Evidence mapping and quality assessment of systematic reviews in dental traumatology

BACKGROUND/AIMS

Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research.

METHODS

Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed.

RESULTS

The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods.

CONCLUSION

The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.

Effect of intrathecal morphine plus patient-controlled analgesia with morphine versus patient-controlled analgesia with morphine alone on total morphine dose 24 hours post-surgery: a systematic review

OBJECTIVE

The objective of this review was to evaluate the effects of preoperative intrathecal morphine (ITM) in addition to patient-controlled analgesia with morphine (PCAM) versus PCAM without preoperative ITM on total morphine dose in the first 24 hours postoperatively in adult patients undergoing abdominal or thoracic surgery.

INTRODUCTION

Postoperative pain is a significant problem for patients undergoing major abdominal and thoracic surgery. Intrathecal morphine can reduce postoperative pain and reduce intravenous (IV) morphine requirements during the first 24 hours after surgery; however, the amount of IV morphine dose reduction achieved has not been well established. This knowledge could help anesthesia providers determine if ITM is an appropriate analgesic option for patients.

INCLUSION CRITERIA

This review included studies with participants 18 years of age or older receiving general anesthesia for abdominal or thoracic surgery. Studies were included that used the intervention of preoperative ITM in addition to PCAM versus PCAM without preoperative ITM. Total morphine dose in milligrams during the first 24 hours after surgery was the outcome of interest.

METHODS

A search of PubMed and CINAHL was conducted for studies published between January 1984 and October 2018 using the key terms intrathecal, morphine, postoperative, pain, patient-controlled analgesia and general anesthesia. Index terms and keywords from identified articles were used to search CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, Ovid MEDLINE, ProQuest Dissertations and Theses/Nursing and Allied Health Databases, and Scopus. The reference lists of articles that underwent critical appraisal were searched for additional studies. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. Two independent reviewers assessed each selected article. Study results were pooled in statistical meta-analysis using the JBI System for the Unified Management, Assessment and Review of Information, and two studies were described in narrative form. Differences in IV morphine dose between the ITM plus PCAM and PCAM alone groups were calculated to produce the weighted mean difference (WMD) utilizing a 95% confidence interval (CI). Heterogeneity was assessed using χ and I values. Subgroup analysis was conducted on two studies that included IV non-opioid analgesia in addition to ITM and PCAM for postoperative analgesia.

RESULTS

Seven RCTs with a total sample size of 352 patients were included in this review. Five studies that evaluated postoperative total morphine dose in milligrams with and without preoperative ITM were included for statistical meta-analysis, with 277 participants from four countries. Total morphine dose was significantly reduced in patients who received ITM (WMD = -24.44 mg, 95% CI -28.70 to -20.18 mg) compared to PCAM without ITM. Subgroup analysis of two studies involving 112 participants using IV acetaminophen in addition to ITM and PCAM indicated no additional benefit after ITM was already administered (WMD = -25.93, 95% CI -32.05 to -19.80 mg). Two studies with 75 participants were described narratively because total morphine dose was reported as median rather than mean values.

CONCLUSIONS

In this review, ITM provided a significant decrease in overall total morphine dose during the first 24 hours after surgery in abdominal surgery patients. The addition of IV non-opioids to the postoperative analgesia protocol showed no additional reduction in postoperative IV morphine dose between groups.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018100613.

Osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures: A systematic review

PURPOSE

The evidence pertaining to the contribution of the sinus membrane to new bone formation following maxillary sinus augmentation procedures is equivocal. The purpose of this study was to analyse the evidence currently available on the osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures, and the effect of local delivery of recombinant human bone morphogenic proteins (rhBMPs) on the bone-forming potential of the sinus membrane.

MATERIALS AND METHODS

An electronic search was conducted using six different databases to identify controlled trials, prospective and retrospective cohort studies, case series and case reports, as well as preclinical (animal) studies reporting on new bone formation in close proximity with the sinus membrane after maxillary sinus augmentation procedures, assessed through histological and/or histomorphometrical evaluation, on the basis of pre-established eligibility criteria.

RESULTS

No clinical studies were identified. Twenty-six preclinical studies were included in the review. Nine of them supported the osteogenic potential of the sinus membrane, while eight reported no evidence of osteogenicity from the sinus membrane. The nine remaining studies reported on the local effect of rhBMPs. The majority of these nine studies reported enhanced new bone formation in the sinus membrane region.

CONCLUSIONS

The sinus membrane contains pluripotent mesenchymal cells with the capacity to differentiate and participate in the process of new bone formation. However, the findings from the studies selected in this systematic review do not consistently support that the sinus membrane significantly contributes to new bone formation following maxillary sinus augmentation procedures.

Impact of a tannin extract on animal performance and nitrogen excretion of dairy cows grazing a tropical pasture

Context Tannin extracts have been investigated as natural feed additives with the potential to decrease the enteric emission of methane and urinary N and to improve the productive performance of ruminants. However, the impact of this additive in dairy cattle grazing tropical grass pastures has not been extensively evaluated. Aims To evaluate the impact of the Acacia mearnsii bark extract (TA) on productive and nutritional variables in dairy cows grazing a Cynodon dactylon pasture and receiving supplementary corn silage and concentrate. Methods Fourteen multiparous Holstein dairy cows were assigned in a randomised block design to either of the following two treatments: concentrate without TA (control) or with 10 g of TA/kg dry matter (DM). The concentrate and corn silage accounted for ~0.30 and 0.30 of total DM intake respectively. Key results The dietary concentration of TA was 2.9 g/kg DM and it did not affect nutrients intake, milk production and composition, rumen microbial protein synthesis, plasma urea concentration or faecal N excretion. Total N and urea N excreted in urine were higher, whereas total N excreted in manure tended to be higher in TA treatment. Conclusions No productive advantage was obtained by including TA in the diet of dairy cows grazing Cynodon dactylon pasture. Instead, it increased the excretion of labile urinary N. Implications The effect of the use of TA as a feed additive for cows fed tropical grass-based diets is negative from the environmental point of view.

Effects of preoperative intrathecal morphine on postoperative intravenous morphine dosage: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The purpose of this systematic review is to describe the effect of preoperative intrathecal morphine (ITM) on postoperative intravenous (IV) morphine dosage during the first postoperative day. This systematic review will compare the postoperative IV morphine dosage of patients receiving ITM plus morphine morphine-based patient-controlled analgesia (PCA), to patients receiving PCA morphine without ITM. This will establish the magnitude of the postoperative morphine sparing effect of ITM.This review aims to answer the following specific question: In adult abdominal and thoracic surgery patients undergoing general anesthesia (GA), what is the effect of ITM plus PCA morphine, compared to PCA morphine alone, on total IV morphine dosage (in milligrams) during the first 24 hours after surgery?

Detection of estrus in dairy cows by electrical measurements of vaginal mucus and by milk progesterone

Electrical resistance (ohms) of mucus were analyzed in 20 postpartum Holstein cows by use of a probe inserted into the anterior vagina every other day for 30 days. Composite milk samples were taken on the same day, and progesterone was determined by radioimmunoassay. Cows were observed twice daily for standing estrus and reproductive organs palpated weekly per rectum (rectal palpation). Fifteen cows which were cycling showed increasing progesterone 6 to 7 days after the onset of estrus with values of 8.1 to 10.0 ng progesterone/ml milk on days 10 to 17. Concentrations had declined rapidly 2 days before onset of the next estrus. Progesterone in milk was affected by cow and by day of the cycle. Electrical resistance followed a similar cyclical pattern, but variability was large and only cows differed. The correlation between milk progesterone and mucus resistance was .22. Progesterone concentrations for four cows with follicular cysts fluctuated randomly with a mean of 2.6 ng/ml. Mean resistance of vaginal mucus was 44 omega for both cycling and cystic cows, indicating that a single measurement of electrical resistance every 2nd day was unreliable in distinguishing physiological states. One cow had high progesterone in milk on days 19 to 25 and was diagnosed pregnant by rectal palpation 3 wk later. Cows were not seen in estrus 28% of the time when milk progesterone and rectal palpation indicated they were in the follicular phase of the estrous cycle and were cycling.