scholarly journals Effects of Acetaminophen or Ibuprofen Monotherapy in Febrile Children: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Ning Kuo ◽  
Nien-Yin Su ◽  
Sen-Kuang Hou ◽  
Yi-No Kang
Keyword(s):  
Adverse Event ◽  
Body Temperature ◽  
Randomized Controlled Trials ◽  
Treatment Time ◽  
Meta Analysis ◽  
Interaction Model ◽  
Clinical Encounter ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Randomized Controlled

IntroductionWhen a child presents with fever in the clinical encounter, parents are usually concerned about alleviating the fever. However, the indications for selecting an appropriate drug from the most commonly used antipyretic drugs acetaminophen and ibuprofen remain unclear. The purpose of this study was to assess the efficacy and safety of acetaminophen and ibuprofen in febrile children through a systematic review with meta-analysis of randomized controlled trials (RCTs).Material and methodsCochrane, Embase, and PubMed databases were searched for the relevant RCTs. Two authors individually extracted information on trial design, demography, rate of fever resolution, body temperature, and overall adverse event. Data were pooled mainly using random-effects model; however, because of some sparse data, Peto odds ratios (PORs) were used for outcomes of fever resolution and adverse event. 95% confidence intervals (CIs) were also presented.ResultsIn total, 26 RCTs (n=4137) fulfilled eligibility criteria. Pooled estimates demonstrated that acetaminophen led to significantly lower fever resolution rates than ibuprofen did (POR=0.91, 95%CI: 0.84–0.98; I2=0%) in the subgroup of trials with a mean age of <2 years. However, the treatment–time interaction model for body temperature demonstrated that the fever resolution effect was mainly from the time factor based on the available data (effect size=−0.20; 95%CI: −0.30 to −0.11; I2=6.9%). Acetaminophen demonstrated a lower overall adverse event rates than ibuprofen (POR=0.71; 95%CI: 0.58–0.87; I2=0%).ConclusionsThe effects of ibuprofen are similar to acetaminophen even in children mean aged approximately 5 years old. Nevertheless, acetaminophen is safer than ibuprofen, particularly in children approximately 5 years old.

scholarly journals The Effect of Acupuncture in Breast Cancer–Related Lymphoedema (BCRL): A Systematic Review and Meta-Analysis

2019 ◽  
Vol 18 ◽  
pp. 153473541986691 ◽  
Author(s):  
Tsai-Ju Chien ◽  
Chia-Yu Liu ◽  
Ching-Ju Fang
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Large Scale ◽  
Meta Analysis ◽  
Lymphatic Drainage ◽  
Controlled Trials ◽  
Breast Cancer Patients ◽  
Eligibility Criteria ◽  
Randomized Controlled

Background: Breast cancer–related lymphedema (BCRL) is hard to control. Management may include lymphatic drainage, skin care, bandaging, or even surgery. Since acupuncture has been proven to affect the neurophysiology and neuroendocrine systems, it has the potential to control BCRL. Aim: To evaluate the effect of acupuncture in BCRL in randomized controlled trials. Design: A literature search was performed, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and without language restrictions. Data Sources: Five databases were searched from inception tthrough September 2018. Only studies that fulfilled the eligibility criteria of evaluating the effect of acupuncture on lymphedema in breast cancer were included. The methodological quality of these trials was assessed using the Cochrane criteria, and meta-analysis software (RevMan 5.3) was used for analysis. Results: We examined 178 breast cancer patients from 6 trials. All included randomized controlled trials had medium to high quality, based on the modified Jadad scale. The systematic review showed that acupuncture is safe and has a trend to improve symptoms, but trials did not consistently measure outcomes. The meta-analysis showed that acupuncture produced no significant improvement in the extent of lymphedema as compared with the control intervention (−1.90; 95% confidence interval = −5.39 to 1.59, P = .29). None of the studies reported severe adverse events. Conclusions: Acupuncture is safe and has a trend to improve the lymphedema related to breast cancer, yet it did not significantly change arm circumference in BCRL. Future studies should include both subjective and objective measurements and large-scale studies are warranted.

Is intramedullary nailing better than the use of volar locking plates for fractures of the distal radius? A meta-analysis of randomized controlled trials

2016 ◽  
Vol 41 (5) ◽  
pp. 543-552 ◽  
Author(s):  
J. Wang ◽  
L. Zhang ◽  
J. Ma ◽  
Y. Yang ◽  
H. Jia ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Intramedullary Nailing ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Controlled Trials ◽  
Locking Plates ◽  
Distal Radial Fractures ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Randomized Controlled

We conducted a meta-analysis of randomized controlled trials that compared the use of intramedullary nails and volar locking plates in distal radial fractures. PubMed, EMBASE and the Cochrane Collaboration Central database were used to find randomized controlled trials that met the eligibility criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality and analysed the data with RevMan 5.1 software. No statistically significant differences were detected in the disability of the arm, shoulder and hand and the Gartland and Werley scores, radiographic parameters, wrist range of motion, grip strength, total complication rate and incidence of tendon rupture between the two groups. However, carpal tunnel syndrome occurred less often after intramedullary nailing. The two fixation methods achieved equal clinical, functional and radiological outcomes for primary fixation of the indicated types of distal radial fractures. Level of evidence: Therapeutic/LevelI

scholarly journals The adverse event profile of brivaracetam: A meta-analysis of randomized controlled trials

Seizure ◽  
2017 ◽  
Vol 45 ◽  
pp. 7-16 ◽  
Author(s):  
Li-na Zhu ◽  
Deng Chen ◽  
Tao Chen ◽  
Da Xu ◽  
Si-han Chen ◽  
...  
Keyword(s):  
Adverse Event ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Adverse Event Profile ◽  
Randomized Controlled

Dissociation of vasospasm-related morbidity and outcomes in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: a meta-analysis of randomized controlled trials

2013 ◽  
Vol 119 (1) ◽  
pp. 180-189 ◽  
Author(s):  
Jian Shen ◽  
Jian-Wei Pan ◽  
Zuo-Xu Fan ◽  
Xiao-Xing Xiong ◽  
Ren-Ya Zhan
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Randomized Controlled Trials ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Pulmonary Complications ◽  
Neurological Deficits ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Randomized Controlled

Object Clazosentan therapy after aneurysmal subarachnoid hemorrhage (SAH) has been found to be effective in reducing the incidence of vasospasm in randomized controlled trials. However, while vasospasm-related morbidity, including delayed ischemic neurological deficits (DINDs) and delayed cerebral infarctions, was consistently decreased, statistical significance was not demonstrated and outcomes were not affected by clazosentan treatment. The objective of this meta-analysis was to determine whether clazosentan treatment after aneurysmal SAH significantly reduced the incidence of DINDs and delayed cerebral infarctions and improved outcomes. Methods All randomized controlled trials investigating the effect of clazosentan were retrieved via searches with sensitive and specific terms. Six variables were abstracted after the assessment of the methodological quality of the trials. Analyses were performed following the method guidelines of the Cochrane Back Review Group. Results Four randomized, placebo-controlled trials met eligibility criteria, enrolling a total of 2181 patients. The meta-analysis demonstrated a significant decrease in the incidence of DINDs (relative risk [RR] 0.76 [95% CI 0.62–0.92]) and delayed cerebral infarction (RR 0.79 [95% CI 0.63–1.00]) in patients treated with clazosentan after aneurysmal SAH. However, this treatment regimen was not shown to outcomes including functional outcomes measured by Glasgow Outcome Scale-Extended (RR 1.12 [95% CI 0.96–1.30]) or mortality (RR 1.02 [95%CI 0.70–1.49]). Adverse events, including pulmonary complications, anemia, and hypotension, were all significantly increased in patients who received clazosentan therapy. Conclusions The results of the present meta-analysis show that treatment with clazosentan after aneurysmal SAH significantly reduced the incidence of the vasospasm-related DINDs and delayed cerebral infarctions, but did not improve poor neurological outcomes in patients with aneurysmal SAH. Further study is required to elucidate the dissociation between vasospasm-related morbidity and outcomes.

scholarly journals The Efficacy of Guanxinning Injection in Treating Angina Pectoris: Systematic Review and Meta-Analysis of Randomized Controlled Trials

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Yongliang Jia ◽  
Siu-wai Leung ◽  
Ming-Yuen Lee ◽  
Guozhen Cui ◽  
Xiaohui Huang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sensitivity Analysis ◽  
Angina Pectoris ◽  
Randomized Controlled Trials ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Randomized Controlled ◽  
Study Characteristics

Objective. The randomized controlled trials (RCTs) on Guanxinning injection (GXN) in treating angina pectoris were published only in Chinese and have not been systematically reviewed. This study aims to provide a PRISMA-compliant and internationally accessible systematic review to evaluate the efficacy of GXN in treating angina pectoris.Methods. The RCTs were included according to prespecified eligibility criteria. Meta-analysis was performed to evaluate the symptomatic (SYMPTOMS) and electrocardiographic (ECG) improvements after treatment. Odds ratios (ORs) were used to measure effect sizes. Subgroup analysis, sensitivity analysis, and metaregression were conducted to evaluate the robustness of the results.Results. Sixty-five RCTs published between 2002 and 2012 with 6064 participants were included. Overall ORs comparing GXN with other drugs were 3.32 (95% CI: [2.72, 4.04]) in SYMPTOMS and 2.59 (95% CI: [2.14, 3.15]) in ECG. Subgroup analysis, sensitivity analysis, and metaregression found no statistically significant dependence of overall ORs upon specific study characteristics.Conclusion. This meta-analysis of eligible RCTs provides evidence that GXN is effective in treating angina pectoris. This evidence warrants further RCTs of higher quality, longer follow-up periods, larger sample sizes, and multicentres/multicountries for more extensive subgroup, sensitivity, and metaregression analyses.

Intravenous dexmedetomidine versus intravenous clonidine for post spinal anesthesia shivering: a meta-analysis of randomized controlled trials

2020 ◽  
Vol 65 (3) ◽  
pp. 94-102
Author(s):  
Na Wang ◽  
Zaitang Wang ◽  
Xuesong Song ◽  
Jinguo Wang
Keyword(s):  
Randomized Controlled Trials ◽  
Spinal Anesthesia ◽  
Odds Ratio ◽  
Treatment Time ◽  
Meta Analysis ◽  
Effective Rate ◽  
Controlled Trials ◽  
Adrenergic Agonists ◽  
Randomized Controlled ◽  
Mean Differences

Background Dexmedetomidine and clonidine are the most extensively studied drugs for shivering treatment, because α2-adrenergic agonists can reduce the shivering threshold. The objective of this meta-analysis was to compare the efficacy and complications of dexmedetomidine with those of clonidine, when used for control of post spinal anesthesia shivering. Methods Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of dexmedetomidine versus clonidine for control of post spinal anesthesia shivering. The endpoints were effective rate of shivering treatment, time to cease shivering, recurrent rate of shivering and complications. Results Six studies comprising 340 adult patients were included in this meta-analysis. Dexmedetomidine had higher effective rate of shivering treatment (odds ratio [OR]: 4.11, 95% confidence interval (CI): [1.53, 11.07], P = 0.005), shorter time to cease shivering (Mean differences (MD)=–1.91; 95% CI [–3.66, –0.15], P = 0.03), lower recurrent rate of shivering (OR = 0.30; 95% CI [0.12, 0.75], P = 0.01), compared to clonidine. Dexmedetomidine had a lower rate of hypotension and higher incidence of sedation than clonidine. Conclusions Dexmedetomidine is superior to clonidine when used for shivering treatment after spinal anesthesia, because of higher incidence of effective rate and sedation, faster control of shivering, lower incidence of recurrent rate and hypotention.

Acupressure for labor pain management: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
pp. 096452842094604
Author(s):  
Yao Chen ◽  
Xiang-Yin Xiang ◽  
Kien Howe Robert Chin ◽  
Jing Gao ◽  
Junmei Wu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Mode Of Delivery ◽  
Labor Pain ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Second Stage Of Labor ◽  
Randomized Controlled ◽  
Standard Procedures

Objective: To evaluate the efficacy/effectiveness of acupressure as an adjunct to standard procedures during labor and delivery, compared with standard procedures with/without sham acupressure, in randomized controlled trials (RCTs). Methods: Ten main databases were searched from their inception until 31 January 2018. Two reviewers independently extracted data concerning the effects of acupressure on pain intensity, labor duration, mode of delivery, use of medications and adverse events. A meta-analysis of these measures was performed using RevMan 5.3. Pooled standardized mean differences (SMDs) or odds ratios (ORs) for the above outcomes were estimated with a fixed or random effects model, according to the heterogeneity. Results: A total of 13 RCTs including 1586 enrolled patients met the eligibility criteria. Acupressure plus standard procedures (ASP) for labor management significantly reduced pain sensation, compared with sham acupressure plus standard procedures (SASP) and standard procedures (SP) alone. The analgesic effect of acupressure was immediate and persisted for at least 60 min (all p < 0.01). Compared with the untreated control groups, the acupressure group had a shorter duration of labor, especially the first stage of labor (SMD = −0.76, 95% confidence interval (CI) = −1.10 to −0.43; p < 0.001; I2 = 74%) and second stage of labor (SMD = −0.37, 95% CI = −0.59 to −0.18; p < 0.001; I2 = 0%). Data suggesting that acupressure reduced the Cesarean section rate was inconclusive. The use of pharmacologic agents (oxytocin and analgesics) did not differ between the ASP, SASP and SP groups. No adverse events were reported in this limited number of studies. Conclusion: Moderate evidence indicates that acupressure may have promising effects on labor pain and duration. However, high-quality trials to verify these findings are warranted.

scholarly journals Do Docosahexaenoic and Eicosapentaenoic Acids Have Similar Effects on Inflammation Markers? Pairwise and Network Meta-Analyses of Randomized Controlled Trials

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 485-485
Author(s):  
Cécile Vors ◽  
Janie Allaire ◽  
Sonia Blanco Mejia ◽  
Tauseef Khan ◽  
John Sievenpiper ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Outcome Data ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Randomized Controlled ◽  
Tnf Α ◽  
Mean Differences ◽  
Meta Analyses

Abstract Objectives The aim of this study was to compare the effect of DHA and EPA on several markers of systemic inflammation by pairwise and network meta-analyses of randomized controlled trials (RCTs). Methods MEDLINE, EMBASE and The Cochrane Library were searched through September 2019. We included RCTs of ≥ 7 days that directly compared the effects of DHA with EPA and RCTs of indirect comparisons, in which the effects of DHA or EPA were assessed individually compared with a control fatty acid. Differences in circulating concentrations of CRP, IL-6, TNF-α and adiponectin were the primary outcome. Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic) in the pairwise meta-analysis. Inconsistency and transitivity were evaluated in the network meta-analysis. The certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results Eligibility criteria were met by 5 RCTs (N = 411) for the pairwise meta-analysis and 20 RCTs (N = 1231) for the network meta-analysis. In the pairwise meta-analysis, DHA and EPA had similar effects on plasma CRP (MDDHA vs. EPA = 0.14 mg/L [95% CI −0.57, 0.85]; I2 = 61%), IL-6 (MDDHA vs. EPA = 0.10 pg/mL [−0.15, 0.34]; I2 = 40%) and TNF-α (MDDHA vs. EPA = −0.10 pg/mL [−0.37, 0.18]; I2 = 40%). The effects of DHA and EPA on plasma CRP (MDDHA vs. EPA = −0.33 mg/L [−0.75, 0.10]), IL-6 (MDDHA vs. EPA = 0.09 pg/mL [−0.12, 0.30]) and TNF-α (MDDHA vs. EPA = −0.02 pg/mL [−0.25, 0.20]) were also similar according to the network meta-analysis. DHA and EPA had similar effects on plasma adiponectin in the network meta-analysis. Conclusions The present pairwise and network meta-analyses comparing EPA to DHA suggest that DHA and EPA do not differentially modify systemic markers of subclinical inflammation. Funding Sources The authors have no funding to report.

scholarly journals The Clinical Effectiveness of Cognitive Behavioral Therapy for Patients with Insomnia and Depression: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Guiyu Feng ◽  
Mei Han ◽  
Xun Li ◽  
Le Geng ◽  
Yingchun Miao
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Grey Literature ◽  
Clinical Effectiveness ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Synthesis Methods ◽  
China National Knowledge Infrastructure ◽  
Eligibility Criteria ◽  
Randomized Controlled

Background. Insomnia and depression often co-occurr. However, there is lack of effective treatment for such comorbidity. CBT-I has been recommended as the first-line treatment for insomnia; whether it is also effective for comorbidity of insomnia and depression is still unknown. Therefore, we conducted this meta-analysis of randomized controlled trials to assess the clinical effectiveness and safety of CBT-I for insomnia comorbid with depression. Data Sources. Seven electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science Technology Journal Database, SinoMed Database, PubMed, the Cochrane Library, and EMBASE, as well as grey literature, were searched from the beginning of each database to July 1, 2019. Study Eligibility Criteria. Randomized controlled trials that compared CBT-I to no treatment or hypnotics (zopiclone, estazolam, and benzodiazepine agonist) for insomnia comorbid with depression and reported both insomnia scales and depression scales. Study Assessment and Synthesis Methods. Cochrane Reviewer’s Handbook was used for evaluating the risk of bias of included studies. Review Manager 5.3 software was used for meta-analysis. Online GRADEpro was used to assess the quality of evidence. Results. The pooled data showed that CBT-I was superior to no treatment for insomnia, while it was unsure whether CBT-I was better than no treatment for depression. And the effectiveness of CBT-I was comparable to hypnotics for both insomnia and depression. CBT-I was likely to be safe due to its noninvasive nature. The methodological quality varied across these trials. The evidence quality varied from moderate to very low, and the recommendation level was low. Conclusions. Currently, findings support that CBT-I seems to be effective and safe for insomnia comorbid with depression to improve the insomnia condition, while it is unsure whether CBT-I could improve depression condition. More rigorous trials are needed to confirm our findings.

Sign in / Sign up

Export Citation Format

Share Document