Cochrane Central Register Of Controlled Trails Research Articles

A Systematic Review on Comparison between Otago Exercise Program and Balance Exercise in Balance and Fall Risk among elderly with Knee Osteoarthritis

Background: Patients with knee osteoarthritis have balance issues and an increased fall risk; nevertheless, it is unclear whether the Otago exercise programme (OEP) or balance exercise will improve balance and reduce fall risk among individuals with knee osteoarthritis. Therefore, there is a need to compare the effectiveness of these exercises in treating knee osteoarthritis. This review aims to investigate the effects of an OEP and balance exercise programme to improve balance and reduce fall risk among the elderly population with knee osteoarthritis (OA). Methodology: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to conduct this systematic review. Four databases (PubMed, Cochrane central register of controlled trails (CENTRAL), Physiotherapy Evidence Database (PEDro), and Science Direct) were searched until September 2022 using predefined terms by two independent reviewers. The methodological quality of the studies was assessed using PEDro. All literature published from each source was selected according to the inclusion and exclusion criteria, and data extraction was performed independently with the outcomes of the Berg balance scale (BBS), time up and go test (TUG), chair stand test (CST), and short falls efficacy scale (SFES I). RESULT: The literature review studied seven full-text articles that met the selection criteria and PRISMA guidelines. Those articles were reviewed by grouping them into five different sub-groups based on the interventions. The quality of studies ranged from good (5 studies) to fair (2 studies). The improvement in balance and fall risk prevention following OEP and balance training showed mixed results, and the findings from this review may form the basis for a future systematic research program. CONCLUSION: It is difficult to conclude clear evidence-based recommendations for Otago exercise programmes and balance exercises in improving balance and reducing fall risk among the elderly population with knee OA due to limited availability and weak evidence. KEYWORDS: Fall risk, community dwelling older adults, elderly population, knee osteoarthritis.

Clinical Outcomes and Complications of the Zadek Calcaneal Osteotomy in Insertional Achilles Tendinopathy: A Systematic Review and Meta-analysis

Category: Hindfoot; Ankle Introduction/Purpose: Insertional Achilles Tendinopathy (IAT) is a degenerative process at the insertion of Achilles tendon onto the calcaneal tuberosity that often coexists with retrocalcaneal bursitis and Haglund’s deformity. The Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with IAT that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT. Methods: PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95% confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4). Results: Ten studies with 232 patients were included. The AOFAS (American Orthopaedic Foot and Ankle Society) Ankle- Hindfoot Score and the VISA-A score (Victorian Institute of Sports of Australia-Achilles score) were significantly improved after the Zadek osteotomy (p < 0.00001). Pain levels were also significantly reduced (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia. Conclusion: The Zadek osteotomy is a safe and effective procedure for patients with IAT. The osteotomy improves pain levels and functions and is associated only with minor complications and a low complication rate. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this.

Comparison of discover cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical degenerative disc diseases: A meta-analysis of prospective, randomized controlled trials.

This study aims to evaluate the clinical efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) in Cervical degenerative disc diseases. Two researchers independently conducted a search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trails (CENTRAL) for randomized controlled trials (RCTs) following the Cochrane methodology guidelines. A fixed-effects or random-effects model was applied based on different heterogeneity. Review Manager (Version 5.4.1) software was used to perform data analysis. A total of 8 RCT studies were included in this meta-analysis. The results indicate that the DCDA group had a higher incidence of reoperation (P = 0.03) and a lower incidence of ASD (P = 0.04) than the CDA group. There was no significant difference between two groups regarding NDI score (P = 0.36), VAS ARM score (P = 0.73), VAS NECK score (P = 0.63), EQ-5D score (P = 0.61) and dysphagia incidence (0.18). DCDA and ACDF have similar results in terms of NDI scores, VAS scores, EQ-5D scores, and dysphagia. In addition, DCDA can reduce the risk of ASD but increases the risk of reoperation.

Amputation versus Reconstruction in Severe Lower Extremity Injury: A Systematic Review and Meta-Analysis.

Cases of severe lower limb injuries that previously were amenable only to amputation can now, in certain circumstances, be managed with reconstruction. The present systematic review and meta-analysis was designed to compare the results of amputation and reconstruction in severe lower extremity injuries. PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were comprehensively searched for studies comparing amputation and reconstruction for severe lower extremity injuries. The search terms used were the following: "amputation", "reconstruction", "salvage", "lower limb", "lower extremity", and "mangled limb", "mangled extremity", "mangled foot". Two investigators screened eligible studies, assessed the risk of bias and extracted the data from each study. Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4). The I2 index was used to assess heterogeneity. Fifteen studies with 2,732 patients were included. Amputation is associated with lower rehospitalization rates, lower length of stay in the hospital, lower number of operations and additional surgery and fewer cases of infection and osteomyelitis. Limb reconstruction leads to faster return to work and lower rates of depression. The outcomes with respect to function and pain are variable among the studies. Statistically significance was achieved only with regards to rehospitalization and infection rates. This meta-analysis suggests that amputation yields better outcomes in variables during the early postoperative period, while reconstruction is associated with improved outcomes in certain long-term parameters. Severe lower limb injuries should be managed on their individual merit. The results of this study may be a useful tool to aid in the decision-making for the treating surgeon. High-quality Randomized Controlled Studies are still required to further our conclusions.

Predictability and Clinical Stability of Barrier Membranes in Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

The adjunctive use of GTR membranes helps us to achieve predictable periodontal regeneration. The aim of this systematic review was to evaluate and compare the treatment efficacy of resorbable versus non-resorbable barrier membranes used in guided tissue regeneration in the treatment of intrabony defects in chronic periodontitis patients. The following databases were searched: Medline, the Cochrane Central Register of Controlled Trails (CENTRAL), SCOPUS, EMBASE. Randomized clinical trials (RCTs) published in English languages over the past 25 years were included. The primary outcomes assessed were: change of probing pocket depth (PD), change in clinical attachment level (CAL) and gingival recession coverage (GRC), and intrabony defect fill (IBDF). A total of eight RCTs were included for systematic review. The outcome of GR at a six-month interval revealed a significant difference in treatment effect with a mean difference of 0.42, 95% CI [0.02, 0.81]; Z = 2.09, (p = 0.04) favouring the resorbable membrane group. The intrabony defect depth fill at a 12-month interval revealed a significant difference in treatment effect with MD of 0.79, p = 0.00001; favoring the resorbable membrane group. The resorbable membrane showed a significant improvement in gingival recession coverage and intrabony defect fill, owing to its advantage of avoiding the second surgical intervention.

Primary prophylaxis for venous thromboembolism in ambulatory cancer patients: a systematic review and network meta-analysis.

Ambulatory cancer patients carry a high risk of venous thromboembolism (VTE). However, the optimal prophylaxis strategy remains controversial. This meta-analysis compared the effectiveness and safety of apixaban, rivaroxaban, low molecular weight heparin (LMWH), semuloparin, aspirin, and warfarin for the prevention of VTE in ambulatory cancer patients. A systematic review and network meta-analysis was performed. PubMed, the Cochrane Central Register of Controlled Trails (CENTRAL) and EMBASE electronic databases were searched from inception to 26 April 2019. In the meta-analysis, 19 randomized controlled trials (RCTs) in ambulatory cancer patients administrated venous thromboprophylaxis agents were included. The primary outcome was the risk of VTE. Safety outcomes included the occurrence of major-bleeding. Two investigators identified the studies and performed data extraction. A network meta-analysis was performed and agents were ranked using cumulative ranking (SUCRA) probabilities. We identified 19 studies, including 11,430 patients comparing 10 interventions. Compared to placebo controls, apixaban (5 mg) showed the highest efficacy for the prevention of VTE [odds ratio (OR) 0.36, 95% confidence interval (CI): 0.18-0.71, SUCRA=69.5] and was more effective than LMWH (OR 0.5, 0.39-0.63; SUCRA=52.1) or warfarin (OR 0.75, 95% CI: 0.35-1.59; SUCRA=25.6). Moreover, the safety of apixaban (5 mg) (OR 1.41, 95% CI: 0.33-5.93; SUCRA=58.5) was higher than LMWH (OR 1.96, 95% CI: 0.99-3.86; SUCRA=44.1) or warfarin (OR 3.06, 95% CI: 1.03-9.08; SUCRA=29.1). There were no significant differences between placebo and experimental groups in terms of patient deaths. Anticoagulation therapies in ambulatory cancer patients can significantly reduce the risk of VTE. However, this protective effect was associated with a significantly increased risk of major bleeding. Apixaban at the appropriate dose can decrease the risk of VTE without increasing the bleeding risk. These findings require validation in larger study cohorts.

Moxibustion therapy for treating patients with primary osteoporosis: A systematic review and meta-analysis protocol.

Background:Primary osteoporosis (POP) is a common disease among elderly, which increase the risk of fracture and impact to the quality of life. As a Chinese traditional therapy, moxibustion has been commonly applied in treating chronic musculoskeletal diseases in China. Many trails have shown that moxibustion therapy is effective in treating primary osteoporosis. The protocol aims to present the methods used to access the effectiveness and safety of moxibustion therapy for patients with primary osteoporosis.Methods:The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trails(CENTRAL), Pubmed, EMBASE, China National Knowledge Infrastructure(CNKI), Chinese Biomedical Literature Database(CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomized controlled trials related to moxibustion therapy for treating primary osteoporosis will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. We will select the fixed-effects or random-effects model according to the heterogeneity assessment for data synthesis. Bone mineral density(BMD) will be the primary outcomes. Visual analogue scale(VAS), response rate, TCM Syndrome scale(TCMSS), bone gla protein(BGP), alkaline phosphatase(BALP), blood calcium(Ca), blood phosphate(P), quality of life(QOL) will be the second outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference(WMD) or standard mean difference (SMD) 95% CIs for continuous data.Trial registration number:PROSPERO CRD42019129507

Clinical values of preemptive therapy versus universal prophylaxis in the prevention of cytomegalovirus infection post kidney transplantation: a systematic review and Meta-analysis

Objective To evaluate the clinical efficacy of preemptive therapy versus universal prophylaxis in prevention of cytomegalovirus(CMV) infection post kidney transplantation. Methods Databases including the PubMed, EMbase, sinoMed, Web of Knowledge, the Cochrane Central Register of Controlled Trails (CENTRAL) and other databases were searched up to December 2016 for controlled clinical studies which involved preemptive therapy and universal prophylaxis. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) was performed using Review Manager 5.3 software to synthesize the results. Results 11 studies with a total of 2 560 patients were included in this Meta-analysis. Results showed that universal prophylaxis was superior to preemptive therapy in the total CMV infection and CMV disease(OR=3.38, 95%CI 2.13-5.36, P<0.001; OR=1.69, 95%CI 1.14-2.48, P=0.008), otherwise it was on the contrary in the late onset CMV infection and CMV disease (OR=0.07, 95%CI 0.02~0.19, P<0.001; OR=0.08, 95%CI 0.01-0.60, P=0.01). However, there was no significance in the short outcomes between the two groups including 1-year recipient and graft survival and renal function. In addition, preemptive therapy was superior to universal prophylaxis in the adverse events (OR=0.33, 95%CI 0.15-0.72, P=0.006). Conclusions There was no significant difference between the two prophylaxis in the prevention of CMV infection, but preemptive therapy was superior to universal prophylaxis in the prevention of anti-virus adverse effects. Key words: Kidney transplantation; Cytomegalovirus infection; Preemptive therapy; Universal prophylaxis; Meta-analysis

Can high-flow nasal cannula reduce the rate of reintubation in adult patients after extubation? A meta-analysis

BackgroundThe effects of high flow nasal cannula (HFNC) on adult patients after extubation remain controversial. We aimed to further determine the effectiveness of HFNC in comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT).MethodsThe Pubmed, Embase, Medline, Cochrane Central Register of Controlled Trails (CENTRAL) as well as the Information Sciences Institute (ISI) Web of Science were searched for all the controlled study comparing HFNC with NIPPV and COT in adult patients after extubation. The primary outcome was rate of reintubation and the secondary outcomes were intensive care unit (ICU) mortality and length of ICU stay (ICU LOS).ResultsEight trials with a total of 2936 patients were pooled in our final studies. No significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with lower rate of reintubation (Z = 2.97, P = 0.003), and the same result was found in the comparison between HFNC and NIPPV (Z = 0.87, P = 0.38). As for the ICU mortality and ICU LOS, we did not find any advantage of HFNC over COT or NIPPV.ConclusionsIn patients after extubation, HFNC is a reliable alternative of NIPPV to reduce rate of reintubation compared with COT.

Self-Management Intervention for Adult Cancer Survivors After Treatment: A Systematic Review and Meta-Analysis

This study aims to evaluate the effects of self-management interventions (SMIs) for cancer survivors who completed primary treatment. . Using PubMed, EMBASE, CINAHL®, PsycINFO®, and Cochrane Central Register of Controlled Trails (CENTRAL), the authors conducted a systematic search of randomized, controlled trials published in English from database conception through June 2016. . The meta-analysis was conducted with Cochrane Review Manager, version 5.3, and R program, version 3.3.1. . 12 studies were systematically reviewed for self-management content, mode of delivery, session composition, and type of self-management skills used. Then, a meta-analysis of nine randomized, controlled trials involving 2,804 participants was conducted comparing SMIs with usual care, attention control, and a waitlist group. Qualitative synthesis showed that (a) the major study population was comprised of breast cancer survivors; (b) SMIs focused on medical/behavioral and emotional management; (c) the most common mode of delivery was web-based; and (d) the most frequently evaluated outcomes were depression, self-efficacy, and health-related quality of life (HRQOL). Quantitative results demonstrated a significant medium effect on HRQOL and a large effect on fatigue of borderline significance. The effects on anxiety, depression, and self-efficacy were not statistically significant. . SMIs had a significant medium effect on HRQOL for cancer survivors post-treatment, but the findings should be interpreted with caution because of substantial heterogeneity. In addition, the small number of studies limits conclusions. . SMI as a nursing intervention for improving HRQOL of cancer survivors can be recommended, but more research should be undertaken to determine the most effective SMI format in terms of type, mode of delivery, and session composition.

PS 14-34 LCZ696 COMPARED WITH ANGIOTENSIN II RECEPTOR BLOCKERS FOR PATIENTS WITH HYPERTENSION

Objective: LCZ696 an angiotensin receptor neprilysin inhibitor has great advantages in the treatment of heart failure. However, limited data evaluated the efficacy of LCZ696 on controlling the blood pressure (BP). This meta-analysis aim to evaluate the effects of LCZ696 on systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour ambulatory blood pressure, BP control rate, and adverse events (serious and non-serious) versus renin-angiotensin-system inhibitor or other anti-hypertension medicines in patients with primary hypertension. Design and Method: We searched the Cochrane Central Register of Controlled Trails (CENTRAL), EMBASE and PubMed for randomized controlled trials between January 1990 and December 2015. Fourteen studies with 7153 patients were included. The blood pressure and adverse effects in patients with hypertension were used as evaluation indicators. Results: The results showed that LCZ696 was more effective in lowing SBP (SMD = −8.06 mmHg; 95%CI, −14.91–1.21; P < 0.01), DBP (SMD = −6.52 mmHg; 95%CI, −7.95–5.10; P < 0.01), 24-h-ABPM (SMD = −9.18 mmHg; 95%CI, −10.23–8.12, P < 0.01) than Placebo. LCZ696 was more effective in reducing SBP (SMD = −4.652 mmHg; 95%CI, −10.72–1.42; P < 0.01), DBP (SMD = −2.012 mmHg; 95%CI, −2.46–1.56; P < 0.01), 24h-ABMP (SMA = −3.052 mmHg; 95%CI, −4.37–1.72; P < 0.01) compared with ARBs. LCZ696 has a better effect on blood pressure control compared to ARB (OR = 1.50; 95%CI, 1.32–1.71; P < 0.01). There was no significant difference with adverse events incidence between LCZ696 and ARB (OR = 0.92; 95%CI, 0.77–1.10; P < 0.01). For the different dose of LCZ696, the SBP (SMD = 2.70 mmHg; 95%CI, 1.55–3.86; P < 0.01), DBP (SMD = 0.64 mmHg; 95%CI, 0.12–1.15; P < 0.01). High-dose LCZ696 has a better blood pressure control rate (OR = 0.85; 95%CI, 0.75–0.96; P < 0.01).). Conclusions: This meta-analysis suggested that the anti-hypertensive effect of LCZ696 might be superior to an angiotensin II receptor blocker. Comparisons did not show significant effects on the incidences of adverse events. However, most studies included only have shorter follow-up period (eight weeks), further prospective studies assessing the efficacy and safety of LCZ696, especially with different dosages, are needed.

Light therapy for preventing seasonal affective disorder.

Light therapy for preventing seasonal affective disorder.

The efficacy and safety of low-molecular-weight heparin use for cancer treatment: A meta-analysis

BackgroundLow-molecular-weight heparin (LMWH) has an anti-tumour effect in-vitro and in animal models of malignancy; however, the evidence from clinical trials is controversial. Thus, we performed a meta-analysis from the results of randomised controlled trials (RCTs) to assess LMWH efficacy and safety in cancer patients who had no venous thromboembolism (VTE). MethodsWe searched the MEDLINE, EMBASE and CENTRAL (The Cochrane Central Register of Controlled Trails) databases covering all papers published up until April 2012. Two reviewers (D. H. Che and J. Y. Cao) extracted the data independently. The inclusion criteria used were patients with cancer who had no VTE and were treated with LMWH. The outcomes of interest included the 1-year mortality rate, VTE, bleeding and major bleeding complications. The results were presented as a relative risk (RR), and the STATA 11.0 package was used for comprehensive quantitative analysis. ResultsA total of 11 studies with 3835 cases and 3449 controls were included. The meta-analysis showed significant differences in the rates of bleeding with an RR: 1.32 [95% confidence interval (95% CI, 1.08–1.62)] and VTE with an RR: 0.53 (95% CI, 0.42–0.67) in cancer patients when LMWH was compared with placebo or no anticoagulant. There were no significant differences in the 1-year mortality rate with an RR: 0.97 (95% CI, 0.92–1.02) and major bleeding with an RR: 1.22 (95% CI, 0.87–1.71). ConclusionLMWH does not significantly reduce the 1-year mortality rate for cancer patients. Although LMWH can prevent VTE, we should consider the risk-effect ratio (in case of an increased bleeding event) when we use LMWH in the patients with cancer. Thus, further research is still needed to confirm these results.

Cannabis use and oral diseases

Medline and the Cochrane Central register of controlled trails (CENTRAL). Randomised Controlled Trials, Controlled Clinical Trials and Cohort Studies conducted on humans investigating cannabis usage were included. Screening was performed independently by two reviewers. Only English language studies were included. Case reports, letters and historical reviews were excluded. A narrative synthesis was conducted. Seven studies were included and a range of cannabis-associated oral side effects identified. Based on the limited data, it seems justified to conclude that with increasing prevalence of cannabis use, oral health care providers should be aware of cannabis-associated oral side effects such as xerostomia, leukoedema and an increased prevalence and density of Candida albicans.

Effect of cannabis usage on the oral environment: a review

To evaluate oral environmental changes in cannabis users. The MEDLINE and Cochrane Central register of controlled trails (CENTRAL) were searched up to April 2007 to identify appropriate studies. Independent screening of 982 titles and abstracts (MEDLINE-Pubmed) and (Cochrane) papers resulted in seven eligible publications. Based on the limited data, it seems justified to conclude that with increasing prevalence of cannabis use, oral health care providers should be aware of cannabis-associated oral side effects, such as xerostemia, leukoedema and an increased prevalence and density of Candida albicans.