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Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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The role of prenatal vitamin D on the development of childhood asthma and wheeze: An umbrella review of systematic reviews and meta-analyses.

Revista Clinical nutrition (Edinburgh, Scotland)
Año 2022
Enlaces Pubmed DOI
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BACKGROUND & OBJECTIVE: It has been suggested that prenatal vitamin D plays a role in the development of childhood asthma and wheeze. Several systematic reviews have been conducted, but the results are inconsistent, and the methodological quality has not been studied. Therefore, the objective of this umbrella review was to assess the internal validity of the evidence base and the evidence for an association between prenatal vitamin D and asthma or wheezing in the offspring. METHODS: We searched the electronic databases Embase, PubMed, and Cochrane Library for studies on prenatal vitamin D using search words such as vitamin D, 25-hydroxyvitamin D, calcidiol, fetal, and neonatal. The search was conducted in June 2020, and the databases were searched from their date of establishment. We included systematic reviews and/or meta-analyses of experimental and observational studies assessing the association between prenatal vitamin D or asthma and wheeze. We excluded narrative reviews, commentaries, and other umbrella reviews. The methodological quality of systematic reviews was assessed using AMSTAR 2 tool. PROSPERO reg. no. CRD42020151329. RESULTS: We identified 22 eligible systematic reviews (17 on asthma and 20 on wheeze). Using the AMSTAR 2 quality assessment tool, the methodological quality was rated as critically low in 21 out of 22 systematic reviews, suggesting that previous reviews and meta-analyses did not provide accurate and comprehensive summaries of the included studies and that conclusions reached were potentially flawed. The majority of the included reviews reported that prenatal vitamin D reduces the risk of wheeze in the offspring. CONCLUSION: Prior to informing public guidelines, high-quality systematic reviews of the current evidence are greatly warranted.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis

Revista Therapeutic advances in gastroenterology
Año 2019
Enlaces Pubmed DOI PubMed Central
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Background: An overview of systematic reviews (SRs) and a network meta-analysis (NMA) were conducted to evaluate the comparative effectiveness of acupuncture and related therapies used either alone, or as an add-on to other irritable bowel syndrome (IBS) treatments. Methods: A total of eight international and Chinese databases were searched for SRs of randomized controlled trials (RCTs). The methodological quality of SRs was appraised using the AMSTAR instrument. From the included SRs, data from RCTs were extracted for the random-effect pairwise meta-analyses. An NMA was used to evaluate the comparative effectiveness of different treatment options. The risk of bias among included RCTs was assessed using the Cochrane risk of bias tool. Results: From 15 SRs of mediocre quality, 27 eligible RCTs (n = 2141) were included but none performed proper blinding. Results from pairwise meta-analysis showed that both needle acupuncture and electroacupuncture were superior in improving global IBS symptoms when compared with pinaverium bromide. NMA results showed needle acupuncture plus Geshanxiaoyao formula had the highest probability of being the best option for improving global IBS symptoms among 14 included treatment options, but a slight inconsistency exists. Conclusion: The risk of bias and NMA inconsistency among included trials limited the trustworthiness of the conclusion. Patients who did not respond well to first-line conventional therapies or antidepressants may consider acupuncture as an alternative. Future trials should investigate the potential of (1) acupuncture as an add-on to antidepressants and (2) the combined effect of Chinese herbs and acupuncture, which is the norm of routine Chinese medicine practice.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Revisiones sistemáticas Cochrane de hierbas medicinales chinas: una visión general.

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Autores Hu J , Zhang J , Zhao W , Zhang Y , Zhang L , Shang H
Revista PloS one
Año 2011
Enlaces Pubmed DOI PubMed Central
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OBJETIVOS: El estudio tenía dos objetivos: a) identificar de forma sistemática todas las revisiones sistemáticas existentes de las hierbas medicinales chinas (HMC), publicado en la Cochrane Library, b) evaluar la calidad metodológica de las revisiones incluidas. Metodología / Principales conclusiones: Se realizó una búsqueda sistemática de la Base de Datos Cochrane de Revisiones Sistemáticas (CDSR, Número 5, 2010) para identificar todas las revisiones de CHM. Un total de cincuenta y ocho exámenes fueron elegibles para este estudio. Veintiuna de las revisiones incluidas tenían al menos una medicina tradicional china (MTC), médico como su co-autor. 7 comentarios no incluía ningún estudio primario, los exámenes restantes (n = 51) incluyó una mediana de 9 estudios y 936 participantes. 50% de los exámenes fueron evaluados por última vez ya que hasta al día anterior a 2008. Las preguntas formuladas por 39 críticas eran de amplio alcance, en la que 9 comentarios combina los estudios con diferentes hierbas medicinales. Para OQAQ, la media de puntuación global de calidad (artículo 10) fue de 5,05 (IC del 95%, 4.58 a 5.52). Todas las opiniones que evaluaron la calidad metodológica de los estudios primarios, el 16% de los estudios primarios incluidos utiliza generación de la secuencia adecuada y el 7% utiliza ocultamiento de la asignación adecuada. De los 51 comentarios vacíos, 23 opiniones se reportaron como no concluyentes, mientras que el 27 llegó a la conclusión de que podría haber beneficio del mecanismo de facilitación, que se vio limitado por la mala calidad o cantidad inadecuada de los estudios incluidos. 58 comentarios informó buscando una mediana de siete bases de datos electrónicas, mientras que 10 comentarios no buscar cualquier base de datos china. CONCLUSIÓN: Una vez CDSR ha incluido un gran número de comentarios CHM, nuestro estudio ha identificado algunas áreas que podrían mejorarse, como casi la mitad de las revisiones incluidas no cuentan con la participación de los profesionales de la MTC y no estaban al corriente la fecha de acuerdo a los criterios de Cochrane, algunas de las críticas se agruparon los resultados de las diferentes hierbas medicinales e ignoró la búsqueda de bases de datos chinas.

Síntesis amplia

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Safety and efficacy of acupuncture in children: A review of the evidence

Autores Jindal V , Ge A , Mansky PJ
Revista Journal of pediatric hematology/oncology
Año 2008
Enlaces Pubmed DOI PubMed Central
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Acupuncture has been used therapeutically in China for thousands of years and is growing in prominence in Europe and the United States. In a recent review of complementary and alternative medicine use in the US population, an estimated 2.1 million people or 1.1% of the population sought acupuncture care during the past 12 months. Four percent of the US population used acupuncture at any time in their lives. We reviewed 31 different published journal articles, including 23 randomized controlled clinical trials and 8 meta-analysis/ systematic reviews. We found evidence of some efficacy and low risk associated with acupuncture in pediatrics. From all the conditions we reviewed, the most extensive research has looked into acupuncture;s role in managing postoperative and chemotherapy-induced nausea/vomiting. Postoperatively, there is far more evidence of acupuncture's efficacy for pediatrics than for children treated with chemotherapy. Acupuncture seems to be most effective in preventing postoperative induced nausea in children. For adults, research shows that acupuncture can inhibit chemotherapy-related acute vomiting, but conclusions about its effects in pediatrics cannot be made on the basis of the available published clinical trials data to date. Besides nausea and vomiting, research conducted in pain has yielded the most convincing results on acupuncture efficacy. Musculoskeletal and cancer-related pain commonly affects children and adults, but unfortunately, mostly adult studies have been conducted thus far. Because the manifestations of pain can be different in children than in adults, data cannot be extrapolated from adult research. Systematic reviews have shown that existing data often lack adequate control groups and sample sizes. Vas et al, Alimi et al, and Mehling et al demonstrated some relief for adults treated with acupuncture but we could not find any well-conducted randomized controlled studies that looked at pediatrics and acupuncture exclusively. Pain is often unresolved from drug therapy, thus there is a need for more studies in this setting. For seasonal allergic rhinitis, we reviewed studies conducted by Ng et al and Xue et al in children and adults, respectively. Both populations showed some relief of symptoms through acupuncture, but questions remain about treatment logistics. Additionally, there are limited indications that acupuncture may help cure children afflicted with nocturnal enuresis. Systematic reviews show that current published trials have suffered from low trial quality, including small sample sizes. Other areas of pediatric afflictions we reviewed that suffer from lack of research include asthma, other neurologic conditions, gastrointestinal disorders, and addiction. Acupuncture has become a dominant complementary and alternative modality in clinical practice today, but its associated risk has been questioned. The National Institutes of Health Consensus Statement states "one of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted procedures for the same conditions." A review of serious adverse events by White et al found the risk of a major complication occurring to have an incidence between 1:10,000 and 1:100,000, which is considered "very low." Another study found that the risk of a serious adverse event occurring from acupuncture therapy is the same as taking penicillin. The safety of acupuncture is a serious concern, particularly in pediatrics. Because acupuncture's mechanism is not known, the use of needles in children becomes questionable. For example, acupoints on the vertex of infants should not be needled when the fontanel is not closed. It is also advisable to apply few needles or delay treatment to the children who have overeaten, are overfatigued, or are very weak. Through our review of pediatric adverse events, we found a 1.55 risk of adverse events occurring in 100 treatments of acupuncture that coincides with the low risk detailed in the studies mentioned previously. The actual risk to an individual patient is hard to determine because certain patients, such as an immunosuppressed patient, can be predisposed to an increased risk, acupuncturist's qualifications differ, and practices vary in certain parts of the world. Nevertheless, it seems acupuncture is a safe complementary/alternative medicine modality for pediatric patients on the basis of the data we reviewed. © 2008 by Lippincott Williams & Wilkins.

Síntesis amplia

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Síndrome del intestino irritable en adultos: Diagnóstico y Manejo del Síndrome del Intestino Irritable en Atención Primaria

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Reporte London: Royal College of Nursing (UK); National Institute for Health and Clinical Excellence: Guidance .
Año 2008
Enlaces ncbi.nlm.nih.gov
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Esta guía cubre las áreas de interés para el diagnóstico y tratamiento del síndrome del intestino irritable (SII) que reflejan el viaje completo del paciente, de la persona que presenta con los síntomas del SII, el diagnóstico y la gestión positiva, dirigidas a controlar los síntomas. La guía incorpora revisiones Cochrane, publicada orientación clínica y de salud pública de NICE, los informes de Evaluación de Tecnologías Sanitarias, revisiones sistemáticas económicos y de salud producidos por el Centro Nacional de Colaboración para la Enfermería y Atención de apoyo. Las recomendaciones se basan en la evidencia clínica y la rentabilidad, y donde esto no es suficiente, el GDG utilizan todas las fuentes de información disponibles y la experiencia para hacer recomendaciones de consenso utilizando la técnica de grupo nominal.