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BMJ Open Aug 2019Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and...
OBJECTIVES
Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for gout and hyperuricemia.
DESIGN
Systematic review and quality assessment using the appraisal of guidelines for research and evaluation (AGREE) II methodology.
DATA SOURCES
PubMed and EMBASE (27 October 2016), two Chinese academic databases, eight guideline databases, and Google and Google scholar (July 2017).
ELIGIBILITY CRITERIA
We included the latest version of international and national/regional clinical practice guidelines and consensus statements for diagnosis and/or treatment of hyperuricemia and gout, published in English or Chinese.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently screened searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid.
RESULTS
Twenty-four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. Included documents performed well in the domains of scope and purpose (median 85.4%, range 66.7%-100.0%) and clarity of presentation (median 79.2%, range 48.6%-98.6%), but unsatisfactory in applicability (median 10.9%, range 0.0%-66.7%) and editorial independence (median 28.1%, range 0.0%-83.3%). The 2017 British Society of Rheumatology guideline received the highest scores. Recommendations were concordant on the target serum uric acid level for long-term control, on some indications for urate-lowering therapy (ULT), and on the first-line drugs for ULT and for acute attack. Substantially inconsistent recommendations were provided for many items, especially for the timing of initiation of ULT and for treatment for asymptomatic hyperuricemia.
CONCLUSIONS
Methodological quality needs improvement in guidance documents on gout and hyperuricemia. Evidence for certain clinical questions is lacking, despite numerous trials in this field. Promoting standard guidance development methods and synthesising high-quality clinical evidence are potential approaches to reduce recommendation inconsistencies.
PROSPERO REGISTRATION NUMBER
CRD42016046104.
Topics: Consensus; Gout; Gout Suppressants; Humans; Hyperuricemia; Practice Guidelines as Topic; Uric Acid
PubMed: 31446403
DOI: 10.1136/bmjopen-2018-026677 -
Obesity Reviews : An Official Journal... Dec 2022The dose-response association between sedentary time and the risk of metabolic syndrome is unclear, which indicates an important knowledge gap in public health. The... (Meta-Analysis)
Meta-Analysis Review
The dose-response association between sedentary time and the risk of metabolic syndrome is unclear, which indicates an important knowledge gap in public health. The objective of this study was to determine the categorical and continuous dose-response associations between sedentary time and the risk of metabolic syndrome. A systematic literature search of English articles published in PubMed, CINHAL, Embase, and Web of Science Core Collection prior to June 2022 was conducted. All cohort and cross-sectional studies that examined the association between sedentary time and the risk of metabolic syndrome were considered, and duplicate and non-related studies were excluded. Data extraction using a standardized chart and quality assessment using two appraisal tools were also performed. Two independent reviewers were involved in these processes. In categorical meta-analyses, the pooled effect sizes for metabolic syndrome associated with different categories of sedentary time were calculated by comparing the highest and intermediate with the lowest categories. In continuous meta-analyses, the linear and nonlinear dose-response associations were estimated using generalized least squares and restricted cubic spline models, respectively. Data were collected and analyzed from March to June 2022. Four prospective cohort studies and 22 cross-sectional studies with 105,239 participants and 16,185 MetS cases were included in this study. In categorical analyses, both intermediate (median duration: 4.11 h/day; pooled OR: 1.17, 95% CI: 1.08-1.26, P < 0.001) and high levels (median duration: 7.26 h/day; pooled OR: 1.71, 95% CI: 1.43-2.04, P < 0.001) of total sedentary time were significantly associated with an increased risk of metabolic syndrome. Similarly, a significant association between screen time and the risk of metabolic syndrome was also found in intermediate (median duration: 2.22 h/day; pooled OR: 1.20, 95% CI: 1.10-1.32, P < 0.001) and high levels (median duration: 3.40 h/day; pooled OR: 1.63, 95% CI: 1.44-1.86, P < 0.001) of exposure. Of note, these associations were significantly stronger in women. Different patterns of the behavior-disease association were not observed in children, adolescents, and adults. The findings of continuous meta-analyses could not provide solid evidence for the linearity and nonlinearity of the behavior-disease association. This study demonstrated that long-time sedentary behavior was associated with a higher risk of MetS independent of physical activity and the patterns of association varied by gender instead of age. These findings have implications for future guideline recommendations on physical activity, sedentary behavior, and prevention of metabolic syndrome.
Topics: Child; Adolescent; Adult; Humans; Female; Sedentary Behavior; Metabolic Syndrome; Cross-Sectional Studies; Prospective Studies; Exercise
PubMed: 36261077
DOI: 10.1111/obr.13510 -
BMC Musculoskeletal Disorders Dec 2022Studies reporting on the population burden of people living with shoulder pain show wide heterogeneity in terms of case definition, study samples, and occurrence. This...
BACKGROUND AND OBJECTIVES
Studies reporting on the population burden of people living with shoulder pain show wide heterogeneity in terms of case definition, study samples, and occurrence. This systematic review aims to summarize evidence pertaining to the prevalence and incidence of shoulder pain, including variability based on sex and geography. We also explored the potential influence of methodological limitations and important sources of heterogeneity (case definition and reference period) on reported estimates of shoulder pain prevalence.
DATABASES AND DATA TREATMENT
The study protocol was registered on Prospero under CRD42021243140. We searched EMBASE, CINAHL, Web of Science and Medline from inception to March 2021. Study selection, data extraction and risk of bias assessment was conducted by a team of three researchers. We performed a narrative synthesis of the data, using forest plots to summarize study findings, and stratified data presentation to explore the potential association of risk of bias, case definition, and reference period with estimates of prevalence and incidence of shoulder pain.
RESULTS
We obtained data from 61 studies reporting data from high-, middle- and low-income countries. The overall risk of bias was low, with most rated as "low-risk" and no studies rated as "high-risk". The community prevalence of shoulder pain varied widely across the countries included in our review, with a median of 16% (range 0.67 to 55.2%). Longer reference periods were typically associated with higher prevalence estimates. Primary care prevalence ranged from 1.01 to 4.84% (median 2.36%). Estimates were generally higher for women than men and were higher in high-income nations. The incidence of shoulder pain ranged from 7.7 to 62 per 1000 persons per year (median 37.8 per 1000 persons per year). Risk of bias did not clearly explain variability in study findings, but there was considerable variation in study samples, methods used, and a relative absence of data from low-income countries.
CONCLUSIONS
Our review demonstrates that a significant proportion of the population across the world will experience shoulder pain daily, yearly, and throughout a lifetime. Regional gaps in evidence and methodological inconsistencies must be addressed in order to establish a more definitive global burden.
Topics: Female; Humans; Shoulder Pain; Geography
PubMed: 36476476
DOI: 10.1186/s12891-022-05973-8 -
Sports Medicine - Open Jul 2020The test-retest reliability of the one-repetition maximum (1RM) test varies across different studies. Given the inconsistent findings, it is unclear what the true... (Review)
Review
BACKGROUND
The test-retest reliability of the one-repetition maximum (1RM) test varies across different studies. Given the inconsistent findings, it is unclear what the true reliability of the 1RM test is, and to what extent it is affected by measurement-related factors, such as exercise selection for the test, the number of familiarization trials and resistance training experience.
OBJECTIVES
The aim of this paper was to review studies that investigated the reliability of the 1RM test of muscular strength and summarize their findings.
METHODS
The PRISMA guidelines were followed for this systematic review. Searches for studies were conducted through eight databases. Studies that investigated test-retest reliability of the 1RM test and presented intra-class correlation coefficient (ICC) and/or coefficient of variation (CV) were included. The COSMIN checklist was used for the assessment of the methodological quality of the included studies.
RESULTS
After reviewing 1024 search records, 32 studies (pooled n = 1595) on test-retest reliability of 1RM assessment were found. All the studies were of moderate or excellent methodological quality. Test-retest ICCs ranged from 0.64 to 0.99 (median ICC = 0.97), where 92% of ICCs were ≥ 0.90, and 97% of ICCs were ≥ 0.80. The CVs ranged from 0.5 to 12.1% (median CV = 4.2%). ICCs were generally high (≥ 0.90), and most CVs were low (< 10%) for 1RM tests: (1) among those without and for those with some resistance training experience, (2) conducted with or without familiarization sessions, (3) with single-joint or multi-joint exercises, (4) for upper- and lower-body strength assessment, (5) among females and males, and (6) among young to middle-aged adults and among older adults. Most studies did not find systematic changes in test results between the trials.
CONCLUSIONS
Based on the results of this review, it can be concluded that the 1RM test generally has good to excellent test-retest reliability, regardless of resistance training experience, number of familiarization sessions, exercise selection, part of the body assessed (upper vs. lower body), and sex or age of participants. Researchers and practitioners, therefore, can use the 1RM test as a reliable test of muscular strength.
PubMed: 32681399
DOI: 10.1186/s40798-020-00260-z -
Therapeutic Advances in Chronic Disease 2022Although data on the effects of liraglutide and semaglutide in patients with diabetes have been reviewed, their therapeutic outcomes in obese/overweight individuals... (Review)
Review
BACKGROUND & OBJECTIVE
Although data on the effects of liraglutide and semaglutide in patients with diabetes have been reviewed, their therapeutic outcomes in obese/overweight individuals without diabetes have not been summarized. We conducted a systematic review to evaluate their effects on the latter population.
METHODS
We searched the PubMed, EMBASE, Cochrane, CNKI, and Wanfang databases. Studies regarding obese/overweight adults without diabetes treated with liraglutide/semaglutide compared with other active agents or placebos were accessed. The primary outcomes were the proportions of adults with at least 5% and 10% weight reduction. The secondary outcomes included metabolic indicators and adverse events.
RESULTS
Eighteen studies with 10,938 obese/overweight adults without diabetes were included. When stratified by the categories of at least 5% and 10% weight loss, the pooled data showed medians 27.7% and 10.3% of control groups versus 65.3% and 30.7% of liraglutide 3 mg once daily, respectively; whereas medians 47.6% and 20.4% of control groups vs 86.6% and 75.3% of semaglutide 2.4 mg once weekly were found in the two categories, respectively. Both agents either improved or had no impact on lipid or glycemia. Liraglutide or semaglutide therapy had discontinuation rates of 2.4%-11.4% which overlapped with 0.7%-8.6% in control groups. The frequency of adverse events was comparable between the treatment groups and the control groups (66.5%-95.8% vs 46.9%-96.1%), which were mild to moderate graded by studies.
CONCLUSION
Liraglutide and semaglutide therapy led to a clinically relevant (⩾5%) weight loss of 48.2%-88.7% among obese/overweight adults without diabetes. Both liraglutide and semaglutide are associated with weight loss and are well-tolerated.
PubMed: 35813188
DOI: 10.1177/20406223221108064 -
JAMA Network Open Oct 2021Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on...
IMPORTANCE
Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region.
OBJECTIVE
To estimate organ system-specific frequency and evolution of PASC.
EVIDENCE REVIEW
PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility.
FINDINGS
From a total of 2100 studies identified, 57 studies with 250 351 survivors of COVID-19 met inclusion criteria. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC was 54.0% (45.0%-69.0%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term). Most prevalent pulmonary sequelae, neurologic disorders, mental health disorders, functional mobility impairments, and general and constitutional symptoms were chest imaging abnormality (median [IQR], 62.2% [45.8%-76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), general functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]), respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders.
CONCLUSIONS AND RELEVANCE
In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.
Topics: COVID-19; Fatigue; Humans; Lung Diseases; Mental Disorders; Mobility Limitation; Muscle Weakness; Nervous System Diseases; Survivors
PubMed: 34643720
DOI: 10.1001/jamanetworkopen.2021.28568 -
Journal of Clinical Anesthesia Dec 2022Intraoperative hypotension (IOH) is common in noncardiac surgery and is associated with serious postoperative complications. Hypotension Prediction Index (HPI) has shown... (Review)
Review
Intraoperative hypotension (IOH) is common in noncardiac surgery and is associated with serious postoperative complications. Hypotension Prediction Index (HPI) has shown high sensitivity and specificity for predicting hypotension and may reduce IOH in noncardiac surgery. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the applications and effects of HPI in reducing hypotension during noncardiac surgery. We comprehensively searched the PubMed, Embase, Cochrane Library, Google Scholar, and http://ClinicalTrials.gov databases to identify RCTs conducted before May 2022. The primary outcome measures were the time-weighted average (TWA) of hypotension and the area under the hypotensive threshold (65 mmHg). Secondary outcomes were the incidence and duration of hypotension and the percentage of hypotensive time during surgery. The Cochrane Risk of Bias (RoB) tool was used to assess the quality of selected studies. We conducted data synthesis for median differences and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We included five studies with a total of 461 patients. Limited evidence suggested that HPI-guided intraoperative hemodynamics management leads to lower a) TWA of hypotension (median of difference of medians [MDM], -0.27 mmHg; 95% confidence interval [CI], -0.38, -0.01), b) area under the hypotensive threshold (MDM, -60.28 mmHg*min; 95% CI, -74.00, -1.30), c) incidence of hypotension (MDM, -4.50; 95% CI, -5.00, -4.00), d) total duration of hypotension (MDM, -12.80 min; 95% CI, -16.11, -3.39), and e) percentage of hypotension (MDM, -5.80; 95% CI, -6.65, -4.82) than routine hemodynamic management during noncardiac surgery. However, only very low- to low-quality evidence on the benefit of intraoperative HPI-based hemodynamic management is available. Our review revealed that HPI has the potential to reduce the occurrence, duration, and severity of IOH during noncardiac surgery compared to standard intraoperative care with proper adherence to the protocol. Systematic review registration PROSPERO CRD42022333834.
Topics: Humans; Hypotension; Postoperative Complications; Time Factors
PubMed: 36242978
DOI: 10.1016/j.jclinane.2022.110981 -
Neuro-oncology Jun 2021Patients with metastatic breast cancer (MBC) are living longer, but the development of brain metastases often limits their survival. We conducted a systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patients with metastatic breast cancer (MBC) are living longer, but the development of brain metastases often limits their survival. We conducted a systematic review and meta-analysis to determine the incidence of brain metastases in this patient population.
METHODS
Articles published from January 2000 to January 2020 were compiled from four databases using search terms related to breast cancer, brain metastasis, and incidence. The overall and per patient-year incidence of brain metastases were extracted from studies including patients with human epidermal growth factor receptor-2 positive (HER2+), triple negative, and hormone receptor (HR)+/hormone receptor negative (HER2-) MBC; pooled overall estimates for incidence were calculated using random effects models.
RESULTS
937 articles were compiled, and 25 were included in the meta-analysis. Incidence of brain metastases in patients with HER2+ MBC, triple negative MBC, and HR+/HER2- MBC was reported in 17, 6, and 4 studies, respectively. The pooled cumulative incidence of brain metastases was 31% for the HER2+ subgroup (median follow-up: 30.7 months, IQR: 24.0-34.0), 32% for the triple negative subgroup (median follow-up: 32.8 months, IQR: 18.5-40.6), and 15% among patients with HR+/HER2- MBC (median follow-up: 33.0 months, IQR: 31.9-36.2). The corresponding incidences per patient-year were 0.13 (95% CI: 0.10-0.16) for the HER2+ subgroup, 0.13 (95%CI: 0.09-0.20) for the triple negative subgroup, and only 0.05 (95%CI: 0.03-0.08) for patients with HR+/HER2- MBC.
CONCLUSION
There is a high incidence of brain metastases among patients with HER2+ and triple negative MBC. The utility of a brain metastases screening program warrants investigation in these populations.
Topics: Brain Neoplasms; Breast Neoplasms; Female; Humans; Incidence; Receptor, ErbB-2; Triple Negative Breast Neoplasms
PubMed: 33367836
DOI: 10.1093/neuonc/noaa285 -
Journal of Hematology & Oncology Mar 2023TP53 mutations, which are present in 5% to 10% of patients with acute myeloid leukemia (AML), are associated with treatment resistance and poor outcomes. First-line... (Meta-Analysis)
Meta-Analysis
BACKGROUND
TP53 mutations, which are present in 5% to 10% of patients with acute myeloid leukemia (AML), are associated with treatment resistance and poor outcomes. First-line therapies for TP53-mutated (TP53m) AML consist of intensive chemotherapy (IC), hypomethylating agents (HMA), or venetoclax combined with HMA (VEN + HMA).
METHODS
We conducted a systematic review and meta-analysis to describe and compare treatment outcomes in newly diagnosed treatment-naïve patients with TP53m AML. Randomized controlled trials, single-arm trials, prospective observational studies, and retrospective studies were included that reported on complete remission (CR), CR with incomplete hematologic recovery (CRi), overall survival (OS), event-free survival (EFS), duration of response (DoR), and overall response rate (ORR) among patients with TP53m AML receiving first-line treatment with IC, HMA, or VEN + HMA.
RESULTS
Searches of EMBASE and MEDLINE identified 3006 abstracts, and 17 publications describing 12 studies met the inclusion criteria. Random-effects models were used to pool response rates, and time-related outcomes were analyzed with the median of medians method. IC was associated with the greatest CR rate of 43%, and CR rates were 33% for VEN + HMA and 13% for HMA. Rates of CR/CRi were comparable for IC (46%) and VEN + HMA (49%) but were lower for HMA (13%). Median OS was uniformly poor across treatments: IC, 6.5 months; VEN + HMA, 6.2 months; and HMA, 6.1 months. For IC, the EFS estimate was 3.7 months; EFS was not reported for VEN + HMA or HMA. The ORR was 41% for IC, 65% for VEN + HMA, and 47% for HMA. DoR was 3.5 months for IC, 5.0 months for VEN + HMA, and was not reported for HMA.
CONCLUSIONS
Despite improved responses seen with IC and VEN + HMA compared to HMA, survival was uniformly poor, and clinical benefits were limited across all treatments for patients with newly diagnosed, treatment-naïve TP53m AML, demonstrating a significant need for improved treatment for this difficult-to-treat population.
Topics: Humans; Retrospective Studies; Treatment Outcome; Leukemia, Myeloid, Acute; Progression-Free Survival; Mutation; Tumor Suppressor Protein p53; Observational Studies as Topic
PubMed: 36879351
DOI: 10.1186/s13045-023-01417-5 -
The Lancet. Oncology Jul 2022Patients with small-cell lung cancer (SCLC) are at high risk for intracranial metastatic disease (IMD). Although stereotactic radiosurgery (SRS) has supplanted whole... (Meta-Analysis)
Meta-Analysis
Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis.
BACKGROUND
Patients with small-cell lung cancer (SCLC) are at high risk for intracranial metastatic disease (IMD). Although stereotactic radiosurgery (SRS) has supplanted whole brain radiotherapy (WBRT) as first-line treatment for IMD in most solid cancers, WBRT remains first-line treatment for IMD in patients with SCLC. We aimed to evaluate the efficacy of SRS in comparison with WBRT and assess treatment outcomes following SRS.
METHODS
In this systematic review and meta-analysis, we searched MEDLINE, Embase, CENTRAL, and grey literature sources for controlled trials and cohort studies published in English reporting on SRS for IMD treatment in patients with SCLC from inception to March 23, 2022. Studies were excluded that did not report on SRS for IMD secondary to SCLC. Summary data were extracted. The primary outcome was overall survival, presented as pooled hazard ratios (HR) through random-effects meta-analysis for studies comparing SRS with WBRT with or without SRS boost, and as medians for single-arm SRS studies. This study is registered with the Open Science Framework, DOI 10.17605/OSF.IO/8M4HC, and PROSPERO, CRD42021258197.
FINDINGS
Of 3823 identified records, 31 were eligible for inclusion; seven were included in the meta-analysis. Overall survival following SRS was longer than following WBRT with or without SRS boost (HR 0·85; 95% CI 0·75-0·97; n=7 studies; n=18 130 patients), or WBRT alone (0·77; 0·72-0·83; n=7 studies; n=16 961 patients), but not WBRT plus SRS boost (1·17, 0·78-1·75; n=4 studies; n=1167 patients). Using single-arm studies, pooled median overall survival from SRS was 8·99 months (95% CI 7·86-10·16; n=14 studies; n=1682 patients). Between-study heterogeneity was considerable when pooled among all comparative studies (I=71·9%).
INTERPRETATION
These results suggest survival outcomes are equitable following treatment with SRS compared with WBRT in patients with SCLC and IMD. Future prospective studies should focus on tumour burden and differences in local and distant intracranial progression between WBRT-treated and SRS-treated patients with SCLC.
FUNDING
None.
Topics: Brain; Brain Neoplasms; Combined Modality Therapy; Cranial Irradiation; Humans; Lung Neoplasms; Prospective Studies; Radiosurgery; Small Cell Lung Carcinoma
PubMed: 35644163
DOI: 10.1016/S1470-2045(22)00271-6