scholarly journals Laser Interstitial Thermal Therapy in Patients with Newly Diagnosed Glioblastoma: A Systematic Review

2021 ◽  
Vol 10 (2) ◽  
pp. 355
Author(s):  
Ilaria Viozzi ◽  
Alis Guberinic ◽  
Christiaan G. Overduin ◽  
Maroeska M. Rovers ◽  
Mark ter Laan
Keyword(s):  
Cost Effectiveness ◽  
Case Series ◽  
Risk Of Bias ◽  
Thermal Therapy ◽  
Newly Diagnosed ◽  
Quality Of Evidence ◽  
Laser Interstitial Thermal Therapy ◽  
Multicenter Randomized Controlled Trial ◽  
Newly Diagnosed Glioblastoma

Background: Laser interstitial thermal therapy (LITT) is a minimal invasive neurosurgical technique for the treatment of brain tumors. Results of LITT have been reported in a case series of patients with deep seated and/or recurrent glioblastoma or cerebral metastases. With this review we aim to summarize the currently available evidence regarding safety and effectiveness of LITT in patients with newly diagnosed glioblastoma (nGBM). Methods: A literature search was performed using electronic databases (PubMed and Embase). Papers were assessed for the methodological quality using the Risk Of Bias In Non- randomised Studies - of Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of the evidence. Results: We identified 835 papers of which only 11 articles were eligible for our review. All papers suffered from serious or critical risk of bias, and the quality of evidence was graded as very low according to the GRADE criteria. None of the studies was randomized and reporting of confounders and other parameters was poor. Median overall survival (OS) ranged from 4.1 to 32 months and progression free survival (PFS) from 2 to 31 months. The mean complication rate was 33.7%. No quality of life or cost-effectiveness data were reported. Conclusions: Due to the low quality of the studies, it is not possible to draw firm conclusions regarding the (cost) effectiveness of LITT in patients with newly diagnosed glioblastoma. The low quality of evidence shows the need for a well-designed prospective multicenter randomized controlled trial.

scholarly journals A Protocol for the Use of Case Reports/Studies and Case Series in Systematic Reviews for Clinical Toxicology

2021 ◽  
Vol 8 ◽  
Author(s):  
Aboubakari Nambiema ◽  
Grace Sembajwe ◽  
Juleen Lam ◽  
Tracey Woodruff ◽  
Daniele Mandrioli ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Human Subjects ◽  
Case Reports ◽  
Case Series ◽  
Risk Of Bias ◽  
Clinical Toxicology ◽  
New Drugs ◽  
Control Group ◽  
Quality Of Evidence

Introduction: Systematic reviews are routinely used to synthesize current science and evaluate the evidential strength and quality of resulting recommendations. For specific events, such as rare acute poisonings or preliminary reports of new drugs, we posit that case reports/studies and case series (human subjects research with no control group) may provide important evidence for systematic reviews. Our aim, therefore, is to present a protocol that uses rigorous selection criteria, to distinguish high quality case reports/studies and case series for inclusion in systematic reviews.Methods: This protocol will adapt the existing Navigation Guide methodology for specific inclusion of case studies. The usual procedure for systematic reviews will be followed. Case reports/studies and case series will be specified in the search strategy and included in separate sections. Data from these sources will be extracted and where possible, quantitatively synthesized. Criteria for integrating cases reports/studies and case series into the overall body of evidence are that these studies will need to be well-documented, scientifically rigorous, and follow ethical practices. The instructions and standards for evaluating risk of bias will be based on the Navigation Guide. The risk of bias, quality of evidence and the strength of recommendations will be assessed by two independent review teams that are blinded to each other.Conclusion: This is a protocol specified for systematic reviews that use case reports/studies and case series to evaluate the quality of evidence and strength of recommendations in disciplines like clinical toxicology, where case reports/studies are the norm.

scholarly journals Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Allen Abbing ◽  
Vasiliki Koretsi ◽  
Theodore Eliades ◽  
Spyridon N. Papageorgiou
Keyword(s):  
Treatment Duration ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Adult Patients ◽  
Comprehensive Treatment ◽  
Orthodontic Appliances ◽  
Duration Of Treatment ◽  
Quality Of Evidence ◽  
Fixed Appliances

Abstract Objectives Adults with fixed orthodontic appliances are increasing nowadays. Compared with adolescents, adults present biological differences that might influence treatment duration. Therefore, the aim of the study was to compare duration of treatment with fixed appliances between adults and adolescents. Materials and methods Eight databases were searched up to September 2019 for randomized and non-randomized clinical studies comparing treatment duration with fixed appliances in adolescents and adult patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane ROBINS-I tool, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE. Results A total of 11 unique studies (one prospective and 10 retrospective non-randomized) with 2969 adolescents and 1380 adult patients were finally included. Meta-analysis of 7 studies found no significant difference in the duration of comprehensive treatment with fixed appliances (MD = − 0.8 month; 95% CI = − 4.2 to 2.6 months; P = 0.65; I2 = 92%) between adults and adolescents. Similarly, both distalization of upper first molars with skeletal anchorage for class II correction and the retraction of canines into the premolar extraction spaces lasted similarly long among adults and adolescents. On the other hand, alignment of palatally displaced canines lasted considerably longer in adults compared to adolescents (1 study; MD = 3.8 months; 95% CI = 1.4 to 6.2 months; P = 0.002). The quality of evidence for the meta-analysis was low due to the inclusion of non-randomized studies with considerable risk of bias. Conclusions While existing evidence does not indicate a difference in the overall duration of treatment with fixed appliances between adults and adolescents, the alignment of palatally displaced canines lasted significantly longer in adults. However, our confidence in these estimates is low due to the risk of bias in the included studies. Trial registration PROSPERO: (CRD42019148169)

scholarly journals A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?

2014 ◽  
Vol 2014 ◽  
pp. 1-28 ◽  
Author(s):  
Faith Donald ◽  
Kelley Kilpatrick ◽  
Kim Reid ◽  
Nancy Carter ◽  
Ruth Martin-Misener ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Nurse Practitioners ◽  
Internal Validity ◽  
Risk Of Bias ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
Education Experience ◽  
The Cost

Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles.Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization).Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012.Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n=11), NP-transition (n=5), NP-inpatient (n=2), CNS-outpatient (n=11), CNS-transition (n=13), and CNS-inpatient (n=1). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity.Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.

scholarly journals Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies

2017 ◽  
Vol 76 (11) ◽  
pp. 1870-1882 ◽  
Author(s):  
Sabrina M Nielsen ◽  
Else M Bartels ◽  
Marius Henriksen ◽  
Eva E Wæhrens ◽  
Henrik Gudbergsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Longitudinal Studies ◽  
Randomised Trial ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Short Term ◽  
Quality Of Evidence

ObjectivesWeight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout.MethodsWe searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.ResultsFrom 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from −168 to 30 μmol/L, and 0%–60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose–response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery.ConclusionsThe available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials).Systematic review registrationPROSPERO, CRD42016037937.

Opportunities to improve reporting of rapid response in health technology assessment

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Matheus O. de Almeida ◽  
Thais Montezuma ◽  
Haliton A. de Oliveira Júnior ◽  
Cleusa Pinheiro Ferri
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Epidemiologic Study ◽  
Health Technology ◽  
Risk Of Bias ◽  
Quality Of Reporting ◽  
Quality Of Evidence ◽  
Health Technologies ◽  
Study Selection

Abstract Introduction Mini health technology assessment (HTA) reports have been used to support policy makers and health systems by providing a timely summary of scientific evidence. The objective of this meta-epidemiologic study was to evaluate the quality of reporting of mini-HTA reports published in Brazil. Methods An electronic search for all mini-HTA reports published between 2014 and March 2019 was conducted in the SISREBRATS and CONITEC databases. The study selection and data extraction were performed by two independent assessors. The following data were extracted: bibliographic data; research question; characteristics of the population, health technologies and outcomes assessed; eligibility criteria; information about searches and study selection; risk of bias assessment; quality of evidence assessment; synthesis of results; and recommendation about the technology evaluated. A descriptive analysis was used to summarize the information retrieved from all the included mini-HTA reports. Results We included 103 mini-HTA reports, the great majority of which (92.3 percent) focused on the coverage of the technologies in the healthcare system, with more than 60 percent being about drugs. Only five mini-HTA reports (4.8 percent) gave reasons for the choice of outcomes, and fifteen (14.5 percent) discriminated between primary and secondary outcomes. All mini-HTAs reported the databases searched and 99 percent of them reported using Medline. Sixty percent of the mini-HTA reported assessing the risk of bias, and 52 percent reported assessing the quality of evidence. Conclusion The quality of reporting of the mini-HTA reports performed in Brazil is insufficient and needs to be improved to guarantee transparency and replicability.

Outpatient total hip arthroplasty does not increase complications and readmissions: a meta-analysis

2020 ◽  
pp. 112070002094879
Author(s):  
Vittorio Bordoni ◽  
Niccolò Marelli ◽  
Davide Previtali ◽  
Paolo Gaffurini ◽  
Giuseppe Filardo ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Complication Rate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Moderate Risk ◽  
Readmission Rates ◽  
Quality Of Evidence ◽  
Total Hip

Background: There is no consensus about the safety of outpatient total hip arthroplasty (THA). Therefore, the purpose of this meta-analysis was to quantitatively evaluate and compare outpatient and inpatient THA studies in terms of complication and readmission rates. Methods: A systematic search of the literature was performed on 26 July 2019 on PubMed, Web of Science, Cochrane library, and on the grey literature databases. The papers thus collected were used for a meta-analysis comparing outpatient and inpatient THA in terms of complication and readmission rates. Risk of bias and quality of evidence were defined according to Cochrane guidelines. The PRISMA guidelines were used to determine which papers to include in this study. Results: The literature search resulted in 2317 articles; of these, 8 articles were used for the meta-analysis. A total of 66,971 patients were included, of which 1428 were THA outpatients. The overall complication rate for outpatient THAs was 3.0%, while inpatient THAs had an overall complication rate of 4.7%. The readmission rate was 1.4% in outpatient THAs and 3.0% in inpatient THAs. Only 6 studies reported the number of deaths, which ranged from 0% to 0.01%. The included studies present a moderate risk of bias and, according to GRADE guidelines, the level of evidence for complications and readmissions is very low. Conclusions: This meta-analysis documented that outpatient THA is a feasible approach since it does not increase complications or readmissions with respect to inpatient THA, but the available studies present a moderate risk of bias and the quality of evidence of these findings is very low. Future high-level studies are needed to confirm results and indications for outpatient THA.

scholarly journals Antidepressant Use and Risk of Venous Thromboembolism: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 22 ◽  
pp. 57-71
Author(s):  
Ying Wang ◽  
Zhikang Ye ◽  
Lihong Liu ◽  
Xiangli Cui
Keyword(s):  
Venous Thromboembolism ◽  
Case Control ◽  
Tricyclic Antidepressant ◽  
Risk Of Bias ◽  
Low Risk ◽  
Case Control Studies ◽  
Quality Of Evidence ◽  
Antidepressant Use ◽  
Grade Approach

Purpose. Studies provided conflicting results on whether antidepressant use increased the risk of venous thromboembolism (VTE). Our aim was to examine the association between antidepressant use and the risk of VTE. Methods. Pubmed, Embase, and the Cochrane Library were searched up to March 13, 2018. Case-control studies and cohort studies that examined the association between antidepressant use and the risk of VTE, deep vein thrombosis or pulmonary embolism were included. Several subgroup analyses and sensitivity analyses were conducted. GRADE approach was used to assess the quality of evidence. Results. Nine studies (six case-control studies and three cohort studies) were included. Overall, antidepressant use may be associated with an increased risk of VTE (OR 1.27, 95% CI 1.09 to 1.49); however, no association was observed in studies with low risk of bias (OR 1.27, 95% CI 0.84 to 1.92). No association between selective serotonin reuptake inhibitor use and VTE risk was detected in the overall analysis (OR 1.10, 95% CI 0.90 to 1.34) and in subgroup analysis of studies with low risk of bias. Tricyclic antidepressant may be associated with an increased VTE risk (OR 1.26, 95% CI 1.02 to 1.57), and the quality of evidence was rated as very low by GRADE approach; however, no association was observed when we only included studies with low risk of bias. Conclusions. There was no association between selective serotonin reuptake inhibitor use and VTE risk. Tricyclic antidepressant may be associated with an increased VTE risk, but the quality of evidence was very low.

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