scholarly journals Adjuvant Corticosteroids With Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 15 ◽  
Author(s):  
Min Shi ◽  
Ling-fei Xiao ◽  
Ting-bao Zhang ◽  
Qing-wen Tang ◽  
Wen-yuan Zhao
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Adjuvant Treatment ◽  
Observational Studies ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Efficacy And Safety ◽  
All Cause Mortality ◽  
Length Of Hospitalization

The use of adjuvant corticosteroids with surgery for chronic subdural hematoma (CSDH) has received considerable attention in recent years. However, there is no conclusive evidence regarding its effectiveness and safety for CSDH. Therefore, we performed a meta-analysis and systematic review to evaluate the effectiveness and safety of corticosteroids as an adjuvant treatment for the treatment of CSDH. We comprehensively searched electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) to identify relevant trials that investigated the efficacy and safety of adjuvant corticosteroids with surgery for CSDH, published from inception until May 2021. Outcome measures included recurrence rate, all-cause mortality, good functional outcome, length of hospitalization, and adverse events. We used the Cochrane risk of bias method to evaluate the quality of randomized controlled trials (RCTs), and the Newcastle Ottawa Scale to evaluate the quality of observational studies. We included nine studies, consisting of three RCTs and six observational studies, that compared corticosteroids as an adjuvant treatment to surgery with surgery alone. Pooled results revealed that the risk of recurrence was significantly reduced in patients who received adjuvant corticosteroids with surgery compared to those who underwent surgery alone (relative risk [RR] = 0.52, 95% confidence interval [CI] = 0.39–0.69, p < 0.00001). However, no statistically significant difference was observed between these groups in all-cause mortality (RR = 0.91, 95% CI = 0.37–2.23, p = 0.83), good functional outcome (RR = 1.03, 95% CI = 0.96–1.10, p = 0.47), length of hospitalization (MD = 0.35, 95% CI = –2.23 to 1.67, p = 0.83), and infection rates (RR = 0.99, 95% CI = 0.64–1.53, p = 0.95). Adjuvant corticosteroids with surgery reduce the risk of recurrence of CDSH, but do not improve the all-cause mortality or functional outcome, as compared to surgery alone. These findings support the use of adjuvant corticosteroids with surgery for CSDH patients. Further high-quality RCTs are required to confirm the efficacy and safety of adjuvant corticosteroids in the treatment of CSDH patients.

scholarly journals Hip Fractures in Elderly People: Surgery or No Surgery? A Systematic Review and Meta-Analysis

2017 ◽  
Vol 8 (3) ◽  
pp. 173-180 ◽  
Author(s):  
Cornelis L. P. van de Ree ◽  
Mariska A. C. De Jongh ◽  
Charles M. M. Peeters ◽  
Leonie de Munter ◽  
Jan. A. Roukema ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
High Risk ◽  
Functional Outcome ◽  
Hip Fractures ◽  
Frail Elderly ◽  
Observational Studies ◽  
Methodological Quality ◽  
Meta Analysis

Introduction: Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients’ prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture. Objective: The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years. Methods: A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist. Results: Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups. Conclusion: This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy.

scholarly journals Does propofol ameliorate occurrence of postoperative cognitive dysfunction after general anaesthesia? A protocol of systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Xi Zhao ◽  
Ze-qing Huang
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Short Term Memory ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
China National Knowledge Infrastructure

Abstract Background Postoperative cognitive dysfunction (POCD) is a common condition after general anesthesia (GA). Previous studies have reported that propofol can ameliorate the occurrence of such disorder. However, its results are still inconsistent. Therefore, this systematic review will assess the efficacy and safety of propofol on POCD after GA. Methods Literature sources will be sought from inception to the present in Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for randomized controlled trials (RCTs) assessing the administration of propofol on POCD after GA. All searches will be carried out without limitations to language and publication status. Outcomes comprise of cognitive impairments changes, impairments in short-term memory, concentration, language comprehension, social integration, quality of life, and adverse events. Cochrane risk of bias tool will be utilized to assess study quality. We will evaluate the quality of evidence for each outcome using Grading of Recommendations Assessment, Development and Evaluation approach. A narrative synthesis or a meta-analysis will be undertaken as appropriate. Discussion This study will systematically and comprehensively search literature and integrate evidence on the efficacy and safety of propofol on POCD after GA. Our findings will be of interest to clinicians and health-related policy makers. Systematic review registration PROSPERO CRD42020164096

scholarly journals Acupuncture for refractory gastro-oesophageal reflux disease: a systematic review and meta-analysis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030713 ◽  
Author(s):  
Dacheng Li ◽  
Li Zhu ◽  
Daming Liu
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Adverse Events ◽  
Reflux Disease ◽  
Meta Analysis ◽  
Oesophageal Reflux ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Oesophageal Reflux Disease

IntroductionRefractory gastro-oesophageal reflux disease (rGORD) is a common disease, affecting patients’ quality of life. Since conventional medicines have limitations, like low effective rates and adverse events, acupuncture may be a promising therapy for rGORD. While no related systematic review has been published, the present study is designed to evaluate the efficacy and safety of acupuncture for rGORD.Methods and analysisPubMed, the Cochrane Central Register of Controlled Trials and Chinese electronic databases, including China National Knowledge Infrastructure, Wan Fang database, VIP, SinoMed and the Chinese Clinical Trial Registry, will be searched from establishment of the database to 31 August 2019. There will be no limitations on language, and all articles will be screened and collected by two reviewers independently. RevMan V.5.3.5 software will be used for meta-analysis, and the conduction of study will refer to the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. The efficacy and safety of acupuncture for rGORD will be evaluated based on outcomes, including global symptom improvement, oesophageal sphincter function test measured by high-resolution manometry, quality of life, recurrence rate and adverse events.Ethics and disseminationThere is no necessity for this study to acquire an ethical approval, and this review will be disseminated in a peer-reviewed journal or conference presentation.Trial registration numberCRD42018111912.

scholarly journals Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis

2019 ◽  
Vol 57 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Tom A Rayner ◽  
Sean Harrison ◽  
Paul Rival ◽  
Dominic E Mahoney ◽  
Massimo Caputo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Impairment ◽  
Minimally Invasive ◽  
Risk Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Ascending Aorta ◽  
Mean Difference ◽  
Standardized Mean Difference

Summary Limited uptake of minimally invasive surgery (MIS) of the aorta hinders assessment of its efficacy compared to median sternotomy (MS). The objective of this systematic review is to compare operative and perioperative outcomes for MIS versus MS. Online databases Medline, EMBASE, Cochrane Library and Web of Science were searched from inception until July 2018. Both randomized and observational studies of patients undergoing aortic root, ascending aorta or aortic arch surgery by MIS versus MS were eligible for inclusion. Primary outcomes were 30-day mortality, reoperation for bleeding, perioperative renal impairment and neurological events. Intraoperative and postoperative timing measures were also evaluated. Thirteen observational studies were included comparing 1101 MIS and 1405 MS patients. The overall quality of evidence was very low for all outcomes. Mortality and the incidence of stroke were similar between the 2 cohorts. Meta-analysis demonstrated increased length of cardiopulmonary bypass (CPB) time for patients undergoing MS [standardized mean difference 0.36, 95% confidence interval (CI) 0.15–0.58; P = 0.001]. Patients receiving MS spent more time in hospital (standardized mean difference 0.30, 95% CI 0.17–0.43; P < 0.001) and intensive care (standardized mean difference 0.17, 95% CI 0.06–0.27; P < 0.001). Reoperation for bleeding (risk ratio 1.51, 95% CI 1.06–2.17; P = 0.024) and renal impairment (risk ratio 1.97, 95% CI 1.12–3.46; P = 0.019) were also greater for MS patients. There was substantial heterogeneity in meta-analyses for CPB and aortic cross-clamp timing outcomes. MIS may be associated with improved early clinical outcomes compared to MS, but the quality of the evidence is very low. Randomized evidence is needed to confirm these findings.

scholarly journals Dietary factors and diabetes-related health outcomes in patients with type 2 diabetes: protocol for a systematic review and meta-analysis of prospective observational studies

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027298
Author(s):  
Janett Barbaresko ◽  
Manuela Neuenschwander ◽  
Lukas Schwingshackl ◽  
Sabrina Schlesinger
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Observational Studies ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Dietary Factors ◽  
Dietary Behaviour ◽  
Health Concern

IntroductionType 2 diabetes (T2D) is a major health concern associated with several comorbidities such as diabetic chronic kidney disease, neuropathy and cardiovascular diseases. Many of these complications may be preventable by an adequate lifestyle, including a favourable dietary behaviour, additionally to pharmacological management. In general, dietary guidelines for patients with diabetes recommend a hypocaloric diet to achieve a normal weight, but there is a lack of detailed instructions on specific nutrients and foods to prevent diabetes-related outcomes. Therefore, the aim of this systematic review and meta-analysis is to summarise the available evidence on the association between dietary factors and health-related outcomes in patients with T2D.Methods and analysisA systematic literature search will be conducted in PubMed and Web of Science in May 2019 to identify prospective observational studies investigating dietary factors in association with major complications in patients with T2D. We will include studies investigating dietary patterns, food groups, foods, macronutrients and micronutrients as well as secondary plant compounds. As diabetes-related outcomes, we will include macrovascular (cardiovascular and cerebrovascular diseases) and microvascular outcomes (nephropathy, neuropathy and retinopathy), as well as cancer, quality of life, depression, cognitive disorders and mortality. We will conduct dose-response meta-analyses using random effects models. We will investigate heterogeneity across studies and publication bias. To assess the risk of bias and quality of the included studies, we will use the Cochrane risk of bias tool ROBINS-I and the quality of evidence will be assessed using Grades of Recommendation, Assessment, Development, and Evaluation.Ethics and disseminationAs the systematic review is based on published studies, ethical considerations are not required. The systematic review and meta-analysis will be published in a peer-reviewed Journal.PROSPERO registration numberCRD42018110669

Efficacy and Safety of Adjunctive Trimetazidine Therapy for Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Cardiology ◽  
2016 ◽  
Vol 135 (3) ◽  
pp. 188-195 ◽  
Author(s):  
Yongyong Li ◽  
Dewei Wang ◽  
Chunxiao Hu ◽  
Peng Zhang ◽  
Dongying Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Adverse Events ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Short Term ◽  
All Cause Mortality ◽  
Acute Mi

Background: Several lines of evidence support the clinical use of trimetazidine as an adjunctive therapy in cardioischemic patients. Therefore, we assessed here the efficacy and safety of adjunctive trimetazidine therapy in acute myocardial infarction (MI) patients by a systematic review and meta-analysis of the current literature. Methods: PubMed, the Cochrane Library, and the China National Knowledge Infrastructure databases were searched for clinical studies comparing adjunctive trimetazidine therapy against placebo in adult acute MI patients. Several clinical outcomes [early/short-term all-cause mortality, long-term all-cause mortality, total major adverse cardiac events (MACE), recurrent nonfatal MI, in-hospital adverse events, target vessel revascularization (TVR), and coronary artery bypass graft (CABG)] were analyzed by the intention-to-treat principle. Odds ratios (OR) and their 95% confidence intervals (CI) were derived from the number of outcome events in each study arm to estimate the association between adjuvant trimetazidine administration and the various clinical outcomes. A random-effects model was applied for all meta-analyses. Results: We found that adjunctive trimetazidine therapy showed a significant effect upon total MACE (OR = 0.33, 95% CI = 0.15-0.74; p = 0.007) but showed no significant effect upon early/short-term all-cause mortality, long-term all-cause mortality, recurrent nonfatal MI, in-hospital adverse events, TVR, or CABG (p > 0.05). Conclusions: This is the first meta-analysis to report that adjunctive trimetazidine therapy has a beneficial effect upon total MACE in acute MI patients. Clinical investigators should consider further trials on adjunctive trimetazidine therapy in order to better define its risks and benefits in acute MI patients.

scholarly journals Comparative Efficacy and Safety of the Moxibustion for the Treatment of Coronavirus Disease 2019 (COVID-19): Protocol for a Systematic Review and Meta-analysis.

2021 ◽  
Author(s):  
Juan Gao ◽  
Xiujuan Zhou ◽  
Hongyan Xie ◽  
hong Gao ◽  
xiaoxu Fu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Symptoms ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Eligibility Criteria ◽  
Manual Search ◽  
Acute Respiratory Insufficiency ◽  
The World ◽  
Complementary And Alternative

Abstract Background Coronavirus disease 2019 (COVID-19) has spread from its origins to the world and become a pandemic since late 2019. It predominantly damages the lungs and causes diffuse alveolar injury with edema, cellular fibroblasts and hyaline membrane formation, resulting in acute respiratory insufficiency, respiratory failure, sepsis, acute heart injury, heart failure and other severe complications. It is also reported that moxibustion can effectively modify the negative emotions and relieve the symptoms of chest distress and impaired appetite for the patient with COVID-19. The main objective of current research is to make an assessment for effectiveness and safety of the moxibustion as an important complementary and alternative therapeutic method for COVID-19.Methods and analysis Articles for the systematic literature will be located at the MEDLINE, OVID, EMBASE, CNKI, CBM, NTR, Chi CTR databases. With no restriction about language, manual search will be conducted for potential eligible articles as supplements. Any randomized controlled trials (RCTs) with any moxibustion interventions issued by the therapeutic regimen on all patients diagnosed with COVID-19 will be included. We will include the published studies with no restriction about language. All study records of the title and abstract identified by the search strategies will be directly imported and assessed based on the eligibility criteria. Risk of individual studies for the methodological quality of eligible RCTs will be assessed with the tool from the Cochrane Collaboration’s risk of bias tool.Discussion The purpose of this study is to conduct a systematic review and meta-analysis of the efficacy and safety of moxibustion as a complementary and alternative treatment for COVID-19.No studies have investigated whether moxibustion will relieve clinical symptoms and shorten the length of hospitalization time.To the best of our knowledge, this is the first systematic review and meta-analysis program designed to update the currently available evidence. Despite the fact of controversial views in using moxibustion, if this study confirms its efficacy and safety, it could provide a better guide for clinical practice around the world.Systematic review registrationPROSPERO CRD42020176572.

scholarly journals Efficacy and safety of tocilizumab in the management of COVID-19: A systematic review and meta-analysis of observational studies

2021 ◽  
Author(s):  
Gollapalle L Viswanatha ◽  
CH K V L S N Anjana Male ◽  
Hanumanthappa Shylaja
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Efficacy And Safety ◽  
Risk Of Mortality ◽  
Significant Difference ◽  
Newcastle Ottawa Scale ◽  
Soc Control ◽  
Ottawa Scale

AbstractBackgroundThis systematic review and meta-analysis was aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 (COVID-19).MethodsThe electronic search was performed using PubMed, Scopus, CENTRAL, and Google scholar to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th September 2020. Participants were hospitalized COVID-19 patients. Interventions included tocilizumab versus placebo/standard of care. The comparison will be between TCZ versus standard of care (SOC)/placebo. Inconsistency between the studies was evaluated with I2 and quality of the evidences were evaluated by Newcastle-Ottawa scale.ResultsBased on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced the mortality (M-H,RE-OR −0.11(−0.18 to −0.04) 95% CI, p =0.001, I2 =88%) and increased the incidences of super-infections (M-H, RE-OR 1.49(1.13 to 1.96) 95% CI, p=0.004, I2=47%). However, there is no significant difference in ICU admissions rate (M-H, RE-OR −0.06(−0.23 to 0.12), I2=93%), need of MV (M-H, RE-OR of 0.00(−0.06 to 0.07), I = 74%), LOS (IV −2.86(−0.91 to 3.38), I2=100%), LOS-ICU (IV: −3.93(−12.35 to 4.48), I2=100%), and incidences of pulmonary thrombosis (M-H, RE-OR 1.01 (0.45 to 2.26), I2=0%) compared to SOC/control.ConclusionBased on cumulative low to moderate certainty evidence shows that TCZ could reduce the risk of mortality in hospitalized patients. However, there is no statistically significant difference observed between the TCZ and SOC/control groups in other parameters.

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