BACKGROUND: The evidence for treatment decision-making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions.
METHODS: Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non-randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non-surgical invasive or non-invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist.
RESULTS: The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty-one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non-randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty-five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non-surgical interventions. Fifty-seven reviews (53·8 per cent) were rated as low risk of bias.
CONCLUSION: This overview of reviews highlights the need for more and better research in this field.
BACKGROUND: Foot ulcers in people with diabetes mellitus are a common and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use.
OBJECTIVES: To summarize data from systematic reviews of randomised controlled trial evidence on the effectiveness of dressings for healing foot ulcers in people with diabetes mellitus (DM).
METHODS: We searched the following databases for relevant systematic reviews and associated analyses: the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2015, Issue 2); Database of Abstracts of Reviews of Effects (DARE; The Cochrane Library 2015, Issue 1); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 14 April 2015); Ovid EMBASE (1980 to 14 April 2015). We also handsearched the Cochrane Wounds Group list of reviews. Two review authors independently performed study selection, risk of bias assessment and data extraction. Complete wound healing was the primary outcome assessed; secondary outcomes included health-related quality of life, adverse events, resource use and dressing performance.
MAIN RESULTS: We found 13 eligible systematic reviews relevant to this overview that contained a total of 17 relevant RCTs. One review reported the results of a network meta-analysis and so presented information on indirect, as well as direct, treatment effects. Collectively the reviews reported findings for 11 different comparisons supported by direct data and 26 comparisons supported by indirect data only. Only four comparisons informed by direct data found evidence of a difference in wound healing between dressing types, but the evidence was assessed as being of low or very low quality (in one case data could not be located and checked). There was also no robust evidence of a difference between dressing types for any secondary outcomes assessed.
AUTHORS' CONCLUSIONS: There is currently no robust evidence for differences between wound dressings for any outcome in foot ulcers in people with diabetes (treated in any setting). Practitioners may want to consider the unit cost of dressings, their management properties and patient preference when choosing dressings.
BACKGROUND: numerosas, muitas vezes multi-facetada regimes estão disponíveis para o tratamento de feridas complexas, mas a evidência dessas intervenções é recôndito do outro lado da literatura. Nosso objetivo foi identificar intervenções eficazes para tratar feridas complexas através de uma visão geral de revisões sistemáticas.
MÉTODOS: MEDLINE (interface de OVID de 1946 até 26 de Outubro de 2012), EMBASE (interface de OVID de 1947 até 26 de Outubro de 2012), ea base de dados Cochrane de revisões sistemáticas (Edição 10, de 12, de 2012) foram pesquisados em 26 de outubro de 2012 . As revisões sistemáticas que examinaram adultos que recebem cuidados por suas feridas complexas foram incluídos. Dois revisores independentemente selecionados a literatura, os dados abstraídos, e qualidade do estudo usando a Avaliação de Múltiplas Revisões Sistemáticas ferramenta (AMSTAR).
RESULTADOS: No total, 99 revisões sistemáticas foram incluídos após a triagem 6.200 títulos e resumos e textos completos-422; 54 eram revisões sistemáticas com meta-análise (incluindo dados de mais de 54.000 pacientes) e 45 eram revisões sistemáticas sem uma meta-análise. No geral, 44% dos comentários incluídos foram classificados como sendo de alta qualidade (pontuação AMSTAR ≥8). Baseado em dados de revisões sistemáticas, incluindo uma meta-análise com uma pontuação AMSTAR ≥8, foram identificadas intervenções promissoras para feridas complexas. Estas ligaduras incluídos ou meias (multi-layer, alta compressão) e limpeza da ferida para úlceras venosas de perna; bandagens de quatro camadas para arterial misto / úlceras venosas; biológicos, ultra-som e curativos de hidrogel para úlceras de perna / pé diabético; curativos hidrocolóides, eletroterapia, camas de ar fluidizado, e colchões de espuma alternativos para úlceras de pressão; e pensos com prata e ultra-som para feridas complexas mistos não especificada. Para as infecções de feridas cirúrgicas, pressão negativa tópica e vácuo-assistida encerramento foram intervenções promissoras, mas esta foi baseada em evidências de moderada a baixa qualidade revisões sistemáticas.
CONCLUSÕES: numerosas intervenções podem ser utilizadas para pacientes com diferentes tipos de feridas complexas, ainda alguns tratamentos foram consistentemente eficazes em todos os resultados ao longo da literatura. Os médicos e os pacientes podem usar os resultados para adequar o tratamento eficaz de acordo com o tipo de ferida complexa. Rede de meta-análise será de benefício para os tomadores de decisão, uma vez que irá permitir comparações múltiplas de tratamento e ranking da eficácia de todas as intervenções. Por favor, veja o artigo relacionado: http://dx.doi.org/10.1186/s12916-015-0326-3.
The evidence for treatment decision-making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions.
METHODS:
Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non-randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non-surgical invasive or non-invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist.
RESULTS:
The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty-one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non-randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty-five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non-surgical interventions. Fifty-seven reviews (53·8 per cent) were rated as low risk of bias.
CONCLUSION:
This overview of reviews highlights the need for more and better research in this field.
