Articles: treatment.
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This study examined the efficacy of internet-delivered cognitive and behavioural interventions for adults with chronic pain AND explored the role of clinical and study characteristics as moderators of treatment effects. PubMed, Embase, PsycINFO, CENTRAL and CINAHL were searched to identify randomized controlled trials published up to October 2021. A meta-analysis of 36 studies (5778 participants) was conducted, which found small effect sizes for interference/disability (Hedges' g = 0.28; 95% confidence interval [CI] 0.21-0.35), depression ( g = 0.43; 95% CI 0.33-0.54), anxiety ( g = 0.32; 95% CI 0.24-0.40), pain intensity ( g = 0.27; 95% CI 0.21-0.33), self-efficacy ( g = 0.39; 95% CI 0.27-0.52) and pain catastrophizing ( g = 0.31; 95% CI 0.22-0.39). ⋯ No differences were found between treatments based on traditional cognitive behaviour therapy vs acceptance and commitment therapy. Sample size, study year, and overall risk of bias (Cochrane rating) did not consistently moderate treatment effects. Overall, the results support the use of internet-delivered cognitive and behavioural interventions as efficacious and suggest guided interventions are associated with greater clinical gains for several key pain management outcomes.
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Critical care medicine · Oct 2022
Meta AnalysisThe Comparative Effectiveness of Vasoactive Treatments for Hepatorenal Syndrome: A Systematic Review and Network Meta-Analysis.
Hepatorenal syndrome (HRS) is associated with high rates of morbidity and mortality. Evidence examining commonly used drug treatments remains uncertain. We assessed the comparative effectiveness of inpatient treatments for HRS by performing a network meta-analysis of randomized clinical trials (RCTs). ⋯ Terlipressin increases HRS reversal compared with placebo. Terlipressin may reduce mortality. Until access to terlipressin improves, initial norepinephrine administration may be more appropriate than initial trial with midodrine+octreotide. Our review has the potential to inform future guideline and practice in the treatment of HRS.
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Review Meta Analysis
Acute Rockwood type III ACJ dislocation: Conservative vs surgical approach. A systematic review and meta-analysis of current concepts in literature.
The most appropriate approach, surgical or conservative, for acute Rockwood type III acromioclavicular joint (ACJ) dislocation is still under debate. In literature, similar results have been reported with both treatments. This review aims to analyze the operative and conservative outcomes of acute Rockwood type III ACJ dislocation to guide orthopedics in daily practice. ⋯ This study demonstrated statistically significant superiority of the mean ACD score in the radiological follow-up of the surgical group compared to the conservative one. A tendency for better radiological and clinical results, mean CCD and CS scores, respectively, although non statically significant, was reported in the surgical group. High-quality randomized controlled clinical trials should help determine the most appropriate treatment for acute Rockwood type III ACJ dislocations.
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Comment Meta Analysis
In fibromyalgia, amitriptyline is comparable to FDA-approved drugs for symptoms and acceptability.
Farag HM, Yunusa I, Goswami H, et al. Comparison of amitriptyline and US Food and Drug Administration-approved treatments for fibromyalgia: a systematic review and network meta-analysis. JAMA Netw Open. 2022;5:e2212939. 35587348.
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Cerebrospinal fluid (CSF) shunting is widely used in refractory idiopathic intracranial hypotension (IIH). Although multiple reviews have assessed its efficacy compared with other surgical treatments, there is no detailed analysis that evaluates the clinical outcomes after CSF shunting. ⋯ CSF shunting for IIH is associated with significant improvement in clinical symptoms. Shunting rarely causes periprocedural complications except overdrainage-related low-pressure headache. However, CSF shunting has a relatively high revision rate.