TY  - THES
A1  - Held, Helena
T1  - The effectiveness of non-occlusal therapies in relation to the chronicity of temporomandibular disorders: a systematic review with meta-analysis
T1  - Die Effektivität von nicht-okklusalen Therapien in Bezug auf die Chronifizierung von Craniomandibulärer Dysfunktionen: eine Systematische Übersichtsarbeit mit Metaanalyse
N2  - Background: That a differentiated treatment of subjects with low and high levels of disabling pain might be necessarily has only been suspected but not sufficiently confirmed so far. Furthermore, the effectiveness of extraoral therapy methods for TMD is still controversial in the literature. The present work could make an important contribution to this.
Objectives: Five systematic reviews with meta-analysis were conducted to investigate the efficacy of extraoral therapies (acupuncture, laser, medication, psychosocial interventions, and physiotherapy) in the treatment of TMD in relation to the degree of chronicity of pain.
Literature sources: With this objective, the databases Pubmed/MEDLINE, EMBASE, Cochrane Library, Livivo, OpenGrey, drks.de, Clinicaltrials.gov. were searched.
Criteria for the selection of suitable studies: Adults suffering from painful TMD and treated with either acupuncture, laser, medication, psychosocial interventions, or physiotherapy. The studies were then examined for evidence in the subjects' characteristics suggesting that they were suffering from chronic TMD in terms of pain dysfunction. These included a high score on the GCPS, resistance to undergone treatments, multilocular pain, depression, and regular use of pain medication. The effectiveness of the five interventions was then differentiated according to the suspected degree of chronicity. Effectiveness was assessed by the following outcomes: patient- related current pain intensity, MMO, pain on palpation, temporomandibular joint sounds, depression, and somatization.
Study evaluation: After the assessment of the studies, the quality assessment (Risk of Bias Tool of the Cochrane Institute) and the extraction of the data were conducted. After that five meta-analyses were carried out for each of the five interventions using the Review Manager of the Cochrane Institute (RevMan 5.3)
Results: Acupuncture and dry needling were statistically significantly more effective in providing short-term pain relief compared to the control group in patients with low disability pain (p=0.04) and (p=0.02), respectively. Acupuncture or dry needling did not show a significant result in the improvement of MMO in the short-term period. Laser therapy is more effective in relieving pain (p<0.0001) and functional outcomes (p=0.03) in the short term compared to placebo for low disability pain. Botulinum toxin (p=0.003) and NSAIDs (p=0.03) showed significantly better short-term improvement in pain intensity for high disability pain. Low disability pain is significantly better treated by psychosocial interventions than by other treatments in terms of long-term pain relief (more than 12 months) (p=0.02). Patients with high disability pain had significantly lower depression scores after psychosocial interventions than after other treatments (p=0.008). Physiotherapy showed a statistically significant short-term analgesic effect in patients with high disability pain compared to placebo (p=0.04). Manual Therapy (MT) showed a statistically significant short-term analgesic effect in high disability pain compared to the control group (p=0.01). Patients with low disability pain showed a statistically significant short-term pain-relieving effect with the single intervention of MT in combination with exercise compared to the control groups (p=0.003). A statistically significant result in the improvement of MMO was found in the short-term period in low disability pain for the single interventions of physiotherapy (p=0.008) and physiotherapy in combination with another treatment compared to other treatments (p=0.03), MT compared to the control group (p=0.03) and physiotherapy compared to splint therapy (p=0.03). Clinical conclusion: Individual interventions of the five extraoral therapies confirm the hypothesis that painful TMDs respond differently to established therapies depending on the degree of chronic pain-related disability and that the prognosis of therapy is significantly influenced by the degree of chronic pain- related disability of the condition, according to the GCPS.
Registration number of the review at PROSPERO: CRD42020202558
Keywords: meta-analysis, systematic review, temporomandibular disorders, extra oral therapy, acupuncture, laser, medication, psychosocial interventions, physiotherapy, low disability, high disability, pain, chronification
N2  - Hintergrund: Das eine differenzierte Behandlung von Probanden mit funktionalem (fS) und dysfunktionalem Schmerz (dS) notwendig sein könnte, wurde bisher nur vermutet, aber nicht ausreichend bestätigt. Darüber hinaus ist die Wirksamkeit extraoraler Therapiemethoden bei CMD in der Literatur noch umstritten. Die vorliegende Arbeit könnte hierzu einen wichtigen Beitrag leisten. Ziele: Fünf systematische Übersichten mit Metaanalyse wurden durchgeführt, um die Wirksamkeit extraoraler Therapien (Akupunktur, Laser, Medikamente, psychosoziale Interventionen und Physiotherapie) bei der Behandlung von einer schmerzhaften CMD in Abhängigkeit von dem Chronifizierungsgrad zu untersuchen. Literaturquellen: Die Datenbanken Pubmed/MEDLINE, EMBASE, Cochrane Library, Livivo, OpenGrey, drks.de und Clinicaltrials.gov wurden durchsucht. Auswahlkriterien: Erwachsene PatientInnen, die an schmerzhaften CMD leiden und entweder mit Akupunktur, Laser, Medikamenten, psychosoziale Interventionen oder Physiotherapie behandelt wurden. Die Studien wurden dann auf Hinweise in den Probandenmerkmalen untersucht, die darauf schließen lassen, dass die ProbandInnen unter chronischer CMD im Sinne einer Schmerzdysfunktion leiden. Dazu gehörten ein hoher Wert im GCPS, Behandlungen, die die Probanden bereits erfolglos durchgeführt hatten, multilokuläre Schmerzen, Depressionen und regelmäßige Einnahme von Schmerzmitteln. Anschließend wurde die Wirksamkeit der fünf Interventionen nach dem vermuteten Grad der Chronifizierung differenziert. Die Wirksamkeit wurde anhand der folgenden Ergebnisse untersucht: patientenbezogene aktuelle Schmerzintensität, MMO, Schmerz bei Palpation, Kiefergelenkgeräusche, Depression und Somatisierung. Studienbewertung: Nach der Bewertung der Studien, der Qualitätsbeurteilung (Risk of Bias Tool des Cochrane-Instituts) und der Extraktion der Daten wurden für jede der fünf Interventionen fünf Meta-Analysen mit dem Review Manager des Cochrane-Instituts (RevMan 5.3) durchgeführt Ergebnisse: Akupunktur und Dry Needling waren statistisch signifikant wirksamer bei der kurzfristigen Schmerzlinderung im Vergleich zur Kontrollgruppe bei Patienten mit geringem Grad an beeinträchtigendem Schmerz (p=0,04) bzw. (p=0,02). Akupunktur oder Dry-Needling zeigten im kurzfristigen Zeitraum kein statistisch signifikantes Ergebnis in der Verbesserung der Kieferöffnung. Die Lasertherapie ist im Vergleich zu Placebo bei funktionalem Schmerz kurzfristig wirksamer bei der Reduktion der Schmerzintensität (p<0,0001) und funktionellen Ergebnissen (p=0,03). Botulinumtoxin (p=0,003) und NSARs (p=0,03) zeigten eine signifikant bessere kurzfristige Verbesserung der Schmerzintensität bei dS. FS werden durch die psychosozialen Interventionen signifikant besser behandelt als durch andere Behandlungen, was die langfristige Schmerzlinderung (mehr als 12 Monate) betrifft (p=0,02). PatientInnen mit dS wiesen nach psychosozialen Interventionen signifikant niedrigere Depressionswerte auf als nach anderen Behandlungen (p=0.008). Physiotherapie zeigte eine statistisch signifikante kurzfristige schmerzlindernde Wirkung bei PatientInnen mit dS im Vergleich zu Placebo (p=0,04). Manuelle Therapie (MT) zeigte eine statistisch signifikante kurzfristige schmerzlindernde Wirkung bei dS im Vergleich zur Kontrollgruppe (p=0,01). Bei PatientInnen mit fS zeigte sich im Vergleich zu den Kontrollgruppen eine statistisch signifikante kurzfristige schmerzlindernde Wirkung bei der Einzelintervention von MT in Kombination mit Bewegung (p=0,003). Ein statistisch signifikantes Ergebnis bei der Verbesserung der MMO wurde im Kurzzeitzeitraum bei fS für die Einzelinterventionen der Physiotherapie (p=0,008) und der Physiotherapie in Kombination mit einer anderen Behandlung im Vergleich zu anderen Behandlungen (p=0,03), der MT im Vergleich zur Kontrollgruppe (p=0,03) und der Physiotherapie im Vergleich zur Schienentherapie festgestellt (p=0,03). Schlussfolgerung: Einzelne Interventionen der fünf extraoralen Therapien bestätigen die Hypothese, dass schmerzhafte CMD je nach Grad der Schmerz Chronifizierung unterschiedlich auf etablierte Therapien ansprechen und dass die Prognose der Therapie signifikant durch den Grad der Chronifizierung der Erkrankung beeinflusst wird. Registrierungsnummer der Review bei PROSPERO: CRD42020202558.
KW  - Metaanalyse
KW  - Gesichtsschmerz
KW  - Lasertherapie
KW  - Akupunktur
KW  - systematic review
KW  - TMD
KW  - chronic pain
KW  - extraoral intervention
Y1  - 2024
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-347990
N1  - Appendix VII bis X fehlen in der gedr. Ausgabe
ER  - 
TY  - JOUR
A1  - Weibel, Stephanie
A1  - Popp, Maria
A1  - Reis, Stefanie
A1  - Skoetz, Nicole
A1  - Garner, Paul
A1  - Sydenham, Emma
T1  - Identifying and managing problematic trials: A research integrity assessment tool for randomized controlled trials in evidence synthesis
JF  - Research Synthesis Methods
N2  - Evidence synthesis findings depend on the assumption that the included studies follow good clinical practice and results are not fabricated or false. Studies which are problematic due to scientific misconduct, poor research practice, or honest error may distort evidence synthesis findings. Authors of evidence synthesis need transparent mechanisms to identify and manage problematic studies to avoid misleading findings. As evidence synthesis authors of the Cochrane COVID-19 review on ivermectin, we identified many problematic studies in terms of research integrity and regulatory compliance. Through iterative discussion, we developed a research integrity assessment (RIA) tool for randomized controlled trials for the update of this Cochrane review. In this paper, we explain the rationale and application of the RIA tool in this case study. RIA assesses six study criteria: study retraction, prospective trial registration, adequate ethics approval, author group, plausibility of methods (e.g., randomization), and plausibility of study results. RIA was used in the Cochrane review as part of the eligibility check during screening of potentially eligible studies. Problematic studies were excluded and studies with open questions were held in awaiting classification until clarified. RIA decisions were made independently by two authors and reported transparently. Using the RIA tool resulted in the exclusion of >40% of studies in the first update of the review. RIA is a complementary tool prior to assessing “Risk of Bias” aiming to establish the integrity and authenticity of studies. RIA provides a platform for urgent development of a standard approach to identifying and managing problematic studies.
KW  - COVID-19 pandemic
KW  - systematic review
KW  - research integrity
KW  - randomized controlled trial
KW  - good clinical practice
KW  - evidence synthesis
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318236
VL  - 14
IS  - 3
SP  - 357
EP  - 369
ER  - 
TY  - JOUR
A1  - Schmid, Benedikt
A1  - Griesel, Mirko
A1  - Fischer, Anna-Lena
A1  - Romero, Carolina S.
A1  - Metzendorf, Maria-Inti
A1  - Weibel, Stephanie
A1  - Fichtner, Falk
T1  - Awake prone positioning, high-flow nasal oxygen and non-invasive ventilation as non-invasive respiratory strategies in COVID-19 acute respiratory failure: a systematic review and meta-analysis
JF  - Journal of Clinical Medicine
N2  - Background: Acute respiratory failure is the most important organ dysfunction of COVID-19 patients. While non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) oxygen are frequently used, efficacy and safety remain uncertain. Benefits and harms of awake prone positioning (APP) in COVID-19 patients are unknown. Methods: We searched for randomized controlled trials (RCTs) comparing HFNC vs. NIV and APP vs. standard care. We meta-analyzed data for mortality, intubation rate, and safety. Results: Five RCTs (2182 patients) were identified. While it remains uncertain whether HFNC compared to NIV alters mortality (RR: 0.92, 95% CI 0.65–1.33), HFNC may increase rate of intubation or death (composite endpoint; RR 1.22, 1.03–1.45). We do not know if HFNC alters risk for harm. APP compared to standard care probably decreases intubation rate (RR 0.83, 0.71–0.96) but may have little or no effect on mortality (RR: 1.08, 0.51–2.31). Conclusions: Certainty of evidence is moderate to very low. There is no compelling evidence for either HFNC or NIV, but both carry substantial risk for harm. The use of APP probably has benefits although mortality appears unaffected.
KW  - respiratory failure
KW  - non-invasive ventilation
KW  - high-flow nasal cannula
KW  - awake prone positioning
KW  - COVID-19
KW  - systematic review
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-255225
SN  - 2077-0383
VL  - 11
IS  - 2
ER  - 
TY  - JOUR
A1  - Janson, Patrick
A1  - Willeke, Kristina
A1  - Zaibert, Lisa
A1  - Budnick, Andrea
A1  - Berghöfer, Anne
A1  - Kittel-Schneider, Sarah
A1  - Heuschmann, Peter U.
A1  - Zapf, Andreas
A1  - Wildner, Manfred
A1  - Stupp, Carolin
A1  - Keil, Thomas
T1  - Mortality, morbidity and health-related outcomes in informal caregivers compared to non-caregivers: a systematic review
JF  - International Journal of Environmental Research and Public Health
N2  - A systematic overview of mental and physical disorders of informal caregivers based on population-based studies with good methodological quality is lacking. Therefore, our aim was to systematically summarize mortality, incidence, and prevalence estimates of chronic diseases in informal caregivers compared to non-caregivers. Following PRISMA recommendations, we searched major healthcare databases (CINAHL, MEDLINE and Web of Science) systematically for relevant studies published in the last 10 years (without language restrictions) (PROSPERO registration number: CRD42020200314). We included only observational cross-sectional and cohort studies with low risk of bias (risk scores 0–2 out of max 8) that reported the prevalence, incidence, odds ratio (OR), hazard ratio (HR), mean- or sum-scores for health-related outcomes in informal caregivers and non-caregivers. For a thorough methodological quality assessment, we used a validated checklist. The synthesis of the results was conducted by grouping outcomes. We included 22 studies, which came predominately from the USA and Europe. Informal caregivers had a significantly lower mortality than non-caregivers. Regarding chronic morbidity outcomes, the results from a large longitudinal German health-insurance evaluation showed increased and statistically significant incidences of severe stress, adjustment disorders, depression, diseases of the spine and pain conditions among informal caregivers compared to non-caregivers. In cross-sectional evaluations, informal caregiving seemed to be associated with a higher occurrence of depression and of anxiety (ranging from 4 to 51% and 2 to 38%, respectively), pain, hypertension, diabetes and reduced quality of life. Results from our systematic review suggest that informal caregiving may be associated with several mental and physical disorders. However, these results need to be interpreted with caution, as the cross-sectional studies cannot determine temporal relationships. The lower mortality rates compared to non-caregivers may be due to a healthy-carer bias in longitudinal observational studies; however, these and other potential benefits of informal caregiving deserve further attention by researchers.
KW  - cohort studies
KW  - longitudinal studies
KW  - cross-sectional studies
KW  - family caregivers
KW  - informal caregiving
KW  - mental health
KW  - physical health
KW  - population-based studies
KW  - systematic review
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-275219
SN  - 1660-4601
VL  - 19
IS  - 10
ER  - 
TY  - JOUR
A1  - Halbig, Andreas
A1  - Latoschik, Marc Erich
T1  - A systematic review of physiological measurements, factors, methods, and applications in virtual reality
JF  - Frontiers in Virtual Reality
N2  - Measurements of physiological parameters provide an objective, often non-intrusive, and (at least semi-)automatic evaluation and utilization of user behavior. In addition, specific hardware devices of Virtual Reality (VR) often ship with built-in sensors, i.e. eye-tracking and movements sensors. Hence, the combination of physiological measurements and VR applications seems promising. Several approaches have investigated the applicability and benefits of this combination for various fields of applications. However, the range of possible application fields, coupled with potentially useful and beneficial physiological parameters, types of sensor, target variables and factors, and analysis approaches and techniques is manifold. This article provides a systematic overview and an extensive state-of-the-art review of the usage of physiological measurements in VR. We identified 1,119 works that make use of physiological measurements in VR. Within these, we identified 32 approaches that focus on the classification of characteristics of experience, common in VR applications. The first part of this review categorizes the 1,119 works by field of application, i.e. therapy, training, entertainment, and communication and interaction, as well as by the specific target factors and variables measured by the physiological parameters. An additional category summarizes general VR approaches applicable to all specific fields of application since they target typical VR qualities. In the second part of this review, we analyze the target factors and variables regarding the respective methods used for an automatic analysis and, potentially, classification. For example, we highlight which measurement setups have been proven to be sensitive enough to distinguish different levels of arousal, valence, anxiety, stress, or cognitive workload in the virtual realm. This work may prove useful for all researchers wanting to use physiological data in VR and who want to have a good overview of prior approaches taken, their benefits and potential drawbacks.
KW  - virtual reality
KW  - use cases
KW  - sesnsors
KW  - tools
KW  - biosignals
KW  - psychophyisology
KW  - HMD (Head-Mounted Display)
KW  - systematic review
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260503
VL  - 2
ER  - 
TY  - JOUR
A1  - Willeke, Kristina
A1  - Janson, Patrick
A1  - Zink, Katharina
A1  - Stupp, Carolin
A1  - Kittel-Schneider, Sarah
A1  - Berghöfer, Anne
A1  - Ewert, Thomas
A1  - King, Ryan
A1  - Heuschmann, Peter U.
A1  - Zapf, Andreas
A1  - Wildner, Manfred
A1  - Keil, Thomas
T1  - Occurrence of mental illness and mental health risks among the self-employed: a systematic review
JF  - International Journal of Environmental Research and Public Health
N2  - We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.
KW  - incidence
KW  - mental disorders
KW  - mental health
KW  - mental illness
KW  - prevalence
KW  - self-employed
KW  - small business
KW  - systematic review
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-245085
SN  - 1660-4601
VL  - 18
IS  - 16
ER  - 
TY  - JOUR
A1  - Müller, Sophie
A1  - Köhler, Franziska
A1  - Hendricks, Anne
A1  - Kastner, Carolin
A1  - Börner, Kevin
A1  - Diers, Johannes
A1  - Lock, Johan F.
A1  - Petritsch, Bernhard
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Armin
T1  - Brain metastases from colorectal cancer: a systematic review of the literature and meta-analysis to establish a guideline for daily treatment
JF  - Cancers
N2  - Colorectal cancer (CRC) is the third most common malignancy worldwide. Most patients with metastatic CRC develop liver or lung metastases, while a minority suffer from brain metastases. There is little information available regarding the presentation, treatment, and overall survival of brain metastases (BM) from CRC. This systematic review and meta-analysis includes data collected from three major databases (PubMed, Cochrane, and Embase) based on the key words “brain”, “metastas*”, “tumor”, “colorectal”, “cancer”, and “malignancy”. In total, 1318 articles were identified in the search and 86 studies matched the inclusion criteria. The incidence of BM varied between 0.1% and 11.5%. Most patients developed metastases at other sites prior to developing BM. Lung metastases and KRAS mutations were described as risk factors for additional BM. Patients with BM suffered from various symptoms, but up to 96.8% of BM patients were asymptomatic at the time of BM diagnosis. Median survival time ranged from 2 to 9.6 months, and overall survival (OS) increased up to 41.1 months in patients on a multimodal therapy regimen. Several factors including age, blood levels of carcinoembryonic antigen (CEA), multiple metastases sites, number of brain lesions, and presence of the KRAS mutation were predictors of OS. For BM diagnosis, MRI was considered to be state of the art. Treatment consisted of a combination of surgery, radiation, or systemic treatment.
KW  - brain metastases
KW  - cerebral metastases
KW  - BM
KW  - colorectal cancer
KW  - CRC
KW  - systematic review
KW  - meta-analysis
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228883
SN  - 2072-6694
VL  - 13
IS  - 4
ER  - 
TY  - JOUR
A1  - Riemer, Manuel
A1  - Kranke, Peter
A1  - Helf, Antonia
A1  - Mayer, Debora
A1  - Popp, Maria
A1  - Schlesinger, Tobias
A1  - Meybohm, Patrick
A1  - Weibel, Stephanie
T1  - Trial registration and selective outcome reporting in 585 clinical trials investigating drugs for prevention of postoperative nausea and vomiting
JF  - BMC Anesthesiology
N2  - Background:  Selective outcome reporting in clinical trials introduces bias in the body of evidence distorting clinical decision making.  Trial registration aims to prevent this bias and is suggested by the International Committee of Medical Journal Editors (ICMJE) since 2004.
Methods:  The 585 randomized controlled trials (RCTs) published between 1965 and 2017 that were included in a recently published Cochrane review on antiemetic drugs for prevention of postoperative nausea and vomiting were selected. In a retrospective study, we assessed trial registration and selective outcome reporting by comparing study publications with their registered protocols according to the ‘Cochrane Risk of bias’ assessment tool 1.0. 
Results:  In the Cochrane review, the first study which referred to a registered trial protocol was published in 2004. Of all 585 trials included in the Cochrane review, 334 RCTs were published in 2004 or later, of which only 22% (75/334) were registered. Among the registered trials, 36% (27/75) were pro- and 64% (48/75) were retrospectively registered. 41% (11/27) of the prospectively registered trials were free of selective outcome reporting bias, 22% (6/27) were incompletely registered and assessed as unclear risk, and 37% (10/27) were assessed as high risk. Major outcome discrepancies between registered and published high risk trials were a change from the registered primary to a published secondary outcome (32%), a new primary outcome (26%), and different outcome assessment times (26%). Among trials with high risk of selective outcome reporting 80% favoured at least one statistically significant result. Registered trials were assessed more often as ‘overall low risk of bias’ compared to non-registered trials (64% vs 28%). 
Conclusions:  In 2017, 13 years after the ICMJE declared prospective protocol registration a necessity for reliable clinical studies, the frequency and quality of trial registration in the field of PONV is very poor. Selective outcome reporting reduces trustworthiness in findings of clinical trials. Investigators and clinicians should be aware that only following a properly registered protocol and transparently reporting of predefined outcomes, regardless of the direction and significance of the result, will ultimately strengthen the body of evidence in the field of PONV research in the future.
KW  - clinical trial
KW  - postoperative nausea and vomiting
KW  - selective outcome reporting
KW  - systematic review
KW  - trial registration
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265518
VL  - 21
ER  - 
TY  - JOUR
A1  - Fricke, Julia
A1  - Ávila, Gabriela
A1  - Keller, Theresa
A1  - Weller, Karsten
A1  - Lau, Susanne
A1  - Maurer, Marcus
A1  - Zuberbier, Torsten
A1  - Keil, Thomas
T1  - Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta‐analysis
JF  - Allergy
N2  - Background and objectives:
Urticaria is a frequent skin condition, but reliable prevalence estimates from population studies particularly of the chronic form are scarce. The objective of this study was to systematically evaluate and summarize the prevalence of chronic urticaria by evaluating population‐based studies worldwide.

Methods:
We performed a systematic search in PUBMED and EMBASE for population‐based studies of cross‐sectional or cohort design and studies based on health insurance/system databases. Risk of bias was assessed using a specific tool for prevalence studies. For meta‐analysis, we used a random effects model.

Results:
Eighteen studies were included in the systematic evaluation and 11 in the meta‐analysis including data from over 86 000 000 participants. Risk of bias was mainly moderate, whereas the statistical heterogeneity (I\(^{2}\)) between the studies was high. Asian studies combined showed a higher point prevalence of chronic urticaria (1.4%, 95%‐CI 0.5‐2.9) than those from Europe (0.5%, 0.2‐1.0) and Northern American (0.1%, 0.1‐0.1). Women were slightly more affected than men, whereas in children < 15 years we did not find a sex‐specific difference in the prevalence. The four studies that examined time trends indicated an increasing prevalence of chronic urticaria over time.

Conclusions:
On a global level, the prevalence of chronic urticaria showed considerable regional differences. There is a need to obtain more sex‐specific population‐based and standardized international data particularly for children and adolescents, different chronic urticaria subtypes and potential risk and protective factors.
KW  - chronic urticaria
KW  - meta‐analysis
KW  - prevalence
KW  - sex differences
KW  - systematic review
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213700
VL  - 75
IS  - 2
SP  - 423
EP  - 432
ER  - 
TY  - JOUR
A1  - Petzke, Frank
A1  - Klose, Petra
A1  - Welsch, Patrick
A1  - Sommer, Claudia
A1  - Häuser, Winfried
T1  - Opioids for chronic low back pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks of double‐blind duration
JF  - European Journal of Pain
N2  - Background and Objective
This updated systematic review evaluated the efficacy, tolerability and safety of opioids compared to placebo in non‐malignant chronic low back pain.

Databases and Data Treatment
Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to May 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks of double‐blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences. We added nine new studies with 2,980 participants for a total of 21 studies with 7,650 participants. Study duration ranged between 4 and 15 weeks. Studies with a parallel and cross‐over design: Based on very low to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater, but a clinically relevant reduction of disability compared to placebo. Enriched enrolment randomized withdrawal (EERW) design: Based on very low to low‐quality evidence, opioids provided a clinically relevant pain relief of 50% or greater, but not a clinically relevant reduction of disability compared to placebo. There was no clinically relevant harm with regard to serious adverse events by opioids compared to placebo in studies with parallel/cross‐over and EERW design. There was a relevant harm with regard to drop out rates due to adverse events in studies with parallel/cross‐over, but not in studies with EERW design.

Conclusions
Opioids may provide a safe and clinically relevant pain relief for 4–15 weeks in highly selected patients.

Significance
Within the context of randomized controlled trials of 4–15 weeks, opioids provided a clinically relevant pain relief of 30% or greater and a clinically relevant reduction of disability compared to placebo in non‐malignant chronic low back pain. Number needed to treat for an additional drop out due to side effects was 11 (95% confidence interval: 6–33). Assessment of abuse and addiction was incomplete. The frequency of serious adverse events including deaths did not differ from placebo.
KW  - opioids
KW  - back pain
KW  - systematic review
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218498
VL  - 24
IS  - 3
SP  - 497
EP  - 517
ER  -