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Moxibustion for ulcerative colitis: a systematic review and meta-analysis
Dong-Hyo Lee, Jong-In Kim, Myeong Soo Lee, Tae-Young Choi, Sun-Mi Choi, Edzard Ernst
BMC Gastroenterology , 2010, DOI: 10.1186/1471-230x-10-36
Abstract: We searched the literature using 18 databases from their inception to February 10, 2010, without language restrictions. We included randomized clinical trials (RCTs), in which human patients with UC were treated with moxibustion. Studies were included if they were placebo-controlled or controlled against a drug therapy or no treatment group. The methodological quality of all RCTs was assessed using the Cochrane risk of bias.In total, five RCTs were included. All were of low methodological quality. They compared the effects of moxibustion with conventional drug therapy. Three tested moxibustion against sulfasalazine and two against sulfasalazine plus other drugs. A meta-analysis of five RCTs showed favorable effects of moxibustion on the response rate compared to conventional drug therapy (n = 407; risk ratio = 1.24, 95% CI = 1.11 to 1.38; P < 0.0001; heterogeneity: I2 = 16%).Current evidence is insufficient to show that moxibustion is an effective treatment of UC. Most of included trials had high risk of bias. More rigorous studies seem warranted.Ulcerative colitis (UC) is a common, chronic idiopathic inflammatory bowel disease (IBD) [1]. Patients typically present with bloody diarrhea, passage of pus, mucus, or both, and abdominal cramping during bowel movements [2]. UC often requires lifelong medication, but poor adherence to medication has been an important barrier to successful management. Relapse rates are high, and the risk of colorectal cancer has increased [3,4].Complementary and alternative medicine (CAM) is increasingly used for treatment of IBD [5], and acupuncture and moxibustion are particularly popular options. Moxibustion is a traditional Oriental medicine that uses the heat generated by burning herbal preparations containing Artemisia vulgaris to stimulate acupuncture points. Direct moxibustion is applied directly to the skin surface at an area around an acupuncture point, whereas indirect moxibustion is performed with some insulating materials (e.g.
Telemedicine Application in the Care of Diabetes Patients: Systematic Review and Meta-Analysis  [PDF]
Milena Soriano Marcolino, Junia Xavier Maia, Maria Beatriz Moreira Alkmim, Eric Boersma, Antonio Luiz Ribeiro
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079246
Abstract: Background The impact of telemedicine application on the management of diabetes patients is unclear, as the results are not consistent among different studies. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of telemedicine interventions on change in hemoglobin A1c (HbA1c), blood pressure, LDL cholesterol (LDL-c) and body mass index (BMI) in diabetes patients. Methods Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched to identify relevant studies published until April 2012, supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Of the 6.258 articles retrieved, 13 RCTs (4207 patients) were included. Random effects model was applied to estimate the pooled results. Results Telemedicine was associated with a statistically significant and clinically relevant absolute decline in HbA1c level compared to control (mean difference -0.44% [-4.8 mmol/mol] and 95% confidence interval [CI] -0.61 to -0.26% [-6.7 to -2.8 mmol/mol]; p<0.001). LDL-c was reduced in 6.6 mg/dL (95% CI -8.3 to -4.9; p<0.001), but the clinical relevance of this effect can be questioned. No effects of telemedicine strategies were seen on systolic (-1.6 mmHg and 95% CI -7.2 to 4.1) and diastolic blood pressure (-1.1 mmHg and 95% CI -3.0 to 0.8). The 2 studies that assessed the effect on BMI demonstrated a tendency of BMI reduction in favor of telemedicine. Conclusions Telemedicine strategies combined to the usual care were associated with improved glycemic control in diabetic patients. No clinical relevant impact was observed on LDL-c and blood pressure, and there was a tendency of BMI reduction in diabetes patients who used telemedicine, but these outcomes should be further explored in future trials.
Moxibustion for hypertension: a systematic review
Jong-In Kim, Jun-Yong Choi, Hyangsook Lee, Myeong Soo Lee, Edzard Ernst
BMC Cardiovascular Disorders , 2010, DOI: 10.1186/1471-2261-10-33
Abstract: We searched 15 databases without language restrictions from their respective dates of inception until March 2010. We included randomized controlled trials (RCTs) comparing moxibustion to either antihypertensive drugs or no treatment. The risk of bias was assessed for each RCT.During the course of our search, we identified 519 relevant articles. A total of 4 RCTs met all the inclusion criteria, two of which failed to report favorable effects of moxibustion on blood pressure (BP) compared to the control (antihypertensive drug treatment alone). However, a third RCT showed significant effects of moxibustion as an adjunct treatment to antihypertensive drug therapy for lowering BP compared to antihypertensive drug therapy alone. The fourth RCT included in this review addressed the immediate BP-lowering effects of moxibustion compared to no treatment. None of the included RCTs reported the sequence generation, allocation concealment and evaluator blinding.There is insufficient evidence to suggest that moxibustion is an effective treatment for hypertension. Rigorously designed trials are warranted to answer the many remaining questions.By 2025, the number of adults with hypertension is predicted to be 1.56 billion worldwide [1]. Despite the efforts of conventional healthcare, more than 50% of the patients with high blood pressure (BP) fail to satisfactorily control this condition [2]. One reason is the adverse effects of many antihypertensive drugs, which result in patient noncompliance [3]. Therefore, a substantial proportion of hypertensive patients resort to complementary and alternative medicines to reduce their BP [4,5].Moxibustion is a traditional East Asian medical intervention that involves the burning of moxa (i.e., Artemisia vulgaris or mugwort) directly or indirectly at the acupuncture points. The indications of moxibustion include breech presentation, dysmenorrhea, knee osteoarthritis, diarrhea, asthma, stroke, cancer and hypertension, and so on [6,7]. Unlike th
Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries  [PDF]
Ignacio Ricci-Cabello, Isabel Ruiz-Perez, Antonio Rojas-García, Guadalupe Pastor, Daniela C. Gon?alves
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0084464
Abstract: Background and Aims Despite well documented disparities in health and healthcare in rural communities, evidence in relation to quality improvement (QI) interventions in those settings is still lacking. The main goals of this work were to assess the effectiveness of QI strategies designed to improve diabetes care in rural areas, and identify characteristics associated with greater success. Methods We conducted a systematic review and meta-analysis. Systematic electronic searches were conducted in MEDLINE, EMBASE, CINAHL, and 12 additional bibliographic sources. Experimental studies carried out in the OECD member countries assessing the effectiveness of QI interventions aiming to improve diabetes care in rural areas were included. The effect of the interventions and their impact on glycated hemoglobin was pooled using a random-effects meta-analysis. Results Twenty-six studies assessing the effectiveness of twenty QI interventions were included. Interventions targeted patients (45%), clinicians (5%), the health system (15%), or several targets (35%), and consisted of the implementation of one or multiple QI strategies. Most of the interventions produced a positive impact on processes of care or diabetes self-management, but a lower effect on health outcomes was observed. Interventions with multiple strategies and targeting the health system and/or clinicians were more likely to be effective. Six QI interventions were included in the meta-analysis (1,496 patients), which showed a significant reduction in overall glycated hemoglobin of 0.41 points from baseline in those patients receiving the interventions (95% CI -0.75% to -0.07%). Conclusions This work identified several characteristics associated with successful interventions to improve the quality of diabetes care in rural areas. Efforts to improve diabetes care in rural communities should focus on interventions with multiple strategies targeted at clinicians and/or the health system, rather than on traditional patient-oriented interventions.
Systematic Review of Integrative Health Care Research: Randomized Control Trials, Clinical Controlled Trials, and Meta-Analysis
Raheleh Khorsan,Ian D. Coulter,Cindy Crawford,An-Fu Hsiao
Evidence-Based Complementary and Alternative Medicine , 2011, DOI: 10.1155/2011/636134
Abstract: A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED), BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent reviewers rated each article and assessed the methodological quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN 50). Our search yielded 11,891 total citations but 6 clinical studies, including 4 randomized, met our inclusion criteria. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. The methodological quality of the included studies was assessed independently using quality checklists of the SIGN 50. Only a small number of RCTs and CCTs with a limited number of patients and lack of adequate control groups assessing integrative health care research are available. These studies provide limited evidence of effective integrative health care on some modalities. However, integrative health care regimen appears to be generally safe.
Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis
Andreas H Kramer, Derek J Roberts, David A Zygun
Critical Care , 2012, DOI: 10.1186/cc11812
Abstract: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing intensive insulin therapy with conventional glycemic control among patients with traumatic brain injury, ischemic or hemorrhagic stroke, anoxic encephalopathy, central nervous system infections or spinal cord injury.Sixteen RCTs, involving 1248 neurocritical care patients, were included. Glycemic targets with intensive insulin ranged from 70-140 mg/dl (3.9-7.8 mmol/L), while conventional protocols aimed to keep glucose levels below 144-300 mg/dl (8.0-16.7 mmol/L). Tight glycemic control had no impact on mortality (RR 0.99; 95% CI 0.83-1.17; p = 0.88), but did result in fewer unfavorable neurological outcomes (RR 0.91; 95% CI 0.84-1.00; p = 0.04). However, improved outcomes were only observed when glucose levels in the conventional glycemic control group were permitted to be relatively high [threshold for insulin administration > 200 mg/dl (> 11.1 mmol/L)], but not with more intermediate glycemic targets [threshold for insulin administration 140-180 mg/dl (7.8-10.0 mmol/L)]. Hypoglycemia was far more common with intensive therapy (RR 3.10; 95% CI 1.54-6.23; p = 0.002), but there was a large degree of heterogeneity in the results of individual trials (Q = 47.9; p<0.0001; I2 = 75%). Mortality was non-significantly higher with intensive insulin in studies where the proportion of patients developing hypoglycemia was large (> 33%) (RR 1.17; 95% CI 0.79-1.75; p = 0.44).Intensive insulin therapy significantly increases the risk of hypoglycemia and does not influence mortality among neurocritical care patients. Very loose glucose control is associated with worse neurological recovery and should be avoided. These results suggest that intermediate glycemic goals may be most appropriate.A key paradigm in the care of patients with acute brain and spinal cord injury is prevention of physiological abnormalities that may contribute to secondary neurological damage. Hyperglycemia is c
Care management for Type 2 diabetes in the United States: a systematic review and meta-analysis
Jason S Egginton, Jennifer L Ridgeway, Nilay D Shah, Saranya Balasubramaniam, Joann R Emmanuel, Larry J Prokop, Victor M Montori, Mohammad Murad
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-72
Abstract: A comprehensive literature search of electronic bibliographic databases was performed to identify care management trials in type 2 diabetes. Random effects meta-analysis was used when feasible to pool outcome measures.Fifty-two studies were eligible. Most commonly reported were surrogate outcomes (such as HbA1c and LDL), followed by process measures (clinic visit or testing frequency). Less frequently reported were quality of life, patient satisfaction, self-care, and healthcare utilization. Most care management modalities were carved out from primary care. Meta-analysis demonstrated a statistically significant but trivial reduction of HbA1c (weighted difference in means -0.21%, 95% confidence interval -0.40 to -0.03, p < .03) and LDL-cholesterol (weighted difference in means -3.38 mg/dL, 95% confidence interval -6.27 to -0.49, p < .02).Most care management programs for patients with type 2 diabetes are 'carved-out', accomplish limited effects on metabolic outcomes, and have unknown effects on patient important outcomes. Comparative effectiveness research of different models of care management is needed to inform the design of medical homes for patients with chronic conditions.Chronic care delivery continues to represent a challenge to the healthcare system. New ways to deliver and manage care for patients with chronic conditions such as type 2 diabetes emerged in the late 90s, notably the Chronic Care Model [1]. In 2003, a revision formalized the need for care management [2]. Since then, many approaches have emerged to implement the Chronic Care Model, including those emphasizing the components of self management support and links to community resources. However, many care management models are offered in a carved-out approach- not integrated with the rest of the patients' care, and their effectiveness despite their popularity remains unknown. Care management programs in chronic diseases such as diabetes, congestive heart failure and asthma can be associated with r
热敏灸治疗膝关节骨性关节炎的系统评价与meta分析
Heat-sensitive moxibustion for the treatment of knee osteoarthritis:a systematic review and meta-analysis
 [PDF]

陶思源,郑敬环,梁繁荣,蒲晨,彭介入,张桂婷,杨春霞
- , 2017,
Abstract: 目的 系统评价热敏灸疗法与传统灸对比治疗膝关节骨性关节炎的疗效差异,为热敏灸疗法的推广及膝关节骨性关节炎治疗方法的选择提供依据。方法 检索CNKI、CBM、WF、VIP、Pubmed、Medline、Cochrane Library和Embase等国内外数据库,筛选热敏灸与传统灸对比治疗膝关节骨性关节炎随机对照试验,并使用Revman 5.3软件进行meta分析。结果 本研究纳入7个随机对照试验共计596名患者。Meta分析提示,患者经过热敏灸治疗后,VAS积分明显降低(P<0.05),患者膝关节肿胀、僵硬得到有效缓解,步行能力明显提高(P<0.05),且膝关节功能得到较好改善(P<0.05)。热敏灸疗法相比传统灸法具有更好的短期治愈率(P<0.05),在降低VAS积分、缓解临床症状、恢复膝关节功能等方面,更具优势(P<0.05)。结论 热敏灸疗法是一种有效缓解膝骨关节炎症状,改善患者膝关节功能的方法,值得推广。同时该研究结果还需更多大样本多中心随机对照试验予以佐证。
Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review
Anneke L Francke, Marieke C Smit, Anke JE de Veer, Patriek Mistiaen
BMC Medical Informatics and Decision Making , 2008, DOI: 10.1186/1472-6947-8-38
Abstract: A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews.Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws.A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective.Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation.In addition, characteristics of professionals – e.g., awareness of the existence of the guideline and familiarity with its content – likewise affect implementation.Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines are followed.Finally, environmental characteristics may influence guideline implementation. For example, a lack of support from peers or superiors, as well as insufficient staff and time, appear to be the main impediments.Existing reviews describe various factors that influence whether guidelines are actually used. However, the evidence base is still thin, and future sound research – for instance comparing combinations of im
Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis
Hayfaa A Wahabi, Rasmeia A Alzeidan, Ghada A Bawazeer, Lubna A Alansari, Samia A Esmaeil
BMC Pregnancy and Childbirth , 2010, DOI: 10.1186/1471-2393-10-63
Abstract: We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2009, without language restriction, for any preconception care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women of reproductive age group with type I or type II diabetes. Study design were trials (randomized and non-randomized), cohort and case-control studies. Of the 1612 title scanned 44 full papers were retrieved of those 24 were included in this review. Twelve cohort studies at low and medium risk of bias, with 2502 women, were included in the meta-analysis.Meta-analysis suggested that preconception care is effective in reducing congenital malformation, RR 0.25 (95% CI 0.15-0.42), NNT17 (95% CI 14-24), preterm delivery, RR 0.70 (95% CI 0.55-0.90), NNT = 8 (95% CI 5-23) and perinatal mortality RR 0.35 (95% CI 0.15-0.82), NNT = 32 (95% CI 19-109). Preconception care lowers HbA1c in the first trimester of pregnancy by an average of 2.43% (95% CI 2.27-2.58). Women who received preconception care booked earlier for antenatal care by an average of 1.32 weeks (95% CI 1.23-1.40).Preconception care is effective in reducing diabetes related congenital malformations, preterm delivery and maternal hyperglycemia in the first trimester of pregnancy.Diabetes mellitus (DM) is a global public health problem with expected 300 million diabetics by the year 2030 worldwide [1]. In many areas around the globe including the West as well as many developing and Middle Eastern countries, diabetes has become a major health burden affecting young adults and women in their reproductive age [2,3].Despite improved access and quality of antenatal care, women with pre-gestational diabetes and their fetuses are at increased risk of developing serious complications compared with the non-diabetic pregnant women, including spontaneous abortion, preterm labor, hypertensive disor
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