Topical Nonsteroidal Anti-inflammatory Drugs for Corneal Abrasions: Meta-analysis of Randomized Trials
|
|
- Darren Leonard
- 6 years ago
- Views:
Transcription
1 ACAD EMERG MED d May 2005, Vol. 12, No. 5 d SPECIAL CONTRIBUTION Topical Nonsteroidal Anti-inflammatory Drugs for Corneal Abrasions: Meta-analysis of Randomized Trials LisaAnneCalder,BScH,MD,SowmyaBalasubramanian,BSc,MSc, Dean Fergusson, MHA, PhD Abstract Objectives: To determine the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in traumatic corneal abrasions. Methods: This was a systematic literature review and meta-analysis of randomized clinical trials (RCTs). The following databases were searched: MEDLINE ( ), EMBASE ( ), and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (first quarter 2004). The structured search strategy included a RCT filter and the terms cornea, wounds and injuries, trauma, corneal diseases, eye injuries, anti-inflammatory agents, nonsteroidal and specific trade names of topical NSAIDs. In addition, four journals in ophthalmology and emergency medicine were hand searched. Two authors independently reviewed citations from the literature searches. To be included, studies had to be RCTs evaluating topical NSAIDs in traumatic corneal abrasions. Trials were included regardless of language or whether they were unpublished or published. Exclusion criteria were corneal ulcers, nonrandomized studies, animal studies, or perioperative setting. Outcomes were pain scale scores at 24 hours and adverse effects. Two independent reviewers assessed four trial quality components: randomization, double blinding, reporting of withdrawals, and concealment of allocation. Weighted mean difference, using a random effects model, was calculated. Results: Of the 200 citations identified, 11 RCTs met inclusion criteria. Eight trials were identified from the MEDLINE search, two from the EMBASE search, and one from conference proceedings. Seven trials enrolled fewer than 100 patients, and more than half of the studies were conducted in Europe. Five trials reported suitable data for analysis. The overall weighted mean difference for 459 patients was a reduction in pain by 1.30 points (95% confidence interval = to 21.03) on the pain scale. Five of the trials met criteria for good quality. Transient stinging was a commonly noted adverse effect. Conclusions: Topical NSAIDs are effective analgesics for traumatic corneal abrasions. Key words: corneal diseases; eye injuries; anti-inflammatory agents; nonsteroidal. ACA- DEMIC EMERGENCY MEDICINE 2005; 12: When a patient presents with a traumatic corneal abrasion, possible therapeutic modalities include cycloplegics, patching, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and oral analgesics. The amount and quality of evidence supporting the use of these modalities are varied. There are few studies supporting the use of cycloplegics in corneal abrasions. One randomized controlled trial showed no benefit in pain scores and oral analgesia use. 1 Many clinical trials 2 9 and a meta-analysis 10 have shown that patching does not improve pain or healing in traumatic corneal abrasions. One therapy that does show promise for effective pain relief is topical NSAIDs. Several small clinical trials have examined From the Clinical Epidemiology Unit, Ottawa Health Research Institute, University of Ottawa (LAC, DF), Ottawa, Ontario, Canada; and Queen s University (SB), Kingston, Ontario, Canada. Received September 15, 2004; revision received October 26, 2004; accepted October 27, Address for correspondence and reprints: Lisa Anne Calder, BScH, MD, Department of Emergency Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9. Fax: ; lcalder@sympatico.ca. doi: /j.aem topical NSAIDs as analgesics for corneal abrasions, yet definitive evidence does not exist. A recent survey of Canadian emergency physicians assessing the management of traumatic corneal abrasions 11 showed that the average physician saw ten cases per month and yet only 53% were using topical NSAIDs. Given this lack of consensus, we conducted a systematic review of the literature and meta-analysis to identify randomized clinical trials (RCTs) using topical NSAIDs for traumatic corneal abrasions. The objective was to determine whether topical NSAIDs provide effective analgesia for this common eye injury. METHODS Study Design. This was a systematic literature review and meta-analysis of RCTs. Ethics approval was not required for this study because it did not involve human subjects or medical records. Study Population and Setting. Only randomized controlled trials were considered for analysis. The study population was patients with traumatic corneal abrasions, but the setting could be the emergency department or an ophthalmology clinic. Topical rather
2 468 Calder et al. d CORNEAL ABRASION META-ANALYSIS specify the type of pain scale used a priori. Clinical heterogeneity was assessed by examining descriptive statistics of individual study elements such as study population, setting, intervention type, and outcome assessment. Figure 1. Results of literature selection process. than oral NSAIDs were included because we did not want to confound the effect of analgesia by combining different routes of administration. There were no restrictions on type of NSAID because the mechanisms of action within the class are the same. The pain outcome had to be measured on a scale; we did not Study Protocol. A structured search strategy was developed and included the medical subject heading (MeSH) terms cornea, cornea/injuries, wounds and injuries, corneal diseases, eye injuries, antiinflammatory agents, non-steroidal, and specific trade and generic names of topical NSAIDs (diclofenac, Voltaren, ketorolac, Acular, flurbiprofen, indomethacin, Indocollyre, Indocid). The following text words were included with truncation where appropriate: injury, trauma, abrasion, wound, tear, perforation, anti-inflammatory, and non steroid. This strategy was combined with a Cochrane RCT filter 12 and applied to the following databases: MEDLINE (1966 to the first week of February in 2004), EMBASE (1980 to week 10 of 2004), the Cochrane Central Register of Controlled Trials (first quarter 2004), and the Cochrane Database of Systematic Reviews (first quarter 2004) using a standard search engine (Ovid). In addition to searching the bibliographic databases, the reference lists of all identified clinical trials and reviews recovered were hand searched. Academic Emergency Medicine, American Journal of Ophthalmology, Annals of Emergency Medicine, and Archives of Ophthalmology were also hand searched for relevant trials (from 1995 to 2004). The search included conference proceedings. Pharmaceutical companies that manufacture topical NSAIDs were contacted to obtain access to industry-sponsored trials. Efforts were made to contact the authors of the original articles to confirm the reported findings and determine any unreported details. TABLE 1. Study Characteristics First Author Year Country Setting NSAID Albertiy 2001 France, Portugal Ophthalmology clinics Indomethacin 0.1% Brahma 1996 United Kingdom Emergency eye center Flurbiprofen 0.03% Donnenfeld 1995 United States ED and ophthalmology clinic Ketorolac 0.5% Goyal 2001 United Kingdom Unclear Ketorolac 0.5% Jayamanne 1997 United Kingdom Eye casualty department Diclofenac 0.1% Kaisery 1997 United States Eye emergency unit Ketorolac 0.5% Le Sagey 2004 Canada ED Diclofenac Patroney 1999 Italy Emergency eye clinic Indomethacin 0.1% Solomon 2000 Israel Ophthalmology clinic Indomethacin 1% Szucs 2000 United States ED Diclofenac 0.1% Vigasioy 1986 Italy Emergency eye clinic Piroxicam 0.5% *Cointervention indicates that another therapy was given to both the treatment and control groups. ytrial with suitable data for analysis. zcontrol group was given two drops of chloramphenicol instead of the one drop received by the treatment group.
3 ACAD EMERG MED d May 2005, Vol. 12, No. 5 d Selection. The citations and abstracts identified by the literature search were screened independently by two reviewers (LAC, SB) using predefined selection criteria. Any interobserver discrepancies were resolved after further discussion and reaching mutual agreement. The goal of the citation review was to find all RCTs that studied topical NSAIDs in the setting of traumatic corneal abrasions. We considered published and unpublished trials conducted in humans and also considered abstracts and letters. We included all languages. Corneal ulcers were excluded because this was considered to be a different pathophysiologic process. Likewise, we excluded trials that were conducted in the perioperative setting, because this is a different population of patients. Validity Assessment. The quality of the trials was assessed by each reviewer independently, examining four main components: randomization, double blinding, reporting of withdrawals, and concealment of allocation. A Jadad score 13 was assigned to each trial; this was deemed appropriate given that it has been validated in pain studies. High-quality trials were defined as a score of 3 or greater on the Jadad scale. 13 No attempt was made to blind the reviewers to the authors, journal, or results. Data Abstraction. Two trained reviewers (LAC, SB) independently abstracted data from the retrieved trials onto a standardized and piloted data collection form. Disagreement was once again resolved by consensus. Abstracted variables included study identifying information, population, treatment groups, outcomes, follow-up period, and relevant results. The primary outcome was mean pain scale score at 24 hours, and the secondary outcome was rate of adverse effects. Data Analysis. Pain scales were standardized to a 0 10 scale. For example, to convert scores on a threepoint scale to those on a ten-point scale, scores were multiplied by a factor of The implicit assumption is that the relative difference between scores remains the same. The overall summary statistic used (standardized or weighted mean difference) was chosen depending on the uniformity of type of pain scales used in the individual trials. For the primary outcome, a weighted mean difference and 95% confidence interval (CI) was calculated using Review Manager software. 14 A random effects model was used to account for variability among trials. Trials that contained adequate data and were homogeneous in terms of population, design, and outcome were pooled to produce a summary effect. The Cochrane Q statistic was used as a measure of heterogeneity and a guide to selecting the model. A negative mean difference (and hence pain reduction) with a 95% CI that did not cross zero was considered to favor topical NSAIDs. Sensitivity analysis was planned to test the impact of the following variables: type of pain scale, trial quality, type of control, language, country of origin, type of topical NSAID, and any other sources of clinical or methodological heterogeneity. To assess publication bias, a funnel plot was to be constructed if a sufficient number of trials were identified. RESULTS Trial Flow. The results of the literature search are summarized in Figure 1. Of the 200 citations identified, eight RCTs were identified from the MEDLINE search, two from the EMBASE search, and one from conference proceedings. The citation reviewers (LAC, SB) agreed on citation selection 95% of the time. Discrepancies for the remaining 5% were resolved through mutual agreement. Study Characteristics. Study characteristics are displayed in Table 1. The sample sizes ranged from 22 to TABLE 1. (Continued). Cointervention* Control Pain Scale Used Times of Measurement Gentamicin Cointervention only 10-cm VAS 1 hr after first dose, 1 hr after second dose, 24 hr, day 4 Eye patch, chloramphenicol Liquifilm tears 10-cm VAS Every 6 hr for 24 hr Bandage contact lens, Polytrim, Placebo drops Unclear 24 hr cyclopentolate Cyclopentolate, chloramphenicol Liquifilm tears VAS hr Chloramphenicol Placebo drops 10-cm VAS 24 hr, 48 hr Cyclopentolate, phenylephrine, Placebo drops Verbal pain scale hr, 48 hr Polysporin None Placebo drops 10-cm VAS 24 hr, 48 hr, 72 hr Bandage contact lens, netilmicin Cointervention only Verbal pain scale minutes, 12 hr, 24 hr Cyclopentolate, chloramphenicol Cointerventionz Verbal pain scale hr, hr and eye patch Gentamicin, oral analgesia Placebo drops 10-cm VAS 2 hr, 4 hr, hr, 10 days Chloramphenicol, eye patch Placebo drops Verbal pain scale hr
4 470 Calder et al. d CORNEAL ABRASION META-ANALYSIS 347 with a median of 85. Seven of the trials enrolled fewer than 100 patients. One trial 15 was in Italian, and the other ten were published in English. Eight trials were reported in ophthalmology journals, and three trials were reported in emergency medicine journals. 1,16,17 Ten trials were reported as full-text articles and one as an abstract 17 from a conference proceeding. The demographics of the trials were similar; subjects were mostly men (median proportion, 82.5%; range, 73% 100%) in their late 30s (mean [6SD] age, 37 [63.22] years). Two trials 15,18 did not report baseline characteristics of their study population. Eight of the 11 trials were placebo controlled. The source of funding was not stated in six trials; four trials 1,17,19,20 were funded by pharmaceutical companies, with three stating that these were unrestricted grants. One trial 21 was funded by a laboratory. All pain assessments were patient-reported levels of pain, and no trials indicated that their pain measurement tools were validated. Primary Outcome Analysis. Suitable data for analysis were reported in five of the 11 identified trials (Table 1). The requirements for analysis were pain outcome data at 24 hours with raw or mean pain scores and standard deviation or standard errors reported. The reasons for excluding the six trials from the analysis are listed in Figure 1. The primary analysis consisted of three of the five eligible trials because these shared similar methods of pain measurement (verbal pain scales). As such, a weighted mean difference was calculated for a total of 459 patients. The overall weighted mean difference was (95% CI = to 21.03), suggesting a reduction in pain and favoring treatment with topical NSAIDs. This result was statistically significant (p, ). The Q statistic was 1.57 (p = 0.46); thus, heterogeneity was unlikely. A visual inspection of the Forest plot in Figure 2 confirms the lack of statistical heterogeneity among the trials. When the two trials using visual analog scales with adequate data were included, the standardized mean difference was (95% CI = to 20.13). The standardized mean difference summary statistic was used because of the differing pain scales among the pooled trials. Secondary Outcome Analysis. Eight of the 11 trials reported adverse effects. Two trials 18,22 had no adverse effects occur, while four trials 1,15,16,23 recorded that some patients experienced transient stinging with instillation of the drops. One trial 15 provided the actual number of patients (two) with these symptoms. One trial 20 reported three recurrent corneal erosions: two in the control group and one in the NSAID group. One patient developed a corneal abscess in the control group of one trial, 21 while three developed urticaria in the NSAID group. In this latter trial, the NSAID group also received gentamicin drops; therefore, the cause of the urticaria was unclear. Insufficient data were provided to conduct a meta-analysis of adverse effects. Trial Quality. Five of the trials 15 18,21 met Jadad s criteria for high quality. All trials were randomized; however, nine trials 1,15,17 20,22 24 did not describe the methods of randomization. Four trials 1,19,23,24 were not double blinded. Four trials 15,18,21,22 were described as double blinded but did not outline the methods of double blinding. Withdrawals or losses to follow-up were not described for each group by six trials. 16,17,19,20,22,24 Two trials had large losses to follow-up. Brahma et al. 1 conducted their follow-up via postal survey and thus lost 56% of the study group to follow-up. Solomon et al. 23 lost 21% of the control group and 29% of the NSAID group to follow-up. Neither of these trials was included in the metaanalysis. None of the 11 trials reported that their methods of allocation were concealed. Two trial authors 17,21 responded to correspondence and indicated that their method of allocation was concealed, although it was not reported in their published article or abstract. Sensitivity Analyses. When only trials of high quality based on the Jadad score were analyzed, this resulted in a standardized mean difference of (95% CI = to 0.00). This represents three trials with a total of 299 patients. In terms of quality components, only one trial 21 fulfilled all criteria for randomization, two trials did so for double blinding, 17,20 one did so for description of withdrawals, 15 and none did so for concealment of allocation. Thus, no sensitivity analysis was performed for individual components of trial quality. Sensitivity analyses for placebo-controlled trials, language, and country of origin did not change the statistical significance of the overall estimate. A funnel plot is not reported because few of the trials were suitable for analysis. DISCUSSION Based on the pooling of data from three randomized controlled trials, topical NSAIDs appear to reduce selfreported pain in traumatic corneal abrasions. These trials shared similar populations, study settings, and intervention characteristics. They all measured pain using verbal pain scales. The weighted mean difference of is statistically significant and has a narrow CI, but the question of clinical significance requires examination of the pain literature. Previous work 25 has determined that a difference of 1.3 (with a 95% CI of 1.0 to 1.5) on the verbally administered numerical rating scale is considered clinically significant among emergency department patients with acute pain. This was found to be highly correlated with the clinically
5 ACAD EMERG MED d May 2005, Vol. 12, No. 5 d Figure 2. Pain scores at 24 hours. significant difference of 1.4 cm (95% CI = 1.1 to 1.7) on the visual analog scale. The authors of the study concluded that a verbally administered numerical rating scale (0 10) can be substituted for the visual analog scale. When the two trials 21 eligible for analysis that used a visual analog scale were included, the statistical significance remained. More than half of the 11 trials identified in our review used visual analog scales, but unfortunately the majority did not report adequate data for meta-analysis. Corneal tissue recovers quickly from abrasions, often in hours. Thus, measuring pain outcomes at 24 hours could be considered late in the recovery process. None of the trials examined the immediate impact of the topical NSAIDs. We chose the 24-hour outcome because all of the clinical trials took measurements at this time point. Only four of the 11 trials measured pain at less than 24 hours. None of these were consistent in the time points of pain measurement (i.e., measurements varied from one to 12 hours after presentation). Therefore, even a subgroup metaanalysis was not possible. Because none of the trials reported a mean of less than 1/10 in their placebo groups, we can assume that these patients were still having pain. It is possible that a greater analgesic effect could have been observed if pain outcomes were measured earlier among the trials. Variability in the timing of pain scores was an issue in this analysis, but we also found that the number and type of cointerventions used was variable. Two trials 19,24 used bandage contact lenses that may help reduce pain in corneal abrasions. Both trials distributed this intervention equally among the treatment and control groups; therefore, a differential impact on the outcome is unlikely. However, the overall pain scores may have been reduced compared with other trials. Three trials 1,15,23 had eye patches as cointerventions; two 1,15 gave the patch to both groups, and one 23 provided the patch to the control group and not the treatment group. All of the trials except one 17 used topical antibiotics as a cointervention. The use of these agents is unlikely to have influenced the primary outcome of pain relief but may have influenced the rates of adverse effects in the one trial 21 that identified urticaria among some participants. Overall, the use of cointerventions was varied but, for the most part, applied equally to treatment groups. Thus, these effects are nondifferential. One key finding from this systematic review is the issue of adequate trial reporting. Previous investigators have highlighted this as a concern for the ophthalmology literature In this analysis, six of the 11 identified RCTs presented inadequate data for pooled analysis. These problems ranged from not describing the anchors of the pain scale to not reporting measures of variance. Scherer and Crawley 26 analyzed the use of the CONSORT 29 descriptors in reporting of RCTs among three ophthalmology journals ( ). They found that the mean number of descriptors included by investigators was 15.8 out of a possible 56. In particular, poor reporting was noted in the areas of allocation and masking. This is consistent with our findings. Scherer and Crawley s work was replicated with the journal Ophthalmology for all of the issues in Improvements in reporting of CONSORT descriptors were found, although several items were still underreported. Similar studies were not found for emergency medicine journals. Our review confirms that efforts to improve trial reporting in both fields are worthy of continued pursuit.
6 472 Calder et al. d CORNEAL ABRASION META-ANALYSIS LIMITATIONS The limitations of this meta-analysis stem from the exclusion of six trials (473 patients) that could have contributed meaningful data if adequately reported. The use of different pain scales (visual analog, verbal, differing anchors) and different cointerventions contributed to heterogeneity across the 11 trials. The variable levels of trial quality were of concern, especially when the sensitivity analysis demonstrated a near loss of statistically significant effect when trials of lower quality were excluded. An underlying assumption of using the mean to describe the pain data is that the distribution of the pain scores among the study populations was normal. We were unable to confirm that this was indeed the case; it is possible that some of the populations were skewed in terms of their pain scores. There also exists the possibility of publication bias because there were few negative trials identified and unpublished literature was not discovered. The pharmaceutical companies contacted indicated they were unaware of such data. Unfortunately, there were insufficient data to assess this via a funnel plot. The strengths of this meta-analysis include the systematic way in which the literature was searched and the independent review and quality assessment by two reviewers. The homogeneity of the analyzed trials in terms of study population, intervention, and randomized design also contributes to the strength of the results. There are two nonsystematic reviews 30,31 previously published on this topic. These articles were written by the same group, the second as an update of the first. The first article utilized a search of MED- LINE for RCTs, and the second article expanded the search to include the Cochrane Library and ACP Journal Club. The first review identified four of the 11 trials included in the present systematic literature review, and these authors of the review 30 evaluated two of them using the User s Guide to the Literature series 32 to assess validity. There was no pooling of data. The second review identified three additional trials and included five of the trials used in the present systematic literature review. The data were presented in a qualitative manner because these investigators believed that the timing and means of assessing pain reduction prevented meta-analysis. The report 31 identified only two of the five trials ultimately included in the present meta-analysis. Thus, we believe that our systematic literature review and meta-analysis represents an improvement on previous work. CONCLUSIONS While traumatic corneal abrasions are not considered severe injuries, the pain can be quite debilitating. Patients are often unable to drive, read, or perform any work requiring depth perception for hours. If this pain were better controlled, patients could return to work sooner and have less disruption of their daily activities. Rather than prescribing several different potentially ineffective treatments, if topical NSAIDs were indeed shown to be effective, this could provide a simpler solution to the management of this common condition. Previous meta-analysis of patching 10 as a treatment modality for corneal abrasions showed no benefit, and our recent survey 11 confirmed that a shift in practice from common to sparing use of this therapy had occurred. Our current meta-analysis demonstrates a positive effect of topical NSAIDs, and we conclude that this therapy can provide effective analgesia for patients with traumatic corneal abrasions. Future areas of investigation could explore the effectiveness of topical analgesia versus oral analgesia. The authors thank Dr. Lorenzo Moja for his assistance with Italian translation and Dr. Christian Vaillancourt for his suggestions in revising the manuscript. References 1. Brahma AK, Shah S, Hillier VF, et al. Topical analgesia for superficial corneal injuries. J Accid Emerg Med. 1996; 13: Le Sage N, Verreault R, Rochette L. Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial. Ann Emerg Med. 2001; 38: Hulbert MFG. Efficacy of eyepad in corneal healing after corneal foreign body removal. Lancet. 1991; 337: Kirkpatrick JNP, Hoh HB, Cook SD. No eye pad for corneal abrasion. Eye. 1993; 7: Patterson J, Fetzer D, Krall J, Wright E, Heller M. Eye patch treatment for the pain of corneal abrasion. South Med J. 1996; 89: Kaiser PK, the Corneal Abrasion Patching Study Group. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Ophthalmology. 1995; 102: Campanile TM, St. Clair DA, Benaim M. The evaluation of eye patching in the treatment of traumatic corneal epithelial defects. J Emerg Med. 1997; 15: Arbour JD, Brunette I, Boisjoly HM, Shi ZH, Dumas J, Guertin C. Should we patch corneal erosions? Arch Ophthalmol. 1997; 115: Michael JG, Hug D, Dowd MD. Management of corneal abrasion in children: a randomized clinical trial. Ann Emerg Med. 2002; 40: Flynn CA, D Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. Fam Pract. 1998; 47: Calder L, Balasubramanian S, Stiell I. Lack of consensus on how to treat corneal abrasions: results of a national survey. Can J Emerg Med. 2004; 6: Cochrane Reviewers Handbook. In: Alderson P, Green S, Higgins JPT (eds). The Cochrane Library. Chichester, England: Wiley, Jadad AR, Moore A, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials. 1996; 17: Review Manager (version 4.2). Cochrane Collaboration, Vigasio F, Giroletti G. Piroxicam 0,5% topico e corpi estranei corneali. Minerva Oftalmologica. 1986; 28: Szucs PA, Nashed AH, Allegra JR, Eskin B. Safety and efficacy of diclofenac ophthalmic solution in the treatment of corneal abrasions. Ann Emerg Med. 2000; 35:131 7.
7 ACAD EMERG MED d May 2005, Vol. 12, No. 5 d Le Sage N, Rochette L, Verreault R. Non-steroidal antiinflammatory and mydriatic in the treatment of traumatic corneal abrasion: a randomized clinical study. Can J Emerg Med. 2004; 6: Jayamanne DGR, Fitt AWD, Dayan M, Andrews RM, Mitchell KW, Griffiths PG. The effectiveness of topical diclofenac in relieving discomfort following traumatic corneal abrasions. Eye. 1997; 11: Donnenfeld ED, Selkin BA, Perry HD, et al. Controlled evaluation of a bandage contact lens and a topical nonsteroidal anti-inflammatory drug in treating traumatic corneal abrasions. Ophthalmology. 1995; 102: Kaiser PK, Pineda R. The Corneal Abrasion Patching Study Group. A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Ophthalmology. 1997; 104: Alberti MM, Bouat CG, Allaire CM, Trinquand CJ, The Study Group. Combined indomethacin/gentamicin eyedrops to reduce pain after traumatic corneal abrasion. Eur J Ophthalmol. 2001; 11: Goyal R, Shankar J, Fone DL, Hughes DS. Randomised controlled trial of ketorolac in the management of corneal abrasions. Acta Ophthalmol Scand. 2001; 79: Solomon A, Halpert M, Frucht-Pery J. Comparison of topical indomethacin and eye patching for minor corneal trauma. Ann Ophthalmol. 2000; 32: Patrone G, Sacca SC, Macri A, Rolando M. Evaluation of the analgesic effect of 0.1% indomethacin solution on corneal abrasions. Ophthalmologica. 1999; 213: Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med. 2003; 10: Scherer RW, Crawley B. Reporting of randomized clinical trial descriptors and use of structured abstracts. JAMA. 1998; 280: Sanchez-Thorin JC, Cortes MC, Montenegro M, Villate N. The quality of reporting of randomized clinical trials published in ophthalmology. Ophthalmology. 2001; 108: Hawkins BS. The CONSORT Statement: will it lead to improved reporting of clinical trials in ophthalmology? Arch Ophthalmol. 1999; 117: Begg C, Eastwood S, Horton R. Improving the quality of reporting of randomized controlled trials. JAMA. 1996; 276: Brown MD, Cordell WH, Gee AS. Do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing? Ann Emerg Med. 1999; 34: Weaver CS, Terrell KM. Update: do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing? Ann Emerg Med. 2003; 41: Guyatt GH, Sackett DL, Cook DJ. Users guide to the medical literature II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1993; 270:
Update: Do Ophthalmic Nonsteroidal Anti-Inflammatory Drugs Reduce the Pain Associated With Simple Corneal Abrasion Without Delaying Healing?
EVIDENCE-BASED EMERGENCY MEDICINE/UPDATE Update: Do Ophthalmic Nonsteroidal Anti-Inflammatory Drugs Reduce the Pain Associated With Simple Corneal Abrasion Without Delaying Healing? Christopher S. Weaver,
More informationEfficacy of Topical Analgesics in Pain Control for Corneal Abrasions: A Systematic Review
Open Access Review Article DOI: 10.7759/cureus.1121 Efficacy of Topical Analgesics in Pain Control for Corneal Abrasions: A Systematic Review Bryan Thiel 1, Alexandra Sarau 2, Daniel Ng 2 1. University
More informationEfficacy of Eye Patching for Traumatic Corneal Abrasions: A Controlled Clinical Trial
ORIGINAL CONTRIBUTION Efficacy of Eye Patching for Traumatic Corneal Abrasions: A Controlled Clinical Trial From Research Center, Centre Hospitalier Affilié de l Université Laval (CHA), * and the Department
More informationJOURNAL OF OPHTHALMOLOGY AND RELATED SCIENCES
JOURNAL OF OPHTHALMOLOGY AND RELATED SCIENCES Patching in Corneal Abrasions in Children Ayman M. Elghonemy 1,2 1 Magrabi Eye Hospital, Cairo, Egypt 2 Memorial Institute of Ophthalmic Research, Giza, Egypt
More informationSystematic reviews and meta-analyses of observational studies (MOOSE): Checklist.
Systematic reviews and meta-analyses of observational studies (MOOSE): Checklist. MOOSE Checklist Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease:
More informationDatabase of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright 2017 University of York.
A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling Brown
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews Closed reduction methods for acute anterior shoulder dislocation [Cochrane Protocol] Kanthan Theivendran, Raj Thakrar, Subodh Deshmukh,
More informationData extraction. Specific interventions included in the review Dressings and topical agents in relation to wound healing.
Systematic reviews of wound care management: (2) dressings and topical agents used in the healing of chronic wounds Bradley M, Cullum N, Nelson E A, Petticrew M, Sheldon T, Torgerson D Authors' objectives
More informationSystematic Reviews and Meta- Analysis in Kidney Transplantation
Systematic Reviews and Meta- Analysis in Kidney Transplantation Greg Knoll MD MSc Associate Professor of Medicine Medical Director, Kidney Transplantation University of Ottawa and The Ottawa Hospital KRESCENT
More informationDo Ophthalmic Nonsteroidal Anti-inflammatory
EVIDENCE-BASED EMERGENCY MEDICINE/CLINICAL QUESTION Do Ophthalmic Nonsteroidal Anti-inflammatory Drugs Reduce the Pain Associated With Simple Corneal Abrasion Without Delaying Healing? From the Department
More informationIntroduction to systematic reviews/metaanalysis
Introduction to systematic reviews/metaanalysis Hania Szajewska The Medical University of Warsaw Department of Paediatrics hania@ipgate.pl Do I needknowledgeon systematicreviews? Bastian H, Glasziou P,
More informationDownloaded from:
Arnup, SJ; Forbes, AB; Kahan, BC; Morgan, KE; McKenzie, JE (2016) The quality of reporting in cluster randomised crossover trials: proposal for reporting items and an assessment of reporting quality. Trials,
More informationTraumatic brain injury
Introduction It is well established that traumatic brain injury increases the risk for a wide range of neuropsychiatric disturbances, however there is little consensus on whether it is a risk factor for
More informationAuthors' objectives To assess the value of treatments for foot ulcers in patients with Type 2 diabetes mellitus.
A systematic review of foot ulcer in patients with Type 2 diabetes mellitus - II: treatment Mason J, O'Keeffe C, Hutchinson A, McIntosh A, Young R, Booth A Authors' objectives To assess the value of treatments
More informationDeep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H
Deep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H Authors' objectives To systematically review the incidence of deep vein
More informationCitation Characteristics of Research Published in Emergency Medicine Versus Other Scientific Journals
ORIGINAL CONTRIBUTION Citation Characteristics of Research Published in Emergency Medicine Versus Other Scientific From the Division of Emergency Medicine, University of California, San Francisco, CA *
More informationSystematic reviewers neglect bias that results from trials stopped early for benefit
Journal of Clinical Epidemiology 60 (2007) 869e873 REVIEW ARTICLE Systematic reviewers neglect bias that results from trials stopped early for benefit Dirk Bassler a,b, Ignacio Ferreira-Gonzalez a,c,d,
More informationResults. NeuRA Worldwide incidence April 2016
Introduction The incidence of schizophrenia refers to how many new cases there are per population in a specified time period. It is different from prevalence, which refers to how many existing cases there
More informationThe QUOROM Statement: revised recommendations for improving the quality of reports of systematic reviews
The QUOROM Statement: revised recommendations for improving the quality of reports of systematic reviews David Moher 1, Alessandro Liberati 2, Douglas G Altman 3, Jennifer Tetzlaff 1 for the QUOROM Group
More informationCADTH Therapeutic Review
Canadian Agency for Drugs and Technologies in Health Agence canadienne des médicaments et des technologies de la santé CADTH Therapeutic Review August 2012 Volume 1, Issue 1A Antithrombotic Therapy for
More informationAlectinib Versus Crizotinib for Previously Untreated Alk-positive Advanced Non-small Cell Lung Cancer : A Meta-Analysis
Showa Univ J Med Sci 30 2, 309 315, June 2018 Original Alectinib Versus Crizotinib for Previously Untreated Alk-positive Advanced Non-small Cell Lung Cancer : A Meta-Analysis Ryo MANABE 1, Koichi ANDO
More informationTrials and Tribulations of Systematic Reviews and Meta-Analyses
Trials and Tribulations of Systematic Reviews and Meta-Analyses Mark A. Crowther and Deborah J. Cook St. Joseph s Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada Systematic
More informationProblem solving therapy
Introduction People with severe mental illnesses such as schizophrenia may show impairments in problem-solving ability. Remediation interventions such as problem solving skills training can help people
More informationCritical Appraisal of a Meta-Analysis: Rosiglitazone and CV Death. Debra Moy Faculty of Pharmacy University of Toronto
Critical Appraisal of a Meta-Analysis: Rosiglitazone and CV Death Debra Moy Faculty of Pharmacy University of Toronto Goal To provide practitioners with a systematic approach to evaluating a meta analysis
More informationGlucosamine May Reduce Pain in Individuals with Knee Osteoarthritis
1 Glucosamine May Reduce Pain in Individuals with Knee Osteoarthritis Prepared by: Jacqueline Pierce, MSc (PT) candidate, Queen's University Date: April 2005 (planned review date April 2007) Clinical Scenario:
More informationNeuRA Sleep disturbance April 2016
Introduction People with schizophrenia may show disturbances in the amount, or the quality of sleep they generally receive. Typically sleep follows a characteristic pattern of four stages, where stage
More informationResults. NeuRA Hypnosis June 2016
Introduction may be experienced as an altered state of consciousness or as a state of relaxation. There is no agreed framework for administering hypnosis, but the procedure often involves induction (such
More informationCochrane Breast Cancer Group
Cochrane Breast Cancer Group Version and date: V3.2, September 2013 Intervention Cochrane Protocol checklist for authors This checklist is designed to help you (the authors) complete your Cochrane Protocol.
More informationMINDFULNESS-BASED INTERVENTIONS IN EPILEPSY
03 March 2016; v.1 MINDFULNESS-BASED INTERVENTIONS IN EPILEPSY AIM This review aimed to evaluate the effectiveness of mindfulness as a therapeutic intervention for people with epilepsy. METHODS Criteria
More informationSystematic Review & Course outline. Lecture (20%) Class discussion & tutorial (30%)
Systematic Review & Meta-analysisanalysis Ammarin Thakkinstian, Ph.D. Section for Clinical Epidemiology and Biostatistics Faculty of Medicine, Ramathibodi Hospital Tel: 02-201-1269, 02-201-1762 Fax: 02-2011284
More informationAllergen immunotherapy for the treatment of allergic rhinitis and/or asthma
ril 2014 Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma FINAL COMPREHENSIVE RESEARCH PLAN June 2015 Study Team: Systematic Review Unit FINAL COMPREHENSIVE RESEARCH PLAN: Systematic
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews High-dose chemotherapy followed by autologous haematopoietic cell transplantation for children, adolescents and young adults with first
More informationAuthors' objectives To evaluate the efficacy of intravenous immunoglobulin (IVIG) for neurologic conditions.
Use of intravenous immunoglobulin for treatment of neurologic conditions: a systematic review Fergusson D, Hutton B, Sharma M, Tinmouth A, Wilson K, Cameron D W, Hebert P C CRD summary This review assessed
More informationTitle: What is the role of pre-operative PET/PET-CT in the management of patients with
Title: What is the role of pre-operative PET/PET-CT in the management of patients with potentially resectable colorectal cancer liver metastasis? Pablo E. Serrano, Julian F. Daza, Natalie M. Solis June
More informationCritical appraisal: Systematic Review & Meta-analysis
Critical appraisal: Systematic Review & Meta-analysis Atiporn Ingsathit MD.PhD. Section for Clinical Epidemiology and biostatistics Faculty of Medicine Ramathibodi Hospital Mahidol University What is a
More informationMeta-analyses: analyses:
Meta-analyses: analyses: how do they help, and when can they not? Lee Hooper Senior Lecturer in research synthesis & nutrition l.hooper@uea.ac.uk 01603 591268 Aims Systematic Reviews Discuss the scientific
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews Drug-eluting balloon angioplasty versus non-stenting balloon angioplasty for peripheral arterial disease of the lower limbs [Cochrane Protocol]
More informationResults. NeuRA Treatments for internalised stigma December 2017
Introduction Internalised stigma occurs within an individual, such that a person s attitude may reinforce a negative self-perception of mental disorders, resulting in reduced sense of selfworth, anticipation
More informationEVIDENCE DETECTIVES December 28, 2005 Edward Amores, M.D. Reviewed and edited by P. Wyer, M.D. Part I Question Formulation
EVIDENCE DETECTIVES December 28, 2005 Edward Amores, M.D. Reviewed and edited by P. Wyer, M.D. Part I Question Formulation Clinical Scenario Quite often in the Pediatric ED and at times in the adult ED
More informationMeta Analysis. David R Urbach MD MSc Outcomes Research Course December 4, 2014
Meta Analysis David R Urbach MD MSc Outcomes Research Course December 4, 2014 Overview Definitions Identifying studies Appraising studies Quantitative synthesis Presentation of results Examining heterogeneity
More informationThe treatment of postnatal depression: a comprehensive literature review Boath E, Henshaw C
The treatment of postnatal depression: a comprehensive literature review Boath E, Henshaw C Authors' objectives To evalute treatments of postnatal depression. Searching MEDLINE, PsycLIT, Sociofile, CINAHL
More informationFeng-Yi Lai, RN, MSN, Instructor Department of Nursing, Shu-Zen College of Medicine and Management, Asphodel Yang, RN, PhD, Associate Professor
Feng-Yi Lai, RN, MSN, Instructor Department of Nursing, Shu-Zen College of Medicine and Management, Asphodel Yang, RN, PhD, Associate Professor Department of Nursing, Central Taiwan University of Science
More informationAnimal-assisted therapy
Introduction Animal-assisted interventions use trained animals to help improve physical, mental and social functions in people with schizophrenia. It is a goal-directed intervention in which an animal
More informationDistraction techniques
Introduction are a form of coping skills enhancement, taught during cognitive behavioural therapy. These techniques are used to distract and draw attention away from the auditory symptoms of schizophrenia,
More informationGATE CAT Intervention RCT/Cohort Studies
GATE: a Graphic Approach To Evidence based practice updates from previous version in red Critically Appraised Topic (CAT): Applying the 5 steps of Evidence Based Practice Using evidence about interventions
More informationSYSTEMATIC REVIEW: AN APPROACH FOR TRANSPARENT RESEARCH SYNTHESIS
SYSTEMATIC REVIEW: AN APPROACH FOR TRANSPARENT RESEARCH SYNTHESIS A Case Study By Anil Khedkar, India (Masters in Pharmaceutical Science, PhD in Clinical Research Student of Texila American University)
More informationCombination therapy compared to monotherapy for moderate to severe Alzheimer's Disease. Summary
Combination therapy compared to monotherapy for moderate to severe Alzheimer's Disease Summary Mai 17 th 2017 Background Alzheimer s disease is a serious neurocognitive disorder which is characterized
More informationThe role of meta-analysis in the evaluation of the effects of early nutrition on neurodevelopment
Note: for non-commercial purposes only The role of meta-analysis in the evaluation of the effects of early nutrition on neurodevelopment Hania Szajewska The Medical University of Warsaw Department of Paediatrics
More informationSystematic review with multiple treatment comparison metaanalysis. on interventions for hepatic encephalopathy
Systematic review with multiple treatment comparison metaanalysis on interventions for hepatic encephalopathy Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome associated with severe
More informationDrug Class Review on Proton Pump Inhibitors
Drug Class Review on Proton Pump Inhibitors Final Report Update 4 July 2006 Original Report Date: November 2002 Update 1 Report Date: April 2003 Update 2 Report Date: April 2004 Update 3 Report Date: May
More informationResults. NeuRA Treatments for dual diagnosis August 2016
Introduction Many treatments have been targeted to improving symptom severity for people suffering schizophrenia in combination with substance use problems. Studies of dual diagnosis often investigate
More informationResults. NeuRA Mindfulness and acceptance therapies August 2018
Introduction involve intentional and non-judgmental focus of one's attention on emotions, thoughts and sensations that are occurring in the present moment. The aim is to open awareness to present experiences,
More informationBackground: Traditional rehabilitation after total joint replacement aims to improve the muscle strength of lower limbs,
REVIEWING THE EFFECTIVENESS OF BALANCE TRAINING BEFORE AND AFTER TOTAL KNEE AND TOTAL HIP REPLACEMENT: PROTOCOL FOR A SYSTEMATIC RE- VIEW AND META-ANALYSIS Background: Traditional rehabilitation after
More informationResults. NeuRA Forensic settings April 2016
Introduction Prevalence quantifies the proportion of individuals in a population who have a disease during a specific time period. Many studies have reported a high prevalence of various health problems,
More informationTreatment of Corneal Abrasion in Children with Topical Nonsteroidal Anti-Inflammatory Drops without Pressure Patching
JKAU: Med. Sci., Vol. 17 No. 4, pp: 19-29 (2010 A.D. / 1431 A.H.) DOI: 10.4197/Med. 17-4.2 Treatment of Corneal Abrasion in Children with Topical Nonsteroidal Anti-Inflammatory Drops without Pressure Patching
More informationAlcohol interventions in secondary and further education
National Institute for Health and Care Excellence Guideline version (Draft for Consultation) Alcohol interventions in secondary and further education NICE guideline: methods NICE guideline Methods
More informationDoes the use of NSAIDs amongst patients with long-bone fractures increase the risk of non-union: A structured review protocol for a systematic review.
1. TITLE OF PROJECT Does the use of NSAIDs amongst patients with long-bone fractures increase the risk of non-union: A structured review protocol for a systematic review. 2. TEAM and LEAD Alder Hey Orthopaedic
More informationA Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy
A Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy Executive summary Aims of the review The main aim of the review was to assess the
More informationWorkshop: Cochrane Rehabilitation 05th May Trusted evidence. Informed decisions. Better health.
Workshop: Cochrane Rehabilitation 05th May 2018 Trusted evidence. Informed decisions. Better health. Disclosure I have no conflicts of interest with anything in this presentation How to read a systematic
More informationEfficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L
Efficacy of postoperative epidural analgesia Block B M, Liu S S, Rowlingson A J, Cowan A R, Cowan J A, Wu C L CRD summary This review evaluated the efficacy of post-operative epidural analgesia. The authors
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews Review title and timescale 1 Review title Give the working title of the review. This must be in English. Ideally it should state succinctly
More informationApplying the Risk of Bias Tool in a Systematic Review of Combination Long-Acting Beta-Agonists and Inhaled Corticosteroids for Persistent Asthma
Applying the Risk of Bias Tool in a Systematic Review of Combination Long-Acting Beta-Agonists and Inhaled Corticosteroids for Persistent Asthma Lisa Hartling 1 *, Kenneth Bond 1, Ben Vandermeer 1, Jennifer
More informationOutcomes assessed in the review
The effectiveness of mechanical compression devices in attaining hemostasis after removal of a femoral sheath following femoral artery cannulation for cardiac interventional procedures Jones T Authors'
More informationCochrane Bone, Joint & Muscle Trauma Group How To Write A Protocol
A p r i l 2 0 0 8 Cochrane Bone, Joint & Muscle Trauma Group How To Write A Protocol This booklet was originally produced by the Cochrane Renal Group to make the whole process of preparing a protocol as
More informationDrain versus no-drain after gastrectomy for patients with advanced gastric cancer Student EBM presentations
Drain versus no-drain after gastrectomy for patients with advanced gastric cancer Student EBM presentations Selali Fiamanya & Jawaad Farrukh University of Oxford October 2014 The question Mr X is a 56
More informationEssential Skills for Evidence-based Practice Understanding and Using Systematic Reviews
J Nurs Sci Vol.28 No.4 Oct - Dec 2010 Essential Skills for Evidence-based Practice Understanding and Using Systematic Reviews Jeanne Grace Corresponding author: J Grace E-mail: Jeanne_Grace@urmc.rochester.edu
More informationProspective Validation of Clinically Important Changes in Pain Severity Measured on a Visual Analog Scale
ORIGINAL CONTRIBUTION Prospective Validation of Clinically Important Changes in Pain Severity Measured on a Visual Analog Scale From the Department of Emergency Medicine, Albert Einstein College of Medicine,
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews Percutaneous access for endovascular aortic aneurysm repair: a systematic review and meta-analysis Shahin Hajibandeh, Shahab Hajibandeh,
More informationMonth/Year of Review: January 2012 Date of Last Review: February 2007
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Month/Year of Review: January 2012 Date of Last Review:
More informationTranscranial Direct-Current Stimulation
Introduction (tdcs) is a non-invasive form of brain stimulation similar to transcranial magnetic stimulation, but instead of using magnets, it uses a lowintensity, constant current applied through scalp
More informationT A B L E O F C O N T E N T S
Short-term psychodynamic psychotherapies for anxiety, depression and somatoform disorders (Unknown) Abbass AA, Hancock JT, Henderson J, Kisely S This is a reprint of a Cochrane unknown, prepared and maintained
More information5-ASA for the treatment of Crohn s disease DR. STEPHEN HANAUER FEINBERG SCHOOL OF MEDICINE, NORTHWESTERN UNIVERSITY, CHICAGO, IL, USA
5-ASA for the treatment of Crohn s disease DR. STEPHEN HANAUER FEINBERG SCHOOL OF MEDICINE, NORTHWESTERN UNIVERSITY, CHICAGO, IL, USA Background RCTs investigating the efficacy of aminosalicylates for
More informationCochrane Pregnancy and Childbirth Group Methodological Guidelines
Cochrane Pregnancy and Childbirth Group Methodological Guidelines [Prepared by Simon Gates: July 2009, updated July 2012] These guidelines are intended to aid quality and consistency across the reviews
More informationGastrointestinal Safety of Coxibs and Outcomes Studies: What s the Verdict?
Vol. 23 No. 4S April 2002 Journal of Pain and Symptom Management S5 Proceedings from the Symposium The Evolution of Anti-Inflammatory Treatments in Arthritis: Current and Future Perspectives Gastrointestinal
More informationThe moderating impact of temporal separation on the association between intention and physical activity: a meta-analysis
PSYCHOLOGY, HEALTH & MEDICINE, 2016 VOL. 21, NO. 5, 625 631 http://dx.doi.org/10.1080/13548506.2015.1080371 The moderating impact of temporal separation on the association between intention and physical
More informationSchool of Dentistry. What is a systematic review?
School of Dentistry What is a systematic review? Screen Shot 2012-12-12 at 09.38.42 Where do I find the best evidence? The Literature Information overload 2 million articles published a year 20,000 biomedical
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews A systematic review of behaviour change interventions targeting physical activity, exercise and HbA1c in adults with type 2 diabetes Leah
More informationResults. NeuRA Family relationships May 2017
Introduction Familial expressed emotion involving hostility, emotional over-involvement, and critical comments has been associated with increased psychotic relapse in people with schizophrenia, so these
More informationNonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy (Review)
Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy (Review) Lewis SR, Nicholson A, Cardwell ME, Siviter G, Smith AF This is a reprint of a Cochrane review, prepared
More informationMeta-Analysis of Randomized Controlled Trial in Treating Primary Liver Cancer by Fufang Kushen Injection Combined with TACE
4th International Conference on Sustainable Energy and Environmental Engineering (ICSEEE 2015) Meta-Analysis of Randomized Controlled Trial in Treating Primary Liver Cancer by Fufang Kushen Injection Combined
More informationCondition: Pain management
Condition: Pain management Description: In general, over-the-counter (OTC) pain medication or topical ophthalmic drugs (such as cyclopentolate) will be sufficient to ease discomfort in patients under the
More informationStandards for the reporting of new Cochrane Intervention Reviews
Methodological Expectations of Cochrane Intervention Reviews (MECIR) Standards for the reporting of new Cochrane Intervention Reviews 24 September 2012 Preface The standards below summarize proposed attributes
More informationTITLE: Fusidic Acid for Ophthalmic Infections: A Review of Clinical and Cost Effectiveness and Safety
TITLE: Fusidic Acid for Ophthalmic Infections: A Review of Clinical and Cost Effectiveness and Safety DATE: 22 February 2013 CONTEXT AND POLICY ISSUES The antibiotic fusidic acid is available in a 1% suspension
More informationDrug Class Literature Scan: Pancreatic Enzymes
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationSystematic Reviews. Simon Gates 8 March 2007
Systematic Reviews Simon Gates 8 March 2007 Contents Reviewing of research Why we need reviews Traditional narrative reviews Systematic reviews Components of systematic reviews Conclusions Key reference
More informationINDICATIONS ACULAR 0,5 % is indicated for the relief of inflammation following ocular surgery.
Page 1 of 5 SCHEDULING STATUS Schedule 3 PROPRIETARY NAME (AND DOSAGE FORM) ACULAR 0,5 % COMPOSITION ACULAR 0,5 % contains: Preservatives: Benzalkonium chloride 0,01 % m/v Disodium edetate 0,1 % m/v PHARMACOLOGICAL
More informationAdhesive strips for the closure of surgical wounds: a systematic review and meta-analysis
Adhesive strips for the closure of surgical wounds: a systematic review and meta-analysis Presenting author: I Gkegkes, M Mavros, V Alexiou, G Peppas, M Falagas Vangelis G. Alexiou, MD, MSc General Surgery
More informationLearning from Systematic Review and Meta analysis
Learning from Systematic Review and Meta analysis Efficacy and Safety of Antiscabietic Agents: A Systematic Review and Network Meta analysis of Randomized Controlled Trials KUNLAWAT THADANIPON, MD 4 TH
More informationResults. NeuRA Essential fatty acids August 2016
Introduction Alternative treatments are investigated as a possible replacement for antipsychotic medication, which can be associated with severe side effects. Alternative therapies may have less debilitating
More information2. The effectiveness of combined androgen blockade versus monotherapy.
Relative effectiveness and cost-effectiveness of methods of androgen suppression in the treatment of advanced prostate cancer Blue Cross and Blue Shield Association, Aronson N, Seidenfeld J Authors' objectives
More informationHealthcare outcomes assessed with observational study designs compared with those assessed in randomized trials(review)
Cochrane Database of Systematic Reviews Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials (Review) Anglemyer A, Horvath HT, Bero L Anglemyer
More informationControlled Trials. Spyros Kitsiou, PhD
Assessing Risk of Bias in Randomized Controlled Trials Spyros Kitsiou, PhD Assistant Professor Department of Biomedical and Health Information Sciences College of Applied Health Sciences University of
More informationManagement of new onset atrial fibrillation McNamara R L, Bass E B, Miller M R, Segal J B, Goodman S N, Kim N L, Robinson K A, Powe N R
Management of new onset atrial fibrillation McNamara R L, Bass E B, Miller M R, Segal J B, Goodman S N, Kim N L, Robinson K A, Powe N R Authors' objectives To synthesise the evidence that exists to guide
More informationSystematic review: The effectiveness and safety of diclofenac for the. pain management after cesarean
Systematic review: The effectiveness and safety of diclofenac for the pain management after cesarean ABSTRACT This is the protocol of systematic review and there is no abstract. The objective is to evaluate
More informationMethod. NeuRA Biofeedback May 2016
Introduction is a technique in which information about the person s body is fed back to the person so that they may be trained to alter the body s conditions. Physical therapists use biofeedback to help
More informationPROSPERO International prospective register of systematic reviews
PROSPERO International prospective register of systematic reviews The effect of probiotics on functional constipation: a systematic review of randomised controlled trials EIRINI DIMIDI, STEPHANOS CHRISTODOULIDES,
More informationQigong for healthcare: an overview of systematic reviews
RESEARCH Qigong for healthcare: an overview of systematic reviews Myeong Soo 1,2 Byeongsang Oh 3 Edzard Ernst 2 1 Brain Disease Research Centre, Institute of Oriental Medicine, Daejeon, South 2 Complementary
More informationStudy selection Study designs of evaluations included in the review Diagnosis.
Diagnosis and treatment of worker-related musculoskeletal disorders of the upper extremity: epicondylitis Chapell R, Bruening W, Mitchell M D, Reston J T, Treadwell J R Authors' objectives The objectives
More informationResults. NeuRA Motor dysfunction April 2016
Introduction Subtle deviations in various developmental trajectories during childhood and adolescence may foreshadow the later development of schizophrenia. Studies exploring these deviations (antecedents)
More information