by narrative synthesis was used to draw conclusions. Seven studies satisfied the selection criteria. Five were classified as case reports, one as a randomized clinical trial and one as animal study. The latter presented with a high risk of bias, whilst the remaining showed a low risk. The evidence supporting the potential use of single-visit revascularization endodontic procedures is scarce. Successful single-visit revascularization endodontic procedures commonly include the use of high concentrations of sodium hypochlorite and EDTA combined with the use of agitation systems. Further clinical trials with long term follow up are needed to confirm the results of the current review.

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Comparative efficacy of triptans for the abortive treatment of migraine: A multiple treatment comparison meta-analysis

Cephalalgia ◽

10.1177/0333102413508661 ◽

2013 ◽

Vol 34 (4) ◽

pp. 258-267 ◽

Cited By ~ 43

Author(s):

Kristian Thorlund ◽

Edward J Mills ◽

Ping Wu ◽

Elodie Ramos ◽

Anjan Chatterjee ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Treatment Effects ◽

Randomized Clinical Trials ◽

Free Response ◽

Multiple Treatment ◽

Treatment Comparison ◽

Abortive Treatment ◽

Multiple Treatment Comparison

Background Migraine is the most common neurological condition in developed countries. The abortive treatment of migraine attacks is important both for quality of life and costs associated with illness. Triptans, serotonin 5-HT1B/1D receptor agonists, effectively relieve the pain, disability, and associated symptoms of migraine while improving health-related quality of life. Although a number of direct head-to-head triptan comparisons have been made, data for all possible permutations are not available, and unlikely to ever be so, although in clinical practice such information would be useful. Objective We aimed to determine the relative efficacy of all available triptans to abort migraine headache among patients with previous adequate response to migraine treatments. Methods We included only double-blinded randomized clinical trials comparing triptans to either placebo or another triptan. Our primary outcomes were pain-free response at two hours and 24-hour sustained pain-free response, and our secondary outcomes were headache response at two hours and 24-hour sustained headache response. We used Bayesian multiple treatment comparison meta-analyses of seven triptans used in adult patients to abort migraine attacks. We applied a random-effects analysis with meta-regression adjusting for dose. Results are reported as odds ratios with 95% credible intervals. Results We included data from 74 randomized clinical trials. All triptans were significantly superior to placebo for all outcomes, with the exception of naratriptan for 24-hour sustained pain-free response. Eletriptan consistently yielded the highest treatment effect estimates. For the two-hour endpoints, eletriptan was statistically significantly superior to sumatriptan, almotriptan, naratriptan, and frovatriptan for at least one of the two outcomes. Rizatriptan yielded the second highest treatment effects followed by zolmitriptan. For the 24-hour endpoints, eletriptan was statistically significantly superior to sumatriptan, rizatriptan, almotriptan, and naratriptan for at least one of the two outcomes. Frovatriptan data were not available at that endpoint. Further, the probability that eletriptan is the most likely of all triptans to produce a favorable outcome was 68% for pain-free response at two hours, and 54% for 24-hour sustained pain-free response. Conclusion Triptans appear to offer differing treatment effects. In the populations studied eletriptan was most likely to produce pain-free responses that were sustained.

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Intervention Therapies to Reduce Pain-Related Fear in Fibromyalgia Syndrome: A Systematic Review of Randomized Clinical Trials

Pain Medicine ◽

10.1093/pm/pnaa331 ◽

2020 ◽

Author(s):

Javier Martinez-Calderon ◽

Mar Flores-Cortes ◽

Jose Miguel Morales-Asencio ◽

Alejandro Luque-Suarez

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Risk Of Bias ◽

Cochrane Library ◽

Secondary Outcome ◽

Full Detail ◽

Eligibility Criteria ◽

Fear Avoidance Beliefs

Abstract Objective This systematic review aimed to evaluate the effectiveness of different interventions at reducing pain-related fear in people with fibromyalgia and to analyze whether the included trials reported their interventions in full detail. Design Systematic review. Setting No restrictions. Methods The Cochrane Library, CINAHL, EMBASE, PsycINFO, PubMed, and Scopus were searched from their inception to April 2020, along with manual searches and a gray literature search. Randomized clinical trials were included if they assessed pain-related fear constructs as the primary or secondary outcome in adults with fibromyalgia. Two reviewers independently performed the study selection, data extraction, risk-of-bias assessment, Template for Intervention Description and Replication (TIDieR) checklist assessment, and grading the quality of evidence. Results Twelve randomized clinical trials satisfied the eligibility criteria, including 11 cohorts with a total sample of 1,441 participants. Exercise, multicomponent, and psychological interventions were more effective than controls were in reducing kinesiophobia. However, there were no differences in decreasing kinesiophobia when self-management and electrotherapy were used. There were also no differences between groups with regard to the rest of the interventions and pain-related constructs (fear-avoidance beliefs, fear of pain, and pain-related anxiety). However, a serious risk of bias and a very serious risk of imprecision were detected across the included trials. This caused the overall certainty of the judged evidence to be low and very low. Additionally, the included trials reported insufficient details to allow the full replication of their interventions. Conclusions This systematic review shows that there are promising interventions, such as exercise, multicomponent, and psychological therapies, that may decrease one specific type of fear in people with fibromyalgia, i.e., kinesiophobia. However, because of the low–very low certainty of the evidence found, a call for action is needed to improve the quality of randomized clinical trials, which will lead to more definitive information about the clinical efficacy of interventions in this field.

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Quality of reporting and risk of bias of randomized clinical trials published in Spanish and Latin American journals

Medwave ◽

10.5867/medwave.2019.01.7573 ◽

2019 ◽

Vol 19 (01) ◽

pp. e7573-e7573 ◽

Cited By ~ 7

Author(s):

Vivienne C. Bachelet ◽

Hector Pardo-Hernandez

Keyword(s):

Clinical Trials ◽

Latin American ◽

Randomized Clinical Trials ◽

Risk Of Bias ◽

Quality Of Reporting

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Effect of Foot Reflexology on Constipation: A Systematic Review and Meta-Analysis

Shiraz E-Medical Journal ◽

10.5812/semj.100585 ◽

2020 ◽

Vol 22 (1) ◽

Author(s):

Zahra Anjoman Azari ◽

Mojgan Mirghafourvand ◽

Ciara Hughes ◽

Shiva Havizari

Keyword(s):

Clinical Trials ◽

Fixed Effects ◽

Primary Outcome ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Gastrointestinal Disorders ◽

P Value ◽

Prevalent Symptom

Context: Constipation is a prevalent symptom of gastrointestinal disorders, which has an annoying impact on health and quality of life. On the other hand, reflexology is a popular type of complementary and alternative medicine in medical practices. Objectives: The present study aimed to assess the effect of foot reflexology on constipation symptoms. Methods: Nine databases were systematically searched to detect relevant Randomized Clinical Trials. The current used the Cochrane Risk of Bias tool to evaluate the methodological quality of the included articles. The primary outcome was the improvement of constipation symptoms. The Standardized Mean Difference (SMD) was measured, and random effects were reported instead of the fixed effects due to the high heterogeneity. Results: Out of the 693 articles retrieved from the databases and eight additional records identified through other sources, 496 titles, 48 abstracts, and 16 full-texts were reviewed, and 11 articles were included in this study, out of which nine articles entered the meta-analysis. The findings of the meta-analysis indicated that foot reflexology had a significant effect on the constipation score (SMD: -0.82; 95% CI: -1.47 to -0.17; P value = 0.0001; I2 = 93%) Conclusions: Foot reflexology can effectively improve constipation symptoms; however, clinical trials with better designs are recommended.

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Antibacterial effectiveness of drug combinations with calcium hydroxide in apical periodontitis: A systematic review

Research Society and Development ◽

10.33448/rsd-v10i4.14593 ◽

2021 ◽

Vol 10 (4) ◽

pp. e55810414593

Author(s):

Christianne Velozo ◽

Cleidiel Aparecido Araújo Lemos ◽

Diana Santana de Albuquerque ◽

Belmiro Cavalcante do Egito Vasconcelos ◽

Sandra Lúcia Dantas Moraes ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Calcium Hydroxide ◽

Antimicrobial Agents ◽

Randomized Clinical Trials ◽

Clinical Performance ◽

Risk Of Bias ◽

Apical Periodontitis ◽

Permanent Teeth ◽

Publication Date

The aim of this systematic review was to compare the clinical performance of calcium hydroxide (Ca(OH)2) as an intracanal medicament alone or combined with other antimicrobial agents. The PICO question was “Is the antibacterial effectiveness of calcium hydroxide paste as an intracanal medication combined with other drugs greater than that of calcium hydroxide paste alone in apical periodontitis?” The study was carried out according PRISMA guidelines and is registered in PROSPERO (CRD42020205741). Searches were performed in the PubMed/MEDLINE, Web of Science and Cochrane databases without publication date restrictions. Inclusion: randomized clinical trials, non-randomized intervention studies, studies including a minimum of 10 patients, studies comparing the use of Ca(OH)2 alone and in combination with other compounds, studies evaluating primary and permanent teeth with apical periodontitis, and studies including teeth not submitted to retreatment. The Cochrane risk-of-bias tool for randomized clinical trials (RoB 2.0) was used to assess the internal validity (risk of bias) of the included studies. A total of 986 articles were retrieved and 12 randomized clinical trials were selected, totaling 499 patients included in the studies. The effectiveness of Ca(OH)2 plus chlorhexidine was similar to that of Ca(OH)2 alone in eight articles, while a better antibacterial effect was reported in three studies. The combination with ciprofloxacin was more effective than the use of Ca(OH)2 alone in the only study that tested this antibiotic. In teeth with asymptomatic apical periodontitis, the effectiveness of the combination of antimicrobial agents with Ca(OH)2 was similar to that of Ca(OH)2 alone.

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Anti-hypertensive drugs deprescribing: an updated systematic review of clinical trials

BMC Family Practice ◽

10.1186/s12875-021-01557-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Salvatore Crisafulli ◽

Nicoletta Luxi ◽

Raffaele Coppini ◽

Annalisa Capuano ◽

Cristina Scavone ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Experimental Studies ◽

Risk Of Bias ◽

Cochrane Library ◽

Efficacy And Safety ◽

Systematic Assessment ◽

Grade Approach

Abstract Background Polypharmacy is defined as the prescription of at least 5 different medicines for therapeutic or prophylactic effect and is a serious issue among elderly patients, who are frequently affected by multi-morbidity. Deprescribing is one of the proposed approaches to reduce the number of administered drugs, by eliminating those that are inappropriately prescribed. The aim of this systematic review is to provide an updated and systematic assessment of the benefit-risk profile of deprescribing of anti-hypertensive drugs, which are among the most commonly used drugs. Methods MEDLINE, EMBASE and The Cochrane Library were searched for studies assessing the efficacy and safety of anti-hypertensive drugs deprescribing in the period between January, 12,016 and December, 312,019. The quality of randomized clinical trials (RCTs) was assessed using the GRADE approach for the evaluation of the main outcomes. The risk of bias assessment was carried out using the Cochrane risk-of-bias tool. Results Overall, two RCTs were identified. Despite summarized evidence was in favor of anti-hypertensive deprescribing, the overall risk of bias was rated as high for each RCT included. According to the GRADE approach, the overall quality of the RCTs included was moderate regarding the following outcomes: systolic blood pressure < 150 mmHg after 12 weeks of follow-up, quality of life, frailty and cardiovascular risk. Conclusions This updated systematic review of the efficacy and safety of anti-hypertensive treatment deprescribing found two recently published RCTs, in addition to the previous guideline of the National Institute for Health and Care Excellence (NICE). Evidence points towards non-inferiority of anti-hypertensive deprescribing as compared to treatment continuation, despite the quality of published studies is not high. High quality experimental studies are urgently needed to further assess the effect of deprescribing for this drug class in specific categories of patients.

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Psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features—A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis

PLoS ONE ◽

10.1371/journal.pone.0245331 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245331

Author(s):

Mie Sedoc Jørgensen ◽

Ole Jakob Storebø ◽

Jutta M. Stoffers-Winterling ◽

Erlend Faltinsen ◽

Adnan Todorovac ◽

...

Keyword(s):

Clinical Trials ◽

High Risk ◽

Sequential Analysis ◽

Randomized Clinical Trials ◽

Borderline Personality ◽

Risk Of Bias ◽

Trial Sequential Analysis ◽

Attrition Rates ◽

Psychological Therapies

Objectives To review the effectiveness of psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features. Methods We included randomized clinical trials on psychological therapies for adolescents with BPD and BPD features. Data were extracted and assessed for quality according to Cochrane guidelines, and summarized as mean difference (MD) with 95% confidence intervals (CI) for continuous data and as Odds ratios (OR) with 95% CI for dichotomous data. Risk of bias was assessed using Cochrane’s risk of bias tool for each domain. When possible, we pooled trials into meta-analyses, and used Trial Sequential Analysis (TSA) to control for random errors. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results 10 trials on adolescents with BPD or BPD features were included. All trials were considered at high risk of bias, and the quality of the evidence was rated as “very low”. We did TSA on the primary outcome and found that the required information size was reached. The risk of random error was thus discarded. Conclusion Only 10 trials have been conducted on adolescents with BPD or BPD features. Of these only few showed superior outcomes of the experimental intervention compared to the control intervention. No adverse effects of the interventions were mentioned. Attrition rates varied from 15–75% in experimental interventions. The overall quality was very low due to high risk of bias, imprecision and inconsistency, which limits the confidence in effect estimates. Due to the high risk of bias, high attrition rates and underpowered studies in this area, it is difficult to derive any conclusions on the efficacy of psychological therapies for BPD in adolescence. There is a need for more high quality trials with larger samples to identify effective psychological therapies for this specific age group with BPD or BPD features.

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A Systematic Review of Clinical Trials Assessing Sexuality in Hysterectomized Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083994 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3994

Author(s):

Laura Martínez-Cayuelas ◽

Pau Sarrió-Sanz ◽

Antonio Palazón-Bru ◽

Lidia Verdú-Verdú ◽

Ana López-López ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Laparoscopic Approach ◽

Risk Of Bias ◽

Sexual Life ◽

Cochrane Central Register ◽

Central Register ◽

The Impact

In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.

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