scholarly journals Metatarsal Head Resections in Diabetic Foot Patients: A Systematic Review

2020 ◽  
Vol 9 (6) ◽  
pp. 1845 ◽  
Author(s):  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Josep M. García-Alamino ◽  
Yolanda García-Álvarez ◽  
Francisco Javier Álvaro-Afonso ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Diabetic Foot ◽  
Observational Studies ◽  
Meta Analysis ◽  
Case Series ◽  
Metatarsal Head ◽  
Inclusion Criteria ◽  
Heterogeneity Test ◽  
Meta Analyses

A systematic review and proportional meta-analysis were carried out to investigate the complications that occur after surgical metatarsal head resection in diabetic foot patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist recommendations were applied, and the selected studies were evaluated using a Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. PubMed (Medline) and Embase (Elsevier) were searched in December 2019 to find clinical trials, cohort studies, or case series assessing the efficacy of the metatarsal head resection technique in diabetic foot patients. The systematic review covered 21 studies that satisfied the inclusion criteria and included 483 subjects. The outcomes evaluated were the time to heal, recurrence, reulceration, amputation, and other complications. The proportion of recurrence was 7.2% [confidence interval (CI) 4.0–10.4, p < 0.001], that of reulceration was 20.7% (CI 11.6–29.8, p < 0.001), and that of amputation was 7.6% (CI 3.4–11.8, p < 0.001). A heterogeneity test indicated I2 = 72.6% (p < 0.001) for recurrences, I2 = 94% (p < 0.001) for reulcerations, and I2 = 79% (p < 0.001) for amputations. We conclude that metatarsal head resections in diabetic foot patients are correlated with significant complications, especially reulceration.

scholarly journals Prevalence of Splanchnic Vein Thrombosis in Pancreatitis: A Systematic Review and Meta-Analysis of Observational Studies

2015 ◽  
Vol 2015 ◽  
pp. 1-23 ◽  
Author(s):  
Wenda Xu ◽  
Xingshun Qi ◽  
Jiang Chen ◽  
Chunping Su ◽  
Xiaozhong Guo
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Meta Analysis ◽  
Splenic Vein ◽  
Inclusion Criteria ◽  
Splanchnic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Pooled Prevalence ◽  
Meta Analyses ◽  
Acute And Chronic Pancreatitis

Splanchnic vein thrombosis (SVT) may be negatively associated with the prognosis of pancreatitis. We performed a systematic review and meta-analysis of literatures to explore the prevalence of SVT in pancreatitis. All observational studies regarding the prevalence of SVT in pancreatitis were identified via PubMed and EMBASE databases. The prevalence of SVT was pooled in the total of patients with pancreatitis. And it was also pooled in the subgroup analyses according to the stage and causes of pancreatitis, location of SVT, and regions where the studies were performed. After the review of 714 studies, 44 studies fulfilled the inclusion criteria. Meta-analyses showed a pooled prevalence of SVT of 13.6% in pancreatitis. According to the stage of pancreatitis, the pooled prevalence of SVT was 16.6% and 11.6% in patients with acute and chronic pancreatitis, respectively. According to the causes of pancreatitis, the pooled prevalence of SVT was 12.2% and 14.6% in patients with hereditary and autoimmune pancreatitis. According to the location of SVT, the pooled prevalence of portal vein, splenic vein, and mesenteric vein thrombosis was 6.2%, 11.2%, and 2.7% in pancreatitis. The prevalence of SVT in pancreatitis was 16.9%, 11.5%, and 8.5% in Europe, America, and Asia, respectively.

Arthrodesis of First Metatarsophalangeal Joint by Plate and Screws for Treatment of Hallux Rigidus (Systematic Review and Meta-Analysis)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ossama Abdelraoof El Shazly ◽  
Mohamed Mokhtar Abdellah ◽  
Mostafa Abdelnabee Abouzaid
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Superficial Infection ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Meta Analyses

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

scholarly journals Vaccines to prevent COVID-19: a protocol for a living systematic review with network meta-analysis including individual patient data (The LIVING VACCINE Project)

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Steven Kwasi Korang ◽  
Sophie Juul ◽  
Emil Eik Nielsen ◽  
Joshua Feinberg ◽  
Faiza Siddiqui ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Individual Patient Data ◽  
Viral Vector ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Serious Adverse Events ◽  
Meta Analyses ◽  
Harmful Effects

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) which has rapidly spread worldwide. Several human randomized clinical trials assessing potential vaccines are currently underway. There is an urgent need for a living systematic review that continuously assesses the beneficial and harmful effects of all available vaccines for COVID-19. Methods/design We will conduct a living systematic review based on searches of major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify relevant randomized clinical trials. We will update the literature search once a week to continuously assess if new evidence is available. Two review authors will independently extract data and conduct risk of bias assessments. We will include randomized clinical trials comparing any vaccine aiming to prevent COVID-19 (including but not limited to messenger RNA; DNA; non-replicating viral vector; replicating viral vector; inactivated virus; protein subunit; dendritic cell; other vaccines) with any comparator (placebo; “active placebo;” no intervention; standard care; an “active” intervention; another vaccine for COVID-19) for participants in all age groups. Primary outcomes will be all-cause mortality; a diagnosis of COVID-19; and serious adverse events. Secondary outcomes will be quality of life and non-serious adverse events. The living systematic review will include aggregate data meta-analyses, trial sequential analyses, network meta-analyses, and individual patient data meta-analyses. Within-study bias will be assessed using Cochrane risk of bias tool. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Confidence in Network Meta-Analysis (CINeMA) approaches will be used to assess certainty of evidence. Observational studies describing harms identified during the search for trials will also be included and described and analyzed separately. Discussion COVID-19 has become a pandemic with substantial mortality. A living systematic review assessing the beneficial and harmful effects of different vaccines is urgently needed. This living systematic review will regularly inform best practice in vaccine prevention and clinical research of this highly prevalent disease. Systematic review registration PROSPERO CRD42020196492

scholarly journals Impact of Non-Confinement Accommodation on Farrowing Performance: A Systematic Review and Meta-Analysis of Farrowing Crates Versus Pens

Animals ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 957 ◽  
Author(s):  
Dannielle Glencorse ◽  
Kate Plush ◽  
Susan Hazel ◽  
Darryl D’Souza ◽  
Michelle Hebart
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Web Of Science ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Literature Searches ◽  
Piglet Mortality ◽  
Partial Confinement ◽  
Meta Analyses ◽  
Piglet Survival

There are conflicting reports regarding the effect of farrowing house accommodation on piglet performance. The aim of this investigation was to use a systematic review and meta-analyses to summarise the results of publications that focused on direct comparisons between full confinement conventional crates and various designs of loose-housed farrowing pens from loading until weaning. Literature searches in Scopus, BIOSIS Previews, Cab Abstracts, and Web of Science identified 6695 articles. Twenty-two publications were retained for the systematic review and individual meta-analyses after screening for inclusion criteria. The random effects meta-analyses were performed on crate versus pen for number of piglets born alive, number of stillborn piglets, pre-weaning mortality, and number of piglets weaned. Additionally, the modifiers of confinement length (no confinement from loading until weaning or partial confinement for shorter periods of time in the early stages post parturition), enrichment (no enrichment or enrichment provided), and pen size (small, medium, or large) were examined. There was a 14% increase in the relative risk of piglet mortality in farrowing pens when they were compared with crates (p = 0.0015). The number of stillborns per litter was not different between the pen and crate. However, when providing enrichment in the pens, there was an increase in stillborns within farrowing crates versus pens (p = 0.009). There was no overall effect on piglets that were born alive or number weaned. As there is no difference between piglets born alive and mortality is significantly higher in farrowing pens, a reduction in the number of piglets weaned was expected but not observed, which was possibly due to the lack of weaning details provided in the publications. This was the first systematic review and meta-analysis conducted on the performance of farrowing accommodation and identified that farrowing pens do compromise post-natal piglet survival. Future efforts should focus on improving sow comfort in the farrowing crate to maximize both piglet and sow welfare.

scholarly journals Comparative clinical trials in psychotherapy: Have large effects been replicated?

2020 ◽  
Vol 29 ◽  
Author(s):  
Nickolas D. Frost ◽  
Thomas W. Baskin ◽  
Bruce E. Wampold
Keyword(s):  
Clinical Trials ◽  
Treatment Efficacy ◽  
Literature Search ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Depression And Anxiety ◽  
Inclusion Criteria ◽  
Average Quality ◽  
Meta Analyses

Abstract Aims The purpose of this review is to examine the replication attempts of psychotherapy clinical trials for depression and anxiety. We focus specifically on replications of trials that exhibit large differences between psychotherapies. The replicability of these trials is especially important for meta-analysis, where the inclusion of false-positive trials can lead to erroneous conclusions about treatment efficacy. Methods Standard replication criteria were developed to distinguish direct from conceptual replication methodologies. Next, an exhaustive literature search was conducted for published meta-analyses of psychotherapy comparisons. Trials that exhibited large effects (d > 0.8) were culled from these meta-analyses. For each trial, a cited replication was conducted to determine if the trial had been subsequently replicated by either ‘direct’ or ‘conceptual’ methods. Finally, a broader search was conducted to examine the extent of replication efforts in the psychotherapy literature overall. Results In the meta-analytic search, a total of N = 10 meta-analyses met the inclusion criteria. From these meta-analyses, N = 12 distinct trials exhibited large effect sizes. The meta-analyses containing more than two large effect trials reported evidence for treatment superiority. A cited replication search yielded no direct replication attempts (N = 0) for the trials with large effects, and N = 4 conceptual replication attempts of average or above average quality. However, of these four attempts, only two partially corroborated the results from their original trial. Conclusion Meta-analytic reviews are influenced by trials with large effects, and it is not uncommon for these reviews to contain several such trials. Since we find no evidence that trials with such large effects are directly replicable, treatment superiority conclusions from these reviews are highly questionable. To enhance the quality of clinical science, the development of authoritative replication criteria for clinical trials is needed. Moreover, quality benchmarks should be considered before trials are included in a meta-analysis, or replications are attempted.

scholarly journals Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies

2020 ◽  
Vol 34 (10) ◽  
pp. 107638 ◽  
Author(s):  
Kyrstin L. Lane ◽  
Mohammed S. Abusamaan ◽  
Betiel Fesseha Voss ◽  
Emilia G. Thurber ◽  
Noora Al-Hajri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glycemic Control ◽  
Diabetic Foot ◽  
Observational Studies ◽  
Meta Analysis ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer

scholarly journals Seizures in supratentorial meningioma: a systematic review and meta-analysis

2016 ◽  
Vol 124 (6) ◽  
pp. 1552-1561 ◽  
Author(s):  
Dario J. Englot ◽  
Stephen T. Magill ◽  
Seunggu J. Han ◽  
Edward F. Chang ◽  
Mitchel S. Berger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Case Series ◽  
Seizure Freedom ◽  
Peritumoral Edema ◽  
Treatment And Prevention ◽  
Male Sex ◽  
Meta Analyses ◽  
Tumor Types

OBJECT Meningioma is the most common benign intracranial tumor, and patients with supratentorial meningioma frequently suffer from seizures. The rates and predictors of seizures in patients with meningioma have been significantly under-studied, even in comparison with other brain tumor types. Improved strategies for the prediction, treatment, and prevention of seizures in patients with meningioma is an important goal, because tumor-related epilepsy significantly impacts patient quality of life. METHODS The authors performed a systematic review of PubMed for manuscripts published between January 1980 and September 2014, examining rates of pre- and postoperative seizures in supratentorial meningioma, and evaluating potential predictors of seizures with separate meta-analyses. RESULTS The authors identified 39 observational case series for inclusion in the study, but no controlled trials. Preoperative seizures were observed in 29.2% of 4709 patients with supratentorial meningioma, and were significantly predicted by male sex (OR 1.74, 95% CI 1.30–2.34); an absence of headache (OR 1.77, 95% CI 1.04–3.25); peritumoral edema (OR 7.48, 95% CI 6.13–9.47); and non–skull base location (OR 1.77, 95% CI 1.04–3.25). After surgery, seizure freedom was achieved in 69.3% of 703 patients with preoperative epilepsy, and was more than twice as likely in those without peritumoral edema, although an insufficient number of studies were available for formal meta-analysis of this association. Of 1085 individuals without preoperative epilepsy who underwent resection, new postoperative seizures were seen in 12.3% of patients. No difference in the rate of new postoperative seizures was observed with or without perioperative prophylactic anticonvulsants. CONCLUSIONS Seizures are common in supratentorial meningioma, particularly in tumors associated with brain edema, and seizure freedom is a critical treatment goal. Favorable seizure control can be achieved with resection, but evidence does not support routine use of prophylactic anticonvulsants in patients without seizures. Limitations associated with systematic review and meta-analysis should be considered when interpreting these results.

scholarly journals LO075: Clinical exam for acute aortic dissection: a systematic review and meta-analysis

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S56-S56
Author(s):  
R. Ohle ◽  
H. Kareemi ◽  
J.J. Perry
Keyword(s):  
Systematic Review ◽  
Aortic Dissection ◽  
Neurological Deficit ◽  
Acute Aortic Dissection ◽  
Meta Analysis ◽  
Case Series ◽  
Clinical Findings ◽  
Clinical Suspicion ◽  
Clinical Exam ◽  
Meta Analyses

Introduction: Acute aortic dissection (AAD) is difficult to diagnose and if missed carries a significant mortality rate. Our aim was to assess the accuracy of history, physical exam and plain radiographs compared to advanced imaging in the diagnosis of AAD in adults presenting to the ED with a clinical suspicion of AAD. Methods: We conducted a librarian assisted systematic review. Databases searched: Pubmed, Medline, Embase and the Cochrane database from 1968 to January 2016. No restrictions for language were imposed. Studies were reviewed and data extracted by two independent reviewers. AAD was defined by CTA, MRI or TEE Prospective and retrospective studies of patients presenting with a clinical suspicion of AAD were included. Case series were excluded. Studies were combined if low clinical and statistical heterogeonity (I2<30%). Study quality was assessed using the QUADAS tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 was performed. Results: We identified 792 records: 61 selected for full text review, 13 included and a further 7 from reference searches. 20 studies with 4721 participants were included (mean QUADAS score 12/14 SD 1.2, Kappa 0.8). Prevalence of AAD ranged from 9.6-76.1% (mean 39.1% SD 17.1%). Mean diagnosis in those without AAD varied between studies with ACS (30.3% SD 30.1%), Anuerysm(12.4% SD 9.8%), Chest wall pain(18.1% SD 13.3%) and PE(7.9% SD 7.85%) being the most common. The clinical findings most suggestive of AAD were, neurological deficit (specificity 94% LR 4.1 [95% CI, 3.1-5.2], I2 0%, n=9), hypotension(specificity 94% LR 2.6 [95% CI 1.6-4.2], I2 0%, n=8), pulse deficit (specificity 92% LR 3.4 [95% CI 1.8-6.4], I2 0%, n=9) and syncope (specificity 92% LR 1.4 [95% CI 1.1-1.8], I2 10%, n=6). The most useful for identifying patients less likely to have AAD were an absence of a widened mediastinum (sensitivity 80% LR 0.3 [95% CI 0.2-0.5], I2 20%, n=13) and an AHA Aortic dissection risk score <1 (n=2 sensitivity 91%,99% LR 0.02,0.22, [95% CI 0.003-0.128, 95%CI 0.2-0.3]). Conclusion: Suspicion for AAD should be raised with syncope, hypotension and pulse or neurological deficit in the appropriate clinical setting. Conversely the absence of a widened mediastinum and a low ADD score decreases likelihood. Clinical exam alone cannot rule out acute aortic dissection but it can help risk stratify for further testing.

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