scholarly journals Atypical antipsychotics for delirium in hospitalized patients

Medwave ◽  
2021 ◽  
Vol 21 (04) ◽  
pp. e8168-e8168
Author(s):  
Daniza Belén Bilicic Ubierna ◽  
Nicolás Cattarinich Schiffrin ◽  
Daniela Coronel Cárdenas ◽  
Rubén Soto Munizaga ◽  
José Miguel Bernucci Piedra
Keyword(s):  
Systematic Reviews ◽  
Atypical Antipsychotics ◽  
Randomized Trials ◽  
Information Sources ◽  
Response Rate ◽  
Meta Analysis ◽  
Low Complexity ◽  
Hospitalized Patients ◽  
Risk Of Mortality ◽  
Grade Approach

Introduction For the pharmacotherapy of delirium in elderly adults who are hospitalized, atypical antipsychotics are used. Currently, there is insufficient evidence on the effectiveness of this treatment in low complexity units. Methods We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE/PubMed, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. Results and conclusions We identified 13 systematic reviews that included three randomized trials. We concluded that the use of atypical antipsychotics in hospitalized patients likely increases the risk of mortality compared to placebo and could decrease the response rate associated with reducing the risk of adverse effects. Furthermore, using atypical antipsychotics probably results in low or no difference in the severity of delirium.

scholarly journals Radiosurgery for brain oligometastases in lung cancer

Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e8184-e8184
Author(s):  
Gabriela Antúnez ◽  
Tomás Merino
Keyword(s):  
Lung Cancer ◽  
Systematic Reviews ◽  
Poor Prognosis ◽  
Randomized Trials ◽  
Information Sources ◽  
Meta Analysis ◽  
Whole Brain Radiation ◽  
Therapeutic Alternatives ◽  
Brain Radiation ◽  
Grade Approach

INTRODUCTION Brain metastases are a common problem in oncology patients, especially in lung cancer. The usual treatment for cerebral oligometastases is whole brain radiation therapy. Given the persistent poor prognosis of this disease, other therapeutic alternatives such as stereotactic radiosurgery have been considered. However, there is no clarity regarding the effectiveness of its addition. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 17 systematic reviews including seven studies overall, of which four were randomized trials. All trials assessed patients with brain oligometastases, but none of them included exclusively lung cancer population. We concluded that it is not possible to clearly establish whether radiosurgery decreases neurological functionality, cognitive impairment, mortality or serious adverse effects, as the certainty of the existing evidence has been assessed as very low.

scholarly journals Vortioxetine for generalised anxiety disorder in adults

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8171-e8171
Author(s):  
Nicolás Meza ◽  
Fanny Leyton
Keyword(s):  
Anxiety Disorder ◽  
Adverse Effects ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Current Treatment ◽  
Response To Treatment ◽  
Generalised Anxiety Disorder ◽  
Psychopharmacological Treatment ◽  
Grade Approach

INTRODUCTION The currently accepted psychopharmacological treatment for generalised anxiety disorder in adults is associated with several adverse effects which threaten its acceptability. In this line, vortioxetine has been proposed as an alternative with less adverse effects in the treatment of this pathology. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including five primary studies, all corresponding to randomized trials evaluating the effectiveness of vortioxetine in adult patients with generalized anxiety disorder without current treatment. We conclude that there is uncertainty whether vortioxetine increases the response to treatment or improves anxious symptoms, because the certainty of the existing evidence has been assessed as very low. Furthermore, vortioxetine may increase nausea (low certainty evidence).

scholarly journals Extended or shorter prophylaxis for venous thromboembolism in acutely ill hospitalized patients: Updated meta-analysis of randomized trials

2019 ◽  
Vol 24 (2) ◽  
pp. 156-158 ◽  
Author(s):  
Gerald Chi ◽  
Sadaf Sharfaei ◽  
Mehrian Jafarizade ◽  
Farima Kahe ◽  
Yuyin Liu
Keyword(s):  
Venous Thromboembolism ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Hospitalized Patients

scholarly journals Palliative chemotherapy for advanced gallbladder cancer

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8046-e8046
Author(s):  
Gonzalo A Bravo-Soto ◽  
Rocío Brañes ◽  
José Peña ◽  
Bruno Nervi
Keyword(s):  
Gallbladder Cancer ◽  
Systematic Reviews ◽  
Palliative Chemotherapy ◽  
Meta Analysis ◽  
Methodological Errors ◽  
Advanced Gallbladder Cancer ◽  
Therapeutic Alternatives ◽  
New Evidence ◽  
Grade Approach ◽  
Common Malignancy

INTRODUCTION Gallbladder cancer is the most common malignancy of the biliary tract. Given the lack of therapeutic alternatives for advanced stage patients studies have suggested that palliative chemotherapy could benefit these patients. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified two systematic reviews including two studies overall, of which one was a randomized trial. We concluded that palliative chemotherapy may increase survival in advanced gallbladder cancer patients. However, palliative chemotherapy probably increases adverse effects. In addition, it is essential to carry out a new systematic review, since methodological errors were identified in the analysis and there is new evidence that has not been included in the previous reviews

Malleability of Meta-Analysis

2018 ◽  
Author(s):  
Jacob Stegenga
Keyword(s):  
Systematic Reviews ◽  
Gold Standard ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Medical Science ◽  
Ongoing Debate ◽  
Medical Interventions ◽  
Reliable Source ◽  
To Come ◽  
Meta Analyses

An astonishing volume and diversity of evidence is available for many hypotheses in medicine. Some of this evidence—usually from randomized trials—is amalgamated by meta-analysis. Despite the ongoing debate regarding whether or not randomized trials are the gold standard of evidence, the most reliable source of evidence in medical science is usually thought to come from systematic reviews and meta-analyses. This chapter argues that meta-analyses are malleable. Different meta-analyses of the same evidence can reach contradictory conclusions. Meta-analysis fails to provide objective grounds for assessing the effectiveness and harms of medical interventions because numerous decisions must be made when performing a meta-analysis, which allow wide latitude for subjective idiosyncrasies to influence its outcome.

scholarly journals Psychosocial and pharmacologic interventions for methamphetamine addiction: protocol for a scoping review of the literature

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
C. Hamel ◽  
K. Corace ◽  
M. Hersi ◽  
D. Rice ◽  
M. Willows ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Open Science ◽  
Eligibility Criteria ◽  
Study Objective ◽  
Methamphetamine Use ◽  
Sex With Men ◽  
Pharmacologic Treatments

Abstract Background Methamphetamine use and harms are rising rapidly. Management of patients with methamphetamine use disorder (MUD) and problematic methamphetamine use (PMU) is challenging, with no clearly established best approach; both psychosocial and pharmacologic interventions have been described. Furthermore, given the diversity of individuals that use methamphetamines, there is a need to assess evidence for treatments for subgroups including youths; gay, bisexual, and other men who have sex with men; individuals with mental health comorbidities; and individuals in correction services. Establishing awareness of the messages regarding treatment from recent clinical practice guidelines (CPG) in the field is also of value. The first study objective will be to establish a greater understanding of the methods, populations, and findings of controlled studies for psychosocial and pharmacologic treatments for MUD and PMU. Investigation of this information can help establish the potential for advanced syntheses of the evidence (such as network meta-analysis) to compare therapies for this condition and to identify gaps related to key populations where more primary research is needed. Summarizing the recommendations regarding treatment of MUD/PMU from recent CPGs and systematic reviews will be an important secondary objective. Methods A scoping review will be performed. Using the OVID platform, MEDLINE, Embase, PsycINFO, and relevant Cochrane databases from EBM Reviews will be searched (from databases’ inception onwards). Eligibility criteria will include individuals described as having MUD or PMU, with designs of interest including randomized trials, non-randomized trials, and controlled cohort studies with three or more months of follow-up; systematic reviews and CPGs will also be sought. Two reviewers (with support from automation tools) will independently screen all citations, full-text articles, and chart data. Different approaches to handling and summarizing the data will be implemented for each type of study design. Tables and graphics will be used to map evidence sources and identify evidence gaps. Discussion This research will enhance awareness of evidence addressing the effects of psychosocial and pharmacologic interventions for MUD/PMU overall and in sub-populations, both in terms of recent CPGs/reviews and primary studies; inspection of the latter will also help establish the feasibility of future syntheses to compare treatments, such as network meta-analysis. Systematic review protocol registration Open Science Framework (https://osf.io/9wy8p)

scholarly journals Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses

2017 ◽  
Vol 52 (5) ◽  
pp. 415-424 ◽  
Author(s):  
Alby Elias ◽  
Vivek H Phutane ◽  
Sandy Clarke ◽  
Joan Prudic
Keyword(s):  
Confidence Interval ◽  
Electroconvulsive Therapy ◽  
Risk Ratio ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Risk Of Bias ◽  
Meta Analyses ◽  
Depressive Episodes

Objective: Acute course of electroconvulsive therapy is effective in inducing remission from depression, but recurrence rate is unacceptably high following termination of electroconvulsive therapy despite continued pharmacotherapy. Continuation electroconvulsive therapy and maintenance electroconvulsive therapy have been studied for their efficacy in preventing relapse and recurrence of depression. The purpose of this meta-analysis was to examine the efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy in preventing relapse and recurrence of depression in comparison to antidepressant pharmacotherapy alone. Methods: We searched MEDLINE, Embase, PsycINFO, clinicaltrials.gov and Cochrane register of controlled trials from the database inception to December 2016 without restriction on language or publication status for randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. Two independent Cochrane reviewers extracted the data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. The risk of bias was assessed using four domains of the Cochrane Collaboration Risk of Bias Tool. Outcomes were pooled using random effect model. The primary outcome was relapse or recurrence of depression. Results: Five studies involving 436 patients were included in the meta-analysis. Analysis of the pooled data showed that continuation electroconvulsive therapy and maintenance electroconvulsive therapy, both with pharmacotherapy, were associated with significantly fewer relapses and recurrences than pharmacotherapy alone at 6 months and 1 year after a successful acute course of electroconvulsive therapy (risk ratio = 0.64, 95% confidence interval = [0.41, 0.98], p = 0.04, risk ratio = 0.46, 95% confidence interval = [0.21, 0.98], p = 0.05, respectively). There was insufficient data to perform a meta-analysis of stand-alone continuation electroconvulsive therapy or maintenance electroconvulsive therapy beyond 1 year. Conclusion: There are only a few randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. The preliminary and limited evidence suggests the modest efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy with concomitant pharmacotherapy in preventing relapse and recurrence of depressive episodes for 1 year after the remission of index episode with the acute course of electroconvulsive therapy.

scholarly journals Systematic Review and Meta-analysis of Endostar Combined With Transcatheter Arterial Chemoembolization (TACE) Versus TACE Alone for Hepatocellular Carcinoma

2017 ◽  
Vol 22 (4) ◽  
pp. 883-891 ◽  
Author(s):  
Ya-Qing Zhang ◽  
Fei Zhao ◽  
Lei Song ◽  
Hong-Yun Gan ◽  
Xiao-Feng Xie
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Randomized Trials ◽  
Overall Response Rate ◽  
Transcatheter Arterial Chemoembolization ◽  
Response Rate ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Negative Conversion ◽  
Arterial Chemoembolization

Many studies have investigated the efficacy of Endostar combined with transcatheter arterial chemoembolization (TACE) versus TACE alone for hepatocellular carcinoma (HCC). A systematic review was conducted to evaluate the efficacy of Endostar. PubMed, Embase, and other databases were searched, and meta-analysis was performed using RevMan 5.3 software. Nine studies, all of which were clinical randomized controlled trials, involving 411 participants were included. The overall response rate, disease control rate and α-fetoprotein negative conversion ratio, and the 6- and 12-month survival rate of HCC patients treated with combined Endostar and TACE were higher than those treated with TACE alone ( P < .01). Furthermore, the incidence of tumor progression was low after Endostar treatment ( P = .005). The incidence of adverse effects (leukocytopenia, liver function damage, and vomiting) was similar in Endostar with TACE and in TACE alone ( P > .05). However, large studies and more randomized trials are necessary to determine the effects of Endostar on HCC.

scholarly journals Perspectives of patients and consumers on the use of generic medicines

Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e8155-e8155
Author(s):  
Natalia Celedón ◽  
Cristián González ◽  
Cristóbal Cuadrado
Keyword(s):  
Public Health ◽  
Systematic Reviews ◽  
Information Sources ◽  
Evidence Synthesis ◽  
Access To Medicines ◽  
Generic Medicines ◽  
Pharmaceutical Spending ◽  
Public Health Challenge ◽  
Grade Approach ◽  
Low Rate

INTRODUCTION Access to medicines constitutes a public health challenge worldwide. Promoting utilization of generic medicines is one of the strategies that has been proposed to optimize pharmaceutical spending and thus allow greater coverage. However, its use is not yet widespread enough. This study seeks to explore the perspectives and acceptability to the use of generic medicines from patients and consumers. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a evidence synthesis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified four systematic reviews that together include 47 primary studies, of which one corresponds to a randomized trial. A low rate of patients or consumers has a negative perception regarding generic medicines, including dimensions such as risk, quality, safety, risk of adverse effects, among others.

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