• Title/Summary/Keyword: Cochrane Risk of Bias

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Clinical Effectiveness of Traditional Herbal Medicine in the Treatment of Central Post-Stroke Pain and Thalamic Syndrome: a Systemic Review and Meta-analysis of Randomized Clinical Trials Based on Traditional Chinese Medicine Journals (뇌졸중 후 중추성 통증 및 시상증후군에 대한 한약치료의 효과 : 체계적 고찰 및 메타분석 - 중의학 저널을 중심으로)

  • Jung, Yu-jin;Kang, Eun-jin;Hong, Sang-hoon
    • The Journal of Internal Korean Medicine
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    • v.40 no.3
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    • pp.295-311
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    • 2019
  • Objectives: This research aimed to investigate Chinese clinical studies on the treatment of central post-stroke pain (CPSP) and thalamic syndrome after stroke with traditional herbal medicine (THM). Methods: Randomized controlled trials verifying the effects of herbal medicine on treating CPSP and thalamic syndrome after stroke were included in the study. Electrical and hand search were conducted in the China National Knowledge Infrastructure (CNKI), National Discovery for Science Leaders (NDSL), Research Information Sharing Service (RISS), Oriental Medicine Advanced Searching Integrated System (Oasis) for CPSP and thalamic syndrome after stroke. A literature search was performed in the Chinese and Korean databases for papers published from January 1, 2010 to October 1, 2018. The selected literature was assessed by Cochrane's risk of bias. Results: Twelve reports on randomized controlled trials met the inclusion criteria from the 227 identified reports. Effective rate, comparison of visual analogy scale, present pain intensity, pain grading index, recurrence rate, follow-up, and a 36-item short form survey instrument were used to evaluate the treatments. The effective rate of the treatment group was significantly higher than that of the control group in all papers. Side effects occurred less frequently in the treatment group than in the western medicine control group. Conclusions: The treatment of CPSP and thalamic syndrome after stroke with THM was shown to be highly effective. Additional well-designed clinical trials are needed. This study can be used as a basis for further research on the treatment of CPSP and thalamic syndrome after stroke.

Effects of Banhahubak-tang on Gastroesophageal Reflux Disease : A Systematic Review and Meta-Analysis (위식도역류질환에 대한 반하후박탕의 효과 : 체계적 문헌고찰과 메타분석)

  • Kang, Sieun;Kim, Kyoungmin;Jin, Myungho
    • Journal of Society of Preventive Korean Medicine
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    • v.26 no.2
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    • pp.11-24
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    • 2022
  • Objectives : This study was designed to investigate the effect of Banhahubak-tang on gastroesophageal reflux disease(GERD) through a systematic review and meta-analysis of randomized controlled trials(RCTs). Methods : RCTs using Banhahubak-tang on GERD was searched in databases such as EMBASE, PubMed, MEDLINE, CENTRAL, CNKI, KISS, RISS, ScienceON, and OASIS. RCTs published up to October 8th, 2021 were included. Meta-analysis was performed by synthesizing outcome data, including Total Effectiveness Rate (TER), Reflux Symptom Index(RSI), Reflux Finding Score(RFS), and Incidence of Adverse Reactions. RevMan 5.4 software was used for data analysis. The Cochrane collaboration bias risk assessment scale was used to evaluate the methodological quality of the included studies. Results : Ten RCTs met the inclusion criteria. The total effective rate was the most commonly used outcome measure. The meta-analysis revealed that the TER in the experimental group was higher than that of the control group(N=2, RR:1.22, 95% CI:1.09 to 1.36, P=0.0004, I2=0%)(N=6, RR:1.22, 95% CI:1.14 to 1.32, P<0.00001, I2=0%)(N=8, RR:1.22, 95% CI: 1.14 to 1.30, P<0.00001, I2=0%). On the other hand, RSI(N=2, MD : -4.29, 95% CI: -4.71 to -3.86, I2=94%), RFS(N=2, MD : -3.28, 95% CI: -3.71 to -2.85, I2=96%), and Incidence of Adverse Reactions(N=5, RR: 0.32, 95% CI: 0.17 to 0.61, I2=0%) in the experimental group were lower than that of the control group. Conclusion : Treatment with Banhahubak-tang was found to be effective on GERD. However the results might be biased because of the poor quality and small sample size of the included RCTs.

The Effects of Non-pharmacological Interventions on Sleep among Older Adults in Korean Long-term Care Facilities: A Systematic Review and Meta-analysis

  • Jung, Sun Ok;Kim, Hyeyoung;Choi, Eunju
    • Research in Community and Public Health Nursing
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    • v.33 no.3
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    • pp.340-355
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    • 2022
  • Purpose: This study aimed to examine the effects of non-pharmacological sleep intervention programs in improving sleep quality among older adults in long-term care facilities. Methods: A literature search and selection was performed on nine different databases using the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Overall, 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, the effect size was estimated using the random-effects model in Review Manager (RevMan) desktop version 5.4 of the Cochrane Library. Results: The meta-analysis of overall non-pharmacological interventions obtained a total effect size of 1.0 (standardized mean difference [SMD]=1.0, 95% confidence interval [CI]: 0.64~1.35), which was statistically significant (Z=5.55, p<.001). The most frequently studied non-pharmacological intervention was aroma therapy, with an effect size of 0.61 (SMD=0.61, 95% CI: 0.14~1.08), which was statistically significant (Z=2.55, p=.010). In the subgroup analysis, group-based interventions, interventions for >4 weeks, and untreated control studies were more effective. Conclusion: This study confirms that non-pharmacological interventions are effective in improving sleep quality among older adults in long-term care facilities. However, the sample size was small and the risk of bias in assessing the interventions of individual studies was unclear or high, thereby limiting the generalizability of the results. Further reviews that evaluate randomized control trials, evidence-based interventions that consider older adult participants' physical activity levels, different intervention methods and durations, and different control group intervention types are needed to obtain more conclusive evidence.

Role of Oxytocin in Post-traumatic Stress Disorder: A Systematic Review (외상 후 스트레스 장애에 대한 옥시토신의 역할: 체계적 문헌 고찰)

  • Oh, Jaeuk;Kim, Minsu;Chu, Sang Hui
    • Journal of Korean Biological Nursing Science
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    • v.24 no.1
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    • pp.1-16
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    • 2022
  • Purpose: Recently, oxytocin has been introduced experimentally as a pharmacological treatment for post-traumatic stress disorder (PTSD). This study attempted to investigate the possibility of oxytocin as a treatment option for patients with PTSD by examining its dose, interval, and effectiveness in patients with PTSD. Methods: A systematic review was done on articles published from 1967 to 2020 using the PubMed, PsycINFO, and Cochrane databases. Our inclusion criteria were 1) subjects 18 years of age or older diagnosed with PTSD or exposed to a traumatic event that met criterion A of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for PTSD, 2) oxytocin was administered at least once, 3) clinical trials, and 4) studies published in Korean or English. Two independent researchers reviewed 22 articles and recorded the contents. The risk of bias was evaluated to determine the quality of the reviewed article. Results: The parameters for evaluating the effectiveness of oxytocin were identified as socio-behavioral measures in 11 articles, neuronal imaging in 9, and biomarkers in 4. In 5 papers, oxytocin was administered multiple times. Socio-behavioral measures were improved in 3 out of 5 studies in which oxytocin was administered multiple times. In 2 studies in which prolonged exposure treatment and nasal oxytocin administration were combined for 10 weeks, patient symptoms were decreased compared to the control group. Conclusion: The possibility of oxytocin as an adjuvant treatment for PTSD psychotherapy was confirmed. Further studies are necessary to evaluate the long term effectiveness of administering oxytocin multiple times combined with psychotherapy.

Effects of Bojungikgi-tang and its modifications for Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (빈혈에 대한 보중익기탕 및 그 가미방의 효과: 체계적 문헌고찰과 메타분석)

  • Mikyung Kim;Chang-ho Han
    • The Journal of Korean Medicine
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    • v.44 no.2
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    • pp.181-200
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    • 2023
  • Objectives: This study aimed to evaluate the efficacy and safety of Bojungikgi-tang (BJIG) and its modifications for patients with anemia. Methods: The subject of analysis of this study was a parallel design randomized controlled trial in which BJIG or its modifications was administered orally to patients who met the World Health Organization's anemia criteria and the efficacy and safety were prospectively measured. Electronic databases were searched to retrieve eligible literature published from 1 January 2000 to 12 February 2023. A meta-analysis was conducted, and the risk of bias (RoB) and level of evidence of the included studies was assessed using the Cochrane RoB 2 tool and GRADE method, respectively. Results: Five studies were included in the meta-analysis. When BJIG or its modifications was administered to anemia patients receiving conventional treatment, additional benefits compared to the non-administered group were found in terms of an increase in red blood cell count (mean difference (MD) 0.46 × 1012/L, 95% confidence interval (CI) 0.17 to 0.74), hemoglobin concentration (MD 9.28 g/L, 95% CI 6.06 to 12.51), hematocrit (MD 2.57%, 95% CI 1.76 to 3.38), total effective rate (odds ratio 5.29, 95% CI 2.05 to 13.68), and traditional Chinese medicine symptom scores (standardized MD -1.51, 95% CI -2.79 to -0.24). Conclusions: This study demonstrated the clinical potential of BJIG and its modifications to provide additional benefits to patients with anemia receiving conventional treatment.

The effects of diagnostic hysteroscopy on the reproductive outcomes of infertile women without intrauterine pathologies: a systematic review and meta-analysis

  • Yang, Soo Yeon;Chon, Seung-Joo;Lee, Seon Heui
    • Women's Health Nursing
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    • v.26 no.4
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    • pp.300-317
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    • 2020
  • Purpose: Hysteroscopy can be used both to diagnose and to treat intrauterine pathologies. It is well known that hysteroscopy helps to improve reproductive outcomes by treating intrauterine pathologies. However, it is uncertain whether hysteroscopy is helpful in the absence of intrauterine pathologies. This study aimed to confirm whether hysteroscopy improves the reproductive outcomes of infertile women without intrauterine pathologies. Methods: We conducted a systematic review of 11 studies retrieved from Ovid-MEDLINE, Ovid-Embase, and the Cochrane Library. Two independent investigators extracted the data and used risk-of-bias tools (RoB 2.0 and ROBINS-I) to assess their quality. Results: Diagnostic hysteroscopy prior to in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) was associated with a higher clinical pregnancy rate (CPR) and live birth rate (LBR) than non-hysteroscopy in patients with recurrent implantation failure (RIF) (odds ratio, 1.79 and 1.46; 95% confidence interval, 1.40-2.30 and 1.08-1.97 for CPR and LBR, respectively) while hysteroscopy prior to first IVF was ineffective. The overall meta-analysis of LBR showed statistically significant findings for RIF, but a subgroup analysis showed effects only in prospective cohorts (odds ratio, 1.40 and 1.47; 95% confidence interval, 0.62-3.16 and 1.04-2.07 for randomized controlled trials and prospective cohorts, respectively). Therefore, the LBR should be interpreted carefully and further research is needed. Conclusion: Although further research is warranted, hysteroscopy may be considered as a diagnostic and treatment option for infertile women who have experienced RIF regardless of intrauterine pathologies. This finding enables nurses to educate and support infertile women with RIF prior to IVF/ICSI.

Which is the Best Chinese Herb Injection Based on the FOLFOX Regimen for Gastric Cancer? A Network Meta-analysis of Randomized Controlled Trials

  • Wang, Jian-Cheng;Tian, Jin-Hui;Ge, Long;Gan, Yu-Hong;Yang, Ke-Hu
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.12
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    • pp.4795-4800
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    • 2014
  • Background: Few studies have directly compared clinical efficacy and safety among Chinese herb injections (CHIs) for gastric cancer (GC). The present study aimed to compare CHIs combined with FOLFOX regimens for GC to show which provides the best CHIs results. Materials and Methods: 9 electronic databases and 6 gray literature databases were comprehensive searched in April 20, 2013. According to inclusion and exclusion criteria, two reviewers independently selected and assessed the included trials. The risk of bias tool described in the Cochrane Handbook version 5.1.0 and CONSORT statement were used to assess the quality of the trials. All calculations and graphs were performed and produced using ADDIS 1.16.5 software. Results: A total of 541 records were searched and 38 RCTs met the inclusion criteria (2,761 participants), involving 10 CHIs. The results of network meta-analysis showed that compared with FOLFOX alone, combinations with Kanglaite, Astragalus polysaccharides, Cinobufacini, or Yadanziyouru injections could furthest strengthen ORR, improve the quality of life, reduce nausea and vomiting, and reduce the incidence of leukopenia (III-IV). Conclusions: Kanglaite injection, Astragalus polysaccharides injection, Yadanziyouru injection were superior to other CHIs in clinical efficacy and safety for GC. The conclusions now need to be confirmed by large sample size direct head-to-head studies.

The Effect of Boyanghwano-tang for Diabetic Retinopathy: A Systematic Review and Meta-Analysis (당뇨병성 망막병증에 대한 보양환오탕(補陽還五湯)의 효과: 체계적 문헌 고찰 및 메타분석)

  • Jeong-Hwa Oh;Hae-Na Kim;Hwa-Jung Yoon
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.36 no.4
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    • pp.51-69
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    • 2023
  • Objectives : The purpose of this study is to assess the effect of using Boyanghwano-tang(BYHWT) for diabetic retinopathy. Methods : We searched randomized controlled trials(RCTs) that used BYHWT for diabetic retinopathy in 10 databases(RISS, KISS, ScienceON, KCI, OASIS, DBpia, CNKI, Wanfang Database, PubMed, Cochrane Library) on August 12, 2023. Outcome measurements included total effective rate(TER) and visual acuity as the primary outcome measurements, and the secondary outcome measurements included fasting blood glucose(FBG), 2hPG, HbA1c, ET-1, NO, etc. The indicator of stability included adverse reactions. A meta-analysis was conducted according to TER, visual acuity, FBG. Results : A total of 8 randomized control trials were selected. The treatment group which used BYHWT showed significant improvement effects in TER and visual acuity compared to the control group which used western medicine or chinese patent medicine alone. TER: (RR: 1.22, CI 1.14 to 1.31, P=<0.00001), visual acuity: (RR: 2.06, CI 1.40 to 3.03, P=0.0002). Secondary outcome measurements including FBG also showed improvement in the treatment group compared to the control group. FBG: (MD: -0.15, CI -0.43 to 0.31, P=0.28). Adverse reactions were only mentioned in one study, which showed that no adverse reactions occurred in both the treatment and control groups. Conclusions : This study suggests that BYHWT is effective for diabetic retinopathy. However these findings should be interpreted cautiously due to the insufficient number of studies and unknown or high risk of bias in the included trials.

Current Interventions to Improve Adherence to Immunosuppressants in Liver Transplant Recipients: a Systematic Review (간이식 환자의 면역억제제 복용이행 관련 중재에 관한 체계적 문헌고찰)

  • Kim, So Hee;Lee, Young Joo;Lee, Sun Young;Chu, Sang Hui
    • Journal of Korean Biological Nursing Science
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    • v.18 no.1
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    • pp.17-26
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    • 2016
  • Purpose: Adherence to immunosuppressants is the key to prevent organ rejection in organ transplant recipients. The purpose of this study was to investigate current interventions to improve adherence to immunosuppressants in liver transplant recipients. Methods: A systemic literature search was done using PubMed, Embase, Cochrane Library, CINAHL and four Korean databases to identify experimental studies reported in English or Korean up to and including 2015. We identified eight intervention studies on the adherence to immunosuppressants in liver transplant recipients independently reviewed by two reviewers. The quality and risk of bias of the selected studies were assessed. Results: Education, conversion of regimen, and text messaging were identified as intervention techniques to improve adherence. We found positive results in three out of four studies implementing educational strategies, but the results were not sufficient to draw a definite conclusion. Conversion from a twice-daily tacrolimus-based regimen to a once-daily tacrolimus extended-release formula was used in three adult-only studies and its effectiveness was confirmed. One study showed that improved adherence and outcomes were effected by using text messaging with pediatric patients. Conclusion: Future research is needed to facilitate interventions to improve adherence to immunosuppressants in various ages of patients including pediatric/adolescent liver transplant recipients.

Healthy lifestyle interventions for childhood and adolescent cancer survivors: a systematic review and meta-analysis

  • Kyung-Ah Kang;Suk Jung Han;Jiyoung Chun;Hyun-Yong Kim;Yerin Oh;Heejin Yoon
    • Child Health Nursing Research
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    • v.29 no.2
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    • pp.111-127
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    • 2023
  • Purpose: This study investigated the effects of healthy lifestyle interventions (HLSIs) on health-related quality of life (HR-QoL) in childhood and adolescent cancer survivors (CACS). Methods: Major databases were searched for English-language original articles published between January 1, 2000 and May 2, 2021. Randomized controlled trials (RCTs) and non-RCTs were included. Quality was assessed using the revised Cochrane risk-of-bias tool, and a meta-analysis was conducted using RevMan 5.3 software. Results: Nineteen studies were included. Significant effects on HR-QoL were found for interventions using a multi-modal approach (exercise and education) (d=-0.46; 95% confidence interval [CI]=-0.84 to -0.07, p=.02), lasting not less than 6 months (d=-0.72; 95% CI=-1.15 to -0.29, p=.0010), and using a group approach (d=-0.46; 95% CI=-0.85 to -0.06, p=.02). Self-efficacy showed significant effects when HLSIs provided health education only (d=-0.55; 95% CI=-0.92 to -0.18; p=.003), lasted for less than 6 months (d=-0.40; 95% CI=-0.69 to -0.11, p=.006), and were conducted individually (d=-0.55; 95% CI=-0.92 to -0.18, p=.003). The physical outcomes (physical activity, fatigue, exercise capacity-VO2, exercise capacity-upper body, body mass index) revealed no statistical significance. Conclusion: Areas of HLSIs for CACS requiring further study were identified, and needs and directions of research for holistic health management were suggested.