Fish oils in the care of coronary heart disease patients: a meta-analysis of randomized controlled trials

What is the place of fish oils in the care of coronary heart disease (CHD) patients? As several clinical trials have already addressed this question without giving definitive answers, we did a meta‐analysis of trials regarding the efficacy of omega‐3 fatty acids in preventing cardiovascular mortality and morbidity. We searched the MEDLINE (1966–2003), EMBASE databases, proceedings abstracts and references of reviewed articles. Randomized controlled trials (RCTs) of the efficacy of omega‐3 fatty acids among adults with recent or acute myocardial infarction (MI), or angina were selected. Two reviewers abstracted data independently. Five relevant outcomes, mortality from all causes, fatal and non‐fatal MI, non‐fatal stroke and angina, were measured. Data were synthesized using a fixed effect model. Ten RCTs with 14 727 patients were included. No significant heterogeneity was detected. Daily intake of omega‐3 fatty acids for a mean duration of 37 months decreased all causes of mortality by 16% (relative risk 0.84, 95% confidence interval [0.76; 0.94]) and the incidence of death due to MI by 24% (0.76, [0.66; 0.88]). No significant effect was found for the other outcomes. Because of the suboptimal quality of the studies included into the meta‐analysis and the absence of data in patients receiving statins, these results do not justify adding fish oils systematically to the heavy pharmaceutical assortment already recommended in CHD patients.     

The effects of mindfulness‐based stress reduction on depression,anxiety, and stress in older adults: A systematic review and meta‐analysis

Mindfulness‐based stress reduction (MBSR) has been widely used to improve various physical and mental conditions. Studies show the intervention is particularly effective in alleviating depression, anxiety, and stress in working‐aged adults. No recent systematic review has focused on the use of MBSR in older adults. This study aims to examine the effects of MBSR intervention on depression, anxiety, and stress symptoms of older adults. Five electronic databases were searched for relevant randomized controlled trials (RCTs) published between 1990 and 2017. Six eligible studies were included and computed for meta‐analysis. The methodological quality and risk of biases across the included RCTs were assessed using the Cochrane risk of bias assessment tool. Overall, the amount of evidence is limited and of relatively low quality. The results of this review provide evidence that the MBSR is more effective than wait‐list‐control group to reduce depression in older adults with clinically significant symptoms immediately following the intervention. However, there is no clear evidence that the intervention reduced the perception of stress and anxiety, or that positive effects are maintained over the longer term. More robust studies involving larger sample sizes and using longer follow‐up measurements are required.     

Parental presence at anaesthesia induction: A systematic review

This systematic review assessed the effectiveness of parental presence for children undergoing surgical or diagnostic procedures under general anaesthesia (such as bronchoscopy, laryngoscopy and laparoscopy). Randomized and quasi randomized trials with healthy children scheduled for elective diagnostic and surgical procedures under general anaesthesia (age range 0–16 years) where the intervention was parental presence at anaesthesia induction were included. A comprehensive literature search was conducted using electronic databases and the reference lists of included studies. The Cochrane collaboration's tool for assessing risk of bias was used for assessment of risk of bias. The Review Manager software was used to analyse and synthesize data. A random‐effect meta‐analysis was used when there was evidence of clinical and/or statistical heterogeneity. Of the 102 citations identified, nine trials involving 1021 children were eligible for inclusion. Only four were sufficient to be included in the meta‐analysis. There was no statistically significant difference on average in the level of anxiety in children and their parents either at separation or at induction between children allocated to parental presence and those allocated to no presence, premedication or parental presence plus premedication groups. Significant debate still surrounds this issue, and future trials should focus on the use of reliable and validated tools in assessing outcome measures.     

Statin use and the prevention of venous thromboembolism: a meta‐analysis

Aims: Statins are thought to have antithrombotic properties and may attenuate patients’ odds of developing venous thromboembolism (VTE), but clinical studies have yielded variable estimates of this effect. The aim was to conduct a meta‐analysis to evaluate the effect of statin use on development of VTE. Methods: Randomised controlled trials (RCTs) and observational studies evaluating the effects of statins on the incidence of VTE were selected from MEDLINE (1996 to August 2009), Cochrane CENTRAL (second quarter, 2009), Cochrane Database of Systematic Reviews (second quarter, 2009) and a manual review of references. While no further restrictions were placed on RCTs, observational studies were only included if they reported adjusted effect sizes using appropriate methods. Development of deep vein thrombosis (DVT), pulmonary embolism (PE) and any VTE from RCTs and observational studies were pooled using traditional meta analytic techniques with a random‐effects model. Results: Ten studies were identified and eligible for meta‐analysis. Upon meta‐analysis, statin use was associated with a statistically significant reduction in the odds of developing VTE (AOR 0.68, 95% CI 0.54–0.86), DVT (AOR 0.59, 95% CI 0.43–0.82) and PE (AOR 0.70, 95% CI 0.53–0.94). Discussion: Statin use is associated with significantly reduced odds of developing VTE, DVT or PE by 32%, 41% and 30% respectively. Our meta‐analysis included one RCT, JUPITER, which alone provided statistically significant reduction in the odds of developing VTE and DVT (43% and 55% respectively), and a nonsignificant reduction on PE. Conclusion: Currently available evidence suggests that statins can reduce patients’ odds of developing VTE.     

中医药防治胆石症随机对照试验的质量评价

目的评价中医药防治胆石症随机对照试验的方法学和报告质量。方法计算机检索CNKI（1994～2007）、CBM（1978—2007）、CMCC（1994～2007）、VIP（1989～2007））、MEDLINE（1966～2007．4）、Cochrane图书馆（2006年第4期）。全面收集与中医药防治胆石症有关的临床试验，纳入凡文中有“随机”字样或“随机分组”、“随机对照”的以胆石症为目标疾病的研究，按照Cochrane协作网推荐的评价方法对纳入研究进行方法学质量评价，按照CONSORT for TCM清单项目进行研究报告质量评价。结果共纳入17篇文献，其中随机对照试验16个，半随机对照试验1个。评价结果显示，纳入文献方法学质量较低，均为C级；CONSORT for TCM评价最高18分。所有纳入研究的报告质量均低。结论以往的中医药防治胆石症的随机对照试验存在不同程度的方法学质量缺陷，使得其结论存在选择性偏倚、实施偏倚、测量偏倚以及减员偏倚的高度可能性。而较低的报告质量又会严重影响读者对研究结果真实性、重要性及实用性的正确理解和评价。因此期待设计严谨、实施科学、报告完整的大样本高质量的随机对照试验出现。     

中国循证医学/Cochrane中心临床治疗和诊断试验数据库的建立

目的建立中国循证医学/Cochrane中心临床治疗和诊断试验数据库,为临床医疗、教学、科研和系统评价者提供科学可靠的数据,同时向国际Cochrane协作网提供中国的临床医学研究资料.方法采用手检与机检相结合的方法,按国际Cochrane协作网和临床流行病学的标准收集数据.结果截至2003年12月,中国循证医学/Cochrane中心数据库已收集各专业的RCT和CCT 16 652条诊断实验(DT)3 786条,已向国际Cochrane协作网提交RCT和CCT 4 966条,已建立19个专业数据库.结论由中国Cochrane中心组织、全国各专业医护和技术人员承担的临床治疗与诊断试验数据库建库工作现已初具规模,并开始向国内外提供信息服务.     

颅底骨折患者预防性使用抗生素预防脑膜炎的系统评价

目的评价颅底骨折患者预防性使用抗生素预防脑膜炎的效果。方法检索Cochrane临床对照试验资料库(CENTRAL)(Cochrane图书馆2005年第3期)、MEDLINE(1966~2005.09)、EMBASE(1974~2005.06)和LILACS(1982~2005.09)。电子检索美国神经外科医师协会会议记录(1997~2005.09),手工检索神经外科学会欧洲联合会会议记录摘要(1995,1999,2003)。收集比较抗生素与安慰剂或空白对照的随机对照试验。同时对检出的非随机对照试验单独进行Meta分析以比较结果。至少由两名研究者独立评价每项试验的质量并提取数据。采用RevMan4.2软件进行Meta分析。结果纳入的5个随机对照试验和17个非随机对照试验比较了颅底骨折患者使用不同类型的预防性抗生素与安慰剂或空白对照的效果。但多数试验对方法学细节描述不充分。所有试验均将脑膜炎纳入其主要结局。共评价了符合Meta分析纳入标准的四个随机对照试验,共包括208例受试者。在降低脑膜炎的发生率、全因病死率、脑膜炎病死率和需要手术干预的脑脊液漏的发生率等方面,预防性抗生素组与对照组无显著差异。对伴或不伴脑脊液漏的患者进行亚组分析以评价其主要结局。并对所有检出的非随机对照试验(共包括2168例受试者)进行Meta分析,得出的结果与随机数据一致。结论现有的随机对照试验证据并不支持对颅底骨折患者预防性使用抗生素,无论其有无脑脊液漏的迹象。在更多的研究完成之前,尚无法确定颅底骨折患者使用抗生素的效果,因为迄今发表的研究均存在偏倚,尚需更多设计完善的大样本随机对照试验。     

气管切开时机对长期机械通气患者影响的Meta分析

目的 评价早期气管切开和延迟气管切开对长期机械通气(prolonged mechanical ventilation,PMV)患者.方法 计算机检索Ovide MEDLINE(1966-2006.07)、EMBASE(1980-2006.07)、Cechrane Database(2006年第2期)、中国Cochrane中心临床对照试验资料数据库,中国生物医学文献光盘数据库(1978-2006.07).手工检索初步入选文献的全文和参考文献中所列的相关文献和杂志、学术会议论文集、学位论文汇编.收集国内外关于不同气管切开时机对PMV患者影响的随机和半随机对照试验,并进行方法学质量评价,用RevMan 4.2软件进行Meta分析.结果 共检索到随机对照试验(randomized controlled trials,RCTs)4个,病例286例;半随机对照实验(quasi-RCTs)1个,病例106例.合并结果显示,早期气管切开可以降低PMV患者的死亡率[RR 0.69,95%CI(0.51,0.95)],减少机械通气(mechanical ventilation,MY)时间[WMD-8.49,95%CI(-15.32,-1.66)]和ICU住院时间[WMD-15.33,95%CI(-24.58,-6.08)],但对医院获得性肺炎的发病率无显著影响[RR0.91,95%CI(0.70,1.18].结论 现有证据表明,早期气管切开可以降低PMV患者的死亡率,减少MV时间和ICU住院时间,但对医院获得性肺炎的发病率没有显著影响.     

Extended‐release opioids in the management of cancer pain: A systematic review of efficacy and safety

Despite the increased availability of strong analgesics and evidence‐based recommendations for pain management, under‐treatment of cancer‐related pain is still common. Extended‐release (ER) opioids, in contrast to immediate‐release opioids, provide prolonged analgesia. In this review, we aimed to compare the efficacy and safety of ER opioid analgesics in managing moderate‐to‐severe pain in patients with cancer. We identified randomized controlled trials (RCTs) and controlled observational studies that compared ER opioids in cancer pain by searching several databases, including MEDLINE, EMBASE and the Cochrane Library. Two independent reviewers screened and evaluated retrieved records to select relevant studies. We dually assessed the risk of bias for included studies and evaluated the overall strength of evidence for six critical outcomes using Grading of Recommendations Assessment, Development and Evaluation level of evidence. A total of three double‐blind RCTs (comparative efficacy and adverse events), two non‐blinded RCTs and four observational studies (comparative adverse events) were included in this review. All randomized trials and one observational study were of high risk of bias, and three observational studies of unclear risk of bias. The level of evidence for the selected efficacy and safety outcomes was low and very low. We synthesized the findings qualitatively because of the paucity of relevant studies as well as variable study design and quality. This systematic review indicates no substantial differences in efficacy and frequent adverse events among ER opioids for cancer pain. The body of evidence, however, is limited to few comparisons and fraught with methodological shortcomings.     

Autologous transplantation of blood‐derived stem/progenitor cells for ischaemic heart disease

Aims: Early clinical trials suggest that blood‐derived stem/progenitor cells (including peripheral blood‐derived stem cells and circulating progenitor cells) may have a positive impact on patients with ischaemic heart disease (IHD). The therapeutic effects of these cells remain unclear, considering the inconsistent results of several clinical trials. The objective of this meta‐analysis was to evaluate the effects of autologous blood‐derived stem/progenitor cells on improvement of cardiac functional parameters on the basis of a synthesis of the data generated by randomised controlled clinical trials (RCTs) of patients with IHD. Methods: Randomised controlled clinical trials were identified in the MEDLINE, the Cochrane Central Register of Controlled Trials, EBSCO, EMBASE, reviews and reference lists of relevant articles. All searching was completed on 12 January 2011. Weighted mean difference was calculated for changes in left ventricular ejection fraction (LVEF), left ventricular end‐diastolic and end‐systolic volumes (LVEDV and LVESV) using a fixed effects model. Results: Of the 1587 citations identified in the literature search, six RCTs were finally analysed. Compared with controls, blood‐derived stem/progenitor cells infusion was safe and improved LVEF by 3.72% (95% CI: 1.98–5.46%; p < 0.0001). However, no significant improvement in LVEDV and LVESV at follow‐up was observed. Conclusions: Available evidence showed moderate improvements over conventional therapy in LVEF of blood‐derived stem/progenitor cells transplantation in patients with IHD, and supports further RCTs with higher quality.     

Topical Nonsteroidal Anti-inflammatory Drugs for Corneal Abrasions: Meta-analysis of Randomized Trials

Objectives: To determine the effectiveness of topical nonsteroidal anti‐inflammatory drugs (NSAIDs) in traumatic corneal abrasions. Methods: This was a systematic literature review and meta‐analysis of randomized clinical trials (RCTs). The following databases were searched: MEDLINE (1966–2004), EMBASE (1980–2004), and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (first quarter 2004). The structured search strategy included a RCT filter and the terms “cornea,”“wounds and injuries,”“trauma,”“corneal diseases,”“eye injuries,”“anti‐inflammatory agents, nonsteroidal” and specific trade names of topical NSAIDs. In addition, four journals in ophthalmology and emergency medicine were hand searched. Two authors independently reviewed citations from the literature searches. To be included, studies had to be RCTs evaluating topical NSAIDs in traumatic corneal abrasions. Trials were included regardless of language or whether they were unpublished or published. Exclusion criteria were corneal ulcers, nonrandomized studies, animal studies, or perioperative setting. Outcomes were pain scale scores at 24 hours and adverse effects. Two independent reviewers assessed four trial quality components: randomization, double blinding, reporting of withdrawals, and concealment of allocation. Weighted mean difference, using a random effects model, was calculated. Results: Of the 200 citations identified, 11 RCTs met inclusion criteria. Eight trials were identified from the MEDLINE search, two from the EMBASE search, and one from conference proceedings. Seven trials enrolled fewer than 100 patients, and more than half of the studies were conducted in Europe. Five trials reported suitable data for analysis. The overall weighted mean difference for 459 patients was a reduction in pain by 1.30 points (95% confidence interval =?1.56 to ?1.03) on the pain scale. Five of the trials met criteria for good quality. Transient stinging was a commonly noted adverse effect. Conclusions: Topical NSAIDs are effective analgesics for traumatic corneal abrasions.     

Interventions to promote colorectal cancer screening: an integrative review

Behavior change interventions to promote colorectal cancer (CRC) screening have targeted people in community and primary care settings, health care providers, and health systems. Randomized controlled trials provide the strongest evidence of intervention efficacy. The purpose of this integrative review was to evaluate trials of CRC screening interventions published between 1997 and 2007 and to identify knowledge gaps and future directions for research. Thirty-three randomized trials that met inclusion criteria were evaluated using a modified version of the TREND criteria. Significant intervention effects were reported in 6 of 10 trials focused on increasing fecal occult blood testing, 4 of 7 trials focused on sigmoidoscopy or colonoscopy completion, and 9 of 16 trials focused on completion of any screening test. Several effective interventions to promote CRC screening were identified. Future trials need to use theory to guide interventions, examine moderators and mediators, consistently report results, and use comparable outcome measures.     

Marginal public health gain of screening for colorectal cancer: modelling study,based on WHO and national databases in the Nordic countries

Aims To estimate the potential gain of national screening programmes for colorectal cancer (CRC) by stool occult blood testing in the Nordic countries, with comparative reference to the burden of other causes of premature death. Methods Implementation of national screening programmes for CRC was modelled among people 55–74 years in accordance with the 2011 Cochrane review of biannual screening, using the faecal occult blood test (FOBT) for 10 years, resulting in 15% relative risk reduction in CRC deaths among all those invited [intention‐to‐treat; relative risk 0.85; confidence interval (CI) 0.78 to 0.92]. Our calculations are based on the World Health Organization and national databanks on death causes (ICD‐10) and the mid‐year number of inhabitants in the target group. For Finland, Denmark, Norway and Sweden, we used data for 2009. For Iceland, due to the population's small size, we calculated mean mortality for the period 2005–2009. Results Invitation to a CRC screening programme for 10 years could influence 0.5–0.9% (95%CI 0.4–1.2) of all deaths in the age group 65–74 years. Among the remaining 99% of premature deaths, around 50% were caused by lung cancer, other lung diseases, cardiovascular diseases and accidents, with some national variations. Conclusions and implications Establishment of a screening programme for CRC for people aged 55–74 can be expected to affect only a minor proportion of all premature deaths in the Nordic setting. From a public health perspective, prioritizing preventive strategies targeting more prevalent causes of premature death may be a superior approach.     

Effectiveness of pharmacist‐participated warfarin therapy management: a systematic review and meta‐analysis

Summary. Objective: Although pharmacist‐participated warfarin therapy management (PWTM) has been accepted and implemented in various parts of the world, the evidence demonstrating the effects of PWTM compared with usual care on clinical outcomes is lacking. We performed a systematic review and meta‐analysis to compare the effects of PWTM with usual care on bleeding and thromboembolic outcomes. Methods: We searched MEDLINE, SCOPUS, EMBASE, IPA, CINAHL, Cochrane CENTRAL, Thai Index Medicus and Thai Medical Index, and reference lists of studies, without language restriction. Databases were searched from their inception to July 2009. The studies using warfarin as an anticoagulant with sufficient data for compilation of 2 × 2 tables were included. Both randomized controlled trials (RCTs) and non‐RCTs were considered. Two authors independently reviewed each study, assigned quality scores and extracted data for all outcomes using a standardized form. Pooled effect estimates (risk ratio; RR) were obtained using a random effects model. Result: Of 661 articles identified, 24 studies with 728,377 patients were included. In the random‐effects meta‐analysis of RCTs, the PWTM group had statistically significant effects on the prevention of total bleeding [RR, 0.51; 95% confidence interval (CI), 0.28–0.94]. However, the effects on major bleeding (RR, 0.64; 95% CI, 0.18–2.36), thromboembolic events (RR, 0.79; 95% CI, 0.33–1.93), all‐cause mortality (RR, 0.93; 95% CI, 0.41–2.13) and warfarin‐related mortality (RR, 0.65; 95% CI, 0.18–2.42) were not significant. Conclusion: Pharmacist’s participation in the management of warfarin therapy significantly reduces total bleeding, with a non‐significant trend towards decreases in other warfarin‐related complications.     

凝固粉在吞咽障碍患者中应用效果的系统评价与Meta分析

目的：通过系统评价及Meta分析的方法评价凝固粉在吞咽障碍患者中的应用效果。方法通过计算机检索 The Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库（CBM）、中国知网全文数据库（CNKI）、万方数据库中关于凝固粉的随机对照试验,由2名研究者对文献质量进行评价后,采用 RevMan 5.3进行分析。结果共纳入4篇随机对照试验,包括237例患者。 Meta分析结果显示,凝固粉能够降低吞咽障碍患者误吸发生率（Z=4.67,P＜0.01）,改善患者血红蛋白水平（Z=3.91, P＜0.01）。结论凝固粉应用于吞咽障碍患者是安全有效的,建议临床推广使用。但尚需多中心、大样本的临床对照试验来进一步验证此结果。     

The efficacy of Da Chaihu decoction combined with metformin tablets for type 2 diabetes mellitus: A systematic review and meta-analysis

ObjectiveTo assess the efficacy of Da Chaihu decoction combined with metformin tablets on patients with type 2 diabetes compared with metformin alone.MethodsThis systematic review and meta‐analysis is written based on 2020 PRISMA Extension for Chinese Herbal Medicines 2020 (PRISMA-CHM 2020) reporting guidelines. We reviewed all the relevant studies from a search of the following databases from inception to February 2022 without any language restriction: Excerpta Medica Database (EMBASE), Google Scholar, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Information, Wanfang Data, and the Chinese Biomedical Literature Database(CBM). Data were extracted and the quality was independently evaluated by two reviewers, based on the inclusion and exclusion criteria. Data were analyzed using the Cochrane software RevMan 5.3.ResultsSix randomized controlled trials comprising 516 participants were included.The meta‐analysis revealed the Da Chaihu decoction combined with metformin tablets group was significantly superior to the metformin tablets group in terms of fasting blood glucose(FPG) (−0.66 mmol/L; 95 % CI (confidence intervals) [− 1.28, − 0.04]), plasma glucose 2 h after meal (2-h PG) (−1.18 mmol/L; 95 % CI [−1.94, −0.42]) in six RCTs, body mass index (BMI) (−3.07 mmol/L; 95 % CI [−6.89, 0.75]) in three RCTs, glycosylated hemoglobin (HbAlc) (−0.36 mmol/L; 95 % CI [−1.04, 0.31]) in three RCTs, and triglycerides (TG) (−0.76 mmol/L; 95 % CI [−1.37, −0.15]) in two RCTs. In two RCTs, there were significant differences in terms of total cholesterol (TC) (−0.97 mmol/L; 95 % CI [−1.18, −0.76]).ConclusionsVery low-quality research shows that Da Chaihu decoction combined with metformin tablets exert a certain level of efficacy on patients with type 2 diabetes compared with metformin alone. However, random sequence generation methodology was reported in five studies leading to the low quality of the included studies. None of the six studies depicted the blinding method, allocation concealment, selective reporting, and assessed the purity and potency of the product. This observation requires verification through high-quality, multi-center, double-blinded randomized controlled trials, and assesses the purity and potency of the product.     

尼可地尔对造影剂肾病预防作用的Meta分析

目的 探讨尼可地尔在预防造影剂肾病（CIN）的作用。方法 检索Pubmed、Cochrane Library（2017年9期）、Embase、万方、维普及中国知网数据库中所有使用尼可地尔预防CIN的随机对照试验（RCT）,检索时限均为建库至2017年9月。由2名评价员独立筛选文献、评价文章质量及提取数据。采用Revman 5.3软件进行Meta分析。结果 纳入5项研究,纳入患者805例。Meta分析显示尼可地尔能降低CIN的发生率（P=0.0002）。结论 尼可地尔对CIN的发生具有一定的预防作用。     

Quality of life after surgery for colorectal cancer: clinical implications of results from randomised trials

Goals of work Health-related quality of life (HRQL) is an important outcome after surgery for colorectal cancer (CRC), and accurate assessment is required to fully inform clinical decision making. The purpose of this review is to summarise randomised surgical trials in CRC with robust HRQL to consider the role of HRQL in surgical decision making. Materials and methods A systematic review in Medline and the Cochrane Controlled Trials Register identified randomised surgical trials with HRQL. HRQL assessment was categorised as robust according to predefined criteria, and the clinical implications of HRQL were considered. Main results One hundred seventy-seven articles were identified, and a detailed review reduced this to eight trials. Four compared laparoscopic with open surgery, and four evaluated coloanal anastomotic techniques. The most commonly used HRQL instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30, and HRQL was usually a secondary outcome measure. In four (50%) trials, HRQL assessment was categorised as methodologically robust, although only two trials had sample size calculations based upon a HRQL endpoint. Six trials based the final treatment recommendation in the context of the HRQL outcomes. Conclusion In randomised surgical trials in CRC, HRQL assessment informs clinical decision making, and future trials require robust assessment of relevant patient-reported outcomes. The paper was presented as an invited lecture at the MASCC/ISOO 20th Anniversary International Symposium Supportive Care in Cancer in St. Gallen, June 2007.     

Is fresh‐frozen plasma clinically effective? An update of a systematic review of randomized controlled trials (CME)

BACKGROUND: The clinical use of frozen plasma (FP) continues to increase, both in prophylactic and in therapeutic settings. In 2004, a systematic review of all published randomized controlled trials (RCTs) revealed a lack of evidence that supported the efficacy of FP use. This is an update that includes all new RCTs published since the original review. STUDY DESIGN AND METHODS: Trials involving transfusion of FP up to July 2011 were identified from searches of MEDLINE, EMBASE, CINAHL, The Cochrane Library, and the UKBTS/SRI Transfusion Evidence Library. Methodologic quality was assessed. The primary outcome measure was the effect of FP on survival. RESULTS: Twenty‐one new trials were eligible for inclusion. These covered prophylactic and therapeutic FP use in liver disease, in cardiac surgery, for warfarin anticoagulation reversal, for thrombotic thrombocytopenic purpura treatment, for plasmapheresis, and in other settings, including burns, shock, and head injury. The largest number of recent RCTs were conducted in cardiac surgery; meta‐analysis showed no significant difference for FP use for the outcome of 24‐hours postoperative blood loss (weighted mean difference, ?35.24 mL; 95% confidence interval, ?84.16 to 13.68 mL). Overall, there was no significant benefit for FP use across all the clinical conditions. Only two of the 21 trials fulfilled all the criteria for quality assessment. CONCLUSION: Combined with the 2004 review, 80 RCTs have investigated FP with no consistent evidence of significant benefit for prophylactic and therapeutic use across a range of indications evaluated. There has been little improvement in the overall methodologic quality of RCTs conducted in the past few years.     

Effect of perioperative insulin infusion on surgical morbidity and mortality: systematic review and meta-analysis of randomized trials.7

OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients. PATIENTS AND METHODS: We used 6 search strategies including an electronic database search of MEDLINE, EMBASE, and Cochrane CENTRAL, from their inception up to May 1, 2006, and included RCTs of perioperative insulin infusion (with or without glucose targets) measuring outcomes in patients undergoing any surgery. Pairs of reviewers working independently assessed the methodological quality and characteristics of included trials and abstracted data on perioperative outcomes (ie, outcomes that occurred during hospitalization or within 30 days of surgery). RESULTS: We identified 34 eligible trials. In the 14 trials that assessed mortality, there were 68 deaths among 2192 patients randomized to insulin infusion compared with 98 deaths among 2163 patients randomized to control therapy (random-effects pooled relative risk, 0.69; 95% confidence interval [CI], 0.51-0.94; 99% CI, 0.46-1.04; I2, 0%; 95% CI, 0.0%-47.4%). Hypoglycemia increased in the intensively treated group (20 trials, 119/1470 patients in insulin infusion vs 48/1476 patients in control group; relative risk, 2.07; 95% CI, 1.29-3.32; 99% CI, 1.09-3.88; I2, 31.5%; 95% CI, 0.0%-59.0%). No significant effect was seen in any other outcomes. The available mortality data represent only 40% of the optimal information size required to reliably detect a plausible treatment effect; potential methodological and reporting biases weaken inferences. CONCLUSION: Perioperative insulin infusion may reduce mortality but increases hypoglycemia in patients who are undergoing surgery; however, mortality results require confirmation in large and rigorous RCTs.