Studies Of Good Methodological Quality Research Articles

Psychosocial correlates of physical activity in cancer survivors: a systematic review and meta-analysis.

Physical activity (PA) is a non-pharmacological approach to optimize health benefits in cancer survivors and is recommended as part of care. However, most cancer survivors fail to meet PA recommendations. The current systematic review and meta-analysis aimed to identify psychosocial correlates of free-living PA in cancer survivors. Three electronic databases were searched (PubMed, PsycINFO, and SportDiscus). Meta-analyses were conducted for psychosocial correlates tested ≥ 3 times. Sixty-four articles were included. Eighty-eight different free-living PA correlates were identified. Meta-analyses (n = 32 studies) tested 23 PA correlates, of which 16 were significant (p < 0.05). Larger effect sizes (0.30 < ES > 0.45) were found for exercise self-efficacy, perceived behavioral control, intention, lower perceived barriers for exercise, enjoyment, perceived PA benefits, and attitudes. Small-to-moderate effects (0.18 < ES < 0.22) were found for subjective norms, physical functioning, quality of life, depression, and mental health. These findings were generally in line with narrative results. This systematic review highlights important psychosocial correlates of free-living PA that can be targeted in future PA promotion interventions for cancer survivors. Constructs mainly from SCT and TPB were the most studied and appear to be associated with free-living PA in this population. However, we cannot currently assert which frameworks might be more effective. Further studies of better methodological quality, per correlate and theory, exploring longer-term associations and across different types of cancer, are needed. Having higher exercise self-efficacy, perceived behavioral control, intention, enjoyment and perceived PA benefits, more positive attitudes towards PA, and lower perceived barriers for exercise, can help increase PA in cancer survivors.

Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis.

Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible airflow limitation. Patient participation in Pulmonary Rehabilitation (PR) programs has a beneficial effect on disease management, improving patients' functional capacity and quality of life. As an alternative to traditional programs or as a complementary activity, the inclusion of virtual reality (VR) games is proposed. The aim of this research study was to investigate the effectiveness of incorporating VR in the pulmonary rehabilitation program of patients with COPD. A systematic literature search was performed for randomized controlled trials (RCTs) in the electronic databases Google Scholar, PubMed, and Pedro from January 2014 to March 2022. The search involved screening for studies examining the effectiveness of enhancing PR with VR. The PEDro (Physiotherapy Evidence Database) scale was chosen as the tool to assess the quality of studies. A meta-analysis was performed where possible. Six studies were included in this systematic review. The PEDro scale showed five studies of good methodological quality and one of fair quality. The variables examined were: aerobic capacity for exercise, lung function, anxiety and depression, with non-significant improvement for the MRC Dyspnea scale, marginally non-significant improvement regarding 6MWT (p = 0.05) and significant improvement for FEV1 (p < 0.05). There was variability noted in the VR applications and the proposed rehabilitation that the experimental groups followed. The application of VR is recommended for COPD patients, in combination with conventional PR. VR was found to be effective in increasing therapeutic effect and should be considered as a mean of increasing accessibility to PR. Therefore, further research, as well as additional RCTs regarding the effectiveness of VR in patients with COPD, seems necessary.

Treatment of ectopic pregnancy implanted on cesarea scar: cohort study 2018-2022, Lima, Peru

To describe the clinical characteristics and treatment of ectopic pregnancy arising in the cesarean section scar, as well as its complications and obstetric prognosis. Retrospective cohort study of pregnant women with the diagnosis of a scar pregnancy in accordance with Maternal-Fetal Medicine Society criteria, seen between January 2018 and March 2022 in two high complexity institutions of the social security system, located in Lima, Peru. Consecutive sampling was used. Baseline sociodemographic and clinical variables were measured, including diagnosis, type of treatment, complications and obstetric prognosis. A descriptive analysis was performed. Out of 29,919 deliveries, 17 patients were included. Of these, 41.2 % received medical management and the rest were treated surgically. Successful management with intra-gestational sac methotrexate was performed in two patients with ectopic pregnancy type 2. Four patients required total hysterectomy. Six patients became pregnant after the treatment and 4 completed their pregnancy with healthy mother and neonate pairs. Ectopic pregnancy implanted in a cesarean section scar is an infrequent occurrence for which medical and surgical management options are available with apparently good outcomes. Further studies of better methodological quality and random assignment are needed in order to help characterize the safety and effectiveness of the various therapeutic options for women with suspected scar pregnancy.

The effects of aquatic exercises on body functions, activity and participation in children and adolescents with cerebral palsy: a systematic review

Introduction: Aquatic exercises may benefit children and adolescents with cerebral palsy (CP). Nevertheless, there are few studies about the efficacy and safety of those interventions for this population. Therefore, the objective of this study was to perform a systematic review of the effects of aquatic interventions in children and adolescents with CP, considering outcomes related to the body structure, function, activity, and participation; based on the World Health Organization International Classification of Functioning, Disability and Health framework (ICF). Methods: We searched for experimental or quasi-experimental studies about aquatic exercises’ effects on children and adolescents with CP. We used the databases PubMed/MEDLINE, CINAHL, Scielo, LILACS, SPORTDiscus, Cochrane Reviews, Trials, and PEDro, from January 1st, 2011, to December 31st, 2020. In addition, the risk of bias was assessed with the PEDro tool. Results: 10 randomized clinical trials and five quasi-experimental studies were included. The focus was on aerobic activities in children with spastic CP, mainly classified as levels I to III in the Gross Motor Function Classification System (GMFCS), outcomes related to structure and function, and activity. Thirteen studies reported positive effects, but the methodological quality was low. Discussion: Aquatic exercise programs are feasible and demonstrate a positive effect on this population. There is a need for studies of better methodological quality, including children classified as GMFCS V and outcomes based on the domain of participation.

Lattoferrina nella prevenzione delle infezioni: alcune prove di efficacia. I risultati di una revisione sistematica con metanalisi

Lactoferrin in the prevention of infections: some evidence of efficacy. Results of a systematic review with meta-analysis This systematic review included 25 studies including 5 pediatric studies (882 children) to evaluate the effect of lactoferrin (Lf) supplementation on inflammation, immune function, and acute respiratory tract infections. The pediatric studies involved children in the first years of life in whom Lf supplementation was via milk formula at a highly variable dosage ranging from 35 to 833 mg Lf/day. The meta-analysis shows that Lf reduces systemic inflammation and the incidence of respiratory tract infections (VRI) in infants but not in adults. However, 1 of the 3 studies included in the pediatric meta-analysis was judged to be at high risk of bias due to missing data by the authors of another 2021 review that used the Cochrane risk of bias assessment (not adopted in this study) and there is high heterogeneity evidenced by an I2 of 81%. The result of this meta-analysis is not very robust, and further studies of good methodological quality are needed before recommending this type of supplementation to reduce the incidence of VRI in early life.

Iron Salts, High Levels of Hemoglobin and Ferritin in Pregnancy, and Development of Gestational Diabetes: A Systematic Review.

The aim of this study was to systematically review literature on the use of iron supplements (not including iron derived from diet), increased levels of hemoglobin and/or ferritin, and the risk of developing gestational diabetes mellitus (GDM). The following databases were searched, from the study's inception to April 2021: PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl and Lilacs. A total of 6,956 titles and abstracts were reviewed, 9 of which met the final inclusion criteria, with 7,560 women in total. Data extraction was performed by two independent reviewers and disagreements were resolved by a third researcher. Methodological quality in controlled trials were assessed according to the Cochrane Collaboration tools (ROB-2 and ROBINS-1) and for the observational studies, the National Institutes of Health's (NIH) quality assessment tool was used. Among the 5 observational studies, women with a higher hemoglobin or ferritin level were more likely to develop GDM when compared with those with lower levels of these parameters. Among the 3 randomized clinical trials, none found a significant difference in the incidence of GDM among women in the intervention and control groups. However, we identified many risks of bias and great methodological differences among them. Based on the studies included in this review, and due to the important methodological problems pointed out, more studies of good methodological quality are needed to better establish the association between iron supplementation and GDM.

Pelvic physiotherapy in the treatment of female orgasm dysfunction

Background: Among the female sexual dysfunctions, orgasm dysfunctions are highlighted, a topic, however, little studied. Aims: to raise physiotherapeutic techniques that treat female orgasmic dysfunctions, describing the most frequently used. Method: PubMed, Lilacs, PEDro databases were searched for articles published between 2000 and 2016, selected using the following descriptors: physical therapy, female sexual dysfunction, treatment, and its variants in English, including studies published in Portuguese, English and Chinese; clinical trials in women that described treatment for female sexual dysfunctions. Results: 314 articles were found and 15 were included. Conclusion: there are different proposals for physiotherapeutic treatment for anorgasmia suggested in the literature, but their diversity still does not allow a clear conclusion. New studies of better methodological quality on the subject are urgent.

Vitamin D levels and risk of COVID-19 infection: A systematic review

Objective: Consistent independent associations between lowserum 25-hydroxyvitamin D concentrations and susceptibilityto acute respiratory tract infections have suggested apossible involvement of vitamin D in reducing the risk ofrespiratory infections and proposing its replacement as apotential strategy for prevention or treatment in this context.However, the role of vitamin D supplementation in theinfection by the novel coronavirus named SARS-CoV-2 isstill under investigation and no clinical evidence has beenreported to date. Methods: Electronic searches in Pubmed,Embase and Scopus databases were conducted and threecohort studies that analyzed the effects of interaction ofvitamin D with COVID-19, published only in English, wereincluded. Two reviewers, which independently examinedtitles and abstracts, identified records through database searchand reference screening and irrelevant studies were excludedbased in eligibility criteria. Relevant full texts were analyzedfor eligibility, and all relevant studies were included in thesystematic review. Results: Three cohort studies were includedin this systematic review with a mean methodologicalquality low. Only one study demonstrated interaction of lowvitamin D concentration in patients with a positive diagnosisfor COVID-19. Randomized clinical trials and studies of goodmethodological quality are necessary to confirm the findingsof this systematic review. Conclusions: This systematic reviewhas not demonstrated consistent associations between lowlevels of vitamin D and susceptibility to COVID-19 infection.Further studies on vitamin D supplementation for the preventionof COVID-19 infection should be conducted..

Renal Transplantation Improves Erectile Function in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

Erectile dysfunction has a lower prevalence in renal transplant recipients compared to dialysis patients. Despite this observation, the effect of renal transplantation on erectile function remains unknown. We aimed to assess the role of renal transplantation on erectile function and to determine potential factors improving or deteriorating erectile dysfunction. We conducted a systematic review and random effects meta-analysis of observational studies comparing erectile function preoperatively and postoperatively in renal transplant recipients (PROSPERO ID: CRD42020189580). Records reporting relevant outcomes were identified through search of PubMed®, Embase®, Cochrane Library and Scopus® databases from inception to September 2020. Judgment of the strength of evidence was performed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We included 20 studies with 1,695 renal transplant recipients. At postoperative evaluation the number of patients with erectile dysfunction was reduced (RR 1.21, 95% CI 1.02-1.45, I2=88%). Renal transplant recipients reported an improvement in erectile function (RR 2.53, 95% CI 1.44-4.44, I2=90%) and the mean International Index of Erectile Function score increased by 3.04 points (95% CI 0.63-5.45, I2=96%) after renal transplantation. These effects were not demonstrated in the sensitivity analysis. In individuals reporting severe erectile dysfunction, no favorable effect of renal transplantation was observed (RR 1.51, 95% CI 0.85-2.68, I2=33%). For all outcomes the strength of evidence was considered low or very low due to methodological concerns and high heterogeneity among the included studies. Renal transplantation improves erectile function and the risk of erectile dysfunction reduces postoperatively compared to preoperatively. However, evidence on the matter is mostly based on low quality data. More studies with standardized outcomes are needed to validate and strengthen our findings.

888MO Effectiveness of brentuximab vedotin in relapsed/refractory classic Hodgkin lymphoma: A systematic review and meta-analysis

Brentuximab vedotin (BV), an anti-CD30 antibody drug conjugate, was shown to be effective and well-tolerated in relapsed/refractory classic Hodgkin lymphoma (RRcHL) according to a pivotal phase II trial. This study aimed to assess the effectiveness of BV in RRcHL in the real-world. Systematic review of observational studies and meta-analysis based on literature (MEDLINE, Embase, Web of Science), pragmatic searches and snowballing (01/01/2010 – 06/02/2020). Data of interest were patterns of BV use, treatment responses, progression-free survival (PFS), overall survival (OS), and adverse events. Statistical heterogeneity assessed through I2 statistics. Estimates pooled using a random effects model. Primary analysis included only studies of good methodological quality. Publication bias was assessed by a funnel plot. Sensitivity analyses included studies of moderate quality and estimates reported in abstracts. The literature search yielded 2,460 references and pragmatic searches found 21 additional ones. Upon abstract screening and in-depth review, eligibility was confirmed for 32 sources. In 26 sources, the dosing regimen of BV in RRcHL was 1.8 mg/kg every 3 weeks. Median number of cycles administered ranged from 4 to 8, uniformly distributed across studies. In real-world environment, the overall response rate (ORR) to BV based on the revised response criteria for malignant lymphoma ranged from 46.6% to 84.0% (28 sources) with 21.1% to 45.8% patients achieving complete response (26 sources). After 4 cycles, pooled estimate of ORR was 62.6% (95% confidence interval [CI]: 56.0 - 68.9; I2 = 9.5%) while after 4-6 cycles, it was 66.7% (95% CI: 58.5 - 74.5; I2 = 43.9%). Similar results were found in sensitivity analyses. The 1-year, 2-year and 5-year PFS ranged from 52.1% to 63.2% (2 sources), 45.2% to 56.2% (3 sources) and 31.9% to 33.0% (2 sources), respectively. The 1-year, 2-year and 5-year OS ranged from 68.2% to 82.7% (6 sources), 58.0% to 81.9% (7 sources) and 58.0% to 62.0% (2 sources), respectively. The present study corroborates the effectiveness of BV in RRcHL patients managed in the real-world setting by showing results which are consistent with those of the pivotal phase II trial.

Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants.

Lactoferrin, a normal component of human colostrum and milk, can enhance host defenses and may be effective for prevention of sepsis and necrotizing enterocolitis (NEC) in preterm neonates. To assess the safety and effectiveness of lactoferrin supplementation to enteral feeds for prevention of sepsis and NEC in preterm neonates. Secondarily, we assessed the effects of lactoferrin supplementation to enteral feeds on the duration of positive-pressure ventilation, development of chronic lung disease (CLD) or periventricular leukomalacia (PVL), length of hospital stay to discharge among survivors, and adverse neurological outcomes at two years of age or later. We used the standard search strategy of Cochrane Neonatal to update our search. We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 9), MEDLINE via PubMed (1966 to 20 January 2020), PREMEDLINE (1996 to 20 January 2020), Embase (1980 to 20 January 2020), and CINAHL (1982 to 20 January 2020). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. In our search, we included randomized controlled trials (RCTs) evaluating enteral lactoferrin supplementation at any dose or duration to prevent sepsis or NEC in preterm neonates. We used the standard methods of Cochrane Neonatal and the GRADE approach to assess the certainty of evidence. Meta-analysis of data from twelve randomized controlled trials showed that lactoferrin supplementation to enteral feeds decreased late-onset sepsis (typical RR 0.82, 95% CI 0.74 to 0.91; typical RD -0.04, 95% CI, -0.06, -0.02; NNTB 25, 95% CI 17 to 50; 12 studies, 5425 participants, low-certainty evidence) and decreased length of hospital stay (MD -2.38, 95% CI, -4.67, -0.09; 3 studies, 1079 participants, low-certainty evidence). Sensitivity analysis including only good methodological certainty studies suggested a decrease in late-onset sepsis with enteral lactoferrin supplementation (typical RR 0.87, 95% CI, 0.78, 0.97; typical RD -0.03, 95% CI, -0.05, -0.0; 9 studies, 4702 participants, low-certainty evidence). There were no differences in NEC stage II or III (typical RR 1.10, 95% CI, 0.86, 1.41; typical RD -0.00, 95% CI, -0.02, 0.01; 7 studies, 4874 participants; low-certainty evidence) or 'all-cause mortality' (typical RR 0.90, 95% CI 0.69, 1.17; typical RD -0.00, 95% CI, -0.01, 0.01; 11 studies, 5510 participants; moderate-certainty evidence). One study reported no differences in neurodevelopmental testing by Mullen's or Bayley III at 24 months of age after enteral lactoferrin supplementation (one study, 292 participants, low-certainty evidence). Lactoferrin supplementation to enteral feeds with probiotics decreased late-onset sepsis (RR 0.25, 95% CI 0.14 to 0.46; RD -0.13, 95% CI -0.18 to -0.08; NNTB 8, 95% CI 6 to 13; 3 studies, 564 participants; low-certainty evidence) and NEC stage II or III (RR 0.04, 95% CI 0.00 to 0.62; RD -0.05, 95% CI -0.08 to -0.03; NNTB 20, 95% CI 12.5 to 33.3; 1 study, 496 participants; very low-certainty evidence), but not 'all-cause mortality' (very low-certainty evidence). Lactoferrin supplementation to enteral feeds with or without probiotics had no effect on CLD, duration of mechanical ventilation or threshold retinopathy of prematurity (low-certainty evidence). Investigators reported no adverse effects in the included studies. We found low-certainty evidence from studies of good methodological quality that lactoferrin supplementation of enteral feeds decreases late-onset sepsis but not NEC ≥ stage II or 'all cause mortality' or neurodevelopmental outcomes at 24 months of age in preterm infants without adverse effects. Low- to very low-certainty evidence suggests that lactoferrin supplementation of enteral feeds in combination with probiotics decreases late-onset sepsis and NEC ≥ stage II in preterm infants without adverse effects, however, there were few included studies of poor methodological quality. The presence of publication bias and small studies of poor methodology that may inflate the effect size make recommendations for clinical practice difficult.

A systematic review of psychometric assessment of the Jefferson Scale of Empathy using the COSMIN Risk of Bias checklist.

Empathic communication in health care may enhance positive patient and health care professional relationships, patient satisfaction and can buffer professional burnout. The Jefferson Scale of Empathy (JSE) was developed based on the need to quantitatively measure levels of empathy, particularly in health care settings. Evaluating the utility of empathy is underpinned by the psychometric rigour of the instruments used to measure it. The aim of this study was to critically evaluate the current evidence on the measurement properties of the JSE. Two reviewers independently searched six databases for papers describing psychometric assessment of the JSE from January 2000 to July 2018 inclusive. The studies were independently assessed for methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The search strategy resulted in the retrieval of 985 papers, of which 59 were included in this study. The majority of papers reported on measures of structural validity and internal consistency, and it was in these areas which the highest quality of reporting was demonstrated. Additionally, there was a generally very good quality in reporting of convergent validity. Reliability, measurement error, cross-cultural validity were reported with less than optimum quality. The JSE demonstrates robust structural validity, internal consistency, and convergent validity. These measurement properties are generally well reported in the literature in studies of good methodological quality, and thus may be interpreted with relative confidence when used in empathy research. However, current evidence is limited for the properties of reliability, measurement error, and cross-cultural validity. Thus, a degree of caution should be considered in drawing conclusions when using the JSE with regard to these properties. It is recommended that future examinations of the JSE refer to the COSMIN guidelines to ensure complete and well-reported psychometric data are included.

Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review

BackgroundCarpal tunnel syndrome is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. It presents a high prevalence and is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild-to-moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of carpal tunnel syndrome in the last 15 years. MethodsA systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild-to-moderate carpal tunnel syndrome; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. ConclusionsSeveral conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate carpal tunnel syndrome. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed.

Defunding preoperative histories and physical exams: putting the cart before the evidence?

ObjectiveSeveral Canadian health authorities have defunded preoperative cataract history and physical examinations performed by general practitioners. While these authorities suggest that such decisions are evidence-based, we are unaware of reviews addressing this topic, nor have health authorities been forthcoming with evidence used in their decision-making processes. The objective of this study is to perform a comprehensive review of the literature regarding the value of preoperative histories and physical examinations in cataract surgery. DesignSystematic review. MethodsThe following databases were searched: PubMed, MEDLINE, Cochrane Library, Google Scholar, Web of Science, EMBASE, CINAHL, and BIOSIS Previews. Only higher-level forms of evidence were assessed, including randomized controlled trials, cohort, and case-control studies. Two reviewers independently assessed titles and abstracts for concordance with inclusion criteria. Disagreements between authors were resolved by discussion. ResultsWe identified 3 articles that met our inclusion criteria: two prospective and one retrospective cohort studies. These articles suggest traditional preoperative histories and physical examinations could be replaced by a health questionnaire (Jastrzebski et al. and Reeves et al.) or eliminated altogether (Alboim et al.). DiscussionScientific literature presently contains 3 studies suggesting that preoperative histories and physical examinations could be modified or eliminated. However, methodological weaknesses and data analysis derived from these studies suggests defunding preoperative medical examination may be premature. ConclusionsWhile finding efficiencies in medical care is admirable, physicians should be cautious in accepting recommendations that reduce checks ensuring perioperative safety. Further studies of better methodological quality should be completed to clarify the present evidence.

What do Cochrane systematic reviews say about non-surgical interventions for urinary incontinence in women?

Urinary incontinence is a highly prevalent condition that impacts self-esteem and overall quality of life. Many non-surgical treatment options are available, ranging from pharmacological approaches to pelvic exercises. We aimed to summarize the available evidence regarding these non-surgical interventions. Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP). A sensitive search was conducted to identify all Cochrane systematic reviews that fulfilled the inclusion criteria. Titles and abstracts were screened by two authors. We included 20 Cochrane systematic reviews: 4 assessing methods of vesical training, 3 evaluating pharmacological interventions, 4 studying pelvic floor muscle training approaches and 9 aimed at other alternatives (such as urethral injections, weighted vaginal cone use, acupuncture, biostimulation and radiofrequency therapy). The reviews found that the evidence regarding the benefits of these diverse interventions ranged in quality from low to high. This review included 20 Cochrane systematic reviews that provided evidence (of diverse quality) for non-pharmacological interventions for patients with urinary incontinence. Moderate to high quality of evidence was found favoring the use of pelvic floor muscle training among women with urinary incontinence. To establish solid conclusions for all the other comparisons, further studies of good methodological quality are needed.

Non-pharmacological treatments for pain relief: TENS and acupuncture

Acupuncture and transcutaneous electrical nerve stimulation (TENS) are non-pharmacological methods that have been used for millennia to relieve pain. As with all complementary treatments, efficacy evaluations face two hurdles: the non-feasibility of double-blinding and the difficulty in identifying the optimal control population or treatment. Nevertheless, recent studies of good methodological quality have demonstrated benefits in many types of pain compared to conventional treatment. The mechanisms of action of acupuncture and TENS, which are increasingly well understood, involve endogenous pain control systems, cerebral plasticity, and nonspecific effects (e.g., expectations and placebo effect). No serious adverse effects have been reported. These data support the more widespread use of non-pharmacological pain management, most notably in patients with chronic pain inadequately relieved by medications alone.

Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática

BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. MethodsA systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non–pharmacological treatments) have been proposed without conclusive results. ConclusionsSeveral conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed.

Meta-Analysis to Assess Efficacy and Safety of High-Dose Ibuprofen Compared with Standard Treatment of Patent Ductus Arteriosus in Premature Infants

Background: Patent ductus arteriosus (PDA) is a common congenital heart defect in premature infants. Intravenous injection of ibuprofen is used for PDA treatment, but its optimum dose, efficacy, and safety are unclear. Objectives: This meta-analysis aimed to access randomized controlled trials that compared high- or low-dose ibuprofen with a standard dose of ibuprofen for closure of PDA in preterm infants. Methods: The standard search methods of the Cochrane neonatal review group were used to screen ibuprofen versus indomethacin trials. All groups that used ibuprofen in those trials were filtered out. The high-dose group was defined as those using an average dose of ibuprofen greater than or equal to 10 mg/kg in the first three days. Results: We identified 14 studies of good methodological quality comparing ibuprofen to indomethacin trials among neonates. Results showed that high-dose ibuprofen could remarkably raise the closure rate (relative risk = 0.90, 95% CI = [0.81, 1.00], P = 0.04). No significant differences were found in adverse effects, bleeding disorders, or oliguria. The closure rate in neonates with PDA increased with the ibuprofen dosage (R2 = 0.9990). The loading dose produced a significant closure rate compared with the low-dose group (relative risk = 1.91, 95% CI = [1.25, 2.92], P = 0.003), with no increase in toxic side effects. Conclusions: Loading dose is a necessary strategy for infants with PDA. A high dose of ibuprofen for PDA closure was more effective than a normal dose of ibuprofen. The side effects in both treatment groups were not significantly different. Given the small sample size and risk of bias in all trials, the tolerability and safety of the dose regimen should be assessed in a large population before considering the use of these doses for PDA.

Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis.

IntroductionThe use of insulin analogs for the treatment of type 1 diabetes mellitus (T1DM) is widespread; however, the therapeutic benefits still require further evaluation given their higher costs. The objective of this study was to evaluate the effectiveness and safety of analog insulin glargine compared to recombinant DNA (rDNA) insulin in patients with T1DM in observational studies, building on previous reviews of randomized controlled trials comparing neutral protamine Hagedorn insulin and insulin glargine.MethodsA systematic review with a meta-analysis was performed. The review included cohort studies and registries available on PubMed, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as manual and gray literature searches. The meta-analysis was conducted in Review Manager 5.3 software. The primary outcomes were glycated hemoglobin (Hb1Ac), weight gain, and hypoglycemia. Methodological quality was assessed using the Newcastle-Ottawa scale.ResultsOut of 796 publications, 11 studies were finally included. The meta-analysis favored insulin glargine in HbA1c outcomes (adult patients) and hypoglycemic episodes (P < 0.05), but without reaching glycemic control (Hb1Ac to approximately 7%). The methodological quality of the studies was moderate, noting that 45% of studies were funded by pharmaceutical companies.ConclusionGiven the high heterogeneity of the studies, the discrete value presented by the estimated effect on effectiveness and safety, potential conflicts of interest of the studies, and the appreciable higher cost of insulin glargine, there is still no support for recommending first-line therapy with analogs. The role of analogs in the treatment of T1DM could be better determined by further observational studies of good methodological quality to assess their long-term effectiveness and safety, as well as their cost-effectiveness.

Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease

Tiotropium and ipratropium bromide are both recognised treatments in the management of people with stable chronic obstructive pulmonary disease (COPD). There are new studies which have compared tiotropium with ipratropium bromide, making an update necessary. To compare the relative effects of tiotropium to ipratropium bromide on markers of quality of life, exacerbations, symptoms, lung function and serious adverse events in patients with COPD using available randomised controlled trial (RCT) data. We identified RCTs from the Cochrane Airways Group Specialised Register of trials (CAGR) and ClinicalTrials.gov up to August 2015. We included parallel group RCTs of 12 weeks duration or longer comparing treatment with tiotropium with ipratropium bromide for patients with stable COPD. Two review authors independently assessed studies for inclusion and then extracted data on study quality and outcome results. We contacted trial sponsors for additional information. We analysed the data using Cochrane Review Manager. This review included two studies of good methodological quality that enrolled 1073 participants with COPD. The studies used a similar design and inclusion criteria and were of at least 12 weeks duration; the participants had a mean forced expiratory volume in one second (FEV1) of 40% predicted value at baseline. One study used tiotropium via the HandiHaler (18 µg) for 12 months and the other via the Respimat device (5 µg and 10 µg) for 12 weeks. In general, the treatment groups were well matched at baseline but not all outcomes were reported for both studies. Overall the risk of bias across the included RCTs was low.For primary outcomes this review found that at the three months trough (the lowest level measured before treatment) FEV1 significantly increased with tiotropium compared to ipratropium bromide (mean difference (MD) 109 mL; 95% confidence interval (CI) 81 to 137, moderate quality evidence, I(2) = 62%). There were fewer people experiencing one or more non-fatal serious adverse events on tiotropium compared to ipratropium (odds ratio (OR) 0.5; 95% CI 0.34 to 0.73, high quality evidence). This represents an absolute reduction in risk from 176 to 97 per 1000 people over three to 12 months. Concerning disease specific adverse events, the tiotropium group were also less likely to experience a COPD-related serious adverse event when compared to ipratropium bromide (OR 0.59; 95% CI 0.41 to 0.85, moderate quality evidence).For secondary outcomes, both studies reported fewer hospital admissions in the tiotropium group (OR 0.34; 95% CI 0.15 to 0.70, moderate quality evidence); as well as fewer patients experiencing one or more exacerbations leading to hospitalisation in the people on tiotropium in both studies (OR 0.56; 95% CI 0.31 to 0.99, moderate quality evidence). There was no significant difference in mortality between the treatments (OR 1.39; 95% CI 0.44 to 4.39, moderate quality evidence). One study measured quality of life using the St George's Respiratory Questionnaire (SGRQ); the mean SGRQ score at 52 weeks was lower in the tiotropium group than the ipratropium group (lower on the scale is favourable) (MD -3.30; 95% CI -5.63 to -0.97, moderate quality evidence). There were fewer participants suffering one of more exacerbations in the tiotropium arm (OR 0.71; 95% CI 0.52 to 0.95, high quality evidence) and there was also a reported difference in the mean number of exacerbations per person per year which reached statistical significance (MD -0.23; 95% CI -0.39 to -0.07, P = 0.006, moderate quality evidence). From the 1073 participants there were significantly fewer withdrawals from the tiotropium group (OR 0.58; 95% CI 0.41 to 0.83, high quality evidence). This review shows that tiotropium treatment, when compared with ipratropium bromide, was associated with improved lung function, fewer hospital admissions (including those for exacerbations of COPD), fewer exacerbations of COPD and improved quality of life. There were both fewer serious adverse events and disease specific events in the tiotropium group, but no significant difference in deaths with ipratropium bromide when compared to tiotropium. Thus, tiotropium appears to be a reasonable choice (instead of ipratropium bromide) for patients with stable COPD, as proposed in guidelines. A recent large double-blind trial of the two delivery devices found no substantial difference in mortality using 2.5 µg or 5 µg of tiotropium via Respimat in comparison to 18 µg via Handihaler.