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OBJECTIVE@#To analyze the report status of outcomes and measurement instruments of randomized controlled trials (RCTs) of acupuncture for post-stroke dysphagia, so as to provide a basis for designing clinical trials and developing the core outcome set in acupuncture for post-stroke dysphagia.@*METHODS@#RCTs of acupuncture for post-stroke dysphagia were searched in databases i.e. CNKI, SinoMed, Wanfang, PubMed, EMbase, Web of Science and clinical trial registries i.e. ClinicalTrials.gov and Chinese Clinical Trial Registry (ChiCTR), from January 1st, 2012 to October 30th, 2021. By literature screening and data extraction, outcomes and measurement instruments were summarized and analyzed.@*RESULTS@#A total of 172 trials (including 165 RCTs and 7 ongoing trials registrations) were included, involving 91 outcomes. The outcomes could be classified into 7 domains according to functional attributes, namely clinical manifestation, physical and chemical examination, quality of life, TCM symptoms/syndromes, long-term prognosis, safety assessment and economic evaluation. It was found that there were various measurements instruments with large differences, inconsistent measurement time point and without discriminatively reporting primary or secondary outcomes.@*CONCLUSION@#The status quo of outcomes and measurement instruments of RCTs of acupuncture for post-stroke dysphagia is not conducive to the summary and comparison of each trial's results. Thus, it is suggested to develop a core outcome set for acupuncture for post-stroke dysphagia to improve the normative and research quality of their clinical trial design.
Subject(s)
Humans , Deglutition Disorders/therapy , Randomized Controlled Trials as Topic , Acupuncture Therapy , Databases, Factual , Physical Examination , Stroke/complicationsABSTRACT
Objective:To evaluate the efficacy and safety of Chinese medicinal formulae in the treatment of antimicrobial-resistant pneumonia. Method:Following article retrieval from eight databases and data extraction by two reviewers， the methodological quality of the included trials was assessed and the outcome indicators were subjected to Meta-analysis using RevMan 5.3. Result:A total of 24 randomized controlled trials （RCTs） were included， involving 1 818 cases. Meta-analysis showed that Chinese medicinal formulae combined with western routine intervention was superior to the western routine intervention in improving the overall response rate （ORR） ［relative risk （RR）=1.27， 95% confidence interval （CI） （1.21， 1.34）， <inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M005.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M005c.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic></alternatives></inline-formula><0.000 01］， the bacterial clearance rate ［RR=1.49，95% CI （1.33， 1.66）， <inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M006.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M006c.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic></alternatives></inline-formula><0.000 01］， and the clinical pulmonary infection score （CPIS） ［mean difference （MD）=-1.64， 95% CI （-1.87， -1.41）， <inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M007.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M007c.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic></alternatives></inline-formula><0.000 01］. There was no significant difference in the incidence of adverse reactions ［RR=0.72， 95% CI （0.48， 1.07），<inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mtext> </mml:mtext><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M008.jpg"><?fx-imagestate width="3.04799986" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M008c.jpg"><?fx-imagestate width="3.04799986" height="2.62466669"?></graphic></alternatives></inline-formula>=0.1］. The comparison with the western routine intervention also revealed that Chinese medicinal formulae better improved the ORR and CPIS. Conclusion:According to the current research results， the Chinese medicinal formulae alone or combined with western routine intervention yielded more favorable clinical outcomes than western routine intervention in the treatment of antimicrobial-resistant pneumonia， without increasing the incidence of adverse events. Due to limited quality and quantity of the included RCTs， more high-quality trials are required to verify the above conclusions.
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The WFAS Annual Conference 2019 was held between November 14th and 17th at Kaya Palazzo Hotel, Antalya, Turkey. The WFAS executive committee was convened on the 14th. In the EC (Executive Committee) meeting, the JSAM proposed inclusion of the Declaration of Helsinki (DoH) in the WFAS Code of Ethics. Other issues discussed in the EC meeting included approval of the special consultative status by the the United Nations ECOSOC (Economic and Social Council) and preparation of the next WFAS symposium in the Netherlands in 2020. Individual presentations and other exhibitions in the symposium are also introduced in the present report. In addition, recent large-scale RCTs of acupuncture conducted in China were reviewed.
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Databases including CNKI,Wan Fang,CBM,VIP,PubMed and Cochrane Library were searched to collect qualified researches,and the quality of articles was evaluated according to scales. Meta-analysis including subgroup analysis was performed by using Rev Man 5. 3 software and Meta-regression test was performed by using Stata 12. 0 software. All of these methods were used to systematically evaluate the safety and clinical efficacy of Qili Qiangxin Capsules in treatment of ischemic heart failure under two circumstances( with or without syndrome differentiation). A total of 22 randomized controlled trials( RCTs) involving 1 942 patients were included,with generally low quality. RESULTS: of Meta-analysis showed that as compared with the routine Western treatment alone,additional use of Qili Qiangxin Capsules could improve the clinical efficacy( RR = 1. 21,95%CI[1. 16,1. 27],P<0. 000 01) in treatment of ischemic heart failure,with its combined effect of syndrome differentiation group greater than that of non-syndrome differentiation group( P= 0. 03,I~2= 78. 9%),Meta-regression( sig = 0. 9,P = 0. 057); left ventricular ejection fraction( WMD = 7. 28,95% CI[5. 18,9. 38],P<0. 000 01),with combined effect of syndrome differentiation group greater than that of non-syndrome differentiation group( P= 0. 01,I2= 83. 2%),Meta-regression( I~2= 81. 09%,R2= 29. 08%,sig = 0. 47,P = 0. 029); 6-minute walk test( WMD = 33. 20,95%CI[24. 70,41. 70 ],P < 0. 000 01); left ventricular end diastolic diameter( WMD =-4. 61,95% CI[-5. 38,-3. 84 ],P <0. 000 01); left ventricular end diastolic volume( WMD =-34. 43,95%CI[-38. 81,-30. 05],P< 0. 000 01); and left ventricular end systolic volume( WMD =-9. 60,95% CI[-13. 16,-6. 05],P < 0. 000 01). Adverse effects were reported in 11 patients taking Qili Qiangxin Capsules and in 20 patients with routine treatment group,tolerable in both groups. None of the patients had obvious abnormality in liver and kidney function. Qili Qiangxin Capsules were effective and safe in the treatment of ischemic heart failure,which can further improve clinical efficacy as compared with routine treatment alone. Qili Qiangxin Capsules with syndrome differentiation showed more significant effects than those without syndrome differentiation,indicating better efficacy of clinical syndrome differentiation. However,these conclusions still need to be verified with more high-quality and large-sample literature.
Subject(s)
Humans , Male , Capsules , Drugs, Chinese Herbal/therapeutic use , Heart Failure/drug therapy , SyndromeABSTRACT
Objective To evaluate the clinical effect of acupuncture as an adjuvant therapy for acute pancreatitis (AP).Methods We retrieved the databases ofCNKI,VIP,Wanfang,PubMed,EMBase,and Cochrane Library,selected the relevant randomized clinical trials (RCTs) of AP treated with routine western medicine as control group and treated with routine western medicine combined with acupuncture therapy as trial group.And then,the quality of the qualified RCTs was evaluated,and the end-point outcomes of the RCTs were analyzed by Meta-analysis.Results A total of 7 RCTs involving 371 AP patients were included into the analysis.The time for abdominal pain relief(WMD =-1.44;95％CI:-2.38,-0.50),time for abdominal distension relief (WMD =-2.50;5％CI:-4.07,-0.73),time for the restart of anal exhaust(WMD =-1.79;95％CI:-3.73,-0.14),time for defecation (WMD =-1.95;95％CI:-3.51,-0.39),time for the restart of bowel sound(WMD =-1.39;95％CI:-2.44,-0.34),time for blood amylase becoming normal(WMD =-2.09;95％CI:-3.22,-0.96),and hospitalization time (WMD =-3.70;95％CI:-6.04,-1.36) in the trial group were less than those in the control group,and the differences of the above indexes except for the time for the restart of anal exhaust were significant (P ＜ 0.05).Conclusion Acupuncture as an adjuvant therapy is effective for improving the gastrointestinal function of AP patients,and shortening time for blood amylase becoming normal and hospitalization time.However,due to the low methodological quality,more well-designed randomized controlled trials are needed to confirm the therapeutic effect of acupuncture therapy for AP.
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Background: Endometriosis is one of the common gynaecological problems mostly affecting the women in reproductive age, associated with non menstrual pelvic pain and other symptoms and recurrence of endometriosis is common after medical or even surgical treatment. Objectives: This review is done to assess, whether conservative surgery and adjunctive hor- mone suppression therapy is more beneficiary than surgery alone in the treatment of sympto- matic endometriosis in term of pelvic pain and disease recurrence. Data sources and search method: Searched had been performed on Cochrane Central Register of Controlled trials, MEDLINE, PsycINFO. Journals and reference lists had been also searched. Review methods: Only Randomized controlled trials were included if they compared the effec- tiveness of hormone therapy following conservative surgery with surgery alone or surgery plus placebo in the treatment of symptomatic endometriosis. Outcome data had been analysed by using a Mantel-Haenzel Fixed-effect model to perform meta-analysis and results had been pre- sented as Risk ratio for binary data and Standardised Mean difference for continuous data with 95% confidence intervals. Results: Out of 8 trails pelvic pain was reported in 7 trials. No significant benefit was observed both in pelvic pain recurrence (RR= 0.75, 95% Cl- 0.54 to1.04) and disease recurrence (RR 0.89, 95% Cl 0.53 to 1.49) among 5 trials (481& 447 participants) in favour of surgery and adjunctive hormone therapy. On the other hand another 2 trials (280 participants) showed sig- nificant benefit in pelvic pain score (Std. Mean difference-0.80, 95%Cl -1.05 to -0.55) but con- siderable heterogeneity (I²= 96%) was observed. Conclusion: Women who received Post-surgical hormone therapy in the treatment of sympto- matic endometriosis had no advantages in respect of endometriosis and pelvic pain recurrence in compared with surgery alone.
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Introducción: El Molusco Contagioso (MC) es una enfermedad frecuente de la piel en pediatría. Presenta pápulas perladas con una umbilicación central,independientes, en cualquier lugar del cuerpo. Si bien es de carácter benigno y autolimitado afecta al niño y su familia desde el punto de vista estético y social. Objetivo: Realizar una revisión en forma sistemática de la bibliografía sobre distintos tratamientos para establecer si existe evidencia científica sobre la eficacia y seguridad de los mismos. Material y métodos: Se realiza una búsqueda sistemática utilizando las bases de datos Medline, Lilacs y Cochrane; literatura gris en Google Académico y colaboración de la Biblioteca del Hospital Garrahan. Como estrategia se utilizaron las palabras molluscum contagiosum y treatment. Se seleccionaron ECAs, Meta-análisis y Revisiones Sistemáticas cualitativas desde 1990 a la actualidad. Se excluyen trabajos en inmunocomprometidos. Para el análisis se utilizaron las guías JAMA. Resultados: Se obtuvieron 15 ECAs y 1 Revisión Sistemática. Se incluyeron solo 8 estudios por reunir los criterios de validez interna. De los 7 ECAs incluidos solo 3 presentaron resultados estadísticamente significativos, pero todos tuvieron fallas metodológicas impor tantes. La RS concluyó que no existe evidencia científica que avale el uso de los tratamientos. Los principales inconvenientes fueron bajo Nº muestral en todos los trabajos y realizar la comparación con otros tratamientos en vez de placebo. Conclusión: No se cuenta actualmente con adecuada evidencia para avalar o desaconsejar el tratamiento del MC en pediatría. La mejor opción es la conducta expectante acompañando a la familia y reforzando su carácter benigno y autolimitado. Opinion de experto Dr. Adrián Pierini: El mejor tratamiento costo-efectivo del MC es no realizar ningún tratamiento.
Introduction: Molluscum contagiosum (MC) is a commonskin disease in pediatrics. The lesions are pearly in appea-rance with a dimpled center, are independent, and mayappear anywhere on the body. Although the disease isbenign and self limited, it may esthetically and socially affect the child and his/her family. Objective: To conduct a systematic literature review to determine if there is scientific evidence on the safety and efficacy of different treatments for MC. Material and methods: A systematic literature search was conducted using the Medline, Lilacs, and Cochrane data bases, the grey literature, and Google Scholar, and collaboration of the Hospital Garrahan library. Search strategy the words molluscum contagiosum and treatment were used. RCTs, meta-analyses, and qualitative systematic reviews published from 1990 onward were selected.Studies in immunocompromised patients were excluded.The JAMA guides were used for the analysis. Results: 15 RCTs and one systematic review were found. Only eightstudies that met the criteria of internal validity were included. Of the seven RCTs included, only three presented statistically significant results and all had considerable methodological flaws. The systematic review concluded that noscientific evidence exists to support the use of treatment.The main weaknesses were small sample sizes in all stu-dies and the comparison with other treatments instead ofplacebo. Conclusion: Currently, no adequate evidence existsto support or advise against treatment of MC in the pedia-tric population. The best management is a wait-and-seeapproach accompanying the family and emphasizing thebenign and self-limiting character of the disease. Expertopinion of Dr. Adrián Pierini: The most cost-effective treat-ment of MC is no treatment at all.