The effectiveness and safety of acupuncture for allergic rhinitis: Protocol for an overview of systematic reviews and meta-analyses.
- 作者列表："Yang J","Xiong J","Wang X","Yuan T","Fu Y","Jiang Y","Zhou X","Liao K","Xu L
BACKGROUND:Allergic rhinitis (AR) is one of the most common allergic disorders globally. Several systematic reviews and meta-analyses have reported the effectiveness of acupuncture for patients with AR. However, the evidence has not been systematically synthesized. This overview aims to map, synthesize, and assess the reliability of evidence generated from these systematic reviews (SRs) and meta-analyses of acupuncture for AR. METHODS:A Comprehensive literature search will be conducted through the PubMed, Embase, the Cochrane Library of Systematic Reviews, the China National Knowledge Infrastructure Database, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database from inception until January 2020. Additionally, the PROSPERO database and the reference list of included studies will be searched for unpublished, ongoing, or recently completed SRs and meta-analyses. The reviewers will identify reviews independently and extract data according to the methodological guidelines for overviews provided by the Cochrane Collaboration. The risk of bias will be assessed based on the Risk of Bias in Systematic Reviews. The methodological and reporting quality of the included reviews will be assessed using the Assessing the Methodological Quality of Systematic Reviews (V.2) tool and the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. The outcomes of interest include total nasal symptom score, rhinoconjunctivitis quality-of-life questionnaire, immunoglobulin E, visual analog scale, laboratory examination, and side effects. The quality of evidence of outcomes will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation. The evidence will be synthesized where appropriate based on patient subgroups and outcomes. ETHICS AND DISSEMINATION:Ethical approval is not required for overviews. We plan to publish results in peer-reviewed journals and present at international and national academic, clinical, and patient conferences. RESULTS:The results will be published in a peer-reviewed journal. CONCLUSION:This overview will provide comprehensive evidence of acupuncture for patients with AR. PROSPERO REGISTRATION NUMBER:CRD42019140756.
背景: 变应性鼻炎 (AR) 是全球最常见的过敏性疾病之一。一些系统评价和荟萃分析已经报道了针灸对AR患者的有效性。然而，证据还没有被系统地合成。本综述旨在映射，综合和评估从这些系统综述 (SRs) 和针灸AR荟萃分析中产生的证据的可靠性。 方法: 通过PubMed、Embase、Cochrane系统评价图书馆、中国国家知识基础设施数据库、万方数据库、中国生物医学文献数据库、中文科技期刊数据库从创刊至2020年1月进行全面的文献检索。此外，将在PROSPERO数据库和纳入研究的参考列表中搜索未发表、正在进行或最近完成的SRs和荟萃分析。评审员将独立识别评价，并根据Cochrane协作网提供的综述方法学指南提取数据。偏倚风险将根据系统评价中的偏倚风险进行评估。纳入审查的方法和报告质量将使用评估系统审查的方法质量 (V.2) 工具和系统审查和元分析声明的首选报告项目进行评估。感兴趣的结果包括总鼻部症状评分、鼻结膜炎生活质量问卷、免疫球蛋白E、视觉模拟量表、实验室检查和副作用。结果证据的质量将使用建议评估，开发和评估的分级进行评估。证据将在适当情况下根据患者亚组和结果进行综合。 伦理和传播: 概述不需要伦理批准。我们计划在同行评审期刊上发表结果，并在国际和国家学术，临床和患者会议上发表。 结果: 研究结果将发表在同行评审期刊上。 结论: 本综述将为针刺治疗AR患者提供全面的证据。 普洛斯彼罗注册号: CRD42019140756.
METHODS:OBJECTIVE:To evaluate long-term global and site-specific health-related quality of life (HRQoL) in patients treated for sinonasal and nasopharyngeal malignancies. STUDY DESIGN:Cross-sectional. METHODS:One hundred fourteen patients with sinonasal and nasopharyngeal malignancies received surgery, radiation, systemic chemotherapy, or a combination thereof, with curative intent. Validated global ([EuroQol-5D] Visual Analogue Scale [EQ-5D VAS]) and disease-specific instruments (MD Anderson Symptom Inventory-Head and Neck [MDASI-HN], Anterior Skull Base Questionnaire [ASBQ]) were administered to patients who were both free of disease and had completed treatment at least 12 months previously. Associations between instruments, instrument domains, and specific clinical parameters were analyzed. RESULTS:The median age was 55 years. The mean EQ-5D VAS, MDASI-22 composite score, and ASBQ score were 74 (standard deviation [SD] 21), 48 (SD 36), and 130 (SD 27), respectively. The most frequently reported high-severity items in MDASI-HN were dry mouth and difficulty tasting food. The most frequently reported high-severity items in ASBQ were difficulty with smell and nasal secretions. Advanced Tumor (T) classification was associated with worse overall ASBQ sum score (P = 0.02). ASBQ performance at home and MDASI-HN drowsy symptom items independently predicted worse global HRQoL as measured by the EQ-5D VAS (P < 0.001). CONCLUSION:Global HRQoL for survivors of sinonasal and nasopharyngeal malignancies after multimodality treatment approximates that of the U.S. population for the same age group. ASBQ and MDASI-HN correlate well with global HRQoL outcomes as measured by EQ-5D VAS. MDASI-HN and ASBQ elicited unique symptoms, highlighting the complex symptom burden experienced by these patients. Further studies should identify patients predisposed to reduced long-term QOL. LEVEL OF EVIDENCE:3 Laryngoscope, 130:86-93, 2020.
METHODS:BACKGROUND:Allergic rhinitis (AR) and asthma are two common chronic diseases that often coexist. There is a need for a validated tool to evaluate HRQoL of Portuguese speakers with asthma and/or rhinitis patients in clinical practice. OBJECTIVES:To adapt and validate RhinAsthma Patient Perspective (RAPP) in Portuguese. METHODS:The RAPP questionnaire was translated into Portuguese. Asthmatics with comorbidities and rhinitis attending the allergy department of Coimbra University Hospital were asked to complete the Portuguese translation of RAPP, in addition to the SF-12, ACT, and a Symptomatologic VAS twice, with a 4-week interval between visits. During Visit 2, a Global Rating Scale (GRS) was completed to assess any change in health status. Scale dimensions, internal consistency and convergent validity, reliability, discriminant ability and responsiveness to change, as well as Minimal Clinical Difference were assessed. RESULTS:Factor and confirmatory analysis confirm the unidimensional structure of the questionnaire. Internal consistency has been shown to be satisfactory (0.82 visit 1 and 0.86 at visit 2). The tool is able to discriminate between patients on the basis of asthma severity, asthma control level, and rhinitis severity; convergent validity showed a significant correlation with SF-2 Physical component (r=-0.46 and 0.42, p at Visits 1 and 2). An ICC of 0.97 and a CCC=0.94 indicate that the tool is highly reliable. Responsiveness was shown in detecting a significant association with GRS changes (r=0.41, p<0.01) and ACT (r=-0.47, p<0.01) but not with VAS. (r=.14, n.s.). MID value was 2 points. CONCLUSIONS:The Portuguese version of RAPP has been demonstrated to have good measurement properties and sensitivity to health changes, which will provide a valid, reliable and standardized HRQoL measurement in patients with asthma and comorbid allergic rhinitis in clinical practice.
METHODS:OBJECTIVE:To characterize treatment delays in sinonasal cancer managed with surgery and adjuvant radiation and determine the associated impact on survival. STUDY DESIGN:Retrospective cohort study. METHODS:We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004 to 2014. We then examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and radiation duration (RTD). Next, we performed recursive partitioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional hazards regression. RESULTS:Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare insurance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.03-1.40), and RTD (HR, 1.27; 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA-derived threshold was not significantly associated with mortality after adjusting for other covariates. CONCLUSION:Delays in SRT and RTD intervals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment delays could be considered quality indicators for sinonasal cancer treated with surgery and adjuvant radiation. LEVEL OF EVIDENCE:NA Laryngoscope, 130:2-11, 2020.