Role of systematic reviews and meta-analysis in evidence-based clinical practice

The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis examined the effects of electronic cigarettes on periodontal health compared to conventional cigarette smoke and a non-smoking population.

MATERIALS AND METHODS

MEDLINE, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were screened for literature. Eligibility criteria included clinical studies published between 2006 and 2022 that compare e-cigarettes and conventional cigarettes on periodontal health (bleeding on probing (BoP), plaque index (PI), probing depth (PD), attachment loss (AL), marginal bone loss (MBL), tooth loss, molecular inflammation markers, salivary flow rate). Meta-regression analysis was used to examine the influence of moderator variables.

RESULTS

Sixteen studies were found to be eligible for qualitative synthesis. Individual analyses showed that cigarette smokers had significantly higher PI, PD, AL, and MBL and increased concentrations of proinflammatory mediators than e-cigarette users and non-smokers. Meta-analysis revealed a 0.33-fold lower chance for BoP in e-cigarette users compared to smokers (p = 0.03), whereby meta-regression failed to detect any effects regarding the age of users and frequency of smoking. A 0.01-fold decreased chance for positive BoP in e-cigarette users compared with non-smokers was seen (p < 0.01).

CONCLUSIONS

The current findings suggest that that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials.

CLINICAL RELEVANCE

Electronic cigarettes, marketed as a safer alternative to traditional cigarettes, are becoming increasingly popular. Evidence on the use of electronic cigarettes as a cessation aid and its beneficial impact compared to cigarette smoke remains inconclusive, so the analysis conducted in this review addresses a recent question of high clinical relevance.

Harmonization-Information Trade-Offs for Sharing Individual Participant Data in Biomedicine

Biomedical practice is evidence-based. Peer-reviewed papers are the primary medium to present evidence and data-supported results to drive clinical practice. However, it could be argued that scientific literature does not contain data, but rather narratives about and summaries of data. Meta-analyses of published literature may produce biased conclusions due to the lack of transparency in data collection, publication bias, and inaccessibility to the data underlying a publication ('dark data'). Co-analysis of pooled data at the level of individual research participants can offer higher levels of evidence, but this requires that researchers share raw individual participant data (IPD). FAIR (findable, accessible, interoperable, and reusable) data governance principles aim to guide data lifecycle management by providing a framework for actionable data sharing. Here we discuss the implications of FAIR for data harmonization, an essential step for pooling data for IPD analysis. We describe the harmonization-information trade-off, which states that the level of granularity in harmonizing data determines the amount of information lost. Finally, we discuss a framework for managing the trade-off and the levels of harmonization. In the coming era of funder mandates for data sharing, research communities that effectively manage data harmonization will be empowered to harness big data and advanced analytics such as machine learning and artificial intelligence tools, leading to stunning new discoveries that augment our understanding of diseases and their treatments. By elevating scientific data to the status of a first-class citizen of the scientific enterprise, there is strong potential for biomedicine to transition from a narrative publication product orientation to a modern data-driven enterprise where data itself is viewed as a primary work product of biomedical research.

Contributions of Systematic Reviews and Meta-analyses to Nursing Education, Research, and Practice

Systematic reviews and meta-analyses are helpful methodological alternatives that combine, discuss, and assess the quality of the best available evidence through adequate and exhaustive searches of the literature. In the last decade, there has been an increase in systematic reviews and meta-analyses in nursing research. This article intends to reflect on the contributions of systematic reviews and meta-analyses to nursing education, research, and practice. Synthesizing the evidence through high-quality systematic reviews and meta-analyses adds to the disciplinary development of nursing; therefore, students and professionals in the field should be encouraged to employ these methodological tools in education and research and implement the results of these methods in clinical practice for making better decisions regarding the individual needs of patients.

How the Choice of Osteosynthesis Affects the Complication Rate of Intercalary Allograft Reconstruction? A Systematic Review and Meta-analysis

BACKGROUND

There is no clear consensus on the optimal type of fixation in intercalary allograft reconstruction. In this study, we aimed to compare the rate of most common complications following the plate and nail fixation of the intercalary allograft.

MATERIALS AND METHODS

We searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library. Studies in which the complication rate of the single bridging plate and intramedullary nail fixation was extractable were included. Studies that used extra procedures such as cementation and fibular vascular graft augmentation were excluded. The primary outcome was the fixation-specific rate of nonunion. Secondary outcomes were the fixation-specific rate of fracture, infection, and local recurrence.

RESULTS

In total, 13 studies with 431 reconstructions (352 reconstructions in the plate group and 79 reconstructions in the intramedullary nailing group) were included in this study. In the plate fixation, the rate of nonunion, fracture, infection and local recurrence was 12%, 11%, 11%, and 3%, respectively. In the intramedullary nail fixation, the rate of nonunion, fracture, infection, and local recurrence was 37%, 5%, 4%, and 0%, respectively. The rate of nonunion was significantly higher in the intramedullary nail group (OR = 6.34; 95% CI 2.98-13.49, P < 0.001). The rate of fracture, infection, and local recurrence was not significantly different between the two fixation methods.

CONCLUSIONS

Intramedullary nail is associated with a significantly higher rate of nonunion. Since the rate of other complications was not significantly different between the two osteosynthesis types, plate fixation could be considered as a better type of fixation.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-021-00563-7.

Social Work Research and Evidence-Based Practice in Experimental Medicine Exploring Issues in the Xenotransplantation Context

Purpose: The purpose of this paper was to discuss challenges to interdisciplinary evidence-based social work practice (EBP) within a context of xenotransplantation (XTx) using genetically modified animal organs, and the broader context of experimental medicine.Method This paper reviewed EBP terminology and discussed the meaning and function of evidence-based social work practice within an IDT in a XTx setting. Meta-analytic systematic reviews, and psychosocial surveys, were discussed to glean insights into ways in which IDTs can incorporate those research methodologies into EBP within an experimental medical (i.e., XTx) context. Several issues that arise while conducting psychosocial research in preparation for clinical trials were also discussed.Conclusions Social workers can assume leadership roles on IDT's within experimental medicine by using their group facilitation skills and training in EBP. An evidence-based pathway model for interdisciplinary care was proposed and briefly illustrated as a framework for collaboration among IDT members using EBP in XTx practice.

A Systematic Mixed Studies Review of the Intersections of Social-Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South

The role of stigma on psychological wellness and treatment outcomes in people living with HIV (PLWH) has been well documented. However, within the context of the southern United States, the intersection between HIV-related stigma and social-ecological factors has been understudied. Thus, a results-based convergent, mixed synthesis design was used to examine the manifestations of HIV-related stigma in PLWH in the U.S. South. A literature search was conducted using PsycINFO, PubMed (includes MEDLINE), and CINAHL. The first level of screening by title and abstract was administered on 1,829 articles. A full-text screening of 169 studies was completed, and a total of 30 relevant articles were extracted. The mixed synthesis highlighted intervention strategies that can reduce HIV-related stigma while promoting positive health-behavior change. The findings of this review underscored the uniqueness of PLWH in the south and demonstrated the crucial role of intersectionality in investigating HIV-related stigma in treating and preventing HIV.

Mandibular dental arch short and long-term spontaneous dentoalveolar changes after slow or rapid maxillary expansion: a systematic review

OBJECTIVE:

The aim of this systematic review was to analyze the short and long-term spontaneous dentoalveolar changes of the mandibular dental arch after slow (SME) or rapid (RME) maxillary expansion in the mixed and early permanent dentitions.

METHODS:

An electronic search was performed in the following databases: PubMed/Medline, Cochrane Library, Scopus, Embase and Web of Science. Eligibility criteria for article selection included randomized controlled trials and prospective studies written in English, with no restriction of year of publication, involving patients who underwent SME or RME during the mixed or early permanent dentitions. A double-blind search of articles was performed by two reviewers. Initially, the title and the abstract of the studies were read, and their references were also hand-searched for possible missing studies. A methodological quality scoring scale was used to analyze the selected articles.

RESULTS:

The search retrieved 373 articles, but only 6 were selected for review after application of the eligibility and exclusion criteria. Non-clinically significant spontaneous dentoalveolar changes of approximately 1mm were found in the mandibular dental arch in the short and long-term, after slow or rapid maxillary expansions. Furthermore, no significant differences were found between treated and control groups.

CONCLUSIONS:

There is enough evidence to conclude that negligible short and long-term spontaneous dentoalveolar changes tend to occur in the mandibular dental arch after SME or RME in the mixed and early permanent dentitions. More randomized studies with appropriate control group are required to better evaluate this issue.

Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses

BACKGROUND

The purpose of this review is to evaluate the data on the use of antipsychotics in individuals with dementia from meta-analyses.

METHODS

We performed a literature search of PubMed, MEDLINE, EMBASE, PsycINFO and Cochrane collaboration databases through 30 November, 2015 using the following keywords: 'antipsychotics', 'dementia' and 'meta-analysis'. The search was not restricted by the age of the patients or the language of the study. However, in the final analysis we only included studies involving patients that were published in English language journals or had official English translations. In addition, we reviewed the bibliographic databases of published articles for additional studies.

RESULTS

This systematic review of the literature identified a total of 16 meta-analyses that evaluated the use of antipsychotics in individuals with dementia. Overall, 12 meta-analyses evaluated the efficacy of antipsychotics among individuals with dementia. Of these, eight also assessed adverse effects. A further two studies evaluated the adverse effects of antipsychotics (i.e. death). A total of two meta-analyses evaluated the discontinuation of antipsychotics in individuals with dementia. Overall, three meta-analyses were conducted in individuals with Alzheimer's disease (AD) whereas one focused on individuals with Lewy Body Dementia (LBD). The rest of the 12 meta-analyses included individuals with dementia.

CONCLUSIONS

Antipsychotics have demonstrated modest efficacy in treating psychosis, aggression and agitation in individuals with dementia. Their use in individuals with dementia is often limited by their adverse effect profile. The use of antipsychotics should be reserved for severe symptoms that have failed to respond adequately to nonpharmacological management strategies.