Thromboprophylaxis in elective spinal surgery: a protocol for systematic review

Background: Venous thromboembolism (VTE) is a serious, sometimes life-threatening complication that can occur following spine surgery. The incidence of VTE, and the optimal type and timing of thromboprophylaxis for this complication in elective spine surgery is a matter of debate. Objective: To perform a systematic review with the aim of clarifying the efficacy and adverse effects of mechanical and chemical prophylaxis for preventing thromboembolic complications in elective spine surgery for conditions other than trauma and malignant disease. Methods/design: A search strategy of related articles up to March 2018 was designed and executed in Medline and Embase. Patients: adolescents (>10 years) and adults undergoing elective surgery for spinal deformity or degenerative disease (from C1 to S1). Intervention: Perioperative mechanical and chemical thromboprophylaxis. Studies could be randomized controlled trials or observational studies that reported data on any relevant clinical outcomes. Results: In total, 2451 uniquecitations were identified and 35 studies were ultimately included in the systematic review. The overall mean incidence of complications was 3.7% for deep venous thrombosis, 0.0% for pulmonary embolism, and 3.7% for bleeding in chemoprophylaxis group; 2.9% for deep venous thrombosis, 0.4% for pulmonary embolism and 0.0% for bleeding in mechanoprophylaxis; and 0.7% for deep venous thrombosis, 0.1% for pulmonary embolism and 0.2% for bleeding in mixed prophylaxis group with no specific data on these rates for the type of patient and type and location of surgery. None of the articles retrieved provided information on the adolescent population. Discussion and conclusions: The poor design and high variability among the studies regarding characteristics of study population, details of interventions, and definitions of outcomes, determines a low quality of the available evidence and limits the interpretation of the results. We were unable to identify a clear advantage of one type of thromboprophylaxis over the other, although there was an increased risk of bleeding with chemoprophylaxis, which could favor the use of mechanoprophylaxis in this scenario

Thromboprophylaxis in elective spinal surgery

Supplemental Digital Content is available in the text Venous thromboembolism (VTE) is a serious, sometimes life-threatening complication that can occur following spine surgery. The incidence of VTE, and the optimal type and timing of thromboprophylaxis for this complication in elective spine surgery is a matter of debate. To perform a systematic review with the aim of clarifying the efficacy and adverse effects of mechanical and chemical prophylaxis for preventing thromboembolic complications in elective spine surgery for conditions other than trauma and malignant disease. A search strategy of related articles up to March 2018 was designed and executed in Medline and Embase. Patients: adolescents (>10 years) and adults undergoing elective surgery for spinal deformity or degenerative disease (from C1 to S1). Intervention: Perioperative mechanical and chemical thromboprophylaxis. Studies could be randomized controlled trials or observational studies that reported data on any relevant clinical outcomes. In total, 2451 uniquecitations were identified and 35 studies were ultimately included in the systematic review. The overall mean incidence of complications was 3.7% for deep venous thrombosis, 0.0% for pulmonary embolism, and 3.7% for bleeding in chemoprophylaxis group; 2.9% for deep venous thrombosis, 0.4% for pulmonary embolism and 0.0% for bleeding in mechanoprophylaxis; and 0.7% for deep venous thrombosis, 0.1% for pulmonary embolism and 0.2% for bleeding in mixed prophylaxis group with no specific data on these rates for the type of patient and type and location of surgery. None of the articles retrieved provided information on the adolescent population. The poor design and high variability among the studies regarding characteristics of study population, details of interventions, and definitions of outcomes, determines a low quality of the available evidence and limits the interpretation of the results. We were unable to identify a clear advantage of one type of thromboprophylaxis over the other, although there was an increased risk of bleeding with chemoprophylaxis, which could favor the use of mechanoprophylaxis in this scenario

Evaluación y abordaje de la fibromialgia: actualización de las evidencias científicas

Fibromialgia; Revisión sistemática; Guías de práctica clínicaFibromiàlgia; Revisió sistemàtica; Guies de pràctica clínicaFibromyalgia; Systematic review; Clinical Practice GuidelinesEl objetivo es desarrollar un documento de síntesis de la literatura científica que identifique, evalúe y resuma la mejor evidencia disponible referente a la FM: diagnóstico, pruebas complementarias, tratamiento. Presentar datos epidemiológicos de la FM a nivel estatal y europeo.L'objectiu és desenvolupar un document de síntesi de la literatura científica que identifiqui, avaluï i resumeixi la millor evidència disponible referent a la FM: diagnòstic, proves complementàries, tractament. Presentar dades epidemiològiques de la FM a nivell estatal i europeu.To offer a summary of the scientific literature, presenting the best available evidence regarding the diagnosis and treatment of FM and the complementary tests that should be administered. To provide epidemiological data on FM in Spain and in Europe as a whole

Evaluación y abordaje de síndrome de fatiga crónica: actualización de las evidencias científicas

Síndrome de fatiga crónica; Revisión sistemática; Guías de práctica clínicaSíndrome de fatiga crònica; Revisió sistemàtica; Guies de pràctica de clínicaChronic fatigue syndrome; Systematic reviews; Practice guidelinesRevisión sistemática de guías de práctica clínica (GPC), informes de evaluación de tecnologías sanitarias (ETS) y revisiones sistemáticas (RS) publicadas con posterioridad al informe técnico de AQuAs (2011) sobre el diagnóstico y tratamiento del SFC. Búsqueda exhaustiva de la literatura (hasta mayo 2016) en repositorios de GPC e informes de ETS, y en las bases de datos bibliográficas Medline, EMBASE y Cochrane Library. También se consultaron fuentes secundarias como UpToDate y Clinical Evidence. Evaluación de la calidad metodológica de los documentos seleccionados mediante el apartado metodológico del instrumento instrumento Appraisal of Guidelines Research and Evaluation - AGREE II y la escala Assessment of Multiple SysTemAtic Reviews - AMSTAR. Se han identificado estudios que reportan la prevalencia del SFC en los Estados Unidos y algunos países de Europa, pero ninguna en España. La evidencia identificada a fecha de mayo de 2016 es de calidad metodológica variable. El volumen de evidencia es limitado para el SFC. En SFC se ha identificado un informe de evaluación (Smith 2014) con fecha de búsqueda 2014, además del informe AQuAS 2011. No se han iden- 10 INFORMES, ESTUDIOS E INVESTIGACIÓN tificado nuevos criterios diagnósticos o propuestas de pruebas complementarias para la determinación de SFC. Se han incluido 8 revisiones sistemáticas de la literatura que evalúan tratamientos del SFC, 1 de ellas es un overview que evalúa tratamientos farmacológicos y no farmacológicos, y las 7 restantes evalúan exclusivamente tratamientos no farmacológicos.Systematic review of clinical practice guidelines (CPG), evaluation reports  of health technologies (ETS) and systematic reviews (SR) published  after the technical report of AQUAs (2011) on the diagnosis  and treatment of CFS. Comprehensive literature search (up to  May 2016) in CPG repositories and STD reports, and in the databases of  bibliographic data Medline, EMBASE and Cochrane Library. I also know  They consulted secondary sources such as UpToDate and Clinical Evidence. Evaluation  of the methodological quality of the documents selected through  the methodological section of the Instrument instrument Appraisal of  Guidelines Research and Evaluation - AGREE II and the Assessment scale  of Multiple SysTemAtic Reviews - AMSTAR.    Studies have been identified that report the prevalence of CFS in the United States  United and some countries in Europe, but none in Spain.  The evidence identified as of May 2016 is of methodological quality  variable. The volume of evidence is limited for CFS.  In CFS an evaluation report has been identified (Smith 2014) with  2014 search date, in addition to the AQuAS 2011 report.  10 REPORTS, STUDIES AND RESEARCH  new diagnostic criteria or proposals for complementary tests  for the determination of SFC. 8 systematic reviews have been included  of the literature evaluating CFS treatments, 1 of them is a  overview that evaluates pharmacological and non-pharmacological treatments, and  The remaining 7 evaluate exclusively non-pharmacological treatments.Revisió sistemàtica de guies de pràctica clínica (GPC), informes d'avaluació  de tecnologies sanitàries (ETS) i revisions sistemàtiques (RS) publicades  amb posterioritat a l'informe tècnic de aquas (2011) sobre el diagnòstic  i tractament de la SFC. Cerca exhaustiva de la literatura (fins  maig 2016) en repositoris de GPC i informes de MTS, i en les bases de  dades bibliogràfiques Medline, EMBASE i Cochrane Library. també es  van consultar fonts secundàries com UpToDate i Clinical Evidence. avaluació  de la qualitat metodològica dels documents seleccionats mitjançant  l'apartat metodològic de l'instrument instrument Appraisal of  Guidelines Research and Evaluation - AGREE II i l'escala Assessment  of Multiple Systematic Reviews - Amstar.    S'han identificat estudis que reporten la prevalença de la SFC en els Estats  Units i alguns països d'Europa, però cap a Espanya.  L'evidència identificada a data de maig de 2016 és de qualitat metodològica  variable. El volum d'evidència és limitat per la SFC.  En SFC s'ha identificat un informe d'avaluació (Smith 2014) amb  data de cerca 2014, a més de l'informe aquas 2011. No s'han iden-  10 INFORMES, ESTUDIS I RECERCA  tificat nous criteris diagnòstics o propostes de proves complementàries  per a la determinació de SFC. S'han inclòs 8 revisions sistemàtiques  de la literatura que avaluen tractaments de la SFC, 1 d'elles és un  overview que avalua tractaments farmacològics i no farmacològics, i les  7 restants avaluen exclusivament tractaments no farmacològics

Evaluación y abordaje de la fibromialgia y el síndrome de fatiga crónica

Fibromialgia; Síndrome de la fatiga crónica; Revisión sistemáticaFibromyalgia; Chronic fatigue syndrome; Systematic reviewFibromiàlgia; Síndrome de la fatiga crònica; Revisió sistemàticaLos objetivos de este documento son: desarrollar un documento de síntesis de la literatura científica que identifique, evalúe y resuma la mejor evidencia disponible referente a los ámbitos de evaluación del ICAM para la FM y el SFC: diagnóstico, pruebas complementarias y tratamiento. Este informe ofrecerá la base de evidencia sobre la que se pueda fundamentar una actualización de la guía de evaluación del ICAM para la FM y el SFC de 2009 y presentar datos epidemiológicos de las dos condiciones a nivel estatal y europeo

Pregabalin in fibromyalgia - responder analysis from individual patient data

<p>Abstract</p> <p>Background</p> <p>Population mean changes are difficult to use in clinical practice. Responder analysis may be better, but needs validating for level of response and treatment duration. A consensus group has defined what constitutes minimal, moderate, and substantial benefit based on pain intensity and Patient Global Impression of Change scores.</p> <p>Methods</p> <p>We obtained individual patient data from four randomised double blind trials of pregabalin in fibromyalgia lasting eight to 14 weeks. We calculated response for all efficacy outcomes using any improvement (≥ 0%), minimal improvement (≥ 15%), moderate improvement (≥ 30%), substantial improvement (≥ 50%), and extensive improvement (≥ 70%), with numbers needed to treat (NNT) for pregabalin 300 mg, 450 mg, and 600 mg daily compared with placebo.</p> <p>Results</p> <p>Information from 2,757 patients was available. Pain intensity and sleep interference showed reductions with increasing level of response, a significant difference between pregabalin and placebo, and a trend towards lower (better) NNTs at higher doses. Maximum response rates occurred at 4-6 weeks for higher levels of response, and were constant thereafter. NNTs (with 95% confidence intervals) for ≥ 50% improvement in pain intensity compared with placebo after 12 weeks were 22 (11 to 870) for pregabalin 300 mg, 16 (9.3 to 59) for pregabalin 450 mg, and 13 (8.1 to 31) for pregabalin 600 mg daily. NNTs for ≥ 50% improvement in sleep interference compared with placebo after 12 weeks were 13 (8.2 to 30) for pregabalin 300 mg, 8.4 (6.0 to 14) for pregabalin 450 mg, and 8.4 (6.1 to 14) for pregabalin 600 mg. Other outcomes had fewer respondents at higher response levels, but generally did not discriminate between pregabalin and placebo, or show any dose response. Shorter duration and use of 'any improvement' over-estimated treatment effect compared with longer duration and higher levels of response.</p> <p>Conclusions</p> <p>Responder analysis is useful in fibromyalgia, particularly for pain and sleep outcomes. Some fibromyalgia patients treated with pregabalin experience a moderate or substantial pain response that is consistent over time. Short trials using 'any improvement' as an outcome overestimate treatment effects.</p