scholarly journals The Effect of Functional Mandibular Advancement for Adolecent Patients with Skeletal Class Ⅱ Malocclusion on the TMJ——a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Lan Ding ◽  
Rui Chen ◽  
Jiaxin Liu ◽  
Yuan Wang ◽  
Qian Chang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Oral Appliance ◽  
Temporomandibular Joint Disorders ◽  
Mandibular Advancement ◽  
Cochrane Central Register ◽  
Skeletal Class ◽  
Period 2 ◽  
Central Register

Abstract Objectives: This study aimed to assess whether functional mandibular advancement will induce or aggravate temporomandibular joint disorders.Methods: All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails directly observe the condition of patients’ TMJ after finishing treatment will be considered to include in our study. Cochrane Collaboration risk of bias tool was used to assess the quality of included studies according to the established inclusion criteria.Result:Finally 13 researches were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 285 individuals ,there were 142 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients recieved FMA didn’t show more tendency to develop temporomandibular symptoms[I²=25%, OR=0.39, 95%CI (0.22 ,0.68), p=0.001].Conclusion: (1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear during follow-up period. (2) Less convinced evidence indicate that slightly previous TMD will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not induce or aggravate TMD.

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).

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

scholarly journals Conjoined versus separate technique: a meta-analysis of anastomosis techniques for urinary diversion after bladder cancer

2019 ◽  
Author(s):  
Liu Daqian ◽  
Wang Yonghua ◽  
Zhao Yang ◽  
Yang Xuecheng ◽  
wang xinsheng ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urinary Diversion ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Anastomosis Group ◽  
Separate Group ◽  
Cochrane Central Register ◽  
Central Register ◽  
The Difference

Abstract Introduction: This was a meta-analysis of studies on conjoined and separate anastomosis for urinary diversion after radical cystectomy due to bladder cancer. Methods: We searched databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials) for studies regarding anastomosis for urinary diversion due to bladder cancer. The meta-analysis was designed to determine the difference between conjoined and separate anastomosis. Six studies including 1601 patients were considered in the meta-analysis (654 in the separate group and 947 in the conjoined group). Results: There were no significant differences with respect to age, gender or duration of follow-up. There were seven studies that compared the rate of stricture and the rate of hydronephrosis. For overall stricture, there were 186 of 1163 ureters in the separate group and 64 of 1718 ureters in the conjoined group (odds ratio, 4.53; 95% CI, 2.01-10.22; P = 0.0003). For overall hydronephrosis patients, there were 55 of 205 ureters in the separate group and 51 of 254 ureters in the conjoined group (odds ratio, 1.48; 95% CI, 0.95-2.29; P = 0.08). Conclusion: The separate anastomosis had a higher ratio of strictures than did the conjoined group. The separate anastomosis group experienced hydronephrosis more often than did the conjoined anastomosis group. The separate anastomosis is the better choice for surgery during the operation.

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.

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.

Music to reduce pain and anxiety in cystoscopy: a systematic review and meta-analysis

2018 ◽  
Vol 16 (3) ◽  
Author(s):  
Herney Andrés García-Perdomo ◽  
Laura M. Montealegre Cardona ◽  
Maria Juliana Cordoba-Wagner ◽  
James A. Zapata-Copete
Keyword(s):  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Allocation Concealment ◽  
Risk Of Bias ◽  
The Other ◽  
Cochrane Central Register ◽  
Qualitative And Quantitative Analysis ◽  
Central Register ◽  
Flexible Cystoscope ◽  
Almost All

Abstract Background To assess the effectiveness and harms of music to reduce anxiety and pain in cystoscopy. Methods We searched MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. We included clinical trials, involving the assessment of the effect of music in cystoscopy. The primary outcomes were pain and anxiety measured by any scale and the secondary outcomes were length of stay, physiological parameters (blood pressure or heart rate) and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about mean difference (MD) with 95% CI. Heterogeneity was evaluated using the I2 test. Results We included six studies in our qualitative and quantitative analysis. Five studies used a flexible cystoscope and the other one performed the procedure with a rigid cystoscope. Music was played during the procedure in five studies, while the other was before it. All studies compared music vs. no intervention. Almost all items were assessed as low risk of bias; however, the allocation concealment was unclear in all the studies. We found a MD of −1.33 (95% CI −2.45 to −0.21) (I2=97.2%) favoring music for pain and a MD of −8.42 (95% CI −15.02, −1.82) (I2=99.6%) was found, favoring music for anxiety. Conclusions Playing music might be an effective intervention that lowers pain and anxiety in patients who undergo cystoscopy.

Abstract WP371: Role of Troponin as a Biomarker for Predicting Outcome After Ischemic Stroke: A Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adel A Alhazzani ◽  
Amit Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Biomarker ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Elevated Serum ◽  
Cochrane Central Register ◽  
Central Register ◽  
Predicting Outcome

Background: After acute ischemic stroke, a higher level of troponin has been considered as an important biomarker for predicting mortality. The aim of the study was to quantitatively assess the prognostic significance of the effect of baseline troponin levels on mortality in patients with acute ischemic stroke using a meta-analysis approach. Design: The following electronic databases, PubMed, EMBASE, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials , TRIP Database, ClinicalTrials.govwas used for getting the relevant article from literuare. Data were extracted in standardized data collection by two independent investigators. Any disagreements were resolved by consensus. All the statistical analyses were performed in STATA software. Results: 18 studies were included in the present meta-analysis involving a total of 8723 patients. The pooled results suggested that the elevated serum troponin level was associated with in -hospital mortality (RR 2.39, 95% CI 1.37 to 3.41), at the end of last follow up mortality (RR 1.75; 95% CI 1.38 to 2.11) and for overall mortality (RR 1.82; 95% CI 1.47 to 2.17). Sensitivity analysis by removing a single study by turns indicated that there was no obvious impact of any individual study on the pooled risk estimate. No significant publication bias was observed. Conclusion: Our findings indicate that a higher level of troponinmight be an important prognostic biomarker for in hospital and follow up mortality in patients with acute ischemic stroke. The study might have clinical implications by using troponin as a prognostic biomarker for patient stratification and early intervention.

scholarly journals The Role of Orthodontics in the Management of Obstructive Sleep Apnea OSA in Children: Systematic Review

2019 ◽  
Author(s):  
Norah Alotaibi ◽  
Amani alkhamees ◽  
Rabia Bilal
Keyword(s):  
Meta Analysis ◽  
Oral Appliance ◽  
Included Study ◽  
Cochrane Central Register ◽  
Oral Appliances ◽  
Ovid Medline ◽  
Study Selection ◽  
Central Register ◽  
Obstructive Sleep ◽  
Reported Data

Abstract Objective review the effectiveness of the use of different orthodontic oral appliance as a primary or adjective treatment of OSAS in children. methods: systemic search of online databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), international Registry Platform for ongoing trials and clinical trails.gov, Embase Ovid, Medline complete) for randomized control trail and non-randomized prospective or retrospective clinical studies published in 2000-2019 that uses oral appliances for the treatment of OSA in children. Study selection was done by 2 reviews. Results 9 studies were included in the review. Based on the limited evidence oral appliances improve OSA in children measured by the reduction of AHI. Due to heterogeneity of included study designs and reported data meta-analysis was not possible. Limitation limited number of studies and study populations. High risk of bias. Conclusion oral appliances show a promising improvement in AHI and should be considered as a treatment option for OSA in children

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 Do the Clinical Effects of Enamel Matrix Derivatives in Infrabony Defects Decrease Overtime? A Systematic Review and Meta-Analysis

2013 ◽  
Vol 24 (5) ◽  
pp. 446-455 ◽  
Author(s):  
Fabricio Batistin Zanatta ◽  
Fernanda Goulart de Souza ◽  
Tatiana Militz Perrone Pinto ◽  
Raquel Pippi Antoniazzi ◽  
Cassiano Kuchenbecker Rösing
Keyword(s):  
Meta Analysis ◽  
Gingival Recession ◽  
Risk Of Bias ◽  
Enamel Matrix Derivative ◽  
Cochrane Central Register ◽  
Clinical Effects ◽  
Enamel Matrix ◽  
Results Of Treatment

Previous systematic reviews have demonstrated better results with enamel matrix derivative proteins (EMDP) as compared with open flap debridement (OFD) for the management of infrabony periodontal defects (IPD). The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies. Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase and Web of Science electronic databases were searched up to August 2013 for randomized clinical trials.Eligible outcomes were changes in probing depth (PD), clinical attachment level (CAL),gingival recession (GR) and bone changes (BC). Studies with follow-up of 12 months showed differences of 0.97 mm (CI95% 0.52 - 1.43) and 1.19 mm (CI95% 0.77 - 1.60) for PD and CAL, respectively, favorable for EMDP. Studies with follow-up ≥ 24 months presented advantages of 1.11 mm (CI95% 0.74 -1.48) for CAL and 0.83 mm (CI95% 0.19 -1.48) for PD,with use of EMDP. Considering the quality of studies, those with low risk of bias showed lower difference between groups, presenting 0.8 mm (CI95% 0.24-1.36) for CAL, favorable for EMDP and without differences for PS (0.51 mm, CI95% -0.21 - 1.23). In conclusion, follow-up time (< or > 2 years) and the risk of bias influence the results of treatment with EMDP in IPD.

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