A systematic review of Tuina for irritable bowel syndrome: Recommendations for future trials

ObjectivesThis systematic review assessed whether Tuina (therapeutic massage) is more effective and safer than no treatment or routine medical treatment for irritable bowel syndrome (IBS).MethodsEleven databases were searched for randomized controlled trials of IBS diagnosed based on Manning or Rome criteria. Tuina with or without routine treatments (RTs) was tested against RTs. The Cochrane risk of bias was evaluated for each trial. RevMan 5.3 was used to conduct a meta-analysis.ResultsA total of 8 trials (5 IBS-diarrhea and 3 IBS-constipation) with 545 participants using 8 different manipulations were included. All trials were published in Chinese. For overall symptom improving rate (> 30 % improvement in overall symptom scores), it had not been shown that Tuina was significantly better than RTs (RR 1.23, 95 % CI 0.94–1.60, 197 participants, 3 studies, I² = 65 %) for IBS-diarrhea, and Tuina combined with RTs showed more benefit than RTs alone (RR 1.29, 95 % CI 1.08–1.54, 115 participants, 3 studies) for IBS-diarrhea. All trials did not report adverse effect in relation to Tuina. Risk of bias was generally unclear across all domains.ConclusionsTuina combined with RTs may be superior to RTs for improving overall symptom of IBS-diarrhea. Due to the existing methodological issues and the heterogeneity of Tuina manipulation, current findings need to be confirmed in large scale, multicenter, and robust randomized trials (especially on outcome assessing blinding and allocation concealment).     

左奥硝唑治疗厌氧菌感染的系统评价

摘 要 目的：系统评价左奥硝唑治疗厌氧菌感染的临床疗效及安全性，为临床合理用药提供参考。方法：计算机检索PubMed、Medline（viaOvidSP）、Cochrane Library、CNKI、WanFang Data、VIP数据库，搜集有关左奥硝唑治疗厌氧菌感染的随机对照试验（RCTs），检索时限均为建库至2018年10月1日，由两名研究人员独立交叉筛选文献，并进行质量评估和数据提取，采用RevMan 5.3软件进行Meta分析。结果：纳入16个RCTs，共计1 557例研究对象，其中左奥硝唑治疗厌氧菌感染的试验组779例，奥硝唑治疗厌氧菌感染的对照组778例。Meta分析结果显示：试验组的临床治愈率明显优于对照组，差异有统计学意义[OR=2.28，95%CI（1.60，3.25），P<0.000 01]；但腹部感染两组临床治愈率差异无统计学意义[OR=1.73，95%CI（0.76，3.96），P<0.19]。两组在细菌清除上效果相当，差异无统计学意义（P＞0.05）。试验组在消化系统不良反应、过敏反应以及白细胞减少等方面的发生率略低于对照组，但差异均无统计学意义（P＞0.05）；但在神经系统不良反应方面，试验组与对照组相比发生率较低，差异有统计学意义（P＜0.05）。在假设其他治疗方案一致的情况下，试验组的成本及成本 效果比显著高于对照组，在一定程度上增加了患者的医疗负担。结论：基于目前的临床研究，左奥硝唑治疗厌氧菌感染可提高临床治愈率，减少神经系统不良反应的发生，但鉴于临床发生的药品不良反应均为轻中度，无需针对治疗处理，停药后即可缓解或消失，且奥硝唑的成本 效果比远低于左奥硝唑，因此，临床医生综合评估患者病情后仍可考虑选用奥硝唑治疗厌氧菌感染。而对于合并消化系统、神经系统、免疫系统、恶性肿瘤等基础疾病，以及药品不良反应不耐受的患者，则可优选左奥硝唑。     

Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review

BackgroundChromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries.ObjectivesThe primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test.MethodsMEDLINE, LILACS and Scielo databases were consulted using the terms “chromoblastomycosis” AND “diagnosis”. The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods.ResultsConsidering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S = 50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S of 36% - 99%; and Sp of 80% - 100%; while the intradermal test showed S of 83.3% - 100% and Sp of 99.4% - 100%.Study limitationsThe small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis.ConclusionsDirect mycological examination, culture, intradermal test and serology show sensitivity and specificity values ??for the diagnosis of chromoblastomycosis with no significant difference between the studies.     

系统护理干预对慢性胃炎及胃溃疡患者疗效、不良心理及生活质量的影响

目的分析系统护理干预对慢性胃炎及胃溃疡患者疗效、不良心理及生活质量的影响。方法选取2015年9月~2017年12月本院收治的80例慢性胃炎及胃溃疡患者作为研究对象,随机将患者分成两组,一组采用常规的临床护理方式,为对照组,一组采用系统护理干预措施,为实验组,对比分析两组患者的治疗疗效、不良心理及生活质量的变化。结果实验组患者经护理后治疗疗效达到了95%(38例),明显高于对照组的75%(30例)(P0.05);实验组患者治疗后SAS评分为(2.4±1.1)分,SDS评分为(1.9±1.5)分,各项评分均低于对照组(P0.05);实验组患者各项SF-36评分均高于对照组(P0.05)。结论将系统护理干预方式用于慢性胃炎及胃溃疡患者护理有助于帮助患者缓解不良心理情绪,提高其生活质量,具有较高的应用价值。     

Linguistic validation and reliability properties are weak investigated of most dementia-specific quality of life measurements—a systematic review

ObjectiveFor people with dementia, the concept of quality of life (Qol) reflects the disease's impact on the whole person. Thus, Qol is an increasingly used outcome measure in dementia research. This systematic review was performed to identify available dementia-specific Qol measurements and to assess the quality of linguistic validations and reliability studies of these measurements (PROSPERO 2013: CRD42014008725).Study Design and SettingThe MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Methodology Register databases were systematically searched without any date restrictions. Forward and backward citation tracking were performed on the basis of selected articles.ResultsA total of 70 articles addressing 19 dementia-specific Qol measurements were identified; nine measurements were adapted to nonorigin countries. The quality of the linguistic validations varied from insufficient to good. Internal consistency was the most frequently tested reliability property. Most of the reliability studies lacked internal validity.ConclusionQol measurements for dementia are insufficiently linguistic validated and not well tested for reliability. None of the identified measurements can be recommended without further research. The application of international guidelines and quality criteria is strongly recommended for the performance of linguistic validations and reliability studies of dementia-specific Qol measurements.     

Integrated models of care for people who inject drugs and live with hepatitis C virus: A systematic review

BackgroundDespite the key role that people who inject drugs (PWID) play in the hepatitis C virus (HCV) epidemic, HCV treatment rates among this population have been historically low. Integrated models of HCV and substance use care have the potential to overcome some barriers to access; however, the evidence base is uncertain. This systematic review assesses the impacts of integrated HCV and substance use services on engagement in HCV care among PWID.MethodsWe searched five databases up to December 2018 to identify original quantitative studies evaluating the impacts of co-location of HCV and substance use services on engagement in the HCV cascade of care among adult PWID. We conducted a narrative synthesis, categorizing models based on patient entry point (a: HCV facility, b: substance use disorder (SUD) facility, and c: other facilities), and levels of integrated services offered (a: HCV/substance use testing only, b: HCV/substance use treatment, and c: testing/treatment + other services).ResultsA total of 46 articles corresponding to 44 original studies were included. Almost all studies (n = 42) were conducted in high-income countries and only six studies in the Direct-Acting Antiviral (DAA) era. Twenty-six studies discussed the integration of services at SUD facilities, one at HCV facilities, and seventeen at other facilities. Analysis of included studies indicated that overall integrated care resulted in improved engagement in HCV care (e.g., testing, treatment uptake and cure). However, the quality of evidence was predominantly low to moderate.ConclusionsAvailable evidence suggests that integration of HCV and substance use services may improve engagement along the continuum of HCV care among PWID. Given limitations in data quality, and very few studies conducted in the DAA era and in low- and middle-income settings, further research is urgently needed to inform strategies to optimize HCV care access and outcomes among PWID globally.     

Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: a systematic review and aggregation of prediction models

BackgroundThere are several prognostic models to estimate the risk of mortality after surgery for active infective endocarditis (IE). However, these models incorporate different predictors and their performance is uncertain.ObjectiveWe systematically reviewed and critically appraised all available prediction models of postoperative mortality in patients undergoing surgery for IE, and aggregated them into a meta-model.Data sourcesWe searched Medline and EMBASE databases from inception to June 2020.Study eligibility criteriaWe included studies that developed or updated a prognostic model of postoperative mortality in patient with IE.MethodsWe assessed the risk of bias of the models using PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated them into an aggregate meta-model based on stacked regressions and optimized it for a nationwide registry of IE patients. The meta-model performance was assessed using bootstrap validation methods and adjusted for optimism.ResultsWe identified 11 prognostic models for postoperative mortality. Eight models had a high risk of bias. The meta-model included weighted predictors from the remaining three models (EndoSCORE, specific ES-I and specific ES-II), which were not rated as high risk of bias and provided full model equations. Additionally, two variables (age and infectious agent) that had been modelled differently across studies, were estimated based on the nationwide registry. The performance of the meta-model was better than the original three models, with the corresponding performance measures: C-statistics 0.79 (95% CI 0.76–0.82), calibration slope 0.98 (95% CI 0.86–1.13) and calibration-in-the-large –0.05 (95% CI –0.20 to 0.11).ConclusionsThe meta-model outperformed published models and showed a robust predictive capacity for predicting the individualized risk of postoperative mortality in patients with IE.Protocol registrationPROSPERO (registration number CRD42020192602).     

The complex associations between late life depression,fear of falling and risk of falls. A systematic review and meta-analysis

IntroductionDepression rates in older people worldwide vary from 10% to 15% of community-dwelling older persons. There are two others problems related to depression in old age, namely the high incidence of falls and the so-called fear of falling (FOF), with a prevalence ranging from 20% to 85%; it was initially considered a post-fall syndrome, which later as a fall-independent event.AimsStudy aims to conduct a systematic review and meta-analysis to bridge the existing gap in literature about the association between depressive symptomatology, FOF, use of antidepressant therapy and falls, also identifying a possible effect of the study quality on the outcome.MethodsThe selection of studies was carried out between May 20, 2020, and July 27, 2020 and only observational clinical trials, written in English, with participants aged more or equal to 60 years affected by diagnosis of depression or treatment for depression mentioned both as a clinical diagnosis in older patient, and as a predictor/consequence of falls were included. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for reporting systematic reviews and meta-analysis, and the protocol was recorded in the International Prospective Register of Systematic Reviews (PROSPERO).Results and discussionThe screening process ultimately led to the inclusion of 18 articles. Many of the included studies showed that depressive symptoms caused the subsequent increase in the number of falls. Results from the meta-analysis had no highlighted association between depression and falls, in contrast to other review and meta-analysis works: our work includes a substantial number of studies, with a relatively recent publication date, including patients diagnosed with depression, clearly evaluating the association between depression and falls. Results all seem to confirm the hypothesis of an interdependent association between the presence of FOF and the risk of fall, despite the high percentage of cross-sectional studies prevents inferring on the direction of the association. Therapeutic interventions aimed at decrease rate of falls reducing depressive symptoms and FOF.     

Effectiveness of conservative therapy in tendinopathy-related shoulder pain: A systematic review of randomized controlled trials

ObjectiveSystematic review investigated efficacy of conservative therapy on pain and function in people with tendinopathy-related shoulder pain.MethodsSearches were conducted on six databases. All randomized controlled trials investigating efficacy of any conservative therapy on pain and function in people with tendinopathy-related shoulder pain were included. Estimates for each specific conservative therapy were presented as weighted mean differences (WMDs) or mean differences (MDs), with 95% confidence intervals (CIs). Quality of the evidence was assessed using GRADE.ResultsFive randomized controlled trials were included. Extracorporeal shock-wave therapy (ESWT) was effective on pain at short-term (i.e., ≤3 months) when compared with control (WMD = −1.7 out of 101 points, −3.1 to −0.3; n = 158). Individual trials also suggested effects of non-steroidal anti-inflammatory drugs (NSAIDs) (−13.7 to −2.3; n = 365) and extracorporeal radial pressure pulse therapy (rESWT) (−40.0 to −27.0; n = 79). Laser therapy and ESWT were not effective on pain and function at short-term, respectively. No trials investigated medium- or long-term effects, and quality of the evidence ranged from low to very low quality.ConclusionsConservative therapies currently available for the rotator cuff management and biceps tendinopathy are not supported by low to very-low quality evidence.