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评估干奶时使用乳头内封闭剂预防奶牛干奶期内新的乳房内感染或泌乳早期临床型乳房炎的效果:系统评价更新和序贯荟萃分析。

Evaluating the efficacy of internal teat sealants at dry-off for the prevention of new intra-mammary infections during the dry-period or clinical mastitis during early lactation in dairy cows: A systematic review update and sequential meta-analysis.

机构信息

Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

出版信息

Prev Vet Med. 2023 Mar;212:105841. doi: 10.1016/j.prevetmed.2023.105841. Epub 2023 Jan 11.

Abstract

A systematic review and Bayesian sequential pair-wise meta-analyses were conducted to assess the efficacy of internal teat sealants (ITS) administered at dry-off in comparison to no treatment for preventing new intramammary infections (IMI) and clinical mastitis (CM) in dairy cattle. This work updated a previous systematic review and network meta-analysis conducted in 2019 but employed a narrowed scope and eligibility. The updated eligibility included studies that used ITS without concurrent therapy compared to a no treatment control (NTC), a study population of dairy cows or prepartum heifers, controlled trial design, and assessed one of the following outcomes: incidence of new IMI at calving or CM during the first 30 days in milk (DIM). Risk of bias was assessed through the Cochrane Risk of Bias 2.0 tool. Evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). There were 141 potentially relevant records identified from the updated search conducted on April 29, 2021, with a publication date restriction of 2018 or later; one study passed full-text screening and was included. Of the 32 studies included in the previous review, 12 studies were relevant after applying the modified eligibility criteria, totaling 13 studies included in this review (12 addressing IMI at calving outcome, 4 addressing CM at 30 DIM outcome). Sequential meta-analysis was conducted for both outcomes in R 3.6.0. Decisions for stopping were assessed at each analysis for intervention effect or futility in finding an effect based on a priori minimum clinically relevant values (OR =0.5, 0.75). ITS at dry-off significantly reduced odds of new IMI at calving compared to NTC at the second meta-analysis (OR =0.27, 95% CI=0.22-0.34), and onward (OR =0.29, 95% CI=0.27-0.32). For CM at 30 DIM, significance was reached at the second meta-analysis (OR =0.59, 95% CI=0.47-0.73), and onward (OR =0.47, 95% CI=0.42-0.51). Stopping for effect occurred at the second analysis in both outcomes and ORs, but low-quality evidence and heterogeneity concerns were noted. A continuity-correction to include zero-event CM studies showed significance at the third meta-analysis (OR =0.79, 95% CI=0.73-0.86), stopping for effect at the fourth for OR = 0.75 (OR =0.77, 95% CI=0.72-0.83), and stopping for futility at the second for OR = 0.5 (OR =0.94, 95% CI=0.75-1.20), but the main CM analysis was considered more appropriate due to the sensitivity analysis' very low-quality evidence assessment. Based on sequential evidence available, sufficient research currently exists for practical use, and cessation of future research until substantial changes to ITS application occur may be appropriate.

摘要

本研究采用系统评价和贝叶斯序贯成对荟萃分析的方法,评估干奶期使用内乳头密封剂(ITS)与不治疗相比,在预防奶牛新的乳腺炎(IMI)和临床型乳腺炎(CM)方面的疗效。本研究是对 2019 年进行的系统评价和网络荟萃分析的更新,但采用了更窄的范围和纳入标准。更新后的纳入标准包括:与不治疗对照(NTC)相比,不联合其他治疗方法单独使用 ITS;研究对象为奶牛或围产前期小母牛;采用对照试验设计;评估以下结果之一:分娩时新 IMI 的发生率或产后 30 天内(DIM)的 CM。通过 Cochrane 偏倚风险 2.0 工具评估偏倚风险。使用 Grading of Recommendations Assessment, Development, and Evaluation(GRADE)评估证据质量。2021 年 4 月 29 日进行了更新检索,共确定了 141 篇潜在相关记录,出版日期限制在 2018 年或之后;一项研究通过了全文筛选并被纳入。在前一次综述中纳入的 32 项研究中,有 12 项研究在应用修改后的纳入标准后是相关的,因此本综述共纳入了 13 项研究(12 项研究涉及分娩时的 IMI 结局,4 项研究涉及产后 30 天的 CM 结局)。采用 R 3.6.0 进行了这两个结局的序贯荟萃分析。根据事先设定的最小临床相关值(OR=0.5,0.75),在每个分析中评估干预效果或无效性,以确定停止的决策。与 NTC 相比,干奶期使用 ITS 可显著降低分娩时新 IMI 的发生风险,在第二次meta 分析中(OR=0.27,95%CI=0.22-0.34),且结果持续有效(OR=0.29,95%CI=0.27-0.32)。对于产后 30 天的 CM,在第二次 meta 分析中达到了显著性(OR=0.59,95%CI=0.47-0.73),且结果持续有效(OR=0.47,95%CI=0.42-0.51)。在这两个结局和 OR 中,第二次分析均达到了效果停止的标准,但存在低质量证据和异质性问题。对包括零事件 CM 研究的连续性校正显示,在第三次 meta 分析中具有显著性(OR=0.79,95%CI=0.73-0.86),在第四次 meta 分析中对 OR=0.75 达到效果停止标准(OR=0.77,95%CI=0.72-0.83),在第二次 meta 分析中对 OR=0.5 达到无效性停止标准(OR=0.94,95%CI=0.75-1.20),但主要的 CM 分析被认为更合适,因为敏感性分析的低质量证据评估。根据目前可用的序贯证据,目前已经有足够的研究用于实际应用,直到 ITS 应用发生实质性变化,可能需要停止未来的研究。

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