scholarly journals Timing of Arthrocentesis in the Management of Temporomandibular Disorders:A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Dion Tik Shun Li ◽  
Natalie Sui Miu Wong ◽  
Samantha Ka Yan Li ◽  
Colman Patrick McGrath ◽  
Yiu Yan Leung
Keyword(s):  
Conservative Treatment ◽  
Meta Analysis ◽  
Mouth Opening ◽  
Pain Reduction ◽  
Clinical Results ◽  
Computer Search ◽  
Reference List ◽  
Randomized Controlled ◽  
Manual Search ◽  
Meta Analyses

The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regards to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was done. Relevant articles were selected after 3 search rounds for final review based on 6 predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including 5 randomized controlled trials and 6 prospective clinical studies informed this review. The studies were divided into 3 groups based on the timing of arthrocentesis: 1). Arthrocentesis as the initial treatment, 2). Early arthrocentesis, and 3). Late arthrocentesis. Meta-analyses compared the efficacy of improvement in mouth opening and pain reduction in the 3 groups. The results were statistically significant and favoured early arthrocentesis, followed by late arthrocentesis in terms of both improvements in mouth opening and pain reduction. All 3 groups showed improvement in mouth opening and pain reduction. We conclude that early arthrocentesis may be able to produce the best clinical results, while arthrocentesis before attempting conservative treatment may produce less favourable outcomes.

scholarly journals Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 479
Author(s):  
Tatiana Sidiropoulou ◽  
Kalliopi Christodoulaki ◽  
Charalampos Siristatidis
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Controlled Trials ◽  
Success Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Technical Failure ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

scholarly journals Flunarizine as prophylaxis for episodic migraine: a systematic review with meta-analysis

Ból ◽  
2019 ◽  
Vol 20 (1) ◽  
pp. 25-38
Author(s):  
Anker Stubberud ◽  
Nikolai Melseth Flaaen ◽  
Douglas C. McCrory ◽  
Sindre Andre Pedersen ◽  
Mattias Linde
Keyword(s):  
Confidence Interval ◽  
Meta Analysis ◽  
Episodic Migraine ◽  
Pooled Analysis ◽  
Risk Of Bias ◽  
Current Guideline ◽  
Data Synthesis ◽  
Randomized Controlled ◽  
The Mean ◽  
Meta Analyses

Based on few clinical trials, flunarizine is considered a first-line prophylactic treatment for migraine in several guidelines. In this meta-analysis, we examined the pooled evidence for its effectiveness, tolerability, and safety. Prospective randomized controlled trials of flunarizine as a prophylaxis against migraine were identified from a systematic literature search, and risk of bias was assessed for all included studies. Reduction in mean attack frequency was estimated by calculating the mean difference (MD), and a series of secondary outcomes –including adverse events (AEs) – were also analyzed. The database search yielded 879 unique records. Twentyfive studies were included in data synthesis. We scored 31/175 risk of bias items as “high”, with attrition as the most frequent bias. A pooled analysis estimated that flunarizine reduces the headache frequency by 0.4 attacks per 4 weeks compared with placebo (5 trials, 249 participants: MD 20.44; 95% confidence interval 20.61 to 2 0.26). Analysis also revealed that the effectiveness of flunarizine prophylaxis is comparable with that of propranolol (7 trials, 1151 participants, MD 20.08; 95% confidence interval 20.34 to 0.18). Flunarizine also seems to be effective in children. The most frequent AEs were sedation and weight increase. Meta-analyses were robust and homogenous, although several of the included trials potentially suffered from high risk of bias. Unfortunately, reporting of AEs was inconsistent and limited. In conclusion, pooled analysis of data from partially outdated trials shows that 10- mg flunarizine per day is effective and well tolerated in treating episodic migraine – supporting current guideline recommendations.

scholarly journals Systematically Searching Empirical Literature in the Social Sciences: Results from Two Meta-Analyses Within the Domain of Education

2019 ◽  
Vol 15 (4) ◽  
pp. 245-265 ◽  
Author(s):  
David I. Pickup ◽  
Robert M. Bernard ◽  
Eugene Borokhovski ◽  
Anne C. Wade ◽  
Rana M. Tamim
Keyword(s):  
Information Retrieval ◽  
Meta Analysis ◽  
Grey Literature ◽  
Full Range ◽  
Empirical Literature ◽  
Bibliographic Databases ◽  
Campbell Collaboration ◽  
Manual Search ◽  
Review Team ◽  
Meta Analyses

Introduction. This paper provides an overview of the information retrieval strategy employed for two meta-analyses, conducted by a systematic review team at Concordia University (Montreal, QC, Canada). Both papers draw on standards first articulated by H.M. Cooper and further developed by the Campbell Collaboration, which promote a comprehensive approach to systematically searching an extensive array of resources (bibliographic databases, print resources, citation indices, etc.) in order to locate both published and unpublished research. The goal is to verify if searching comprehensively through multiple resources retrieves studies that are unique, and hence, improve the overall representativeness of a diverse body of literature. We also analyze the sensitivity and specificity of the results by data source. Methods. In order to determine the source sensitivity, we consider percentage of results from each source retrieved for full-text review. In order to determine the source specificity, we derive a percentage from the total number of studies included in the final meta-analysis compared against the overall number of initial results found. Results. Results demonstrate the need to search beyond the subject-specific databases of a particular discipline as unique results can be found in many places. Databases for related disciplines provided 129 unique includes to each meta-analysis, and multidisciplinary databases provided 44 and 99 unique includes for the two meta-analyses in question respectively. Manual search techniques were much more sensitive and specific than electronic searches of databases and yield a higher percentage of final includes. Discussion. The results demonstrate the utility of a comprehensive information retrieval methodology like that proposed by the Campbell Collaboration, which goes beyond the main subject databases to locate the full range of information sources, including grey literature.

Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-Analysis

2007 ◽  
Vol 16 (1) ◽  
pp. 50-61 ◽  
Author(s):  
David R. Goldhill ◽  
Michael Imhoff ◽  
Barbara McLean ◽  
Carl Waldmann
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Controlled Trials ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Convincing Evidence ◽  
Controlled Trials ◽  
Respiratory Complications ◽  
Randomized Controlled ◽  
Meta Analyses

• Background Immobility is associated with complications involving many body systems. • Objective To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. • Methods Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. • Results A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. • Conclusions Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

Assessment of Early Tracheostomy in Trauma Patients: A Systematic Review and Meta-Analysis

2006 ◽  
Vol 72 (3) ◽  
pp. 276-281 ◽  
Author(s):  
C. Michael Dunham ◽  
Kenneth J. Ransom
Keyword(s):  
Brain Injury ◽  
Fixed Effects ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Trauma Patients ◽  
Severe Brain Injury ◽  
Early Tracheostomy ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Patient Studies

The objective of this review was to assess outcomes in trauma patients undergoing early tracheostomy (ET). Abstract databases for the Eastern and American Associations for the Surgery of Trauma and Medline were searched to find trauma patient studies comparing ET and late tracheostomy (LT) or ET and no ET. Fixed-effects meta-analyses were performed on the randomized controlled trial (RCT) studies. Of five retrospective and four RCT studies, none demonstrated survival benefit or harm with ET (P > 0.05). In five RCT studies of ET and no ET, ET pneumonia rates were similar to the no ET group (relative risk 1.00 [95% confidence intervals 0.88–1.15], P = 0.97). In five RCT studies of ET and no ET, ET ventilator/intensive care unit (ICU) days were similar to the no ET group (P = 0.27). In the two severe brain injury studies, ET ventilator/ICU days were lower than the no ET group (P = 0.06). In the three nonbrain injury studies, ET ventilator/ICU days were similar to the no ET group (P = 0.79). Five studies described similar laryngotracheal pathology rates with ET and no ET or LT (P > 0.05). In conclusion, ET has no influence on mortality, pneumonia, or laryngotracheal pathology rates in trauma patients. Patients with severe brain injury may be more rapidly liberated from mechanical ventilation with ET. However, additional research is needed.

scholarly journals Effect of folate supplementation on insulin sensitivity and type 2 diabetes: a meta-analysis of randomized controlled trials

2019 ◽  
Vol 109 (1) ◽  
pp. 29-42 ◽  
Author(s):  
Mads Vendelbo Lind ◽  
Lotte Lauritzen ◽  
Mette Kristensen ◽  
Alastair B Ross ◽  
Jane Nygaard Eriksen
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Randomized Controlled Trials ◽  
Fasting Glucose ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Folate Supplementation ◽  
Randomized Controlled ◽  
Meta Analyses

ABSTRACT Background Various mechanisms link higher total homocysteine to higher insulin resistance (IR) and risk of type 2 diabetes (T2D). Folate supplementation is recognized as a way to lower homocysteine. However, randomized controlled trials (RCTs) show inconsistent results on IR and T2D outcomes. Objective The aim of this study was to examine the effect of folate supplementation on IR and T2D outcomes. Design We conducted a systematic literature search in PubMed, Web of Science, and EMBASE and prior systematic reviews and meta-analyses and identified 29 RCTs (22,250 participants) that assessed the effect of placebo-controlled folate supplementation alone or in combination with other B vitamins on fasting glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), or risk of T2D. The meta-analysis was conducted using both random- and fixed-effects models to calculate weighted mean differences (WMDs) or risk ratios with 95% CIs. Subgroup analyses were conducted based on intervention type (folate alone or in combination with other B vitamins), as well as analysis based on population characteristics, duration, dose, and change in homocysteine. Results When compared with placebo, folate supplementation lowered fasting insulin (WMD: −13.47 pmol/L; 95% CI: −21.41, −5.53 pmol/L; P &lt; 0.001) and HOMA-IR (WMD: −0.57 units; 95% CI: −0.76, −0.37 units; P &lt; 0.0001), but no overall effects were observed for fasting glucose or HbA1c. Heterogeneity was low in all meta-analyses, and subgroup analysis showed no signs of effect modification except for change in homocysteine, with the most pronounced effects in trials with a change of &gt;2.5 µmol/L. Changes in homocysteine after folate supplementation correlated with changes in fasting glucose (β = 0.07; 95% CI: 0.01, 0.14; P = 0.025) and HbA1c (β = 0.46; 95% CI: 0.06, 0.85; P = 0.02). Only 2 studies examined folate supplementation on risk of T2D, and they found no change in RR (pooled RR: 0.91; 95% CI: 0.80, 1.04; P = 0.16). Conclusion Folate supplementation might be beneficial for glucose homeostasis and lowering IR, but at present there are insufficient data to conclusively determine the effect on development of T2D. This trial was registered on the Prospero database as CRD42016048254.

scholarly journals Risk of malignancies in patients with spondyloarthritis treated with biologics compared with those treated with non-biologics: a systematic review and meta-analysis

2020 ◽  
Vol 12 ◽  
pp. 1759720X2092569
Author(s):  
Yu Heng Kwan ◽  
Ka Keat Lim ◽  
Warren Fong ◽  
Hendra Goh ◽  
Linkai Ng ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Interleukin 17 ◽  
Randomized Controlled ◽  
Risk Of Malignancy ◽  
Meta Analyses ◽  
Analytical Approaches

Background: The aim of our study was to synthesize evidence on the occurrence of malignancy in spondyloarthritis (SpA), from randomized controlled trials (RCTs) comparing biologics with non-biologics and biologics to each other. Methods: We systematically searched Medline, Cochrane Library, EMBASE, Scopus and ClinicalTrials.gov from inception until 31 October 2018. RCTs with ⩾24-week follow-up were included. We extracted data using standardized forms and assessed the risk of bias using the Cochrane Risk of Bias Tool. We performed pair-wise meta-analyses and network meta-analyses to compare the risk of malignancy for each biologics class and SpA type. We reported the Peto odds ratio (OR) of any malignancy along with 95% confidence intervals (95% CI). Bayesian posterior probabilities comparing risk of malignancy of each biologic class with non-biologics were computed as supplementary measures. Results: Fifty-four trials were included; most (44/54) had follow-up <1 year. Among 14,245 patients, 63 developed a malignancy. While most Peto ORs were >1, they had wide 95% CI and p >0.05. The overall Peto OR comparing biologics with non-biologics was 1.42 (95% CI 0.80–2.53). Only interleukin-17 inhibitors in peripheral SpA had p <0.05 (Peto OR 2.77, 95% CI 1.07–7.13); the posterior probability that the risk was higher than non-biologics was 98%. Stratified analyses revealed no consistent trend by prior exposure to biologics, duration of follow-up, study quality, study-arm crossover, analytical approaches and type of malignancy. Conclusions: Our findings indicate no overall elevated risk of malignancy with biologics in SpA. As our meta-analyses are unable to conclude on the long-term risk, long-term pharmacovigilance of biologics in SpA may still be warranted.

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