Impact of Preoperative Stenting on the Outcome of Flexible Ureterorenoscopy for Upper Urinary Tract Urolithiasis: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-9
Author(s):  
Omar Fahmy ◽  
Hadi SHSM ◽  
CKS Lee ◽  
Mohd Ghani Khairul-Asri
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Ureteral Injury ◽  
Risk Of Bias ◽  
Perioperative Outcomes ◽  
Current Debate ◽  
Ureteral Access Sheath ◽  
Flexible Ureterorenoscopy ◽  
Patient Counselling ◽  
Bias Assessment

<b><i>Purpose:</i></b> This study aimed to investigate the effect of preoperative stenting (POS) on the perioperative outcomes of flexible ureterorenoscopy (fURS). <b><i>Materials and Methods:</i></b> A systematic review and meta-analysis was conducted based on the PRISMA statement. From the initially retrieved 609 reports, we excluded the ineligible studies at 2 stages. We only included studies that contained fURS patients with and without POS in the same report. Data of patients who underwent semirigid ureteroscope only were excluded from the analysis. The Newcastle-Ottawa Scale (NOS) system was applied for risk of bias assessment. <b><i>Results:</i></b> A total of 20 studies including 5,852 patients were involved. 48.5% of the patients had preoperative stent. Stone-free rate was significantly higher with prestenting; odds ratio (OR) was 1.98 (95% CI: 1.51–2.58) (<i>Z</i> = 5.02; <i>p</i> = 0.00001). It also displayed tendency toward lower complications; OR was 0.74 (95% CI: 0.52–1.05) (<i>Z</i> = 1.67; <i>p</i> = 0.09). POS significantly increased the use of ureteral access sheath; OR was 1.49 (95% CI: 1.05–2.13) (<i>Z</i> = 2.22; <i>p</i> = 0.03). Risk of bias assessment showed 13 and 7 studies with low and moderate risk, respectively. <b><i>Conclusions:</i></b> POS clearly improves the stone-free rates after fURS. It might reduce the complications, especially ureteral injury. These findings might help solve the current debate and can be useful for urologists during patient counselling for a proper decision-making.

scholarly journals Behaviour change interventions for the management of Raynaud's phenomenon: a systematic review protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017039 ◽  
Author(s):  
Jo Daniels ◽  
John D Pauling ◽  
Christopher Eccelston
Keyword(s):  
Systematic Review ◽  
Behaviour Change ◽  
Raynaud’S Phenomenon ◽  
Meta Analysis ◽  
Grey Literature ◽  
Raynaud's Phenomenon ◽  
Risk Of Bias ◽  
Bias Assessment ◽  
Behaviour Change Interventions

IntroductionRaynaud's phenomenon (RP) describes excessive peripheral vasospasm to cold exposure and/or emotional stress. RP episodes are associated with digital colour changes, pain and reduced quality of life. Pharmacological interventions are of low to moderate efficacy and often result in adverse effects such as facial flushing and headaches. Recommended lifestyle and behavioural interventions have not been evaluated. The objectives of the proposed systematic review are to assess the comparative safety and efficacy of behaviour change interventions for RP and identify what we can learn to inform future interventions.Methods and analysisStudies eligible for inclusion include randomised controlled trials testing behaviour change interventions with a control comparator. A comprehensive search strategy will include peer review and grey literature up until 30 April 2017. Search databases will include Medline, Embase, PsychINFO and Cochrane. Initial sifting, eligibility, data extraction, risk of bias and quality assessment will be subject to review by two independent reviewers with a third reviewer resolving discrepancies. Risk of bias assessment will be performed using Cochrane risk of a bias assessment tool with quality of evidence assessed using Grading of Recommendations Assessment, Development and Evaluation(GRADE). A meta-analysis will be performed if there are sufficient data. Two subgroup analyses are planned: primary versus secondary RP outcomes; comparison of theoretically informed interventions with pragmatic interventions.Ethics and disseminationThis review does not require ethical approval as it will summarise published studies with non-identifiable data. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Findings will be disseminated in peer-reviewed articles and reported according to PRISMA. This review will make a significant contribution to the management of RP where no review of behaviour-change interventions currently exist. The synopsis and protocol for the proposed systematic review is registered in the International Prospective Register of Systematic Reviews (registration number CRD42017049643).

scholarly journals Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034554
Author(s):  
Zhihan Chen ◽  
Rui Wang ◽  
Min Zhang ◽  
Yitong Wang ◽  
Yulan Ren
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Opioid Use Disorder ◽  
Risk Of Bias ◽  
Control Group ◽  
Opioid Use ◽  
Bias Assessment ◽  
Assess Quality ◽  
Randomised Controlled

IntroductionOpioid use disorder (OUD) is a worldwide health problem. Clinical trials indicated that acupuncture combined with medication is effective in OUD, however, there are different conclusions presented by previous trials. This study is designed to evaluate the efficacy and safety of acupuncture combined with medication in OUD.Methods and analysisPubMed, CENTRAL, Embase, Web of Science, CINAHL, PsycINFO, ProQuest Dissertation and Theses, AMED, OpenGrey, Clinicaltrials.gov and who.int/trialsearch will be searched in September 2019 without a language restriction. Randomised controlled trials (RCTs) and quasi-RCTs which included participants with OUD receiving acupuncture therapy combined with medication versus control group will be included in this study. Two reviewers will independently screen studies, extract data, assess risk of bias by the Cochrane risk of bias assessment tool and assess quality of evidence by Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Any disagreements will be arbitrated by the third reviewer. Data synthesis and analysis will be conducted by using RevMan V.5.3. Subgroup analyses, sensitivity analysis, meta-regression and reporting bias assessment will be conducted if necessary and appropriate.Ethics and disseminationOn account of the nature of this systematic review and meta-analysis, ethical approval is not required. The results will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019123436.

scholarly journals Sex differences in vancomycin-resistant enterococci bloodstream infections—a systematic review and meta-analysis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Carlos L. Correa-Martínez ◽  
Franziska Schuler ◽  
Stefanie Kampmeier
Keyword(s):  
Systematic Review ◽  
Sex Differences ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Prevalence Ratio ◽  
Risk Of Bias ◽  
Control Measures ◽  
Bias Assessment ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Abstract Background Vancomycin-resistant enterococci (VRE) have emerged in the healthcare setting worldwide. Infections with these pathogens, i.e., bloodstream infections (BSI), are accompanied with an impaired patient outcome. Diverse factors comprising patient characteristics, therapeutic strategies, and infection control measures are positively or negatively associated with VRE BSI occurrence. However, whether sex-specific differences influence the frequency of VRE BSI is yet unknown. The aim of this systematic review was to comprehensively summarize and analyze sex prevalence in VRE BSI patients. Main text A systematic search for relevant articles was conducted in PubMed and Web of Science. After screening for eligibility, data extraction from included articles and risk of bias assessment were processed. The prevalence of male/female sex in VRE BSI patients and 95% CI were calculated for each study and summarized as pooled estimated effect. In total, nine articles met the inclusion criteria. Risk of bias assessment resulted in low (six studies) to moderate bias (three studies). The pooled prevalence of male patients suffering from VRE BSI was 59% resulting in a 1.4 male/female prevalence ratio. Conclusions Current literature suggests sex differences with male preference (59%) in the distribution of VRE BSI cases. Further primary studies should address the question of male-specific factors favoring the enhanced frequency of VRE BSI.

scholarly journals The efficacy of antibiotics to control colibacillosis in broiler poultry: a systematic review

2019 ◽  
Vol 20 (2) ◽  
pp. 263-273
Author(s):  
Jan M. Sargeant ◽  
Michele D. Bergevin ◽  
Katheryn Churchill ◽  
Kaitlyn Dawkins ◽  
Bhumika Deb ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Antibiotic Use ◽  
Conversion Ratio ◽  
Risk Of Bias ◽  
Feed Conversion Ratio ◽  
Feed Conversion ◽  
Bias Assessment ◽  
Alternative Product

AbstractThe objective of this systematic review was to evaluate the efficacy of antibiotics to prevent or control colibacillosis in broilers. Studies found eligible were conducted controlled trials in broilers that evaluated an antibiotic intervention, with at least one of the following outcomes: mortality, feed conversion ratio (FCR), condemnations at slaughter, or total antibiotic use. Four electronic databases plus the gray literature were searched. Abstracts were screened for eligibility and data were extracted from eligible trials. Risk of bias was evaluated.Seven trials reported eligible outcomes in a format that allowed data extraction; all reported results for FCR and one also reported mortality. Due to the heterogeneity in the interventions and outcomes evaluated, it was not feasible to conduct meta-analysis.Qualitatively, for FCR, comparisons between an antibiotic and an alternative product did not show a significant benefit for either. Some of the comparisons between an antibiotic and a no-treatment placebo showed a numerical benefit to antibiotics, but with wide confidence intervals. The risk-of-bias assessment revealed concerns with reporting of key trial features.The results of this review do not provide compelling evidence for or against the efficacy of antibiotics for the control of colibacillosis.

scholarly journals MON-154 Inhaled Corticosteroids and Adrenal Insufficiency: A Meta-Analysis and Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Aurelie Pare ◽  
Michael Tsoukas
Keyword(s):  
Systematic Review ◽  
Adrenal Insufficiency ◽  
Inhaled Corticosteroids ◽  
Meta Analysis ◽  
Systemic Effect ◽  
Risk Of Bias ◽  
Inhaled Corticosteroid ◽  
Delivery Method ◽  
Acth Stimulation ◽  
Bias Assessment

Abstract Inhaled corticosteroids have been associated with adrenal insufficiency in adult and pediatric populations¹,². When inhaled corticosteroids are absorbed orally, they can have a systemic effect. Corticosteroid type, particle size, delivery method, liver metabolism via CYP 3A4, protein binding, and half-life all impact the magnitude of the systemic effect of inhaled corticosteroids³. We conducted a systematic review and meta-analysis in order to establish the prevalence of adrenal insufficiency among adult patients taking inhaled corticosteroids. We searched the PubMed, Embase and Cochrane databases for “adrenal insufficiency” AND “inhaled corticosteroids”, yielding 318 search results. We also hand-searched the references of relevant articles. In total, 30 studies were included in our meta-analysis. Amongst these, 15 studies were RCTs and 13 studies were cross-sectional studies. All of these studies used ACTH stimulation testing to diagnose adrenal insufficiency. Risk of bias assessment was completed for all studies using the Cochrane risk of bias assessment tool. Patients with asthma were the population examined in 90% of the included studies. Prevalence of adrenal insufficiency demonstrated by ACTH stimulation testing varied from under 5% to up to 55% among different studies. We recommend that further studies carefully examine and report the clinical impact of abnormal ACTH stimulation testing results, the concomitant use of oral corticosteroids, and the impact of the inhaled corticosteroid delivery method, the corticosteroid type, the corticosteroid dosage, and the duration of therapy. References: 1. Lapi F, Kezouh A, Suissa S, Ernst P. The use of inhaled corticosteroids and the risk of adrenal insufficiency. Eur Respir J. 2013;42(1)-79-86. 2. Goldbloom EB, Mokashi A, Cummings EA, et al. Symptomatic adrenal suppression among children in Canada. Arch Dis Child. 2017;102(4)-338-339. 3. Ahmet A, Kim H, Spier S. Adrenal suppression- A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy Asthma Clin Immunol. 2011;7-13.

scholarly journals Association between periodontal disease and osteoporosis in postmenopausal women: a protocol for systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049277
Author(s):  
Jing Qi ◽  
E Liu ◽  
Yu-Feng Guo ◽  
Jie-Mei Hu ◽  
Yu-Ting Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Periodontal Disease ◽  
Postmenopausal Women ◽  
Effect Size ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Forest Plot ◽  
Publication Date ◽  
Cochrane Central Register ◽  
Bias Assessment

IntroductionPeriodontal disease and osteoporosis are common chronic diseases, especially for the postmenopausal women. Several original studies explore the association, but there still controversial. Therefore, we will conduct this systematic review and meta-analysis to assess the association between periodontal disease and osteoporosis in postmenopausal women.Methods and analysisThis study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols. We will systematically search Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science and Scopus from inception to August 2021 to collect all relevant publications, with no restrictions on publication date or languages. Study selection, data extraction and risk of bias assessment will be conducted independently by two trained reviewers independently. The Cochrane’s tool for assessing risk of bias, Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality will be used for the risk of bias assessment. OR, HR and risk ratio with 95% CI were considered as the effect size for dichotomous outcomes, weighted mean difference with 95% CI were calculated as the effect size for continuous outcomes. Random-effects models will be used. Heterogeneity between studies will be assessed via the forest plot and I². Publication bias will detected by funnel plots, Begg’s test and Egger’s test. The subgroup analyses and sensitivity ananlyses will also be used to explore and interpret the heterogeneity.Ethics and disseminationThis study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.PROSPERO registration numberCRD42021225746.

scholarly journals Does advance contact with research participants increase response to questionnaires: A Systematic Review and meta-Analysis

2021 ◽  
Author(s):  
Benjamin Woolf ◽  
Phil Edwards
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Eligibility Criteria ◽  
Bias Assessment ◽  
Response Data ◽  
Randomised Control Trials ◽  
Study Participants ◽  
The Impact

AbstractBackgroundQuestionnaires remain one of the most common forms of data collection in epidemiology, psychology and other human-sciences. However, results can be badly affected by non-response. One way to potentially reduce non-response is by sending potential study participants advance communication. The last systematic review to examine the effect of questionnaire pre-notification on response is ten years old, and lacked a risk of bias assessment.ObjectivesUpdate Edwards et al. (2009) to include 1) recently published studies, 2) an assessment of risk of bias.MethodsData sources: Edwards et al. (2009); 13 data-bases; the references in, and citations of included studies. Eligibility criteria: Randomised control trials examining the impact of pre-notification on response. Data extraction: data extraction was done twice by a single unblinded reviewer. Risk of bias was assessed using the Cochrane Risk of Bias tool and funnel plots.Results103 trials were included. Over-all pre-notification increased response, OR = 1.38 (95%CI: 1.25-1.53). However, when studies at high or unclear risk of bias were excluded the effect was greatly reduced (OR = 1.11, 95% CI: 1.01-1.21).ConclusionsThe evidence implies that while pre-notification does increase response rates, this may not be of clinical utility.

scholarly journals Comparative efficacy and acceptability of different antihypertensive drug classes for cardiovascular disease prevention: protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044302
Author(s):  
Heidi Jussil ◽  
Anna Chaimani ◽  
Bo Carlberg ◽  
Mattias Brunström
Keyword(s):  
Systematic Review ◽  
Antihypertensive Drug ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Major Adverse Cardiovascular Events ◽  
Bias Assessment ◽  
Drug Classes ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Impact

IntroductionClinical practice guidelines differ in their recommendations on first-line antihypertensive drug classes. No adequately powered randomised controlled trial have assessed all major drug classes against each other, and previous meta-analyses have mainly relied on pairwise meta-analyses for treatment comparisons.Methods and analysisA systematic review and network meta-analysis will be carried out to assess the efficacy and acceptability of all major antihypertensive drug classes. PubMed and CENTRAL were searched on 21 February 2020 to identify randomised controlled trials with at least 1000 person-years of follow-up, assessing any antihypertensive agent against other agents or placebo. All trials fulfilling the inclusion criteria will be assessed for risk of bias using the second version of Cochrane’s risk of bias assessment tool. The study selection process, risk of bias assessment and data extraction are done by two authors in duplicate. Relative risks from individual trials will be combined in pairwise meta-analyses; in the absence of important intransitivity, random-effects network meta-analysis will be performed. The primary outcome for efficacy will be major adverse cardiovascular events, whereas the primary acceptability outcome will be treatment discontinuation for any reason. Additional outcomes include all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, heart failure and acute renal failure. The impact of differences within drug classes will be explored through alternative networks, including analysing thiazide-like and thiazide-type diuretics separately.Ethics and disseminationThis review will only process aggregated study level data and does not require ethical approval. The findings will be published in a peer-reviewed medical journal.PROSPERO registration numberCRD42020205482.

Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data

2019 ◽  
Vol 54 (2) ◽  
pp. 94-101 ◽  
Author(s):  
Fionn Büttner ◽  
David R Howell ◽  
Clare L Ardern ◽  
Cailbhe Doherty ◽  
Catherine Blake ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dual Task ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Mean Difference ◽  
Individual Participant Data ◽  
Bias Assessment ◽  
Sports Concussion ◽  
Individual Participant ◽  
Task Assessment

ObjectivesTo determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment .DesignSystematic review and meta-analysis using individual participant data (IPD).Data sourcesThe search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017.Eligibility criteria for study selectionStudies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case–control matching.Data extraction and synthesisOur review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a ‘one-stage’, random-effects model.Results26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference −0.0039 m; 95% CI: −0.0075 to −0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion.Summary/conclusionsOur IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7–10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion.Protocol pre-registrationThis systematic review was prospectively registered in PROSPERO CRD42017064861.

scholarly journals Bias as a source of inconsistency in ivermectin trials for COVID-19: A systematic review

2021 ◽  
Author(s):  
Ariel Izcovich ◽  
Sasha Peiris ◽  
Martín Ragusa ◽  
Fernando Tortosa ◽  
Gabriel Rada ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Risk Difference ◽  
Risk Of Bias ◽  
Viral Clearance ◽  
Bias Assessment ◽  
Symptom Resolution ◽  
Evidence Review ◽  
Grade Approach

Background and purpose The objective of this systematic review is to summarize the effects of ivermectin for the prevention and treatment of patients with COVID-19 and to assess inconsistencies in results from individual studies with focus on risk of bias due to methodological limitations. Evidence review We searched the L.OVE platform through July 6, 2021 and included randomized trials (RCTs) comparing ivermectin to standard or other active treatments. We conducted random-effects pairwise meta-analysis, assessed the certainty of evidence using the GRADE approach and performed sensitivity analysis excluding trials with risk of bias. Results We included 29 RCTs which enrolled 5592 cases. Overall, the certainty of the evidence was very low to low. Compared to standard of care, ivermectin may reduce mortality, may increase symptom resolution or improvement, may increase viral clearance, may reduce infections in exposed individuals and may decrease hospitalizations (Risk difference (RD) 21 fewer per 1000, 95%CI: 35 fewer to 4 more). However, after excluding trials classified as ″high risk″ or ″some concerns″ in the risk of bias assessment, most estimates of effect changed substantially: Compared to standard of care, low certainty evidence suggests that ivermectin may not significantly reduce mortality (RD 7 fewer per 1000, 95%CI: 77 fewer to 108 more) nor mechanical ventilation (RD 6 more per 1000, 95%CI: 43 fewer to 86 more), and moderate certainty evidence shows that it probably does not significantly increase symptom resolution or improvement (RD 14 more per 1000, 95%CI: 29 fewer to 71 more) nor viral clearance (RD 12 fewer per 1000, 95%CI: 84 fewer to 76 more). It is uncertain if ivermectin increases or decreases severe adverse events and symptomatic infections in exposed individuals. Conclusions and Relevance Ivermectin may not improve clinically important outcomes in patients with COVID-19 and its effects as a prophylactic intervention in exposed individuals are uncertain. Previous reports concluding significant benefits associated with ivermectin are based on potentially biased results reported by studies with substantial methodological limitations. Further research is needed.

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