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Journal of Plastic, Reconstructive &... Sep 2022Systematic reviews (SR) and meta-analyses (MA) are described as the top level of evidence in clinical research and are commonplace in plastic surgery literature. Their... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Systematic reviews (SR) and meta-analyses (MA) are described as the top level of evidence in clinical research and are commonplace in plastic surgery literature. Their quality is limited both by the reliability of primary studies and the method of aggregating data. This study analysed the overall quality of SR's in plastic surgery and identified influencing factors.
MATERIALS AND METHODS
The paper critically appraised SR's published in three prominent plastic surgery journals between July 2019 and July 2020. Study selection and appraisal was performed in duplicate. Articles were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR).
RESULTS
Seventy-six studies were included. 52 (68%) were SR's only and 24 (32%) included meta-analysis (MA) as well. The most common subspecialty areas included breast, craniofacial and hand. 78% of studies followed the PRISMA guidelines. The median (min, max) AMSTAR score was 3.5 (0-7). SR's with MA had significantly higher AMSTAR scores (p<0.001) than SR's alone, with median scores of 5 and 3 respectively. Papers from China had significantly higher AMSTAR scores than the USA. Craniofacial SR's had significantly higher scores than all other subspecialty areas. Most SR's reviewed concluded that there is currently inadequate primary research to make a conclusion and recommended more research be carried out in that area.
CONCLUSIONS
This systematicreview found overall that the quality of research methodology in Plastic Surgery SRs is low, and their conclusions of limited value. Surgeons should be familiar with SR and MA methodology, so they can exercise better judgement in applying findings to clinical practice.
Topics: Humans; Periodicals as Topic; Publications; Reproducibility of Results; Research Design; Surgery, Plastic
PubMed: 35970743
DOI: 10.1016/j.bjps.2022.08.004 -
Transplantation Reviews (Orlando, Fla.) Jul 2023This study aimed to evaluate the outcomes of different treatments for patients with hepatocellular carcinoma (HCC) and macroscopic vascular invasion. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study aimed to evaluate the outcomes of different treatments for patients with hepatocellular carcinoma (HCC) and macroscopic vascular invasion.
METHODS
A systematic review and meta-analysis of comparative studies was performed to evaluate various treatment modalities for HCC with macroscopic vascular invasion, including liver resection (LR), liver transplantation (LT), transarterial chemoembolization (TACE), transarterial radioembolization (TARE), radiotherapy (RT), radiofrequency ablation (RFA), and antineoplastic systemic therapy (AnST).
RESULTS
After applying the selection criteria, 31 studies were included. The surgical resection (SR) group (including LR and LT) had a similar mortality rate to the non-surgical resection (NS) group (RD = -0.01; 95% CI -0.05 to 0.03). The SR group had a higher rate of complications (RD = 0.06; 95% CI 0.00 to 0.12) but a higher 3-year overall survival (OS) rate than the NS group (RD = 0.12; 95% CI 0.05 to 0.20). The network analysis revealed that the overall survival was lower in the AnST group. LT and LR had similar survival benefits. The meta-regression suggested that SR has a greater impact on the survival of patients with impaired liver function.
DISCUSSION
Most likely, LT has a significant impact on long-term survival and consequently would be a better option for HCC with macroscopic vascular invasion in patients with impaired liver function. LT and LR offer a higher chance of long-term survival than NS alternatives, although LR and LR are associated with a higher risk of procedure-related complications.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Network Meta-Analysis; Treatment Outcome; Chemoembolization, Therapeutic
PubMed: 37393656
DOI: 10.1016/j.trre.2023.100763 -
Journal of Digestive Diseases Mar 2023Nonvariceal gastrointestinal bleeding (NVGIB) is a common medical condition with significant mortality and morbidity. Several types of hemostatic modalities are... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Nonvariceal gastrointestinal bleeding (NVGIB) is a common medical condition with significant mortality and morbidity. Several types of hemostatic modalities are currently available in clinical setting. This systematic review and network meta-analysis aimed to assess the efficacy of these modalities in treating NVGIB.
METHODS
PubMed, EMBASE, and the Cochrane Library databases were searched for studies that compared the efficacy of different hemostatic techniques (over-the-scope clip [OTSC], hemostatic powder [HP] and conventional endoscopic treatment [CET]) for NVGIB published up to June 2022. The 30-day rebleeding rate was regarded as the primary outcome. We performed pairwise and network meta-analyses for all treatments. The heterogeneity and transitivity were evaluated.
RESULTS
Twenty-two studies were included. Regarding the 30-day rebleeding rate, OTSC and HP plus CET showed superior efficacy in treating NVGIB compared with CET (OTSC vs CET: relative risk [RR] 0.42, 95% confidence interval [CI] 0.28-0.60; HP plus CET vs CET: RR 0.40, 95% CI 0.17-0.87), while OTSC and HP plus CET had comparable efficacy (RR 0.95, 95% CI 0.38-2.31). HP plus CET ranked the highest in the network ranking estimate. The sensitivity analysis showed that it was not robust that OTSC was superior to CET regarding the short-term rebleeding rate and the initial hemostasis rate. While all-cause mortality, bleeding-related mortality and necessity of surgical or angiographic salvage therapy showed no statistically significant difference.
CONCLUSION
OTSC and HP plus CET significantly reduced 30-day rebleeding rate compared to CET and had comparable efficacy in the treatment of NVGIB.
Topics: Humans; Network Meta-Analysis; Gastrointestinal Hemorrhage; Hemostatic Techniques; Endoscopy; Hemostatics; Hemostasis, Endoscopic
PubMed: 37210622
DOI: 10.1111/1751-2980.13191 -
British Journal of Anaesthesia Mar 2024We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency... (Meta-Analysis)
Meta-Analysis Review
Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials.
BACKGROUND
We aimed to evaluate the comparative effectiveness and safety of various i.v. pharmacologic agents used for procedural sedation and analgesia (PSA) in the emergency department (ED) and ICU. We performed a systematic review and network meta-analysis to enable direct and indirect comparisons between available medications.
METHODS
We searched Medline, EMBASE, Cochrane, and PubMed from inception to 2 March 2023 for RCTs comparing two or more procedural sedation and analgesia medications in all patients (adults and children >30 days of age) requiring emergent procedures in the ED or ICU. We focused on the outcomes of sedation recovery time, patient satisfaction, and adverse events (AEs). We performed frequentist random-effects model network meta-analysis and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rate certainty in estimates.
RESULTS
We included 82 RCTs (8105 patients, 78 conducted in the ED and four in the ICU) of which 52 studies included adults, 23 included children, and seven included both. Compared with midazolam-opioids, recovery time was shorter with propofol (mean difference 16.3 min, 95% confidence interval [CI] 8.4-24.3 fewer minutes; high certainty), and patient satisfaction was better with ketamine-propofol (mean difference 1.5 points, 95% CI 0.3-2.6 points, high certainty). Regarding AEs, compared with midazolam-opioids, respiratory AEs were less frequent with ketamine (relative risk [RR] 0.55, 95% CI 0.32-0.96; high certainty), gastrointestinal AEs were more common with ketamine-midazolam (RR 3.08, 95% CI 1.15-8.27; high certainty), and neurological AEs were more common with ketamine-propofol (RR 3.68, 95% CI 1.08-12.53; high certainty).
CONCLUSION
When considering procedural sedation and analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery time is shorter with propofol, patient satisfaction is better with ketamine-propofol, and respiratory adverse events are less common with ketamine.
Topics: Adult; Child; Humans; Propofol; Midazolam; Ketamine; Network Meta-Analysis; Pain; Analgesics, Opioid; Analgesia; Emergency Service, Hospital; Intensive Care Units; Conscious Sedation; Randomized Controlled Trials as Topic
PubMed: 38185564
DOI: 10.1016/j.bja.2023.11.050 -
European Journal of Pharmaceutical... Jul 2022Dissolving microneedles (MN) with enhanced physiochemical properties are generating considerable interest as antibacterial delivery devices, which minimize hazardous... (Review)
Review
Dissolving microneedles (MN) with enhanced physiochemical properties are generating considerable interest as antibacterial delivery devices, which minimize hazardous sharp wastes, injuries, and transmission of blood-borne pathogens. This systematic review demonstrates and analyzes the current state of dissolvable antibacterial MN to establish their efficacy, and the effect of biomaterials selection on their final properties. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three electronic databases Pubmed, Google scholar, and Scopus were explored for peer-reviewed articles. A total of 551 results with 176 citations and 915 references of resulted articles were reviewed and analyzed. No publication date restrictions were imposed. Last search was placed on 9th of June, 2021. The literature search in electronic databases according to the inclusion criteria was funneled down to 20 papers that were related to antibacterial effects of dissolving microneedles. In conclusion, all included dissolving MN studies presented an enhanced or at least an equal antibacterial activity against common bacterial species when compared to conventional treatments. In addition, composition modifications can enhance their activity and performance. Other factors such as the size and geometry of the produced MN can be tailored to conform to the infected site's characteristics.
Topics: Anti-Bacterial Agents; Research Design
PubMed: 35526676
DOI: 10.1016/j.ejps.2022.106202 -
Surgery Aug 2022A systematic review and network meta-analysis was performed to compare outcomes after living donor right hepatectomy via the following techniques: conventional open... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A systematic review and network meta-analysis was performed to compare outcomes after living donor right hepatectomy via the following techniques: conventional open (Open), mini-laparotomy (Minilap), hybrid (Hybrid), totally laparoscopic (Lap), and robotic living donor right hepatectomy (Robotic).
METHODS
PubMed, EMBASE, Cochrane, and Scopus were searched from inception to August 2021 for comparative studies of patients who underwent living donor right hepatectomy.
RESULTS
Nineteen studies comprising 2,261 patients were included. Operation time was longer in Lap versus Minilap and Open (mean difference 65.09 min, 95% confidence interval 3.40-126.78 and mean difference 34.81 minutes, 95% confidence interval 1.84-67.78), and in Robotic versus Hybrid, Lap, Minilap, and Open (mean difference 144.72 minutes, 95% confidence interval 89.84-199.59, mean difference 113.24 minutes, 95% confidence interval 53.28-173.20, mean difference 178.33 minutes, 95% confidence interval 105.58-251.08 and mean difference 148.05 minutes, 95% confidence interval 97.35-198.74, respectively). Minilap and Open were associated with higher blood loss compared to Lap (mean difference 258.67 mL, 95% confidence interval 107.00-410.33 and mean difference 314.11 mL, 95% confidence interval 143.84-484.37) and Robotic (mean difference 205.60 mL, 95% confidence interval 45.92-365.28 and mean difference 261.04 mL, 95% confidence interval 84.26-437.82). Open was associated with more overall complications compared to Minilap (odds ratio 2.60, 95% confidence interval 1.11-6.08). Recipient biliary complication rate was higher in Minilap and Open versus Hybrid (odds ratio 3.91, 95% confidence interval 1.13-13.55 and odds ratio 11.42, 95% confidence interval 2.27-57.49), and lower in Open versus Minilap (OR 0.07, 95% confidence interval 0.01-0.34).
CONCLUSION
Minimally invasive donor right hepatectomy via the various techniques is safe and feasible when performed in high-volume centers, with no major differences in donor complication rates and comparable recipient outcomes once surgeons have mounted the learning curve.
Topics: Hepatectomy; Humans; Laparoscopy; Laparotomy; Length of Stay; Living Donors; Network Meta-Analysis; Operative Time; Postoperative Complications; Robotic Surgical Procedures
PubMed: 35644687
DOI: 10.1016/j.surg.2022.03.042 -
Cardiovascular Research Feb 2024Resistant hypertension is associated with a high risk of cardiovascular disease, chronic kidney disease, and mortality. Yet, its management is challenging. This study... (Meta-Analysis)
Meta-Analysis
AIMS
Resistant hypertension is associated with a high risk of cardiovascular disease, chronic kidney disease, and mortality. Yet, its management is challenging. This study aims to establish the comparative effectiveness of pharmacologic and interventional treatments by conducting a network meta-analysis.
METHODS AND RESULTS
MEDLINE, Cochrane Register of Controlled Trials, and Web of Science Core Collection were systematically searched in March 2022. Randomized controlled trials comparing treatment options for management of resistant hypertension were included. Outcomes were blood pressure (BP) changes, measured in the office and in 24 h ambulatory BP measurement. We applied a frequentist random effects model to perform a network meta-analysis combining placebo medication and sham procedure as the reference comparator. From 4771 records, 24 studies met the inclusion criteria with 3458 included patients in total. Twelve active treatment alternatives [spironolactone, doxazosin, β-blocker, clonidine, darusentan, guanfacine, various types of renal sympathetic denervation, lifestyle intervention, continuous positive airway pressure, and baroreflex activation therapy (BAT)] were analysed. Among all comparators, spironolactone had the highest ranking probability and was considered the most effective treatment to reduce office systolic blood pressure (sBP) [-13.30 mmHg (-17.89; -8.72); P < 0.0001] and 24 h sBP [-8.46 mmHg (-12.54; -4.38); P < 0.0001] in patients with resistant hypertension. Lifestyle interventions were the most effective non-pharmacological treatment, lowering office sBP by -7.26 mmHg (-13.73; -0.8), whereas BAT lowered office sBP by -7.0 (-18.59; 4.59). Renal denervation lowered office sBP by -5.64 mmHg (-12.95; 1.66) and -3.79 mmHg (-11.39; 3.8) depending on the type of the procedure.
CONCLUSION
Among all pharmacologic and interventional treatments, spironolactone is the most effective treatment in reducing BP in patients with resistant hypertension. More comparative trials and especially trials with long-term follow-up are needed. In the meanwhile, we have to conclude that a combination of spironolactone and lifestyle modification are the most effective treatments in resistant hypertension.
Topics: Humans; Spironolactone; Network Meta-Analysis; Antihypertensive Agents; Hypertension; Blood Pressure; Kidney; Treatment Outcome
PubMed: 37890022
DOI: 10.1093/cvr/cvad165 -
Psychosomatic MedicineAlthough several studies have examined the association between estradiol and human aggression, a consistent understanding of their correlation has yet to be established.... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Although several studies have examined the association between estradiol and human aggression, a consistent understanding of their correlation has yet to be established. This study aimed to investigate this relationship comprehensively.
METHODS
We systematically searched five English databases (PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL) from their inception to June 5, 2023. Two authors independently screened publications and extracted data based on predefined inclusion and exclusion criteria. Statistical analyses were performed using Review Manager 5.4, and a random-effects model was used to pool the data.
RESULTS
We identified 14 eligible studies comprising data from 1820 participants that met the inclusion criteria. This meta-analysis indicated a positive correlation between estradiol and human aggression, albeit a weak one. The pooled Fisher z value was 0.16 (95% confidence interval = 0.05-0.26; I2 = 73%, p <.00001). Furthermore, we found that participants' sex and age, the measures of aggression, and the literature quality might be sources of heterogeneity.
CONCLUSIONS
Human aggression exhibited a weak positive correlation with estradiol concentration, whereas this relationship was influenced by participants' sex and age, the measure of aggression used, and the quality assessment of the literature. Gaining a better understanding of the association between estradiol and aggression could aid in the identification of populations prone to aggression.
Topics: Humans; Aggression; Estradiol; Research Design
PubMed: 37678333
DOI: 10.1097/PSY.0000000000001247 -
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 -
Langenbeck's Archives of Surgery Aug 2023Patients undergoing medical procedures often experience pain and anxiety. These periprocedural outcomes can be overcome by providing a distraction using virtual reality... (Meta-Analysis)
Meta-Analysis
PURPOSE
Patients undergoing medical procedures often experience pain and anxiety. These periprocedural outcomes can be overcome by providing a distraction using virtual reality (VR), decreasing their perception. VR has proved effective in reducing pediatric pain and anxiety; however, limited studies have confirmed its effectiveness in adults. We performed a systematic review and meta-analysis on the effectiveness of VR, as opposed to standard care, in reducing periprocedural pain and anxiety in adults.
METHODS
A systematic search of randomized controlled trials was conducted using the databases of MEDLINE, Cochrane CENTRAL, and Scopus. Trials involving patients (> 18 years) undergoing elective medical procedures conducted with or without local anesthesia and participating in VR therapy were included. Primary outcomes were pre-procedural anxiety, post-procedural anxiety, and intra-procedural pain. Pre-procedural pain, post-procedural pain, and intra-procedural anxiety were secondary outcomes.
RESULTS
Data from 10 studies shortlisted for inclusion revealed no significant association between the use of VR and lower pre-procedural anxiety compared to standard care (p > 0.05) (SMD = -0.02, 95% CI = -0.18 - 0.14, P = 0.81) but demonstrated that the use of VR was significantly associated with a reduction in post-procedural anxiety (SMD = -0.73, 95% CI = -1.08 - -0.39, P < 0.0001), intra-procedural pain (SMD = -0.61, 95% CI = -1.18 - -0.04, P = 0.04), and post-procedural pain (SMD = -0.25, 95% CI = -0.44 - -0.05, P = 0.01).
CONCLUSION
The use of VR caused a significant reduction in post-procedural anxiety, intra-procedural pain, and post-procedural pain in adults undergoing medical procedures, although the findings were insignificant concerning pre-procedural anxiety.
Topics: Child; Humans; Adult; Pain, Procedural; Anxiety; Pain Management; Virtual Reality; Anesthesia, Local
PubMed: 37556082
DOI: 10.1007/s00423-023-03046-5