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Journal of Robotic Surgery Oct 2022Abdominal sacrocolpopexy is considered as the gold standard treatment for pelvic organ prolapse. Sacrocolpopexy can be performed using open (OSC), laparoscopic (LSC),... (Meta-Analysis)
Meta-Analysis
Abdominal sacrocolpopexy is considered as the gold standard treatment for pelvic organ prolapse. Sacrocolpopexy can be performed using open (OSC), laparoscopic (LSC), and robotic-assisted (RSC) approaches. The aim of this study is to compare the outcomes between these three approaches for managing pelvic organ prolapse by conducting a systematic review and network meta-analysis. A systematic search was performed in different databases from their earliest records to April 2021 with no restriction on languages. Only randomized controlled trials that compared the outcomes between OSC, LSC, and RSC were included in this study. A total of 6 studies with 486 participants were included in this study. Operative time was significantly shorter in OSC than in RSC and LSC. The probability rank showed less estimated blood loss in RSC and lowest overall postoperative complications in LSC. Probability scores also showed best anatomical outcomes for postoperative points C and Bp in RSC and for point Ba in LSC. Despite significantly longer operative time, RSC and LSC may provide better anatomical outcomes, less estimated blood loss, and less overall postoperative complications than OSC. However, this study did not find significant differences between RSC and LSC in efficacy and safety.
Topics: Humans; Laparoscopy; Network Meta-Analysis; Pelvic Organ Prolapse; Postoperative Complications; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Treatment Outcome
PubMed: 34779989
DOI: 10.1007/s11701-021-01329-x -
Haemophilia : the Official Journal of... Nov 2015Bleeding frequency is an important outcome commonly used in haemophilia studies. There is a variation in practice in how bleeding is measured and defined. (Review)
Review
INTRODUCTION
Bleeding frequency is an important outcome commonly used in haemophilia studies. There is a variation in practice in how bleeding is measured and defined.
AIM
The primary objective of this study was to determine how investigators define and report bleeding outcome measures.
METHODS
MEDLINE, EMBASE and the CENTRAL were searched from January 1990 to January 2014. We retrieved all published studies that included patients with haemophilia A or B and reported some measures of bleeding. Two reviewers independently performed title and abstract screening, full-text review and data abstraction of the identified studies.
RESULTS
A total of 118 studies fulfilled the inclusion criteria. Study designs were randomized controlled trials (RCT; 14%), cohort (68%), cross-sectional (5%) and others design (11%). The median duration of follow-up (Q1, Q3) was 20 (7.9, 50) months. We found 10 different bleeding outcomes reported [absolute number of bleeding 60 (50.8%) studies, annualized bleeding rate 60 (50.8%) studies, bleed per month 10 (8.5%) studies and others 11 (9.3%) studies]. Of these, 32 (27%) studies reported only mean or median without dispersion and 33 (28%) studies did not report any measures of central tendency (dispersion).
CONCLUSIONS
There is substantial variation in definitions and measures of bleeding outcomes in the haemophilia literature. This creates difficulty and limitations in comparing the outcomes between studies and in performing meta-analysis. The haemophilia research community needs to develop a consensus on a clear definition of bleeding and how to address the limitations associated with variations in measures of bleeding between centres and studies.
Topics: Hemophilia A; Hemophilia B; Hemorrhage; Humans; Research Design
PubMed: 26179330
DOI: 10.1111/hae.12750 -
Journal of General Internal Medicine Aug 2021The number of procedures performed by internal medicine residents in the United States (US) is declining. An increasing proportion of residents do not feel confident... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
The number of procedures performed by internal medicine residents in the United States (US) is declining. An increasing proportion of residents do not feel confident performing essential invasive bedside procedures and, upon graduation, desire additional training. Several residency programs have utilized the medical procedure service (MPS) to address this issue. We aim to summarize the current state of evidence by systematically evaluating the effect of the MPS on resident education, comfort, and training, as well as patient safety and procedural outcomes in the US.
METHODS
We conducted a systematic review of all studies reporting the use of an MPS with supervision from a board-certified physician in internal medicine residencies in the US. Database search was performed on PubMed, Embase, ERIC, and Cochrane Library from January 2000 to November 2020 for relevant studies. Quality of evidence assessment and random-effects proportion meta-analyses were performed.
RESULTS
A total of nine studies reporting on 3879 procedures performed by MPS were identified. Procedures were safely performed, with a pooled complication rate of 2.1% (95% CI: 1.0-3.5) and generally successful, with a pooled success rate of 94.7% (95% CI: 90.8-97.7). The range of procedures performed by residents under MPS was 6.7-72.8 procedures per month (n = 9) compared to 4.3-64.4 procedures (n = 4) without MPS. MPS significantly increased confidence, comfort, and use of appropriate safety measures among residents.
CONCLUSION
There are a limited number of published studies on MPS supervised by a board-certified physician in US internal medicine residencies. Procedures performed by MPS are generally successfully completed and safe. MPS benefits internal medicine residents training by improving competency, comfort, and confidence.
Topics: Certification; Clinical Competence; Humans; Internship and Residency; Patient Safety; United States
PubMed: 33547571
DOI: 10.1007/s11606-020-06526-2 -
Gastrointestinal Endoscopy Jun 2022Evidence is limited on the comparative diagnostic performance of newer end-cutting fine-needle biopsy (FNB) needles for tissue sampling of pancreatic masses. We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Evidence is limited on the comparative diagnostic performance of newer end-cutting fine-needle biopsy (FNB) needles for tissue sampling of pancreatic masses. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of available FNB needles for sampling of solid pancreatic lesions.
METHODS
A systematic literature review (Medline and Cochrane Database) was conducted for studies evaluating the accuracy of newer FNB needles in adults undergoing EUS-guided sampling of solid pancreatic masses. The primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, diagnostic sensitivity, specificity, and adverse event rate. We performed pairwise and network meta-analyses and appraised the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation methodology.
RESULTS
Overall, 16 RCTs (1934 patients) were identified. On network meta-analysis, Franseen needles (Acquire; Boston Scientific, Marlborough, Mass, USA) significantly outperformed reverse-bevel needles (risk ratio [RR], 1.21 [95% confidence interval {CI}, 1.05-1.40] for accuracy and 1.31 [95% CI, 1.05-1.22] for adequacy) and FNA needles (RR, 1.21 [95% CI, 1.01-1.25] for accuracy and 1.07 [95% CI, 1.02-1.13] for adequacy). Likewise, the Fork-tip needle (SharkCore; Medtronic, Dublin, Ireland) was significantly superior to the reverse-bevel needle (RR, 1.17 [95% CI, 1.03-1.33] for accuracy and 1.09 [95% CI, 1.02-1.16] for adequacy) and to the FNA needle (RR, 1.09 [95% CI, 1.01-1.19] for accuracy and 1.03 [95% CI, 1.01-1.07] for adequacy). Other comparisons did not achieve statistical significance. As a consequence, Franseen (surface under the cumulative ranking score, .89 for accuracy and .94 for adequacy) and Fork-tip needles (surface under the cumulative ranking score, .76 for accuracy and .73 for adequacy) ranked as the 2 highest-performing FNB needles. When considering different needle sizes, 25-gauge Franseen and 25-gauge Fork-tip needles were not superior to 22-gauge reverse-bevel needles (RR, 1.18 [95% CI, .96-1.46] and 1.04 [95% CI, .62-1.52]). None of the tested needles was significantly superior to the other FNB devices or to FNA needles when rapid onsite cytologic evaluation was available.
CONCLUSIONS
Franseen and Fork-tip needles, particularly 22-gauge size, showed the highest performance for tissue sampling of pancreatic masses, with low confidence in estimates.
Topics: Adult; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Network Meta-Analysis; Pancreas; Pancreatic Neoplasms; Specimen Handling
PubMed: 35124072
DOI: 10.1016/j.gie.2022.01.019 -
Journal of Music Therapy 2015Individuals undergoing medical procedures frequently experience pain and anxiety. Music-based interventions have the potential to help alleviate these symptoms. (Review)
Review
BACKGROUND
Individuals undergoing medical procedures frequently experience pain and anxiety. Music-based interventions have the potential to help alleviate these symptoms.
OBJECTIVE
This review investigated the effects of music-based interventions (music therapy and music medicine) on pain and anxiety in children and adults undergoing medical procedures.
METHODS
This systematic review examined randomized controlled trial music intervention studies to manage patient-reported pain and/or anxiety during medical procedures. All studies were published in English and peer-reviewed journals. Quality and risk of bias were assessed using criteria from the Checklist to Evaluate a Report of a Nonpharmacological Trial (CLEAR-NPT).
RESULTS
Fifty studies met inclusion criteria, the majority of which (84%) had a high risk of bias. It was not possible to perform a meta-analysis because studies varied greatly in terms of medical procedure and intervention type. Results varied across studies, with approximately half (48%) indicating less anxiety for music intervention participants; fewer studies (36%) reported less pain for music intervention participants.
CONCLUSIONS
There is a need to clearly define and differentiate between music therapy and music medicine interventions in procedural support research. Further research is necessary to determine which patients would benefit most from music interventions during medical procedures, and which interventions are most beneficial. To improve research quality and reduce risk of bias, when designing studies investigators need to carefully consider factors related to design, including randomization, treatment allocation concealment, blinding outcome assessors, and intention-to-treat analysis. In addition, more detailed intervention reporting is needed when publishing results.
Topics: Adult; Anxiety; Child; Diagnostic Techniques and Procedures; Endoscopy; Humans; Music Therapy; Pain; Pain Management
PubMed: 25878063
DOI: 10.1093/jmt/thv004 -
Journal of Surgical Oncology Feb 2018The field of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has suffered from a lack of clinical trials to validate its expanding use. (Review)
Review
BACKGROUND
The field of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has suffered from a lack of clinical trials to validate its expanding use.
OBJECTIVE
To evaluate published and ongoing clinical trials seeking to better define role of CRS/HIPEC in the treatment of peritoneal surface malignancies.
METHODS
Systematic review by PubMed search was performed using terms "Clinical trial," "intraperitoneal chemotherapy," and "HIPEC." ClinicalTrials.gov and EudraCT registries were searched for active clinical trials. Eligibility included CRS/HIPEC trials investigating adult patient populations from published clinical reports and/or trials currently accruing or at completion.
RESULTS
Thirteen published trials and 57 active clinical trials were included for review.
CONCLUSIONS
Published and ongoing U.S. and international clinical trials for CRS and HIPEC are defining important parameters that include improving patient selection, strategic sequences of treatment, cytoreductive strategies, chemotherapeutics, optimal hyperthermic temperature and timing, and toxicity profiles. Main barriers or limitations to trial development remain patient enrollment, trial design, and oncologic community collaboration. Overall progress is positive with increasing number of clinical trials throughout the world. Collaboration between surgeons and the wider oncologic community will be crucial to validate this important treatment strategy.
Topics: Chemotherapy, Cancer, Regional Perfusion; Clinical Trials as Topic; Cytoreduction Surgical Procedures; Humans; Hyperthermia, Induced; Meta-Analysis as Topic; Peritoneal Neoplasms; Prognosis; Survival Rate
PubMed: 29120491
DOI: 10.1002/jso.24813 -
Australian Endodontic Journal : the... Dec 2021This systematic review and meta-analysis was sought to assess whether intentional foraminal enlargement (IFE) is responsible for extrusion of a larger quantity of debris... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis was sought to assess whether intentional foraminal enlargement (IFE) is responsible for extrusion of a larger quantity of debris from extracted human teeth with fully formed apexes. Following the recommendations of Preferred Reporting Items for Systematic Review and Meta-Analysis - PRISMA, electronic and manual searches were performed to identify studies that evaluated the extrusion of debris, comparing different apical limits of instrumentation (with/without IFE). The quality of the studies selected was evaluated, and statistical analysis was conducted. To perform the meta-analysis, just 3 papers could be used. The heterogeneity was high, however; there was no statistically significant difference in relation to the extrusion of debris in teeth either submitted or not submitted to IFE. The general risk of bias was moderate. In conclusion, IFE is not responsible for extrusion of a larger quantity of debris from extracted human teeth with fully formed apexes.
Topics: Electronics; Humans; Research Design
PubMed: 34146366
DOI: 10.1111/aej.12539 -
International Journal of Implant... Dec 2023This systematic review aimed to investigate the accuracy of intraoral scan (IOS) impressions of implant-supported restorations in in vivo studies. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review aimed to investigate the accuracy of intraoral scan (IOS) impressions of implant-supported restorations in in vivo studies.
METHODS
A systematic electronic search and review of studies on the accuracy of IOS implant impressions were conducted to analyze the peer-reviewed literature published between 1989 and August 2023. The bias analysis was performed by two reviewers. Data on the study characteristics, accuracy outcomes, and related variables were extracted. A meta-analysis of randomized control trials was performed to investigate the impact of IOS on peri-implant crestal bone loss and the time involved in the impression procedure.
RESULTS
Ten in vivo studies were included in this systematic review for final analysis. Six studies investigated the trueness of IOS impressions, but did not reach the same conclusions. One study assessed the precision of IOS impressions for a single implant. Four clinical studies examined the accuracy of IOS implant impressions with a follow-up of 1-2 years. In full arches, IOS impression procedure needed significantly less time than conventional one (mean difference for procedure time was 8.59 min [6.78, 10.40 min], P < 0.001), prosthetic survival rate was 100%, and marginal bone levels of all participants could be stably maintained (mean difference in marginal bone loss at 12 months was 0.03 mm [-0.08, 0.14 mm], P = 0.55).
CONCLUSIONS
The accuracy of IOS impressions of implant-supported restorations varied greatly depending on the scanning strategy. The trueness and precision of IOS in the partial and complete arches remain unclear and require further assessment. Based on follow-up clinical studies, IOS impressions were accurate in clinical practice. However, these results should be interpreted with caution, as some evidences are obtained from the same research group.
Topics: Humans; Dental Implants; Research Design; Bone Diseases, Metabolic; Clonal Hematopoiesis; Electronics
PubMed: 38055096
DOI: 10.1186/s40729-023-00517-8 -
Systematic Reviews Mar 2017Systematic reviews of qualitative and quantitative evidence can provide a rich understanding of complex phenomena. This type of review is increasingly popular, has been... (Review)
Review
BACKGROUND
Systematic reviews of qualitative and quantitative evidence can provide a rich understanding of complex phenomena. This type of review is increasingly popular, has been used to provide a landscape of existing knowledge, and addresses the types of questions not usually covered in reviews relying solely on either quantitative or qualitative evidence. Although several typologies of synthesis designs have been developed, none have been tested on a large sample of reviews. The aim of this review of reviews was to identify and develop a typology of synthesis designs and methods that have been used and to propose strategies for synthesizing qualitative and quantitative evidence.
METHODS
A review of systematic reviews combining qualitative and quantitative evidence was performed. Six databases were searched from inception to December 2014. Reviews were included if they were systematic reviews combining qualitative and quantitative evidence. The included reviews were analyzed according to three concepts of synthesis processes: (a) synthesis methods, (b) sequence of data synthesis, and (c) integration of data and synthesis results.
RESULTS
A total of 459 reviews were included. The analysis of this literature highlighted a lack of transparency in reporting how evidence was synthesized and a lack of consistency in the terminology used. Two main types of synthesis designs were identified: convergent and sequential synthesis designs. Within the convergent synthesis design, three subtypes were found: (a) data-based convergent synthesis design, where qualitative and quantitative evidence is analyzed together using the same synthesis method, (b) results-based convergent synthesis design, where qualitative and quantitative evidence is analyzed separately using different synthesis methods and results of both syntheses are integrated during a final synthesis, and (c) parallel-results convergent synthesis design consisting of independent syntheses of qualitative and quantitative evidence and an interpretation of the results in the discussion.
CONCLUSIONS
Performing systematic reviews of qualitative and quantitative evidence is challenging because of the multiple synthesis options. The findings provide guidance on how to combine qualitative and quantitative evidence. Also, recommendations are made to improve the conducting and reporting of this type of review.
Topics: Evaluation Studies as Topic; Humans; Qualitative Research; Research Design
PubMed: 28335799
DOI: 10.1186/s13643-017-0454-2 -
AJNR. American Journal of Neuroradiology May 2017The safety and efficacy of standard poststent angioplasty in patients undergoing carotid artery stent placement have not been well-established. (Meta-Analysis)
Meta-Analysis Review
BACKROUND
The safety and efficacy of standard poststent angioplasty in patients undergoing carotid artery stent placement have not been well-established.
PURPOSE
We conducted a systematic review of the literature to evaluate the safety and efficacy of carotid artery stent placement and analyzed outcomes of standard-versus-selective poststent angioplasty.
DATA SOURCES
A systematic search of MEDLINE, EMBASE, Scopus, and the Web of Science was performed for studies published between January 2000 and January 2015.
STUDY SELECTION
We included studies with >30 patients describing standard or selective poststent angioplasty during carotid artery stent placement.
DATA ANALYSIS
A random-effects meta-analysis was used to pool the following outcomes: periprocedural stroke/TIA, procedure-related neurologic/cardiovascular morbidity/mortality, bradycardia/hypotension, long-term stroke at last follow-up, long-term primary patency, and technical success.
DATA SYNTHESIS
We included 87 studies with 19,684 patients with 20,378 carotid artery stenoses. There was no difference in clinical ( = .49) or angiographic outcomes ( = .93) in carotid artery stent placement treatment with selective or standard poststent balloon angioplasty. Both selective and standard poststent angioplasty groups had a very high technical success of >98% and a low procedure-related mortality of 0.9%. There were no significant differences between both groups in the incidence of restenosis ( = .93) or procedure-related complications ( = .37).
LIMITATIONS
No comparison to a patient group without poststent dilation could be performed.
CONCLUSIONS
Our meta-analysis demonstrated no significant difference in angiographic and clinical outcomes among series that performed standard poststent angioplasty and those that performed poststent angioplasty in only select patients.
Topics: Aged; Angioplasty, Balloon; Carotid Stenosis; Female; Humans; Male; Patient Selection; Stents; Treatment Outcome
PubMed: 28302610
DOI: 10.3174/ajnr.A5103