Local/Topical Antibiotics for Peri-Implantitis Treatment: A Systematic Review

Most studies indicate that the mechanical removal of the bacterial biofilm from the implant surface is the central goal of peri-implantitis therapy. However, controversial results in the treatment of peri-implantitis have led to the consideration of additional strategies that include surgical approaches and chemical adjuvants. Local/topical antibiotics, such as minocycline, azithromycin, tetracycline, amoxicillin, doxycycline, and metronidazole, may improve the efficacy of the definitive treatment of the disease, but the lack of conclusive findings prevents their use in clinical practice. This systematic review aimed to evaluate the effect of local/topical antibiotics for peri-implantitis treatment. Randomised controlled studies (RCT) on patients with peri-implantitis and comparing the efficacy of local/topical antibiotics vs. placebo or mechanical debridement were included. A systematic search strategy was carried out using three registered databases (PubMed, Web of Science, and Scopus). RoB2 was used to assess risk of bias. Five RCTs were identified (n = 250 patients and 333 implants). Contrast results emerged among the included studies, and a high heterogeneity level was observed. Risk of bias revealed some concerns for three studies out of five, while one study was judged at high risk. Only one study analysed the limitations of its findings. Overall, local antibiotic use can be considered a valid approach in the treatment of peri-implantitis. Therefore, future long-term clinical trials with standardised protocols and antibiotics with similar biological activity profiles should be tested to achieve a valid and definitive conclusion.

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Comparative efficacy and safety of interventions for treating head lice: a protocol for systematic review and network meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001129 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001129

Author(s):

Bill Stevenson ◽

Wubshet Tesfaye ◽

Julia Christenson ◽

Cynthia Mathew ◽

Solomon Abrha ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Controlled Trials ◽

Head Lice ◽

Efficacy And Safety ◽

Randomised Controlled ◽

Meta Analyses

BackgroundHead lice infestation is a major public health problem around the globe. Its treatment is challenging due to product failures resulting from rapidly emerging resistance to existing treatments, incorrect treatment applications and misdiagnosis. Various head lice treatments with different mechanism of action have been developed and explored over the years, with limited report on systematic assessments of their efficacy and safety. This work aims to present a robust evidence summarising the interventions used in head lice.MethodThis is a systematic review and network meta-analysis which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for network meta-analyses. Selected databases, including PubMed, Embase, MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials will be systematically searched for randomised controlled trials exploring head lice treatments. Searches will be limited to trials published in English from database inception till 2021. Grey literature will be identified through Open Grey, AHRQ, Grey Literature Report, Grey Matters, ClinicalTrials.gov, WHO International Clinical Trials Registry and International Standard Randomised Controlled Trials Number registry. Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two independent reviewers, with disagreements resolved via a third reviewer. The primary outcome measure is the relative risk of cure at 7 and 14 days postinitial treatment. Secondary outcome measures may include adverse drug events, ovicidal activity, treatment compliance and acceptability, and reinfestation. Information from direct and indirect evidence will be used to generate the effect sizes (relative risk) to compare the efficacy and safety of individual head lice treatments against a common comparator (placebo and/or permethrin). Risk of bias assessment will be undertaken by two independent reviewers using the Cochrane Risk of Bias tool and the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations guideline for network meta-analysis. All quantitative analyses will be conducted using STATA V.16.DiscussionThe evidence generated from this systematic review and meta-analysis is intended for use in evidence-driven treatment of head lice infestations and will be instrumental in informing health professionals, public health practitioners and policy-makers.PROSPERO registration numberCRD42017073375.

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Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials

The British Journal of Psychiatry ◽

10.1192/bjp.2021.148 ◽

2021 ◽

pp. 1-13

Author(s):

Davide Papola ◽

Giovanni Ostuzzi ◽

Federico Tedeschi ◽

Chiara Gastaldon ◽

Marianna Purgato ◽

...

Keyword(s):

Systematic Review ◽

Panic Disorder ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Psychodynamic Therapy ◽

Controlled Trials ◽

First Line ◽

Short Term ◽

Randomised Controlled

Background Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. Aims To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis. Method We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258). Results We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive–behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = −0.67, 95% CI −0.95 to −0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI −0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = −0.61, 95% CI −1.15 to −0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54–1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU. Conclusions CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.

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Efficacy and safety profile of statins in patients with cancer: a systematic review of randomised controlled trials

European Journal of Clinical Pharmacology ◽

10.1007/s00228-020-02967-0 ◽

2020 ◽

Vol 76 (12) ◽

pp. 1639-1651

Author(s):

John P. Thomas ◽

Yoon K. Loke ◽

Leo Alexandre

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Statin Therapy ◽

Safety Profile ◽

Randomised Controlled Trials ◽

Risk Of Bias ◽

Controlled Trials ◽

Efficacy And Safety ◽

Patients With Cancer ◽

Randomised Controlled

Abstract Purpose A growing body of preclinical and observational research suggests that statins have potential as a therapeutic strategy in patients with cancer. This systematic review of randomised controlled trials (RCTs) in patients with solid tumours aimed to determine the efficacy of statin therapy on mortality outcomes, their safety profile and the risk of bias of included studies. Methods Full-text articles comparing statin therapy versus control in solid tumours and reporting mortality outcomes were identified from Medline and Embase from conception to February 2020. A systematic review with qualitative (primarily) and quantitative synthesis was conducted. This systematic review was prospectively registered (Prospero registration CRD42018116364). Results Eleven trials of 2165 patients were included. Primary tumour sites investigated included lung, colorectal, gastro-oesophageal, pancreatic and liver. Most trials recruited patients with advanced malignancy and used sub-maximal statin doses for relatively short durations. Aside from one trial which demonstrated benefit with allocation to pravastatin 40 mg in hepatocellular carcinoma, the remaining ten trials did not demonstrate efficacy with statins. The pooled hazard ratio for all-cause mortality with allocation to pravastatin in patients with hepatocellular carcinoma in two trials was 0.69 (95% confidence interval CI 0.30–1.61). Study estimates were imprecise. There were no clinically important differences in statin-related adverse events between groups. Overall, included trials were deemed low risk of bias. Conclusion The trial evidence is not sufficiently robust to confirm or refute the efficacy and safety of statins in patients with solid malignant tumours. Study and patient characteristics may explain this uncertainty. The potential role of high-dose statins in adjuvant settings deserves further research.

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A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184904008 ◽

2015 ◽

Vol 97 (1) ◽

pp. 11-16 ◽

Cited By ~ 50

Author(s):

JR Berstock ◽

AW Blom ◽

AD Beswick

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Randomised Trial ◽

Lateral Approach ◽

Surgical Approaches ◽

Controlled Trials ◽

Total Hip ◽

Randomised Controlled

Introduction Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking. Currently in the UK, the two most frequently performed approaches to the hip are the posterior and the direct lateral. Methods This systematic review was performed according to Cochrane guidelines following an extensive search for prospective controlled trials published in any language before January 2014. Of the 728 records identified from searches, 6 prospective studies (including 3 randomised controlled trials) involving 517 participants provided data towards this review. Findings Compared with the lateral approach, the posterior approach conferred a significant reduction in the risk of Trendelenburg gait (odds ratio [OR]: 0.31, p=0.0002) and stem malposition (OR: 0.24, p=0.02), and a non-significant reduction in dislocation (OR: 0.37, p=0.16) and heterotopic ossification (OR: 0.41, p=0.13). Neither approach conferred a functional advantage. We draw attention to the paucity of evidence and the need for a further randomised trial.

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Verum versus Sham Manual Acupuncture for Migraine: A Systematic Review of Randomised Controlled Trials

Acupuncture in Medicine ◽

10.1136/acupmed-2015-010903 ◽

2016 ◽

Vol 34 (2) ◽

pp. 76-83 ◽

Cited By ~ 12

Author(s):

Yan Yang ◽

Qinghui Que ◽

Xiaode Ye ◽

Guo hua Zheng

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

Randomised Controlled Trials ◽

Total Effective Rate ◽

Effective Rate ◽

Sham Acupuncture ◽

Risk Of Bias ◽

Controlled Trials ◽

Manual Acupuncture ◽

Randomised Controlled

Background Manual acupuncture (MA) is commonly used as a treatment for migraine in China. However, its specific clinical effects have been challenged on the basis that some of its effects may relate to psychological or ‘placebo’ mechanisms. Objective To identify the effectiveness of verum MA compared with sham acupuncture for the treatment of migraine. Methods Eight electronic databases were searched for randomised controlled trials (RCTs) evaluating the effect of verum versus sham MA on migraine. The quality of included trials was assessed using the ‘risk of bias’ tool provided by the Cochrane Handbook for Systematic Review of Intervention. RevMan 5.2 software was used for data analysis. Results Ten trials with 997 participants were included. Most trials had high methodological quality and were at low risk of bias. Meta-analysis showed superior effects of verum MA over sham acupuncture on the total effective rate, reflected by a reduction in the ‘not effective’ rate (relative risk (RR) 0.24, 95% CI 0.15 to 0.38; p<0.0001, four trials) and a reduced recurrence rate (RR 0.47, 95% CI 0.28 to 0.81; p=0.006, two trials), but no significant differences in headache intensity, frequency or duration, accompanying symptoms and use of medication. No severe adverse events related to acupuncture occurred during treatment with either verum or sham MA. Conclusions Current clinical evidence suggests that verum acupuncture is superior to sham acupuncture in migraine, reflected by a higher total effective rate and decreased recurrence rate. Nevertheless, further large-scale RCTs with a rigorous design are required to confirm these findings in view of the relative paucity of eligible RCTs and small sample sizes of those included.

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The effects of exercise on Bone Mineral Density in Men: a protocol for a systematic review and meta-analysis of randomised controlled trials

10.31236/osf.io/y8nue ◽

2020 ◽

Author(s):

Blair Ross Hamilton ◽

Katherine Staines ◽

George Kelley ◽

Kristi Kelley ◽

Wendy Kohrt ◽

...

Keyword(s):

Bone Mineral Density ◽

Systematic Review ◽

Bone Mineral ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Mineral Density ◽

Skeletal Health ◽

Randomised Controlled

Introduction: Exercise is a cost-effective, widely available intervention that has been reported to help maintain optimal bone mineral density (BMD) in men, however, consideration of exercise modality is needed if the aim is to promote skeletal health. A previous meta-analysis of randomised controlled trials observed a moderate benefit on femoral neck (FN) but no benefit on lumbar spine (LS) BMD. However, since that analysis more randomised controlled trials (RCTs) have been published and updated methods of meta-analysis have been developed and therefore an updated systematic review and meta-analysis is required. Methods and analysis: RCTs of >24 weeks and published in English up to 01/05/20 will be retrieved by searching 3 electronic databases, cross referencing and expert review. The primary outcome measures will be changes in FN and LS BMD and lower limb BMD. Risk of bias for each study will be assessed using the Cochrane Risk of Bias instrument for RCTs, while the strength of evidence for each outcome will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. Standardised effect sizes will be calculated from each study and pooled using the inverse heterogeneity (IVhet) model. Trial Registration number: CRD42020180441.

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Effect of interventions for the well-being, satisfaction and flourishing of general practitioners—a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-046599 ◽

2021 ◽

Vol 11 (8) ◽

pp. e046599

Author(s):

Diana Naehrig ◽

Aaron Schokman ◽

Jessica Kate Hughes ◽

Ronald Epstein ◽

Ian B Hickie ◽

...

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Intervention Studies ◽

Well Being ◽

Risk Of Bias ◽

Effect Sizes ◽

Controlled Trials ◽

Positive Outcomes ◽

Mindfulness Interventions ◽

Randomised Controlled

ObjectivesClinician well-being has been recognised as an important pillar of healthcare. However, research mainly addresses mitigating the negative aspects of stress or burnout, rather than enabling positive aspects. With the added strain of a pandemic, identifying how best to maintain and support the well-being, satisfaction and flourishing of general practitioners (GPs) is now more important than ever.DesignSystematic review.Data sourcesWe searched MEDLINE, PsycINFO, Embase, CINAHL and Scopus from 2000 to 2020.Study selectionIntervention studies with more than 50% GPs in the sample evaluating self-reported well-being, satisfaction and related positive outcomes were included. The Cochrane Risk of Bias 2 tool was applied.ResultsWe retrieved 14 792 records, 94 studies underwent full-text review. We included 19 studies in total. Six randomised controlled trials, three non-randomised, controlled trials, eight non-controlled studies of individual or organisational interventions with a total of 1141 participants. There were two quasi-experimental articles evaluating health system policy change. Quantitative and qualitative positive outcomes were extracted and analysed. Individual mindfulness interventions were the most common (k=9) with medium to large within-group (0.37–1.05) and between-group (0.5–1.5) effect sizes for mindfulness outcomes, and small-to-medium effect sizes for other positive outcomes including resilience, compassion and empathy. Studies assessing other intervention foci or other positive outcomes (including well-being, satisfaction) were of limited size and quality.ConclusionsThere is remarkably little evidence on how to improve GPs well-being beyond using mindfulness interventions, particularly for interventions addressing organisational or system factors. This was further undermined by inconsistent reporting, and overall high risk of bias. We need to conduct research in this space with the same rigour with which we approach clinical intervention studies in patients.PROSPERO registration numberCRD42020164699.Funding sourceDr Diana Naehrig is funded through the Raymond Seidler PhD scholarship.

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Identifying patient-important outcomes for treatment of bipolar disorder: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2021-050453 ◽

2021 ◽

Vol 11 (12) ◽

pp. e050453

Author(s):

Alessia D'Elia ◽

Olivia Orsini ◽

Stephanie Sanger ◽

Alannah Hillmer ◽

Nitika Sanger ◽

...

Keyword(s):

Systematic Review ◽

Bipolar Disorder ◽

Clinical Trials ◽

Systematic Reviews ◽

Treatment Effectiveness ◽

Data Extraction ◽

Risk Of Bias ◽

Observational Research ◽

Cochrane Library ◽

Randomised Controlled

IntroductionTreatment of bipolar disorder is the focus of several clinical trials, however the understanding of the outcomes for establishing treatment effectiveness within these trials is limited. Further, there is limited literature which reports on the outcomes considered to be important to patients, indicating that patient perspectives are often not considered when selecting outcomes of effectiveness within trials. This protocol describes a systematic review which aims to describe the outcomes being used within trials to measure treatment effectiveness, commenting on the inclusion of patient-important outcomes within previous trials.Methods and analysisThis protocol is reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols statement. OVID MEDLINE, OVID Embase, OVID APA PsycINFO, Web of Science, the Wiley Cochrane Library, ClinicalTrials.gov and the International Clinical Trials Registry Platform databases will be searched for eligible studies. Screening, full-text and data extraction stages will be completed in duplicate using the Covidence platform for systematic reviews. Eligible studies will include clinical trials of interventions in bipolar disorder, in order to identify outcomes used to assess treatment effectiveness, and qualitative studies, to determine which outcomes have been reported as important by patients. Risk of bias for included studies will be assessed using the Cochrane Risk of Bias Tool for randomised controlled trials, and the Newcastle-Ottawa Scale for observational research.Ethics and disseminationThis review will involve dissemination to key stakeholders, including primary end users such as patients, clinicians and trialists. Knowledge translation tools will be generated to share the relevant conclusions of this review. Results will be communicated to the scientific community through peer-reviewed publications, conferences and workshops. No ethics approval will be sought as this study is based on literature.PROSPERO registration numberCRD42021214435.

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Cannulation Technique of Vascular Access in Haemodialysis and the Impact on the Arteriovenous Fistula Survival: Protocol of Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312554 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12554

Author(s):

Ricardo Peralta ◽

Luís Sousa ◽

António Filipe Cristóvão

Keyword(s):

Systematic Review ◽

Arteriovenous Fistula ◽

Randomised Controlled Trials ◽

Primary Patency ◽

Risk Of Bias ◽

Current Evidence ◽

Controlled Trials ◽

Cannulation Technique ◽

Randomised Controlled ◽

The Impact

Background: Based on a literature review of various studies, comparisons between BH and RL are inconclusive regarding some outcomes. However, in the last 5 years, some studies have been published that may contribute to clarifying which cannulation technique (CT) allows better fistula survival. Aim: To review which cannulation technique allows better primary patency of the arteriovenous fistula in haemodialysis patients. Methods: We will include all randomised controlled trials and observational studies that include comparisons among CTs and thus define the benefits and risks of each CT. A PRISMA-compliant systematic review and meta-analysis will be performed in accordance with the quality and homogeneity of studies. A comprehensive search strategy will be applied to the CINAHL, MEDLINE and Embase electronic databases from January 2000 to September 2021. The primary outcome is the arteriovenous fistula primary patency. To assess the risk of bias in randomised controlled trials or quasi-experimental studies, we will use the tool Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). For nonrandomised studies, the Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I) will be used. Discussion: The evidence generated from this systematic review of current evidence could inform the design and implementation of continuous quality improvement programs in cannulation techniques in haemodialysis patients, as well as contributing to improving the curricula within haemodialysis courses. This protocol was registered with the National Institute for Health Research PROSPERO database prior to commencement (registration number CRD42021237050).

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Gastric Residual Volumes in the Adult Intensive Care Patient: a Systematic Review

10.26686/wgtn.16968496 ◽

2021 ◽

Author(s):

◽

Rebecca Jane Jarden

Keyword(s):

Systematic Review ◽

At Risk ◽

Intensive Care ◽

Enteral Nutrition ◽

Outcome Measures ◽

Full Text ◽

Primary Outcome ◽

Risk Of Bias ◽

Randomised Controlled ◽

Patient At Risk

<p>Background: Enteral nutrition is one method of delivering nutrition to intubated patients. There are several issues that prevent optimal delivery of the prescribed enteral nutrition goal rates. The measurement of the patient's gastric residual volume (GRV) may demonstrate tolerability, or intolerability, of enteral nutrition. Identifying a safe GRV, at which to accept and continue enteral nutrition delivery, is essential to ensure the delivery of enteral nutrition adequately achieves the nutritional requirements of patients, and to mitigate the risks associated with the delivery of enteral nutrition. Objectives: This systematic review sought to answer the research question: what is the maximum GRV to accept in order to continue the delivery of enteral nutrition in the Intensive Care Unit (ICU) adult patient? This is specifically related to the primary outcome measures indicative of accepting a specified GRV that is too high or too low. Accepting a GRV that is too high would put the patient at risk of vomiting, regurgitation, aspiration of gastric contents and potentially aspiration pneumonia. Conversely, accepting a GRV that is too low would put the patient at risk of not achieving caloric needs, potentially placing the patient at risk of malnutrition and increased morbidity. Search methods: Databases searched included: CCTR, CLCMR, CLTA, CLEED, OVID MEDLINE (R) (Ovid SP), EMBASE, CINAHL Plus with Full Text (EBSCO host via helicon), AMED, Ovid Nursing Full Text plus, CDSR, ACP Journal Club, DARE, Proquest via helicon (advanced search), Pubmed via helicon (limits "all adult", "humans", "abstract", "title"), all EBM reviews, and the reference lists of articles. Selection criteria: The types of studies eligible for inclusion were published randomised controlled trials, case controlled studies, cohort studies and observational studies. Interventions considered were a comparison of two or more GRV measures. The participants eligible were adult ICU or critical care patients receiving enteral nutrition. The primary outcome measures for study inclusion were caloric requirement met, and specified potential adverse events including vomiting, regurgitation, or aspiration. Data collection and analysis: Data was extracted using a data extraction tool created by the researcher. Risk of bias was assessed by the author using two risk of bias assessment tools. Main results: Three studies met the inclusion criteria for the systematic review (McClave et al., 2005; Metheny, Schallom, Oliver, & Clouse, 2008; Pinilla, Samphire, Arnold, Liu, & Thiessen, 2001). Each of these studies contained methodological risks of bias and limitations related to their study designs. McClave et al.'s study was a prospective study (n = 40), Metheny et al.'s study was a prospective descriptive study (n = 206), and Pinilla et al.'s study was a randomised controlled trial (n = 80). No one study, or a combination of studies, provided conclusive evidence to support the use of one particular GRV over another. Author's conclusion: No recommendation for a definitive GRV was made in this systematic review due to the lack of strong evidentiary support for one GRV over another. There remain opportunities for enhancing practice through developing a consistent, multidisciplinary approach to managing GRVs. There are future research opportunities related to improving the management of GRVs in the enterally fed ICU patient, and achieving optimal volumes of nutrition delivered.</p>

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