scholarly journals Is the Sequential Laser Technique for Twin-to-Twin Transfusion Syndrome Truly Superior to the Standard Selective Technique? A Meta-Analysis

2014 ◽  
Vol 37 (4) ◽  
pp. 251-258 ◽  
Author(s):  
Joost Akkermans ◽  
Suzanne H. Peeters ◽  
Frans J. Klumper ◽  
Johanna M. Middeldorp ◽  
Enrico Lopriore ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Meta Analysis ◽  
Group Versus ◽  
Cochrane Library ◽  
Laser Coagulation ◽  
Treatment Technique ◽  
Laser Technique ◽  
Fetal Demise ◽  
Sequential Group ◽  
Sequential Technique

Background and Objective: To investigate the efficacy of sequential laser coagulation in the treatment of twin-to-twin transfusion syndrome (TTTS). Data Sources: MEDLINE, EMBASE and the Cochrane Library were systematically searched for comparative studies on the efficacy of sequential versus standard selective laser coagulation for TTTS. The primary outcome measure in these studies was survival of at least one twin, both twins and fetal demise. Results: Three cohort studies comparing the selective laser treatment technique (n = 120) versus the sequential technique (n = 224) in 344 monochorionic twin pregnancies were included. Mean survival of at least one twin was 88% in the selective group versus 92% (p = 0.22) in the sequential group. Mean survival of both twins was lower in the selective group (52%) than in the sequential group (75%) (p = 0.002). Donor fetal demise decreased from 34% in the selective to 10% in the sequential group (p < 0.01), and recipient fetal demise decreased from 16 to 7% (p = 0.02). Conclusion: Limited evidence suggests improved double neonatal survival as well as decreased donor and recipient fetal demise with the use of the sequential technique. However, these results are based on small non-randomized studies with evident forms of bias and methodological limitations. A randomized controlled trial to assess the efficacy of sequential laser technique is therefore required.

scholarly journals Twenty-Five Years of Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: A Systematic Review

2015 ◽  
Vol 38 (4) ◽  
pp. 241-253 ◽  
Author(s):  
Joost Akkermans ◽  
Suzanne H.P. Peeters ◽  
Frans J. Klumper ◽  
Enrico Lopriore ◽  
Johanna M. Middeldorp ◽  
...  
Keyword(s):  
Systematic Review ◽  
Laser Therapy ◽  
Perinatal Outcome ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Laser Coagulation ◽  
Laser Technique ◽  
The Past ◽  
Time Period ◽  
Perinatal Survival

Objective: The aim of this study was to assess the perinatal outcome of pregnancies with twin-twin transfusion syndrome (TTTS) treated with laser therapy over the past 25 years, and in relation to different techniques used in this time period. Methods: A systematic review of studies reporting on perinatal outcome according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines was conducted. The MEDLINE, Embase and Cochrane Library databases were systematically searched. Comparisons were made in respect to time period and laser technique and Quintero stages. Results: In total, 34 studies reporting on 3,868 monochorionic twin pregnancies were included. The mean survival of both twins increased from 35 to 65% (p = 0.012) and for at least one twin from 70 to 88% (p = 0.009) over the past 25 years. Mean gestational age at birth remained stable over the years at 32 weeks gestation. Also, we showed a significantly improved perinatal survival with the evolution of the laser technique from non-selective to selective, selective sequential and the Solomon technique (p = 0.010). Discussion: Since the introduction of laser therapy for TTTS more than two decades ago, perinatal survival improved significantly. Improved outcome is probably associated with several factors, including evolution of the laser technique, learning curve effect, better referral and improved early neonatal care.

scholarly journals The effect of rTMS in the management of pain associated with CRPS

2020 ◽  
Vol 11 (1) ◽  
pp. 363-370
Author(s):  
Min Cheol Chang ◽  
Sang Gyu Kwak ◽  
Donghwi Park
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Pain Syndrome ◽  
Treatment Session ◽  
Cochrane Library ◽  
Exclusion Criteria ◽  
Analgesic Effects ◽  
Randomized Controlled ◽  
Before And After

AbstractBackgroundTherapeutic management of pain in patients with complex regional pain syndrome (CRPS) is challenging. Repetitive transcranial magnetic stimulation (rTMS) has analgesic effects on several types of pain. However, its effect on CRPS has not been elucidated clearly. Therefore, we conducted a meta-analysis of the available clinical studies on rTMS treatment in patients with CRPS.Materials and methodsA comprehensive literature search was conducted using the PubMed, EMBASE, Cochrane Library, and SCOPUS databases. We included studies published up to February 09, 2020, that fulfilled our inclusion and exclusion criteria. Data regarding measurement of pain using the visual analog scale before and after rTMS treatment were collected to perform the meta-analysis. The meta-analysis was performed using Comprehensive Meta-analysis Version 2.ResultsA total of three studies (one randomized controlled trial and two prospective observational studies) involving 41 patients were included in this meta-analysis. No significant reduction in pain was observed immediately after one rTMS treatment session or immediately after the entire schedule of rTMS treatment sessions (5 or 10 sessions; P > 0.05). However, pain significantly reduced 1 week after the entire schedule of rTMS sessions (P < 0.001).ConclusionrTMS appears to have a functional analgesic effect in patients with CRPS.

scholarly journals Community-based interventions for childhood asthma using comprehensive approaches: a systematic review and meta-analysis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Mei Chan ◽  
Melinda Gray ◽  
Christine Burns ◽  
Louisa Owens ◽  
Susan Woolfenden ◽  
...  
Keyword(s):  
Systematic Review ◽  
Childhood Asthma ◽  
Action Plan ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
Care Utilization ◽  
Community Based Interventions ◽  
Community Based

Abstract Objective We conducted a systematic review and meta-analysis to determine the effectiveness of comprehensive community-based interventions with ≥ 2 components in improving asthma outcomes in children. Methods A systematic search of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), Cochrane Library and hand search of reference collections were conducted to identify any research articles published in English between 2000 and 2019. All studies reporting community-based asthma interventions with ≥ 2 components (e.g., asthma self-management education, home environmental assessment or care coordination etc.) for children aged ≤ 18 years were included. Meta-analyses were performed using random-effects model to estimate pooled odds ratio (OR) with 95% confidence intervals (CIs). Results Of the 2352 studies identified, 21 studies were included in the final analysis: 19 pre-post interventions, one randomised controlled trial (RCT) and one retrospective study. Comprehensive asthma programs with multicomponent interventions were associated with significant reduction in asthma-related Emergency Department (ED) visits (OR = 0.26; 95% CI 0.20–0.35), hospitalizations (OR = 0.24; 95% CI 0.15–0.38), number of days (mean difference = − 2.58; 95% CI − 3.00 to − 2.17) and nights with asthma symptoms (mean difference = − 2.14; 95% CI − 2.94 to − 1.34), use of short-acting asthma medications/bronchodilators (BD) (OR = 0.28; 95% CI 0.16–0.51), and increase use of asthma action plan (AAP) (OR = 8.87; 95% CI 3.85–20.45). Conclusion Community-based asthma care using more comprehensive approaches may improve childhood asthma management and reduce asthma related health care utilization.

scholarly journals Drainage versus No Drainage after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis

2019 ◽  
Vol 85 (1) ◽  
pp. 86-91
Author(s):  
Ming Xu ◽  
You-Liang Tao
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Randomized Clinical Trials ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Wound Infection Rate ◽  
Cochrane Library ◽  
Prophylactic Drainage ◽  
Significant Difference ◽  
The Cochrane Library

To conduct a randomized controlled trial (RCT), meta-analysis to assess the effectiveness of drains in reducing complications after laparoscopic cholecystectomy (LC) for acute cholecystitis needs to be carried out. An electronic search of PubMed, Embase, Science Citation Index, and the Cochrane Library from January 1990 to January 2018 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in LC for acute cholecystitis. The outcomes were calculated as odds ratios (ORs) with 95 per cent confidence intervals (CIs) using RevMan 5.2. Four RCTs, which included 796 patients, were identified for analysis in our study. There was no statistically significant difference in the rate of morbidities (OR = 1.23, 95% CI 0.55–2.76, P = 0.61). Abdominal pain was more severe in the drain group 24 hours after surgery (mean difference = 0.80, 95% CI 0.47–1.14; P < 0.00001). No significant difference was present with respect to wound infection rate and hospital stay. The use of abdominal drainage does not appear to be of any benefit in patients having undergone early LC for acute cholecystitis.

scholarly journals The Effect of Kinesitherapy on Bone Mineral Density in Primary Osteoporosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Shanxi Wang ◽  
Shuzhen Li ◽  
Xing Xie ◽  
Juying Xie
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Primary Osteoporosis ◽  
Mineral Density ◽  
Age Related ◽  
Positive Effect ◽  
Quality Evidence

Objective. Osteoporosis (OP) is a well-established age-related disease, pathologically characterized by bone microarchitectural deterioration, increased fragility, and low BMD. Primary osteoporosis (POP) is the most common type of OP. Methods. Publications pertaining to the effectiveness of kinesitherapy on BMD in POP from PubMed, SCI, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to October 2019. Results. A total of 21 studies with 1840 participants were included. The results of the meta-analysis revealed that kinesitherapy plus antiosteoporosis medications had a positive effect on lumbar spine BMD when the duration of intervention was 6 months (MD = 0.11 g/cm2; 95% CI: 0.06–0.15; P<0.0001) or >6 months (MD = 0.04 g/cm2; 95% CI: 0.02–0.06; P<0.0001) compared with antiosteoporosis medications alone. Additional kinesitherapy plus antiosteoporosis medications were associated with improved femoral neck BMD compared with antiosteoporosis medications alone (MD = 0.09 g/cm2; 95% CI: 0.03–0.16; P=0.004). Conclusions. Kinesitherapy plus antiosteoporosis medications significantly improved lumbar spine and femoral neck BMD in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of kinesitherapy on BMD in patients with POP.

scholarly journals Effect of pretreatment with midazolam on etomidate-induced myoclonus: A meta-analysis

2017 ◽  
Vol 45 (2) ◽  
pp. 399-406 ◽  
Author(s):  
Chengmao Zhou ◽  
Yu Zhu ◽  
Zhen Liu ◽  
Lin Ruan
Keyword(s):  
Incidence Rate ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Group Versus ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Fixed Effects Model ◽  
Control Groups ◽  
Randomized Controlled ◽  
Review Manager

Objective To investigate the effect of pretreatment with midazolam on myoclonus induced by etomidate injection. Methods A meta-analysis was performed using Review Manager software, version 5.2. Two researchers independently searched PubMed, Cochrane Library, and Embase® databases for randomized controlled trials involving patients who underwent etomidate induced general anaesthesia with or without midazolam pretreatment, published between 1990 and 2016. Outcome measures comprised overall myoclonus incidence rate and incidence rate classified by degree of myoclonus following etomidate injection. Data were assessed using a fixed effects model. Results Five studies, comprising 302 patients, were included for analysis. Overall incidence rate of etomidate injection-induced myoclonus was significantly lower in the pooled midazolam group versus controls (relative risk [RR] 0.34, 95% confidence interval [CI] 0.26, 0.44); Results subgrouped by degree of myoclonus showed significantly lower incidence in midazolam groups versus control groups for mild myoclonus (RR 0.56, 95% CI 0.39, 0.80); moderate myoclonus (RR 0.20, 95% CI 0.10, 0.41); and severe myoclonus (RR 0.12, 95% CI 0.04, 0.39). Conclusion Midazolam can effectively prevent etomidate-induced myoclonus, and alleviate the degree of etomidate-induced myoclonus.

scholarly journals Combination between Mifepristone and Methotrexate to Treat Ectopic Pregnancy: A Systematic Review Protocol

2021 ◽  
Author(s):  
Qiling Su ◽  
Huiyan Feng ◽  
Tian Tian ◽  
Xiaoqian Liao ◽  
Yunhui Li ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Control Group ◽  
China National Knowledge Infrastructure ◽  
Advantages And Disadvantages ◽  
Randomized Controlled ◽  
Outcome Index

Background: In recent years, the morbidity of ectopic pregnancy and the proportion of young and childless patients have increased year by year, which makes it important to early diagnose EP, effectively save patients' lives and furthest preserve their fertility. Methotrexate and mifepristone are most widely used in conservative treatments, however, there is no accurate conclusion about which therapy is better. Therefore, the aims in this meta-analysis are, on the one hand, to systematically analyze the efficacy of mifepristone combined with methotrexate in the treatment of ectopic pregnancy through existing studies, and to draw scientific conclusions. On the other hand, to fill the gap of relevant analysis in China and abroad, to evaluate the advantages and disadvantages of inclusion trials and propose improvement measures and scientific designing schemes. Methods: Six electronic databases will be searched, including PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure(CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang Database (WF). Literature from October 2015 to October 2020 on randomized controlled trials will be searched, without any language or publication restriction. Search terms include mifepristone, methotrexate, ectopic pregnancy, and random (free word/synonym expansion). Included in a randomized controlled trial, the treatment group was treated with mifepristone combined with methotrexate, and the control group was treated with mifepristone alone. Revman 5.4 (provided by Cochrane) will be used to evaluate the quality of the literature, and the corresponding effect model will be selected to analyze the results. The cure rate will be the main outcome index, and the remaining outcome measures after literature inclusion will be the secondary outcome indexes. Result: Only when we finish this meta-analysis can we get the result. Discussion: The results of this study will provide reliable evidence for the efficacy of mifepristone combined with methotrexate therapy in the treatment of ectopic pregnancy.

scholarly journals Efficacy and Safety of Proton Therapy for Medulloblastoma Patients: A Mata-Analysis

2022 ◽  
Vol 11 (2) ◽  
pp. 01-07
Author(s):  
Weiping Zhan
Keyword(s):  
Side Effects ◽  
Recurrence Rate ◽  
Proton Therapy ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Quality Criteria ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Prognostic Impact ◽  
Study Materials

Background: Currently, photon therapy is mainly used for radiotherapy, however, the long-term side effects of photon therapy are sometimes reported, especially in children, including cognitive decline, mental decline, growth retardation, endocrine dysfunction and secondary tumor.Compared with photon radiotherapy, proton therapy is a novel method of radiation therapy, which reduces acute and late radiation damage and improves patients’ quality of life. Therefore, we evaluated proton therapy on medulloblastoma patients by meta-analysis in this study. Materials and Methods: A clinical randomized controlled trial was conducted by retrieving the main databases PubMed (Medline), EMbase, Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese Zhi-wang (CNKI), Wanfang Database, and VIP Database. We analyzed the literature which matched the quality criteria for the prognostic impact of proton and photon therapy on medulloblastoma patients. Results: Ten articles were included in this study. The overall survival (OS) rate and side effects were comprehensively analyzed. The results showed that proton radiotherapy significantly reduced the side effects and recurrence rate of tumor. Conclusion: Proton therapy could significantly reduce the side effects and recurrence rate of medulloblastoma in patients.

Efficacy and safety of therapeutic anticoagulation for the treatment of isolated calf muscle vein thrombosis - a systematic review and meta-analysis

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 478-485 ◽  
Author(s):  
Xu-Chen Huang ◽  
Xu-Hua Hu ◽  
Xiao-Ran Wang ◽  
Chao-Xi Zhou ◽  
Gui-Ying Wang
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Small Sample ◽  
Calf Muscle ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
Therapeutic Anticoagulation

Abstract. Background: Diverse treatment suggestions range from monitoring with duplex examinations to therapeutic anticoagulation (TA) for managing isolated calf muscle vein thrombosis (ICMVT). However, the small sample sizes and low-level evidence provided by most studies in the literature mean that the benefits of promising new treatment protocols are unclear. Hence, this meta-analysis is intended to assess the efficacy and safety of TA for patients with ICMVT. Patients and methods: Articles comparing TA with no anticoagulation (NA) or no therapeutic anticoagulation (NTA) in patients with ICMVT were collected from PubMed, the Cochrane Library, EMBASE, and Web of Science. The risk ratio (RR) and 95 % confidence interval (95 % CI) were generated for each outcome of interest. The data were pooled using a random-effects or fixed-effects model to evaluate differences in outcomes between the TA and control groups. Results: Five of 377 initially identified papers were included. One randomized controlled trial, one non-randomized controlled trial and three retrospective cohort studies (a total of 744 patients, 390 in the TA group and the remaining 354 in the NA or NTA group) were included in this meta-analysis. The occurrence of thrombosis progression was significantly less frequent in those who received TA compared with those receiving NTA (RR = 0.33, 95 % CI 0.20 to 0.54, p < 0.01). The rate of complete recanalization was higher, albeit not significantly, in the TA group than in the NTA group (RR = 1.96, 95 % CI 1.01 to 3.80, p = 0.05). None of the pooled outcomes were significantly different when comparing the TA and NA groups. Conclusions: This study suggests that TA may result in a significant reduction in the rate of thrombosis progression and a marginally significant increase in the rate of complete recanalization for patients with ICMVT. Further studies are needed to confirm these findings and clarify whether the benefits of TA outweigh the potential harm.

Effectiveness, efficacy, and safety of wearable cardioverter-defibrillators in the treatment of sudden cardiac arrest – Results from a health technology assessment

2020 ◽  
Vol 36 (4) ◽  
pp. 363-371
Author(s):  
Pamela Aidelsburger ◽  
Janine Seyed-Ghaemi ◽  
Christian Guinin ◽  
Andreas Fach
Keyword(s):  
Cardiac Arrest ◽  
Controlled Trial ◽  
Sudden Cardiac Arrest ◽  
Group Versus ◽  
Comparative Trial ◽  
High Rate ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Appropriate Shocks ◽  
Related Mortality

ObjectivesTo assess the effectiveness, efficacy, and safety of a wearable cardioverter-defibrillator (WCD) in adult persons with high risk for sudden cardiac arrest and for which an implantable cardioverter is currently not applicable.MethodsWe performed a systematic literature search in Medline, Embase, Cochrane Library, and CRD-databases. Study selection was performed by two reviewers independently. Data were presented quantitatively; due to heterogeneity of studies no meta-analysis was performed.ResultsOne randomized-controlled trial (RCT), one non-randomized comparative trial, and forty-four non-comparative trials were included. The RCT reported an overall mortality of 3.1 percent in the WCD group versus 4.9 percent in controls (relative risk [RR]: .64; 95 percent confidence interval [CI], .43–.98, p = .04), but no significant effect on arrhythmia-related mortality. The RR for arrhythmia-related mortality amounted to .67 (95 percent CI, .37–1.21, p = .18) as assessed in the RCT. Appropriate shocks were observed in 1.3 percent of patients in both comparative studies, and inappropriate shocks in .6 percent of patients in the RCT. Termination of ventricular tachycardia (VT) or ventricular fibrillation (VF) was successful in 75 to 100 percent of appropriate shocks in all studies. Adverse events assessed in the RCT showed a lower incidence of shortness of breath (38.8 percent vs. 45.3 percent; p = .004), higher incidence of rash at any location (15.3 percent vs. 7.1 percent; p < .001), and higher incidence of itching at any location (17.2 percent vs. 6.4 percent; p < .001) for WCD.ConclusionsAvailable evidence demonstrates that the WCD detects and terminates VT/VF events reliably and shows a high rate of appropriate shocks in mixed patient populations. Data of large registries confirm that the WCD is a safe intervention.

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