• 제목/요약/키워드: randomized controlled trials (RCTs)

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Comparison Different Methods of Intraoperative and Intraperitoneal Chemotherapy for Patients with Gastric Cancer: A Meta-analysis

  • Huang, Jin-Yu;Xu, Ying-Ying;Sun, Zhe;Zhu, Zhi;Song, Yong-Xi;Guo, Peng-Tao;You, Yi;Xu, Hui-Mian
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권9호
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    • pp.4379-4385
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    • 2012
  • Purpose: To investigate the efficacy and safety of intraperitoneal chemotherapy (IPC) for patients with gastric cancer and to compare effects between different regimens of IPC. Method: Randomized controlled trials comparing the effects of surgery plus intraperitoneal chemotherapy with surgery alone or comparing the efficacy between different regimens of intraperitoneal chemotherapy were searched for in Medline, Embase, Pubmed, the Cochrane Library and the Chinese BioMedical Disc and so on by two independent reviewers. After quality assessment and data extraction, data were pooled for meta-analysis using RevMan5.16 software. Tests of interaction were used to test for differences of effects among subgroups grouped according to different IPC regimens. Results: Fifteen RCTs with a total of 1713 patients with gastric cancer were included for quality assessment and data extraction. Ten studies were judged to be of fair quality and entered into meta-analysis. Hyperthermic intraoperative intraperitoneal chemotherapy (HR=0.60, P<0.01), hyperthermic intraoperative intraperitoneal chemotherapy plus postoperative intraperitoneal chemotherapy (HR=0.47, P<0.01) and normothermic intraoperative intraperitoneal chemotherapy (HR=0.70, P=0.01) were associated with a significant improvement in overall survival. Tests of interaction showed that hyperthermia and additional postoperative intraperitoneal chemotherapy did not impact on its effect. Further analysis revealed that intraperitoneal chemotherapy remarkably decrease the rate of postoperative hepatic metastasis by 73% (OR=0.27, 95% CI=0.12 to 0.67, P<0.01). However, intraperitoneal chemotherapy increased risks of marrow depression (OR=5.74, P<0.01), fever (OR=3.67, P=0.02) and intra-abdominal abscess (OR=3.57, P<0.01). Conclusion: The present meta-analysis demonstrates that hyperthermic intraoperative intraperitoneal chemotherapy and normothermic intraoperative intraperitoneal chemotherapy should be recommended to treat patients with gastric cancer because of improvement in overall survival. However, it is noteworthy that intraperitoneal chemotherapy can increase the risks of marrow depression, intra-abdominal abscesses, and fever.

체계적 문헌 고찰을 통한 인지기능 개선에 도움을 주는 식사 관리에 대한 연구 (Criteria for diet pattern and meal management to improve cognitive function: A systematic review)

  • 박영숙;이현정;최귀정;허림;남예림;김윤하;김민지;신원선
    • 한국식품과학회지
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    • 제52권5호
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    • pp.450-458
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    • 2020
  • 본 논문에서는 인지기능과 식사중재 프로그램의 관련 효과를 확인하고자 체계적 고찰을 시행하였다. 2019년 데이터베이스 검색, 선별을 통해 총 21편의 연구를 비뚤림 평가하였다. 고혈압 예방 식사인 대시 식단(Dietary Approaches to Stop Hypertension, DASH diet) 1편, 지중해 식단(Med diet) 8편, 마인드 식단(Mediterranean-DASH Intervention for Neurodegenerative Delay, MIND diet) 2편이었다(Table 1). 그리고 그 외의 식이중재는 10편이였다(Table 2). 인지 기능 개선을 위해 대표되는 식단 대시 식단(DASH diet), 지중해 식단(Med diet), 마인드 식단(MIND diet) 비교해 본 결과 공통적으로 야채류, 너트류를 권장하고 붉은 육류는 제한한다. 전세계적으로 각 나라마다 고령자의 인지 개선을 위한 연구가 실행되고 있으며 중재 식사관리는 지중해 식단과 비슷한 식단으로 구성되어 있으며 연구 결과 식이교육, 식이중재 시 인지 개선 효과가 있었다. 이 연구를 통해 식이패턴과 식사의 질을 높이는 것이 중요하고 인지기능 개선에 높은 효과를 보인다는 것을 확인할 수 있었고 치매의 치료법은 아직 개발되지 않았으므로 치매의 진행을 예방하고 발병을 지연시키기 위해 식단 구성시 정제되지 않은 통곡물, 야채, 과일, 베리류, 생선, 올리브유, 너트류, 콩류 섭취를 권장한다. 이 고찰을 통해 인지기능 개선을 위해 단일 영양소, 단일 식품의 섭취의 한계를 확인하였고 한국 고령자에게 맞는 맞춤형 식사교육을 통한 식사관리 중재 프로그램이 필요하다는 것을 확인하였다. 그리고, 이 연구의 결과를 바탕으로 한국형 식사관리 중재 프로그램의 기초를 마련하고자 한다.

요통에 대한 침치료 무작위대조군임상연구(RCT)의 FEAS 분석을 통한 계통적 분석 연구 (A Systematic Review of Randomized Controlled Trials on Acupuncture Treatment for Low Back Pain Based on FEAS)

  • 남동우;강중원;김은정;김현욱;송호섭;김선웅;김갑성;이건목;최도영;이재동
    • Journal of Acupuncture Research
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    • 제26권3호
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    • pp.133-147
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    • 2009
  • Objectives : To review RCTs on acupuncture treatment for low back pain in order to establish a standard acupuncture treatment model in treating low back pain. Methods : RCT articles on traditional acupuncture treatment for low back pain were searched through online database. Study Quality was assessed using the FEAS. Results : Ten out of the one hundred six articles searched were reviewed. Among the ten articles reviewed, six articles compared acupuncture treatment with no treatment or non-penetrating sham acupuncture. All six articles concluded significantly positive effect of acupuncture compared to the control. Conclusions : The ideal acupuncture treatment model for low back pain was obtained as follows. A sterile disposable stainless steel(0.30mm${\times}$40mm) should be inserted to more than six acupuncture points on the BL, GV and GB meridians such as $BL_23$, $BL_25$, $BL_40$, $BL_60$, $GV_4$ and $GB_30$. Sparrow pecking method to obtain 'de-qi' is recommended and repeated stimulation during the 20 minute retention time is necessary. Ideal treatment frequency would be more than one a week for about 7 weeks.

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뇌졸중후 경직에 대한 침치료 임상진료지침 (Clinical Practice Guideline on Acupuncture for Post-stroke Spasticity)

  • 김제신;신승원;이의주;신병철;이명수;임성민;남동우;문상관
    • 대한한의학회지
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    • 제36권1호
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    • pp.1-8
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    • 2015
  • Objectives: This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with post-stroke spasticity. Methods: Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on post-stroke spasticity, compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine. Results & Conclusions: One systematic review and 7 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of electroacupuncture treatment for post-stroke spasticity. However, it did not show any sufficient evidence to treat the patients with post-stroke spasticity with the sole acupuncture. The moderate evidence was presented that over 3 times of the electroacupuncture treatments with 1-100 Hz frequency should be performed every week on the acupoints, such as LI11, LI10, TE5, LI4, ST36, GB34, ST40, or LR3, for 20-30 minutes. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for post-stroke spasticity.

고형암 환자의 수술 후 통증에 대한 침 치료 효과 : 체계적 문헌고찰 및 메타분석 (The Efficacy of Acupuncture for Postoperative Pain in Patients with Solid Tumor : A Systematic Review and Meta Analysis)

  • 윤성수;류한성;오혜경;이지영;윤성우
    • 대한암한의학회지
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    • 제22권2호
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    • pp.1-11
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    • 2017
  • Objectives: Postoperative pain is one of postoperative complications in patients with solid tumor. This systematic review and meta-analysis were aimed to evaluate the efficacy of acupuncture for postoperative pain in solid tumor. Methods: We searched for randomized controlled trials (RCTs) using acupuncture for postoperative pain in adult patients with solid tumor up to September 2016. Acupuncture was defined as manual acupuncture, electroacupuncture and pharmacopuncture. The following databases were searched: PubMed, EMBASE, Cochrane Library, CNKI, CiNii, KoreaMed, Kmbase, KISS, NDSL, KISTI. The results of the studies were meta-analyzed and the risk of bias was assessed. Results: Five studies were included in this review. When acupuncture was compared with usual care, Prince-Henry pain scale score was significantly lower in acupuncture group (MD=-0.44, 95% CI: -0.62 to -0.26, P<0.001, $I^2=87%$) and 10 points pain score (including Numeric Rating Scale and Visual Analog Scale) was lower in acupuncture group but not significantly (MD=-1.00, 95% CI: -2.00 to -0.00, p=0.05). When acupuncture was compared with sham acupuncture, 10 points pain score was significantly lower in acupuncture group (MD=-0.39, 95% CI: -0.65 to -0.14, p=0.002, $I^2=0%$). Any serious adverse events were not reported. Conclusion: This review shows that acupuncture may be considered for postoperative pain in patients with solid tumor without serious adverse events. However, only a few studies were included in this study, further investigation is needed in this area.

Effect of luteal phase support with vaginal progesterone on pregnancy outcomes in natural frozen embryo transfer cycles: A meta-analysis

  • Seol, Aeran;Shim, Yoo Jin;Kim, Sung Woo;Kim, Seul Ki;Lee, Jung Ryeol;Jee, Byung Chul;Suh, Chang Suk;Kim, Seok Hyun
    • Clinical and Experimental Reproductive Medicine
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    • 제47권2호
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    • pp.147-152
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    • 2020
  • Objective: The purpose of this study was to determine the effect of vaginal progesterone for luteal phase support (LPS) on the clinical pregnancy rate (CPR) in natural frozen embryo transfer (FET) cycles via a meta-analysis. Methods: We performed a meta-analysis of randomized controlled trials (RCTs) and retrospective studies that met our selection criteria. Four online databases (PubMed, Embase, Medline, and the Cochrane Library) were searched between January 2017 and May 2017. Studies were selected according to predefined inclusion criteria and meta-analyzed using R software version 2.14.2. The main outcome measure was CPR. Results: A total of 18 studies were reviewed and assessed for eligibility. One RCT (n = 435) and three retrospective studies (n = 3,033) met the selection criteria. In a meta-analysis of the selected studies, we found no significant difference in the CPR (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.60-1.55) between the vaginal progesterone and control groups. An analysis of the two retrospective cohort studies that reported the live birth rate (LBR) following FET showed a significantly higher LBR in the vaginal progesterone group (OR, 1.72; 95% CI, 1.21-2.46). A subgroup meta-analysis of FET conducted 5 days after injection of human chorionic gonadotropin showed no significant differences between the two groups with regard to the CPR (OR, 1.18; 95% CI, 0.90-1.55) or miscarriage rate (OR, 0.73; 95% CI, 0.36-1.47). Conclusion: The results of this meta-analysis of the currently available literature suggest that LPS with vaginal progesterone in natural FET cycles does not improve the CPR.

뇌졸중 후 요실금에 대한 침치료 임상진료지침 (Clinical Practice Guideline for acupuncture in Post-stroke urinary incontinence)

  • 이지원;신병철;이명수;임성민;유정희;조충식;문상관;육태한;주종천;이의주
    • 사상체질의학회지
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    • 제29권4호
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    • pp.317-325
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    • 2017
  • Objectives This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the stroke patients with Post-stroke Urinary Incontinence(PSUI). Methods Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on PSUI, compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine. Results & Conclusions 8 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of acupuncture treatment for PSUI. The moderate evidence was presented that over 3 times a week of the acupuncture should be performed over 4 weeks on the acupoints, such as BL23, CV3, SP6, CV4, CV6, ST28, BL28, BL32, GV20, BL22, GV4 or ST36, for 15-30 minutes. 1-150 Hz frequency is suggested if electro-acupuncture treatments is performed with. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. There was a moderate evidence to support safety of acupuncture treatment for PSUI. We recommend acu-points of constitutional acupuncture for Sasangin on the healthy side.

네트워크 분석에 기반한 항암화학요법으로 유발된 말초신경병증의 최적 경혈 조합 (Optimal Combination of Acupoints Based on Network Analysis for Chemotherapy-Induced Peripheral Neuropathy)

  • 김민우;김중일;이진현;조동찬;강수빈;이지원;박태용;고연석
    • 한방재활의학과학회지
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    • 제32권1호
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    • pp.107-124
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    • 2022
  • Objectives This study aimed to identify optimal combinations of acupoints used to treat chemotherapy-induced peripheral neuropathy (CIPN). Methods We searched four international databases (MEDLINE, EMBASE, the Allied and Complementary Medicine Databases [AMED], and China National Knowledge Infrastructure [CNKI]) and five Korean databases (DBpia, Research Information Sharing Service [RISS], Korean Studies Information Service System [KISS], Oriental Medicine Advanced Searching Integrated System [OASIS], and KoreaMed) to identify randomized controlled trials (RCTs) that used acupuncture to treat CIPN. Network analysis was performed on the acupoints used in more than three included articles. We constructed a network by calculating the Jaccard similarity coefficient between acupoints and applied minimum spanning tree. Then, modularity analysis, degree centrality (Cd), and betweenness centrality (Cb) were used to analyze properties of the acupoints. Results A total of 25 articles were included. 24 acupoints were extracted from 25 articles. The combinations of acupoints having the highest Jaccard similarity coefficient were {EX-UE9, EX-LE10} and {ST36, SP6}. In the modularity analysis, acupoints were classified to six modules. ST40, EX-UE11, and KI6 had the highest Cd value while ST40, GB34 had the highest Cb value. Conclusions This study found the systematic framework of acupoint combinations used in CIPN studies. This study is expected to provide new perspectives of CIPN treatment to therapists. A RCT is in progress of using the network of this study as a guideline. If significant results are derived from the RCT, it will be possible to lay the groundwork to consider acupuncture for CIPN treatment.

Efficacy of alpha-lipoic acid in patients with burning mouth syndrome compared to that of placebo or other interventions: a systematic review with meta-analyses

  • Christy, Jessica;Noorani, Salman;Sy, Frank;Al-Eryani, Kamal;Enciso, Reyes
    • Journal of Dental Anesthesia and Pain Medicine
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    • 제22권5호
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    • pp.323-338
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    • 2022
  • Burning mouth syndrome (BMS) is a chronic oral disorder of unknown etiology which presents therapeutic challenges. Alpha-lipoic acid (ALA) has been studied as a potential treatment for BMS. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of ALA compared to that of placebo or other interventions in individuals with BMS. Randomized controlled trials (RCT) using ALA to treat BMS were identified from MEDLINE, Cochrane Library, EMBASE, and Web of Science up to February 3, 2021. The assessment of the risk of bias in the included studies was based on the Cochrane guidelines. The primary outcome evaluated was the visual analog scale (VAS) pain intensity. ALA was compared with placebo, clonazepam, gabapentin, pregabalin, ALA plus gabapentin, capsaicin, Biotène®, and laser therapy. Altogether, 137 records were scanned for inclusion/exclusion, and nine RCTs (two unclear and seven at high risk of bias) were included in the qualitative and quantitative analyses, with a total of 594 patients with BMS included in this review. All studies reported an improvement in VAS pain scores ranging from -0.72 to -2.77. Meta-analysis results showed a non-significant reduction in pain intensity for ALA (P = 0.616) compared to that of placebo on a VAS of 0-10. Patients taking ALA were 1.923 times more likely to show an improvement in self-reported BMS symptoms (P = 0.031) than those in the placebo group. Clonazepam and pregabalin showed a significant VAS pain reduction of 4.08 and 4.68 (P < 0.001), respectively, compared to that with ALA. Although ALA intervention provided a non-significant improvement in the pain score and was more likely to produce a reduction in BMS symptoms, the evidence was of low quality. Further research is needed to establish clear guidelines for the use of ALA for BMS treatment.

전립선비대증에 대한 열민구(熱敏灸)의 효과에 관한 체계적 문헌 고찰 (A Systematic Review of effect on Heat-sensitive Moxibustion for Benign Prostatic Hyperplasia)

  • 김민석;주홍민;김민화;박선영;윤영주;박성하
    • 대한한의학회지
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    • 제42권3호
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    • pp.153-164
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    • 2021
  • Objectives: The aim of this study is to investigate the effect of Heat-sensitive Moxibustion on Benign Prostatic Hyperplasia Methods: We searched articles from Academic Journals(CAJ) online databases, Oriental Medicine Advanced Searching Integrated System (OASIS), Searching key words were '前列腺增生', '熱敏灸' and '열민구', '전립선비대'. The search range included randomized controlled trials (RCTs). Among the articles published to 2020, 10 articles were found. After review the title, abstract and original, 3 articles were selected finally to rule out treatment combined with completely different treatments. Result: The Heat-sensitive moxibustion at acupoints in the treatment of Benign prostatic hyperplasia were significantly superior to control group after treatment in the symptoms of patients, IPSS, QOL, PVR and Qmax(P<0.05). The Heat-sensitive moxibustion can significantly reduce the incidence of temporary urinary incontinence after Transurethral resection of the prostate(TURP) and improve life quality and satisfaction of patients(P<0.05). The individualized desensitization saturated time and amount of Heat-sensitive moxibustion is superior effective to general amount and time of traditional moxibustion in the total effective rate, IPSS, Ru and Qmax(P<0.01) for Benign prostatic hyperplasia. Conclusion: Heat sensitive moxibustion directly transfer heat to the source of a disease. So it can be considered as a good treatment for Benign prostate hypertrophy. It was also shown a better effect on BPH compared to traditional moxibustion, According to the thermo principles of tumor, if the tumor cell's death temperature of 43℃ is reached, that can cause tumor degeneration. Therefore I think Heat sensitive moxibustion can be applied to various tumor disease. The results of this study could be applied to clinical treatment of BPH. However, additional large-scale clinical researches should be conducted.