scholarly journals What is the impact of dexamethasone on postoperative pain in adults undergoing general anaesthesia for elective abdominal surgery: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ciara Mitchell ◽  
C. Mitchell ◽  
S. J. Cheuk ◽  
C. M. O’Donnell ◽  
S. Bampoe ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
General Anaesthesia ◽  
Meta Analysis ◽  
Oral Morphine ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Pain Scores ◽  
Elective Abdominal Surgery ◽  
The Impact

Abstract Background Previous meta-analysis of heterogeneous surgical cohorts demonstrated reduction in postoperative pain with perioperative intravenous dexamethasone, but none have addressed adults undergoing elective abdominal surgery. Objective To determine the impact of intravenous perioperative dexamethasone on postoperative pain in adults undergoing elective abdominal surgery under general anaesthesia. Methods This review was prospectively registered on the international prospective register of systematic reviews (CRD42020176202). Electronic databases Medical Analysis and Retrieval System Online (MEDLINE), Exerpta Medica Database (EMBASE), (CINAHL) Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and trial registries were searched to January 28 2021 for randomised controlled trials, comparing dexamethasone to placebo or alternative antiemetic, that reported pain. The primary outcome was pain score, and secondary outcomes were time to first analgesia, opioid requirements and time to post-anaesthesia care unit (PACU) discharge. Results Fifty-two studies (5768 participants) were included in the meta-analysis. Pain scores ≤4 hours were reduced in patients who received dexamethasone at rest (mean difference (MD), -0.54, 95% confidence interval (CI) -0.72 to -0.35, I2 = 81%) and on movement (MD -0.42, 95% CI -0.62 to -0.22, I2 = 35 ). In the dexamethasone group 4–24 hour pain scores were less at rest (MD -0.31, 95% CI -0.47 to -0.14, I2 = 96) and on movement (MD -0.26, 95% CI -0.39 to -0.13, I2 = 29) and pain scores ≥24 hours were reduced at rest (MD -0.38, 95% CI -0.52 to -0.24, I2 = 88) and on movement (MD -0.38, 95% CI -0.65 to -0.11, I2 = 71). Time to first analgesia (minutes) was increased (MD 22.92, 95% CI 11.09 to 34.75, I2 = 98), opioid requirements (mg oral morphine) decreased (MD -6.66, 95% CI -9.38 to -3.93, I2 = 88) and no difference in time to PACU discharge (MD -3.82, 95% CI -10.87 to 3.23, I2 = 59%). Conclusions Patients receiving dexamethasone had reduced pain scores, postoperative opioid requirements and longer time to first analgesia. Dexamethasone is an effective analgesic adjunct for patients undergoing abdominal surgery.

scholarly journals Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020991 ◽  
Author(s):  
Wen Wang ◽  
Wenwen Chen ◽  
Yanmei Liu ◽  
Reed Alexander C Siemieniuk ◽  
Ling Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Meta Analysis ◽  
Late Recurrence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
High Quality ◽  
Moderate Quality ◽  
The Impact ◽  
Risk Of Treatment

ObjectiveTo assess the impact of adjunctive antibiotic therapy on uncomplicated skin abscesses.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.Study selectionA BMJ Rapid Recommendation panel provided input on design, important outcomes and the interpretation of the results. Eligible randomised controlled trials (RCTs) included a comparison of antibiotics against no antibiotics or a comparison of different antibiotics in patients with uncomplicated skin abscesses, and reported outcomes prespecified by the linked guideline panel.Review methodsReviewers independently screened abstracts and full texts for eligibility, assessed risk of bias and extracted data. We performed random-effects meta-analyses that compared antibiotics with no antibiotics, along with a limited number of prespecified subgroup hypotheses. We also performed network meta-analysis with a Bayesian framework to compare effects of different antibiotics. Quality of evidence was assessed with The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsFourteen RCTs including 4198 patients proved eligible. Compared with no antibiotics, antibiotics probably lower the risk of treatment failure (OR 0.58, 95% CI 0.37 to 0.90; low quality), recurrence within 1 month (OR 0.48, 95% CI 0.30 to 0.77; moderate quality), hospitalisation (OR 0.55, 95% CI 0.32 to 0.94; moderate quality) and late recurrence (OR 0.64, 95% CI 0.48 to 0.85; moderate quality). However, relative to no use, antibiotics probably increase the risk of gastrointestinal side effects (trimethoprim and sulfamethoxazole (TMP-SMX): OR 1.28, 95% CI 1.04 to 1.58; moderate quality; clindamycin: OR 2.29, 95% CI 1.35 to 3.88; high quality) and diarrhoea (clindamycin: OR 2.71, 95% CI 1.50 to 4.89; high quality). Cephalosporins did not reduce the risk of treatment failure compared with placebo (moderate quality).ConclusionsIn patients with uncomplicated skin abscesses, moderate-to-high quality evidence suggests TMP-SMX or clindamycin confer a modest benefit for several important outcomes, but this is offset by a similar risk of adverse effects. Clindamycin has a substantially higher risk of diarrhoea than TMP-SMX. Cephalosporins are probably not effective.

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Ping Li ◽  
Sheng-Wen Wu ◽  
Dong-Fang Ge ◽  
Zai-Rong Tang ◽  
Cong-Chao Ma ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Fluid Therapy ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register ◽  
Clinical Trials Registry

Abstract Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology : We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Eleven RCTs comparing the two therapies were included. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: Restrictive fluid therapy is safe but may have potential dangers, so caution is warranted in its application.

scholarly journals Protocol for a systematic review and meta-analysis of respiratory rehabilitation following intensive care unit discharge for COVID-19 survivors

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041184
Author(s):  
Dan Wang ◽  
Jin Li ◽  
Feilong Zhu ◽  
Qianqin Hong ◽  
Ming Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
The Impact ◽  
Respiratory Rehabilitation

IntroductionBoth physical and mental disorders may be exacerbated in patients with COVID-19 due to the experience of receiving intensive care; undergoing prolonged mechanical ventilation, sedation, proning and paralysis. Pulmonary rehabilitation is aimed to improve dyspnoea, relieve anxiety and depression, reduce the incidence of related complications, as well as prevent and improve dysfunction. However, the impact of respiratory rehabilitation on discharged patients with COVID-19 is currently unclear, especially on patients who have been mechanically ventilated over 24 hours. Therefore, we aim to investigate the efficacy of respiratory rehabilitation programmes, initiated after discharge from the intensive care unit, on the physical and mental health and health-related quality of life in critical patients with COVID-19.Methods and analysisWe have registered the protocol on PROSPERO and in the process of drafting it, we strictly followed the checklist of Preferred Reporting Items for Systematic Review and Meta-Analysis Potocols. We will search the PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, WanFang, VIP information databases and Chinese Biomedical Literature Database. Additionally, ongoing trials in the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN registry will be searched as well. Studies in English or Chinese and from any country will be accepted regardless of study design. Two review authors will independently extract data and assess the quality of included studies. Continuous data are described as standard mean differences (SMDs) with 95% CIs. Dichotomous data from randomised controlled trials are described as risk ratio(RR) with 95% CIs; otherwise, it is described as odds ratio(OR) with 95% CIs. I2 and the Cochrane’s Q statistic will be used to conduct heterogeneity assessment. The quality of evidence of main outcomes will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation(GRADE) criteria. When included studies are sufficient, we will conduct subgroup analysis and sensitivity analysis; the publication bias will be statistically analysed using a funnel plot analysis and Egger’s test.Ethics and disseminationOur review, planning to include published studies, does not need the request to the ethical committee. The final results of this review will be published in a peer-reviewed journal after completion.Patient and public involvementNo patient involved.PROSPERO registration numberCRD42020186791.

Clinical, Endoscopic and Histological Outcomes in Induction of Moderate-to-Severe Ulcerative Colitis: A Systematic Review with Meta-Analysis

2020 ◽  
Author(s):  
Fernando Magro ◽  
Maria Manuela Estevinho ◽  
Cláudia Camila Dias ◽  
Luís Correia ◽  
Paula Lago ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ulcerative Colitis ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Pharmacological Intervention ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Cochrane Central Register ◽  
Histological Remission ◽  
The Impact

Abstract Background and Aims Interest in histology for ulcerative colitis [UC] has increased recently. This systematic review and meta-analysis aims to assess, for the first time, whether histological outcomes are more informative than endoscopic and clinical outcomes in distinguishing the impact of intervention over placebo in induction trials. Methods MEDLINE, ScienceDirect and Cochrane Central Register of Controlled Trials were searched to identify randomized placebo-controlled trials [RCTs] enrolling moderate-to-severe UC patients. Studies were assessed using the Quality Assessment Tool for Studies with Diverse Designs. We analysed the pooled proportion of patients achieving clinical, endoscopic and histological remission and response after a pharmacological intervention and compared the results with those of placebo-treated patients by using a random-effects model. Results From 889 identified records, 13 RCTs were included. The odds ratio [OR] for remission was higher in patients receiving intervention than in those under placebo for clinical (OR 2.13, 95% confidence interval [CI] 1.33–3.43), endoscopic [OR 1.46, 95% CI 0.19–11.18] and histological remission [OR 1.85, 95% CI 1.20–2.84]. Significant differences were observed for all response outcomes [clinical: OR 2.27, 95% CI 1.84–2.85; endoscopic: OR 2.16, 95% CI 1.51–3.10; histological: OR 3.63, 95% CI, 1.41–9.36]. No significant heterogeneity existed; no subgroup effects were found for duration of the induction or histological scale [p > 0.05]. Clinical and histological remission and endoscopic response were concordant in discriminating interventions from placebo. Conclusion Histological outcomes are informative in trials of moderate-to-severe UC. Further studies analysing histology at the end of induction are needed to confirm its relevance in distinguishing the efficacy of an intervention over placebo in comparison to clinical and endoscopic outcomes and to explore its prognostic value.

scholarly journals Impact of surgical margin status on the survival outcome after surgical resection of gastric cancer: a protocol for systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040282
Author(s):  
Zhiyuan Jiang ◽  
Zhaolun Cai ◽  
Yuan Yin ◽  
Chaoyong Shen ◽  
Jinming Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Curative Intent ◽  
Term Survival ◽  
Effect Model ◽  
Statistical Heterogeneity ◽  
The Impact

IntroductionGenerally, complete resection with cancer cell negative (R0) margin has been accepted as the most effective treatment of gastric cancer and positive resection (R1/R2) margin has been associated with decreased survival to varied degrees. However, the independent impact of microscopical positive (R1) margin on long-term survival may be confounded. No meta-analysis has worked at the association between R1 margin and outcomes of gastric cancer and the available evidence are scant. Therefore, we plan to conduct a systematic review and meta-analysis to quantitatively explore the role of R1 margin on gastric (including oesophagogastric junction) cancer survival after curative intent resection.Methods and analysisThe protocol was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search of PubMed, Embase and the Cochrane Central Register of Controlled Trials databases will be performed from their inceptions to 30 April 2020 to identify randomised controlled trials (RCTs), cohort studies and case–control studies focusing on the impact of R1 margin on survival of gastric cancer after curative intent resection. The primary outcome will be the overall survival (OS) and disease-free survival (DFS) and the secondary outcomes will be 5-year OS rate and 5-year DFS rate. The Cochrane tool for bias assessment in randomised trials and Risk Of Bias In Non-randomised Studies-I for the assessment of bias in non-randomised studies (NRS) will be used. Statistical heterogeneity will be assessed by visual inspection of forest plots and measured using the I2 statistics. A fixed-effect model will be used when heterogeneity is low, otherwise, a random-effect model will be chosen. Publication bias will be assessed by funnel plots, subgroup analysis and sensitivity analysis will be performed in the right context. For each outcome, we will perform data synthesis separately for RCTs and NRS using Rev Man V.5.3 software and compile ‘summary of findings’ tables separately for RCTs and NRS using GRADEpro software. Grading of Recommendations, Assessment, Development and Evaluations considerations will also be used to make an overall assessment of the quality of evidence.Ethics and disseminationThere is no requirement for ethics approval because no patient data will be collected at an individual level in this systematic review and meta-analysis.The results of this systematic review will be published in a peer-reviewed journal and presented at relevant conferences, any deviations from the protocol will be clearly documented and explained in its final report.PROSPERO registration numberCRD42020165110.

Effect of Premorbid Beta-Blockers on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 088506662110529
Author(s):  
Daisuke Hasegawa ◽  
Ryota Sato ◽  
Narut Prasitlumkum ◽  
Kazuki Nishida
Keyword(s):  
Systematic Review ◽  
Beta Blockers ◽  
Data Extraction ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Short Term ◽  
Cross Sectional ◽  
Short Term Mortality ◽  
The Impact

Objective The aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of premorbid beta-blockers on mortality in patients with sepsis. Data Sources We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for eligible studies. The protocol was registered at the PROSPERO (CRD42021256813). Study Selection Two authors independently evaluated the following inclusion criteria: (1) randomized controlled trials, cohort studies, cross-sectional studies; (2) patients with sepsis aged ≥18 years, and (3) premorbid beta-blocker use. Data Extraction Two authors extracted the patients’ characteristics and outcomes independently. All analyses were performed using the random-effects models. The primary outcome was short-term mortality, defined as mortality within 30 days, in-hospital or intensive care unit mortality. Data Synthesis Ten studies (n = 24 748 patients) were included. The pooled odds ratio (OR) of short-term mortality associated with the premorbid use of beta-blockers was 0.85 (95% confidence interval [CI], 0.69-1.04; P = .12; I2 = 50%). Five studies reported an adjusted OR of short-term mortality. The pooled adjusted OR of short-term mortality associated with the premorbid use of beta-blockers was 0.73 (95% CI, 0.65-0.83; P < .001; I2 = 0%). Conclusion Premorbid beta-blockers were associated with a lower short-term mortality in patients with sepsis.

scholarly journals The Effects of Melatonin Supplementation on Glycemic Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 50 (11) ◽  
pp. 783-790 ◽  
Author(s):  
Amin Doosti-Irani ◽  
Vahidreza Ostadmohammadi ◽  
Naghmeh Mirhosseini ◽  
MohammadAli Mansournia ◽  
Russel Reiter ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glycemic Control ◽  
Randomized Controlled Trials ◽  
Fasting Glucose ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Insulin Levels ◽  
Randomized Controlled ◽  
The Impact

AbstractThis systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to clarify the effect of melatonin supplementation on glycemic control. Databases including PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were searched until July 30th, 2018. Two reviewers independently assessed study eligibility, extracted data, and evaluated the risk of bias for included trials. Heterogeneity among included studies was assessed using Cochran’s Q test and I-square (I2) statistic. Data were pooled using random-effect models and standardized mean difference (SMD) was considered as the overall effect size. Twelve trials out of 292 selected reports were identified eligible to be included in current meta-analysis. The pooled findings indicated that melatonin supplementation significantly reduced fasting glucose (SMD=–6.34; 95% CI, –12.28, –0.40; p=0.04; I2: 65.0) and increased the quantitative insulin sensitivity check index (QUICKI) (SMD=0.01; 95% CI, 0.00, 0.02; p=0.01; I2: 0.0). However, melatonin administration did not significantly influence insulin levels (SMD=–1.03; 95% CI, –3.82, 1.77; p=0.47; I2: 0.53), homeostasis model assessment of insulin resistance (HOMA-IR) (SMD=–0.34; 95% CI, –1.25, 0.58; p=0.37; I2: 0.37) or HbA1c levels (SMD=–0.22; 95% CI, –0.47, 0.03; p=0.08; I2: 0.0). In summary, the current meta-analysis showed a promising effect of melatonin supplementation on glycemic control through reducing fasting glucose and increasing QUICKI, yet additional prospective studies are recommended, using higher supplementation doses and longer intervention period, to confirm the impact of melatonin on insulin levels, HOMA-IR and HbA1c.

scholarly journals The Effect of Herbal Medicine Supplementation on Clinical and Para-clinical Outcomes in Women With PCOS: A Systematic Review and Meta-analysis

2019 ◽  
Vol 7 (4) ◽  
pp. 423-433 ◽  
Author(s):  
Nava Ainehchi ◽  
Azizeh Farshbaf-Khalili ◽  
Aliyeh Ghasemzadeh ◽  
Kobra Hamdi ◽  
Arash Khaki ◽  
...  
Keyword(s):  
Polycystic Ovary ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Total Testosterone ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Fasting Insulin ◽  
Mentha Spicata ◽  
Herbal Mixture ◽  
The Impact

Objectives: The aim of this study is to assess the impact of Cinnamomum verum, Mentha spicata, Zingiberene officinal on polycystic ovary syndrome (PCOS) treatment. Materials and Methods: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus, Web of Science, Google Scholar, ProQuest, Clinicaltrial.gov, and for Persian articles SID, Magiran, Irandoc, and Iranmedex were searched without any time limitation. Results: Thirteen randomized controlled trials (RCTs) consisting 668 women were entered in the meta-analysis. Significant differences in fasting blood sugar (FBS; weighted mean difference (WMD)=-3.69 mg/dL, 95% CI: -6.67 to -0.7, P=0.02; 241 participants), fasting insulin (WMD=-4.53 µIU/mL, 95% CI: -6.45 to -2.61, P<0.001;183 participants), triglyceride (TG; WMD=-17.97 mg/ dL, 95% CI: -30.51 to -5.43, P=0.005;183 participants), total cholesterol (TC; WMD=-14.60 mg/dL, 95% CI: -22.93 to -6.26, P=0.0006; 183 participants), low-density lipoprotein cholesterol (LDL; WMD=-16.58 mg/dL, 95% CI -23.91 to -9.24, P<0.001; 183 participants), malondialdehyde (MDA; WMD=-0.25 nmol/ml, 95% CI -0.41 to -0.09, P<0.002;124 participants), total testosterone (TT; WMD=-0.18 ng/mL, 95% CI -0.27 to -0.09, P<0.001; 116 participants), free testosterone (FT; WMD=-5.47 pg/mL, 95% CI -8.34 to -2.61, P=0.0002;78 participants) were obtained by using cinnamon alone and herbal mixture containing cinnamon in comparison to control. Conclusions: This meta-analysis showed that cinnamon alone and herbal mixture containing cinnamon improve level of FBS, fasting insulin, TG, TC, LDL, MDA, TT, and FT serum level.

scholarly journals The impact of fish oil supplementation in patients with rheumatoid arthritis

2018 ◽  
Vol 5 (7) ◽  
pp. 2637
Author(s):  
Maram Barkoot ◽  
Abdulrahman Albejawi ◽  
Ali Alhadri ◽  
Sahar Albalawi ◽  
Muayad Al Awwas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Fatty Acids ◽  
Fish Oil ◽  
Meta Analysis ◽  
Clinical Results ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Omega 3 ◽  
Study Heterogeneity ◽  
The Impact

Many clinical trials of omega-3 fatty acids, supplied as fish oil supplements, have been carried out in rheumatoid arthritis (RA) over the past 3 decades. The current analysis evaluates the influence of omega-3 polyunsaturated fatty acids on clinical results in patients with rheumatoid arthritis. We conducted the current meta-analysis using a comprehensive search of EMBASE, MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials till 31 January 2018 for randomized controlled trials that examined the influence of omega-3 PUFAs on clinical results in patients with rheumatoid arthritis. We identified 8 prospective studies that could be included in the meta-analysis. They showed that omega-3 PUFAs had a clear influence on NSAID consumption (SMD −0.52, 95% CI −0.92 to −0.12, p = 0.01) without between-study heterogeneity (I2 = 0%) and in pain (SMD −0.55, 95% CI 0.17–0.027, p = 0.57). The use of omega-3 PUFAs at dosages of >2.7 g/day for more than three months can be effective at decreasing NSAID use in rheumatoid arthritis patients.

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