OBJECTIVE: To evaluate existing evidence from published systematic reviews for the effectiveness and safety of rehabilitation interventions in adult patients with colorectal cancer.
METHODS: A comprehensive literature search was conducted using medical/health science databases up to October 2024. Bibliographies of pertinent articles, journals, and grey literature were searched. Three reviewers independently selected potential reviews, assessed methodological quality, and graded the quality of evidence for outcomes using validated tools.
RESULTS: Sixty systematic reviews (761 randomized controlled trials) evaluated 5 categories of rehabilitation interventions. Over half of the included reviews (n = 31) were of moderate-high quality. The findings suggest: moderate-quality evidence for exercise interventions for improving physical fitness and quality of life; high-quality evidence for nutritional interventions in reducing postoperative infections; high-quality evidence for multimodal prehabilitation for improved preoperative functional capacity; moderate-quality evidence for nutritional interventions for improving humoral immunity, reducing inflammation, and length of stay; moderate-quality evidence for acupuncture in improving gastrointestinal functional recovery; psychosocial interventions in improving short-term quality of life and mental health, and lifestyle interventions for improved quality of life.
CONCLUSION: Rehabilitation interventions yielded positive effects across multiple outcomes. However, high-quality evidence is still needed to determine the most effective rehabilitation approaches for patients with colorectal cancer.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
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.
No existe claridad sobre el efecto del uso de glutamina en pacientes con pancreatitis aguda. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 15 revisiones sistemáticas que en conjunto incluyen 31 estudios aleatorizados pertinentes a la pregunta. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la glutamina podría disminuir las complicaciones infecciosas en la pancreatitis aguda, pero no está claro si tiene algún efecto sobre la mortalidad o el tiempo de hospitalización porque la certeza de la evidencia es muy baja.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: Optimizing body composition for healthy aging in the community is a significant challenge. There are a number of potential interventions available for older people to support both weight gain (for those who are underweight) and weight loss (for overweight or obese people). While the benefits of weight gain for underweight people are generally clearly defined, the value of weight loss in overweight or obese people is less clear, particularly for older people.
OBJECTIVES: This umbrella review aimed to measure the effectiveness of nutritional interventions for optimizing healthy body composition in older adults living in the community and to explore theirqualitative perceptions.
INCLUSION CRITERIA TYPES OF PARTICIPANTS: The participants were older adults, 60 years of age or older, living in the community.
TYPES OF INTERVENTIONS: The review examinedsix types of nutritional interventions: (i) dietary programs, (ii) nutritional supplements, (iii) meal replacements, (iv) food groups, (v) food delivery support and eating behavior, and (vi) nutritional counselling or education.
TYPES OF STUDIES: This umbrella review considered any quantitative systematic reviews and meta-analyses of effectiveness, or qualitative systematic reviews, or a combination (i.e. comprehensive reviews).
TYPES OF OUTCOMES: The quantitative outcome measures of body composition were: (i) nutritional status (e.g. proportion of overweight or underweight patients); (ii) fat mass (kg), (iii) lean mass or muscle mass (kg), (iv) weight (kg) or BMI (kg/m), (v) bone mass (kg) or bone measures such as bone mineral density, and (vi) hydration status.
PHENOMENA OF INTEREST: The phenomena of interestwere the qualitative perceptions and experiences of participants.
SEARCH STRATEGY: We developed an iterative search strategy for nine bibliometric databases and gray literature.
METHODOLOGICAL QUALITY: Critical appraisal of 13 studies was conducted independently in pairs using standard Joanna Briggs Institute tools. Six medium quality and seven high quality studies were identified.
DATA EXTRACTION: Data was extracted independently in pairs from all 13 included studies using the standard Joanna Briggs Institute data extraction tool.
DATA SUMMARY: Only quantitative studies of effectiveness were included. The strength of evidence assessing the effectiveness of interventionswas graded using a traffic light system (green, amber, red). An overall assessment of the quality of the evidence for each comparison was undertaken.
RESULTS: More systematic reviews investigating weight gain than those investigating weight loss were included. Studies onweight gain showed improved body composition for oral nutritional supplements on its own, for oral nutritional supplements in combination with resistance exercise training, and for oral nutritional supplements in combination with nutrition counselling. Studies on weight loss showed that diet in combination with exercise, diet in combination with exercise and nutrition counselling, and nutrition counselling on its own all can lead to reduced weight in older people. The outcomes of lean mass and weight/BMI were responsive to nutritional interventions, but fat mass did not vary. There were no qualitative reviews identified.
CONCLUSIONS: Although effective interventions for weight gain and weight loss to optimize body composition of older people in the community were identified,making long term, clinically relevant changes in body composition is difficult. Multiple interventions are more effective than single interventions.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
Esta revisión evalúa críticamente la literatura sobre la medicina complementaria y alternativa (CAM) como opciones de tratamiento para la artritis reumatoide y la osteoartritis. Diseño: Se realizaron búsquedas en bases de datos electrónicas para identificar todas las revisiones pertinentes sistemáticas de la efectividad de la CAM en la artritis reumatoide y la artrosis publicados entre enero de 2010 y enero de 2011. Las críticas fueron definidas como sistemática si incluyeran inclusión explícita y repetible y criterios de exclusión para los estudios. La calidad metodológica se evaluó mediante los criterios de Oxman para las revisiones sistemáticas. Resultados: Cinco revisiones sistemáticas cumplieron los criterios de inclusión. Todos llegaron a conclusiones prudentes. Cuatro opiniones eran de alta calidad y una fue cargado con alto riesgo de sesgo. La evidencia que apoya la eficacia de la CAM como una opción de tratamiento para la artritis reumatoide y la osteoartritis es ambiguo.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
Esta revisión entrega un resumen de los hallazgos claves de 18 revisiones sistemáticas sobre eccema atópico, pucblicadas o indexadas entre enero de 2009 y el 24 de agosto de 2010. No hubo buena evidencia sobre el posible beneficio del consumo de alimentos orgánicos y eccema. La ingesta materna de pescado o aceite de pescado puede estar asociado con un riesgo reducido eccema en sus hijos, aunque se necesitan más estudios. Hay evidencia que las fórmulas lácteas pacialmente hidrolizadas en lugar de las fórmulas estándar pueden asociarse con riesgo reducido de eccema en lactantes, pero hay deficiencias en la evidencia existente. Se ha encontrado una relación inversa entre gliomas/leucemia linfoblástica aguda y alergia/eccema, pero parece no haber asociación entre esclerosis múltiple y eccema. El trastorno de déficit atencional con hiperactividad sí parece estar asociado con eccema, pero no hay evidencia de relación causal. El riesgo de eccema parece estar aumentado en áreas urbanas en comparación con las rurales. Nueva evidencia ha sugerido la superioridad de pimecrolimus 1% sobre corticosteroides de alta y baja potencia a 6 meses, pero no a 12 meses, y hay evidencia de superioridad de tacrolimus 0.03% y 0.1% sobre pimecrolimus 1%. Una revisión Cochrane actualizada aún no encuentra evidencia de beneficio de ninguna forma de tratamiento antiestafilocócico en el manejo de eccema clínicamente infectado o no infectado. La evidencia es pobre para emolientes en el baño, tratamientos oclusivos (por ejemplo, envolturas húmedas y secas) y ropa de seda tejida en el tratamiento del eccema. En general, los métodos usados en la mayoría de las revisiones sistemáticas de eccema necesitan ser reportados de manera más clara, especialmente con respecto a una evaluación de calidad más vigorosa de los estudios incluidos. Los estudios incluidos son frecuentemente heterogéneos, el reporte por proximidad es común y las definiciones apropiadas de enfermedad suelen faltar. Una mejor adherencia a las guías existentes sobre reporte en estudios y registro prospectivo de estudios clínicos podría ayudar a mejorar la calidad de los estudios.
To evaluate existing evidence from published systematic reviews for the effectiveness and safety of rehabilitation interventions in adult patients with colorectal cancer.
METHODS:
A comprehensive literature search was conducted using medical/health science databases up to October 2024. Bibliographies of pertinent articles, journals, and grey literature were searched. Three reviewers independently selected potential reviews, assessed methodological quality, and graded the quality of evidence for outcomes using validated tools.
RESULTS:
Sixty systematic reviews (761 randomized controlled trials) evaluated 5 categories of rehabilitation interventions. Over half of the included reviews (n = 31) were of moderate-high quality. The findings suggest: moderate-quality evidence for exercise interventions for improving physical fitness and quality of life; high-quality evidence for nutritional interventions in reducing postoperative infections; high-quality evidence for multimodal prehabilitation for improved preoperative functional capacity; moderate-quality evidence for nutritional interventions for improving humoral immunity, reducing inflammation, and length of stay; moderate-quality evidence for acupuncture in improving gastrointestinal functional recovery; psychosocial interventions in improving short-term quality of life and mental health, and lifestyle interventions for improved quality of life.
CONCLUSION:
Rehabilitation interventions yielded positive effects across multiple outcomes. However, high-quality evidence is still needed to determine the most effective rehabilitation approaches for patients with colorectal cancer.
Síntesis amplia»Revisión panorámica de revisiones sistemáticas
