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Vascular and Endovascular Surgery Feb 2017Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and meta-analysis of the current available studies investigating outcomes of DEB and DES in the treatment of infrapopliteal artery disease.
METHODS
Multiple databases were systematically searched to identify studies investigating the outcomes of DEB and DES in the treatment of patients with infrapopliteal artery disease. The quality of studies was assessed by Cochrane Collaboration method. The demographic data, risk factors, outcomes, and antiplatelet strategy were extracted.
RESULTS
Nine studies were identified with 707 and 606 patients in DEB/DES and standard percutaneous balloon angioplasty (PTA)/bare metal stenting (BMS) group, respectively. The risk of target lesion revascularization (TLR; odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.23-0.63, P < .01), restenosis rate (OR = 0.30, 95% CI: 0.18-0.50, P < .01), and amputation rate (OR = 0.49, 95% CI: 0.29-0.83, P < .01) significantly decreased in the DES group. The overall survival (OR = 0.86, 95% CI: 0.56-1.32, P = .50) was similar in DES and standard PTA/BMS group; TLR (OR = 0.59, 95% CI: 0.32-1.09, P = .09), restenosis rate (OR = 0.49, 95% CI: 0.11-2.14, P = .35), amputation rate (OR = 1.32, 95% CI: 0.51-3.40, P = .57), and overall survival (OR = 1.40, 95% CI: 0.72-2.71, P = .32) were similar in DEB and standard PTA group.
CONCLUSION
The present meta-analysis suggests that compared with standard PTA/BMS, DES may decrease the risk of clinically driven TLR, restenosis rate, and amputation rate without any impact on mortality. However, DEB has no obvious advantage in the treatment of infrapopliteal disease. Due to the limitations of our study, more randomized controlled trials, especially those for DEB, are necessary.
Topics: Amputation, Surgical; Angioplasty, Balloon; Chi-Square Distribution; Coated Materials, Biocompatible; Constriction, Pathologic; Drug-Eluting Stents; Humans; Limb Salvage; Odds Ratio; Peripheral Arterial Disease; Popliteal Artery; Prosthesis Design; Recurrence; Risk Factors; Time Factors; Treatment Outcome; Vascular Access Devices; Vascular Patency
PubMed: 28103754
DOI: 10.1177/1538574416689426 -
Frontiers in Endocrinology 2022Obesity-related data derived from multiple complex systems spanning media, social, economic, food activity, health records, and infrastructure (sensors, smartphones,... (Review)
Review
Obesity-related data derived from multiple complex systems spanning media, social, economic, food activity, health records, and infrastructure (sensors, smartphones, etc.) can assist us in understanding the relationship between obesity drivers for more efficient prevention and treatment. Reviewed literature shows a growing adaptation of the machine-learning model in recent years dealing with mechanisms and interventions in social influence, nutritional diet, eating behavior, physical activity, built environment, obesity prevalence prediction, distribution, and healthcare cost-related outcomes of obesity. Most models are designed to reflect through time and space at the individual level in a population, which indicates the need for a macro-level generalized population model. The model should consider all interconnected multi-system drivers to address obesity prevalence and intervention. This paper reviews existing computational models and datasets used to compute obesity outcomes to design a conceptual framework for establishing a macro-level generalized obesity model.
Topics: Humans; Obesity; Diet; Exercise; Machine Learning
PubMed: 36313777
DOI: 10.3389/fendo.2022.1027147 -
Neurology Dec 2016Statistical techniques can investigate data integrity in randomized controlled trials (RCTs). We systematically reviewed and analyzed all human RCTs undertaken by a... (Review)
Review
BACKGROUND
Statistical techniques can investigate data integrity in randomized controlled trials (RCTs). We systematically reviewed and analyzed all human RCTs undertaken by a group of researchers, about which concerns have been raised.
METHODS
We compared observed distributions of p values for between-groups differences in baseline variables, for standardized sample means for continuous baseline variables, and for differences in treatment group participant numbers with the expected distributions. We assessed productivity, recruitment rates, outcome data, textual consistency, and ethical oversight.
RESULTS
The researchers were remarkably productive, publishing 33 RCTs over 15 years involving large numbers of older patients with substantial comorbidity, recruited over very short periods. Treatment groups were improbably similar. The distribution of p values for differences in baseline characteristics differed markedly from the expected uniform distribution (p = 5.2 × 10). The distribution of standardized sample means for baseline continuous variables and the differences between participant numbers in randomized groups also differed markedly from the expected distributions (p = 4.3 × 10, p = 1.5 × 10, respectively). Outcomes were remarkably positive, with very low mortality and study withdrawals despite substantial comorbidity. There were very large reductions in hip fracture incidence, regardless of intervention (relative risk 0.22, 95% confidence interval 0.15-0.31, p < 0.0001, range of relative risk 0.10-0.33), that greatly exceed those reported in meta-analyses of other trials. There were multiple examples of inconsistencies between and within trials, errors in reported data, misleading text, duplicated data and text, and uncertainties about ethical oversight.
CONCLUSIONS
A systematic approach using statistical techniques to assess randomization outcomes can evaluate data integrity, in this case suggesting these RCT results may be unreliable.
Topics: Data Accuracy; Data Interpretation, Statistical; Humans; Meta-Analysis as Topic; Randomized Controlled Trials as Topic
PubMed: 27920281
DOI: 10.1212/WNL.0000000000003387 -
BMC Musculoskeletal Disorders Mar 2016Femoral neck fractures in the elderly make up a large proportion of Orthopaedic surgical admissions each year. Operating on patients with clopidogrel poses a challenge... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Femoral neck fractures in the elderly make up a large proportion of Orthopaedic surgical admissions each year. Operating on patients with clopidogrel poses a challenge because of the risk of bleeding and the difficulty deciding the optimal timing of surgery. The aim of this systematic review is to examine the published evidence to establish a set of guidelines for approaching neck of femur patients who are on clopidogrel.
METHODS
All comparative studies with an intervention group and a control group were considered. Data on patient blood transfusion exposures, units transfused, haemoglobin concentration and drop in haemoglobin were extracted and pooled using the fixed effects model. Heterogeneity of the intervention effect was assessed with the I (2) statistic.
RESULTS
A total of 4219 studies were identified. After removal of duplicates and after exclusion criteria were applied, there were 14 studies to be included. All 14 were case series with controls. There was no significant heterogeneity amongst the studies. Pooled odds ratio for transfusion exposures was 1.24 (95 % confidence interval 0.91 to 1.71) however this was not statistically significant (p = 0.14). No significant mean differences were found for other primary outcome measures.
CONCLUSIONS
On the available evidence, we recommend that these patients can be managed by normal protocols with early surgery. Operating early on patients on clopidogrel is safe and does not appear to confer any clinically significant bleeding risk. As reported in other studies, we believe clopidogrel, if possible, should not be withheld throughout the perioperative period due to increased risk of cardiovascular events associated with stopping clopidogrel. Care should be taken intraoperatively to minimise blood loss due to the increased potential for bleeding.
TRIAL REGISTRATION
This systematic review and meta-analysis has been registered on Research Registry on July 16, 2015. The Review Registry Unique Identifying Number is: reviewregistry61 .
Topics: Blood Loss, Surgical; Chi-Square Distribution; Clopidogrel; Drug Administration Schedule; Femoral Neck Fractures; Fracture Fixation; Humans; Odds Ratio; Platelet Aggregation Inhibitors; Risk Assessment; Risk Factors; Ticlopidine; Treatment Outcome
PubMed: 27005816
DOI: 10.1186/s12891-016-0988-9 -
European Respiratory Review : An... Jan 2017Asthma is a chronic, inflammatory lung disease affecting around 235 million people worldwide. Conventional medications in asthma are not curative and patients have... (Meta-Analysis)
Meta-Analysis Review
Asthma is a chronic, inflammatory lung disease affecting around 235 million people worldwide. Conventional medications in asthma are not curative and patients have significant concerns regarding their side-effects. Consequently, many asthma patients turn to complementary and alternative medicine (CAM) for a more holistic approach to care. We systematically reviewed the available evidence on the effectiveness of CAM in the management of asthma in adults.We searched the MEDLINE, EMBASE, CINAHL, AMED and Cochrane databases for randomised controlled trials published in English between 1990 and 2016 investigating the effectiveness of oral or topical CAM in asthmatic adults. The quality of the studies was assessed using the Cochrane Risk of Bias Assessment Tool.In all, 23 eligible trials were identified covering 19 different CAMs. Overall, there was limited evidence on the effectiveness of CAM in adult asthma as most CAMs were only assessed in a single trial. CAMs with multiple trials provided null or inconsistent results. Many of the trials were rated as having high risk of bias.The existing evidence is insufficient to recommend any of the oral and topical CAMs in the management of asthma in adults.
Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Anti-Asthmatic Agents; Asthma; Chi-Square Distribution; Complementary Therapies; Female; Holistic Health; Humans; Lung; Male; Middle Aged; Treatment Outcome; Young Adult
PubMed: 28143878
DOI: 10.1183/16000617.0092-2016 -
Iranian Journal of Kidney Diseases Mar 2018Uremic pruritus is characterized by an uncomfortable and unlimited sensation which leads to scratch, which strongly reduces the quality of life. Pruritus is a common... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Uremic pruritus is characterized by an uncomfortable and unlimited sensation which leads to scratch, which strongly reduces the quality of life. Pruritus is a common symptom in patients with end-stage renal disease. Various clinical trial studies have examined the effects of acupuncture and acupressure on treatment of uremic pruritus. This systematic review meta-analysis aimed to evaluate the effectiveness based on published studies.
MATERIALS AND METHODS
An electronic literature search was conducted to identify appropriate trial studies. The results for continuous outcomes were presented as weighted mean difference, with 95% confidence intervals.
RESULTS
A total of 5 articles, including 6 trials, were enrolled in this systematic review. Only 3 of the six trial studies used a visual analogue scale score for assessing pruritus and acupressure for intervention regime, which were considered for meta-analysis. The combined results showed that acupuncture or acupressure was effective in treatment of uremic pruritus (pooled mean difference, -1.994; 95% confidence interval, -2.544 to -1.445).
CONCLUSIONS
This study confirms that using acupuncture and acupressure is effective in treatment of uremic pruritus. However, further vigorous studies are needed to verify these findings.
Topics: Acupressure; Acupuncture Points; Acupuncture Therapy; Adult; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Pruritus; Quality of Life; Risk Factors; Treatment Outcome; Uremia
PubMed: 29507269
DOI: No ID Found -
European Urology Mar 2015Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained... (Review)
Review
CONTEXT
Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity.
OBJECTIVE
To report a systematic literature review and cumulative analysis of perioperative outcomes and complications of RARC in comparison with ORC and LRC.
EVIDENCE ACQUISITION
Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. Cumulative analysis was conducted.
EVIDENCE SYNTHESIS
The searches retrieved 105 papers. According to the different diversion type, overall mean operative time ranged from 360 to 420 min. Similarly, mean blood loss ranged from 260 to 480 ml. Mean in-hospital stay was about 9 d for all diversion types, with consistently high readmission rates. In series reporting on RARC with either extracorporeal or intracorporeal conduit diversion, overall 90-d complication rates were 59% (high-grade complication: 15%). In series reporting RARC with intracorporeal continent diversion, the overall 30-d complication rate was 45.7% (high-grade complication: 28%). Reported mortality rates were ≤3% for all diversion types. Comparing RARC and ORC, cumulative analyses demonstrated shorter operative time for ORC, whereas blood loss and in-hospital stay were better with RARC (all p values <0.003). Moreover, 90-d complication rates of any-grade and 90-d grade 3 complication rates were lower for RARC (all p values <0.04), whereas high-grade complication and mortality rates were similar.
CONCLUSIONS
RARC can be performed safely with acceptable perioperative outcome, although complications are common. Cumulative analyses demonstrated that operative time was shorter with ORC, whereas RARC may provide some advantages in terms of blood loss and transfusion rates and, more limitedly, for postoperative complication rates over ORC and LRC.
PATIENT SUMMARY
Although open radical cystectomy (RC) is still regarded as a standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RC are becoming more popular. Robotic RC can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications; however, as for open RC, the risk of postoperative complications is high, including a substantial risk of major complication and reoperation.
Topics: Blood Loss, Surgical; Chi-Square Distribution; Cystectomy; Humans; Length of Stay; Odds Ratio; Operative Time; Patient Readmission; Postoperative Complications; Risk Factors; Robotic Surgical Procedures; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 25560798
DOI: 10.1016/j.eururo.2014.12.007 -
Strahlentherapie Und Onkologie : Organ... Oct 2016Reirradiation is a potentially useful option for many patients with recurrent cancer. The purpose of this study was to review all recently published randomized trials... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Reirradiation is a potentially useful option for many patients with recurrent cancer. The purpose of this study was to review all recently published randomized trials in order to identify methodological strengths and weaknesses, comment on the results, clinical implications and open questions, and give advice for the planning of future trials.
MATERIALS AND METHODS
Systematic review of trials published between 2000 and 2015 (databases searched were PubMed, Scopus and Web of Science).
RESULTS
We reviewed 9 trials, most of which addressed reirradiation of head and neck tumours. The median number of patients was 69. Trial design, primary endpoint and statistical hypotheses varied widely. The results contribute mainly to decision making for reirradiation of nasopharynx cancer and bone metastases. The trials with relatively long median follow-up confirm that serious toxicity remains a concern after high cumulative total doses.
CONCLUSION
Multi-institutional collaboration is encouraged to complete sufficiently large trials. Despite a paucity of large randomized studies, reirradiation has been adopted in different clinical scenarios by many institutions. Typically, the patients have been assessed by multidisciplinary tumour boards and advanced technologies are used to create highly conformal dose distributions.
Topics: Head and Neck Neoplasms; Humans; Neoplasm Recurrence, Local; Prevalence; Prospective Studies; Radiotherapy, Conformal; Randomized Controlled Trials as Topic; Re-Irradiation; Risk Factors; Survival Rate; Treatment Outcome
PubMed: 27534408
DOI: 10.1007/s00066-016-1024-6 -
World Journal of Gastroenterology May 2015To investigate fiber and prebiotic supplementation of enteral nutrition (EN) for diarrhea, fecal microbiota and short-chain fatty acids (SCFAs). (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate fiber and prebiotic supplementation of enteral nutrition (EN) for diarrhea, fecal microbiota and short-chain fatty acids (SCFAs).
METHODS
MEDLINE, EMBASE, Cochrane Library, CINAHL, Academic Search Premier, and Web of Science databases were searched for human experimental and observational cohort studies conducted between January 1990 and June 2014. The keywords used for the literature search were fiber, prebiotics and enteral nutrition. English language studies with adult patient populations on exclusive EN were selected. Abstracts and/or full texts of selected studies were reviewed and agreed upon by two independent researchers for inclusion in the meta-analysis. Tools used for the quality assessment were Jadad Scale and the Scottish Intercollegiate Guidelines Network Critical Appraisal of the Medical Literature.
RESULTS
A total of 456 possible articles were retrieved, and 430 were excluded due to lack of appropriate data. Of the 26 remaining studies, only eight investigated the effects of prebiotics. Results of the meta-analysis indicated that overall, fiber reduces diarrhea in patients receiving EN (OR = 0.47; 95%CI: 0.29-0.77; P = 0.02). Subgroup analysis revealed a positive effect of fiber supplementation in EN towards diarrhea in stable patients (OR = 0.31; 95%CI: 0.19-0.51; P < 0.01), but not in critically ill patients (OR = 0.89; 95%CI: 0.41-1.92; P = 0.77). Prebiotic supplementation in EN does not improve the incidence of diarrhea despite its manipulative effect on bifidobacteria concentrations and SCFA in healthy humans. In addition, the effect of fiber and/or prebiotic supplementation towards fecal microbiota and SCFA remain disputable.
CONCLUSION
Fiber helps minimize diarrhea in patients receiving EN, particularly in non-critically ill patients. However, the effect of prebiotics in moderating diarrhea is inconclusive.
Topics: Chi-Square Distribution; Critical Illness; Diarrhea; Dietary Fiber; Enteral Nutrition; Fatty Acids; Feces; Humans; Incidence; Intestinal Mucosa; Intestines; Microbiota; Odds Ratio; Prebiotics; Risk Factors; Treatment Outcome
PubMed: 25954112
DOI: 10.3748/wjg.v21.i17.5372 -
European Journal of Preventive... Dec 2015The decline in maximal oxygen consumption (VO2max) with age seems to be exacerbated in endurance-trained athletes (EA) relative to untrained healthy subjects. Whether... (Review)
Review
BACKGROUND
The decline in maximal oxygen consumption (VO2max) with age seems to be exacerbated in endurance-trained athletes (EA) relative to untrained healthy subjects. Whether maximal cardiac output (Qmax) parallels this group-specific decline with age remains uncertain. Therefore, we sought to systematically review the literature and determine whether Qmax is similarly enhanced in EA across all ages relative to age-matched untrained counterparts.
DESIGN AND METHODS
We conducted a systematic search of MEDLINE, Cochrane and Web of Science from their inceptions until June 2014 for articles evaluating Qmax in athletes. A meta-analysis was performed to determine the standardized mean difference (SMD) in Qmax between EA and age-matched untrained healthy subjects. Included studies had to (i) comprise EA and control groups matched for body size or (ii) present Qmax values normalized for body size. Subgroup and meta-regression analyses were used to study the influence of age and potential moderating factors.
RESULTS
Eighteen studies were selected after systematic review, comprising 268 EA and 232 age-matched untrained subjects. Nine studies involved young EA (mean age ≤40 years) while nine studies involved master EA (mean age >55 years). After data pooling, young and master EA groups showed higher Qmax compared with control groups (SMD = 1.49 and SMD = 1.68, respectively; both p < 0.0001). The SMD in Qmax between EA and control groups was similar in studies in young EA compared with studies in master EA (p = 0.61). Moreover, the SMD in VO2max between EA and control groups did not differ in studies in young EA compared with studies in master EA (p = 0.37). In meta-regression analyses, the difference in percentage of body fat between EA and control groups was inversely associated with the SMD in Qmax (B = - 0.17, p = 0.01) and the SMD in VO2max (B = -0.20, p = 0.01). Mean age was not associated with the SMD in Qmax (B = -0.001, P = 0.90) nor with the SMD in VO2max (B = 0.01, P = 0.58).
CONCLUSIONS
Based on current published studies, the enhanced Qmax observed in EA compared with untrained healthy subjects matched for body size is not affected by age but may be related, at least in part, to the improved body composition of EA.
Topics: Adaptation, Physiological; Adolescent; Adult; Age Factors; Aged; Aging; Athletes; Body Composition; Cardiac Output; Chi-Square Distribution; Female; Heart; Humans; Male; Middle Aged; Oxygen Consumption; Physical Endurance; Young Adult
PubMed: 25595549
DOI: 10.1177/2047487314566759