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Morelli KM, Carrelli M, Nunez MA, Smith CA, Warren GL. Addition of hip exercises to treatment of patellofemoral pain syndrome: A meta-analysis. World J Meta-Anal 2015; 3:118-124. [DOI: 10.13105/wjma.v3.i2.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/13/2015] [Accepted: 04/02/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine if the addition of hip-strengthening exercises decreases pain and improves function in patients with patellofemoral pain syndrome.
METHODS: The authors completed a systematic review searching eight databases (i.e., PubMed, Cochrane, CINHAL, MEDLINE, SportsDiscus, EMBASE, APTA Hooked on Evidence, and PEDro). Two independent reviewers screened and excluded studies if they did not meet the following inclusion criteria: subjects had a primary diagnosis of patellofemoral pain syndrome (PFPS), intervention group included hip-strengthening exercises, control group included a traditional physical therapy intervention, study included outcome measures of pain and/or function, study used a randomized controlled trial design, PEDro score was ≥ 7, and study was published in a peer-reviewed journal. Primary outcome measures were subjective scales of pain and function. These measures were converted to standardized mean difference [effect size (ES)], and a random-effects model was used to calculate the overall ES.
RESULTS: Two hundred eighty-three studies were screened for inclusion in our meta-analysis. Nine studies were deemed suitable for data extraction and analysis. A total of 426 subjects were used in the nine studies. Overall, there was a significant positive effect of hip-strengthening exercises on measures of pain and function in subjects with PFPS (ES = 0.94, P = 0.00004). None of the individual studies had a negative ES, with study ES ranging from 0.35 to 2.59. Because of the high degree of between-study variance (I2 = 76%; Q = 34.0, P < 0.001), subgroup meta-analyses and meta-regressions were performed. None of the potential moderator variables that were investigated (e.g., outcome type, hip region targeted, duration of treatment) could explain a significant amount of the between-study variance in ES (P≥ 0.23).
CONCLUSION: Overall, the addition of hip-strengthening exercises to traditional physical therapy produced greater improvements in measures of pain and function.
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Kraal T, Beimers L. Arthroscopic capsular release and manipulation under anaesthesia for frozen shoulders: A hot topic. World J Meta-Anal 2015; 3:82-88. [DOI: 10.13105/wjma.v3.i2.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/31/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
A frozen shoulder is a common cause of shoulder pain and stiffness. The etiology and pathology of frozen shoulders is not fully understood yet. Frozen shoulder is characterized by a decrease in intra-articular volume and capsular compliance. This can lead to significant limitations in daily life. The majority of the patients can be treated conservatively, with functional recovery to be expected in two to three years. However, if conservative treatment fails, manipulation under anaesthesia and arthroscopic capsular release can both be considered as appropriate treatments. Manipulation is a traditionally well-established technique but in recent years it seems that arthroscopic capsular release has gained popularity. Manipulation is a relative time efficient and technically low-demanding procedure in which the glenohumeral joint is forced into different directions under general anaesthesia to release the capsular contracture, thereby increasing the range of motion of the joint. In arthroscopic capsular release the glenohumeral capsule can be released in a more controlled manner under direct vision. There are no prospective comparative trials available to display superiority of one procedure over the other. In addition, the optimal timing of both these interventions still has to be determined. An overview of the literature concerning this topic and a description of both procedures with its own advantages and disadvantages is provided.
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Demoulin C, Bruyère O, Somville PR, Vanderthommen M. Low back pain-related meta-analysis: Caution is needed when interpreting published research results. World J Meta-Anal 2015; 3:93-96. [DOI: 10.13105/wjma.v3.i2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/21/2015] [Accepted: 04/07/2015] [Indexed: 02/05/2023] Open
Abstract
The systematic reviews (SRs) including a meta-analysis are considered as the top level of evidence. Although the existence of more than a hundred of low back pain (LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic, a deep analysis indicates that several of these SRs included only very few studies. Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality, or some studies which differed significantly regarding the studied populations and/or the experimental procedure. The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles. To conclude, although meta-analysis is at the top of the evidence pyramid and have several strengths, the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses. This is true, whether it be for LBP-related SRs including a meta-analysis, or any other. Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice. Furthermore, clinical reasoning remains crucial, especially to consider the potential differences between one’s patient and the patients included in the meta-analysis.
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McFarland LV, Malfertheiner P, Huang Y, Wang L. Meta-analysis of single strain probiotics for the eradication of Helicobacter pylori and prevention of adverse events. World J Meta-Anal 2015; 3:97-117. [DOI: 10.13105/wjma.v3.i2.97] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/03/2015] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the efficacy and safety of single strain probiotics for the: (1) eradication of Helicobacter pylori (H. pylori); (2) prevention of adverse events; and (3) prevention of antibiotic-associated diarrhea associated with eradication therapy.
METHODS: We searched PubMed (1960-2014), EMBASE (1974-2014), Cochrane Database of Systematic Reviews (1990-2014), and ISI Web of Science (2000-2014). Additionally, we conducted a grey literature search including contact with National Institutes of Health Clinical Trials Registry, abstracts from annual infectious disease and gastroenterology meetings, experts in the field and correspondence with authors. Randomized controlled trials of H. pylori positive adults or children treated with eradication therapy and assessing the adjunctive therapy with a single strain of probiotics were included. The primary outcomes were the rates of eradication of H. pylori and frequency of patients with adverse events or antibiotic-associated diarrhea. Outcomes were pooled using fixed or random-effects models to calculate the relative risk and corresponding 95%CI and weighted on study size. To explore possible explanations for heterogeneity, a priori subgroup analyses were conducted on daily probiotic dose, study population, and quality of the study. The overall quality of the evidence for each probiotic strain was assessed using the GRADE criteria.
RESULTS: A total of 25 randomized controlled trials (28 treatment arms, with a total of 3769 participants) assessed one of six single probiotic strains as adjunctive treatments to standard eradication therapy. Only one probiotic strain significantly improved H. pylori eradication rates: Saccharomyces boulardii (S. boulardii) CNCM I-745 [pooled relative risks (pRR) = 1.11, 95%CI: 1.07-1.16]. Only one probiotic strain (S. boulardii CNCM I-745) significantly prevented any adverse events (pRR = 0.42, 95%CI: 0.28-0.62). Both S. boulardii CNCM I-745 and Lactobacillus rhamnosus GG significantly reduced antibiotic-associated diarrhea (pRR = 0.47, 95%CI: 0.37-0.60 and pRR = 0.29, 95%CI: 0.17-0.48, respectively) associated with H. pylori eradication therapy. Meta-regression of sub-groups did not detect significant differences by dose, adult vs pediatric, symptom status, or study quality, but did find significant differences by the strain of probiotic. Potential mild publication bias was found for antibiotic-associated diarrhea, but not for eradication or adverse event outcomes. Analysis of the study quality illuminated areas for improvement in future studies (use of placebos, study size calculations, attrition reasons and discussion of limitations and generalizability).
CONCLUSION: The pooled evidence suggests that the adjunctive use of a few probiotic strains may improve H. pylori eradication rates and prevent the development of adverse events and antibiotic-associated diarrhea in those treated with standard eradication therapies. The type of probiotic strain was the most important factor in predicting efficacy.
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Buzás GM. Fate of meta-analyses: The case of Helicobacter pylori. World J Meta-Anal 2015; 3:20-25. [DOI: 10.13105/wjma.v3.i1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/10/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To overview the current diversity of meta-analysis and the implementation of their results in international guidelines.
METHODS: Relevant meta-analysis were identified from PubMed/Medline. The topics of meta-analyses were determined. Some topics (genetics, extragastric tumors) were analysed separately. Core journals publishing meta-analyses on Helicobacter pylori were ranked. The rate of citation of meta-analysis in major guidelines was calculated.
RESULTS: Between 1992 and 2014, some 356 meta-analyses were published on PubMed. These mainly appeared in core journals, but were also found in 128 other journals. Eradicating of the infection was the most addressed topic with 134 articles. Meta-analyses were rarely used in formulating statements and recommendations in the international guidelines. In other topics - genetics, extraintestinal manifestations - meta-analyses were rather overused.
CONCLUSION: The implementation of meta-analysis in current guidelines is rather rare, while other topics benefit from many studies. A more extensive use of meta-analyses in evidence-based medicine is recommended in the future, otherwise their continuous proliferation will lose reason and scientific significance.
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Cramer H. Why meta-analyses are important for complementary and alternative medicine research. World J Meta-Anal 2015; 3:1-3. [DOI: 10.13105/wjma.v3.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/08/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
Complementary and alternative medicine (CAM) is defined as a group of interventions that are not generally considered part of conventional medicine. This definition already implies that CAM interventions are often not systematically studied; and the research evidence from single trials on CAM is often limited by small sample sizes, unclear methodology, and inadequate statistics. As a result, both, significant and insignificant results are often hard to interpret based on single trials. Summarizing the evidence from single CAM trials, qualitative systematic reviews still have to deal with the same problems as individual trials as they can only rely on the original reports. Thus, effects of CAM interventions are often underestimated or overestimated based on single trials or qualitative systematic reviews. While meta-analyses still are limited by the methodological shortcomings of the included studies, a well-conducted meta-analysis can deal with two common problems of CAM trials: inadequate statistics that rely on within-group comparisons and small underpowered sample sizes. Although large and high quality trials are urgently needed for most CAM interventions, funding often is limited. Until higher quality research is available, meta-analyses provide a useful tool to investigate the actual level of evidence of currently published CAM trials. This editorial presents examples of meta-analyses in the field of CAM and discusses how they contribute to the consolidation of evidence.
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Jiang N, Song HJ, Xie GP, Wang L, Liang CX, Qin CH, Yu B. Operative vs nonoperative treatment of displaced intra-articular calcaneal fracture: A meta-analysis of randomized controlled trials. World J Meta-Anal 2015; 3:61-71. [DOI: 10.13105/wjma.v3.i1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/04/2014] [Accepted: 12/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate clinical efficacy of displaced intra-articular calcaneal fracture (DIACF) following operation and nonoperation.
METHODS: Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials (RCTs) comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P > 0.05 or P≤ 0.05 for heterogeneity tests, respectively.
RESULTS: Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job (P = 0.006). No statistical differences were found between the two groups in residual pain (P = 0.33), shoe fitting problems (P = 0.07), limited walking distance (P = 0.56) or secondary late arthrodesis (P = 0.38). However, operative treatment was associated with a higher complication rate (P = 0.003). Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems (P < 0.0001) in operative group, the two groups had similar complication rate in deep wound infection (P = 0.34), compartment syndrome (P = 0.46), thromboembolism (P = 0.32), reflex sympathetic dystrophy (P = 0.51) or traumatic arthritis secondary to DIACF (P = 0.43).
CONCLUSION: Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.
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Beaudry R, Kruger C, Liang Y, Parliament M, Haykowsky M, McNeely ML. Effect of supervised exercise on aerobic capacity in cancer survivors: Adherence and workload predict variance in effect. World J Meta-Anal 2015; 3:43-53. [DOI: 10.13105/wjma.v3.i1.43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/03/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To examine the efficacy of supervised aerobic exercise training on aerobic capacity in survivors of cancer.
METHODS: We conducted a systematic search identifying randomized controlled trials of supervised aerobic exercise interventions among adult cancer survivors with aerobic capacity (VO2max/peak) as the primary outcome. We calculated pooled effect sizes and performed multiple regression moderator analysis.
RESULTS: We identified 18 studies including 1149 survivors of cancer. Studies included mixed cancer groups (4 studies), breast cancer (10 studies), hematological cancers (2 studies), lung cancer (1 study) and liver cancer (1 study). Survivors of cancer who participated in supervised aerobic exercise training improved aerobic capacity (VO2peak) more than controls (18 comparisons, 1093 participants; standardized mean effect: 0.74; 95%CI: 0.52, 0.96; P < 0.001). However, there was significant heterogeneity among the included trials (I2: 63%; P < 0.001). Sixty-six percent of the between-study heterogeneity was explained by differences in exercise adherence and total exercise workload among studies (R2: 65.8%; P < 0.04).
CONCLUSION: Supervised aerobic exercise training provides a moderate-to-large beneficial effect on aerobic capacity among survivors of cancer. Aerobic capacity was improved to a greater degree in exercise studies with better participant attendance and higher overall exercise workload.
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Jin JW, Chen SL, Deng ZT. Association between SHBG (TAAAA)n and AR (CAG)n polymorphisms and PCOS risk: A meta-analysis. World J Meta-Anal 2015; 3:72-81. [DOI: 10.13105/wjma.v3.i1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/28/2014] [Accepted: 11/03/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To systematically assess the association between sex hormone-binding globulin (SHBG) (TAAAA)n and androgen receptor (AR) (CAG)n polymorphisms and polycystic ovarian syndrome (PCOS) risk.
METHODS: We searched MEDLINE (PubMed), EMBASE and Web of Science database from inception to May 2014. To avoid missing any additional studies, we looked through all the references of relevant articles. Case-control studies concerning the (CAG)n variants in the AR gene or the (TAAAA)n polymorphism in the SHBG gene in PCOS patients were included. Five studies regarding the (TAAAA)n polymorphism in the SHBG gene and 14 studies regarding the (CAG)n polymorphism in the AR gene met our criteria. Odd ratio (OR) and weighted mean difference (WMD) were selected as the effect size measurements to evaluate the influence of the (TAAAA)n polymorphism and (CAG)n variants on PCOS risk. Begg’s test was used for the evaluation of publication bias.
RESULTS: With respect to the relationship between the (TAAAA)n polymorphism and PCOS risk, the statistical results showed that there was no significant difference between PCOS patients and controls in the alleles of TAAAA (S: OR = 0.91, 95%CI: 0.78-1.05; L: OR = 1.10, 95%CI: 0.95-1.27). Subgroup analyses of the combination of alleles indicated similar results (short-short: OR = 0.87, 95%CI: 0.66-1.14; short-long: OR = 1.12, 95%CI: 0.86-1.46; long-long: OR = 1.03, 95%CI: 0.72-1.47). As for the relationship between the (CAG)n polymorphism and PCOS risk, we found no association between CAG repeat variants and PCOS risk (WDM = 0.03, 95%CI: -0.13-0.08). Subgroup analyses by race and diagnosis criteria indicated the same results (Asian: WMD = -0.03, 95%CI: -0.14-0.07; Caucasian: WMD = -0.02, 95%CI: -0.24-0.21; the criteria of Rotterdam: WMD = 0.01, 95%CI: -0.01-0.03).
CONCLUSION: There is no association between (TAAAA)n polymorphism in SHBG gene, (CAG)n repeat variants in AR gene and PCOS.
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Mutowo MP, Mangwiro JC, Lorgelly P, Owen A, Renzaho AMN. Hypertension in Zimbabwe: A meta-analysis to quantify its burden and policy implications. World J Meta-Anal 2015; 3:54-60. [DOI: 10.13105/wjma.v3.i1.54] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/02/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To estimate the pooled prevalence of hypertension in Zimbabwe and describe its trend since independence in 1980 using secondary source data.
METHODS: MEDLINE, EMBASE and Scopus databases from April 1980 to December 2013 were searched for population and community based studies on the prevalence of hypertension among adults (≥ 18 years) in Zimbabwe. The key words used were “prevalence”, “epidemiologic studies”, “hypertension” or “high blood pressure”, based on the cut-off (≥ 140 mmHg systolic blood pressure and/or ≥ 90 mmHg diastolic blood pressure). We conducted a meta-analysis on the published studies, using the random-effects model to estimate the pooled prevalence.
RESULTS: The search retrieved 87 publications, of which four studies met the selection criteria. The four studies had a total of 4829 study participants between 1997 and 2010 across 5 provinces in Zimbabwe. Two studies were in urban areas, while the other two had mixed study settings (urban and rural). The overall pooled prevalence of hypertension was 30% (95%CI: 19%, 42%, I2= 98%, χ2 = 164.15, P = 0.00).
CONCLUSION: Our results show a high prevalence of hypertension in Zimbabwe, with urban areas having higher prevalence than rural areas.
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Caldeira D, Cruz I, Calé R, Martins C, Pereira H, Ferreira JJ, Pinto FJ, Costa J. Antithrombotic treatment in chronic heart failure and sinus rhythm: Systematic review. World J Meta-Anal 2015; 3:36-42. [DOI: 10.13105/wjma.v3.i1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/17/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the efficacy and safety of antithrombotic drugs (antiplatelet or anticoagulant drugs) compared to no antithrombotic treatment or placebo in patients with heart failure (HF) and sinus rhythm.
METHODS: We searched Medline and Cochrane Library for randomized controlled trials evaluating antithrombotic treatment and no antithrombotic treatment in patients with HF and sinus rhythm. Risk ratio (RR) and 95%CIs were estimated performing meta-analysis with random effects method.
RESULTS: Two studies met the inclusion criteria: Heart failure Long-term Antithrombotic Study and Warfarin/Aspirin Study in Heart failure, with 336 patients and mean follow-up 1.8-2.25 years. Stroke risk was not reduced by acetylsalicylic acid (RR = 1.18, 95%CI: 0.17-8.15), oral anticoagulation (RR = 0.30, 95%CI: 0.03-2.65) or overall antithrombotic drugs (RR = 0.52, 95%CI: 0.10-2.74). Acetylsalicylic acid showed a significant increased risk of worsening HF (RR = 1.78, 95%CI: 1.08-2.92), while oral anticoagulation had no impact in this outcome (RR = 1.03, 95%CI: 0.61-1.75). Overall antithrombotic drugs showed a significant risk increase of major bleeding (RR = 6.99, 95%CI: 0.89-54.64).
CONCLUSION: Best available evidence does not support the routine use of antithrombotic drugs in patients with HF and sinus rhythm. These drugs, particularly oral anticoagulation has the hazard of increase significantly major bleeding risk.
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Almashhrawi AA, Rahman R, Jersak ST, Asombang AW, Hinds AM, Hammad HT, Nguyen DL, Bechtold ML. Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis. World J Meta-Anal 2015; 3:4-10. [PMID: 25741509 PMCID: PMC4346140 DOI: 10.13105/wjma.v3.i1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/03/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients.
METHODS: UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004-2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias and I2 measure of inconsistency for heterogeneity assessments.
RESULTS: Initial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N = 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P = 0.02). Despite observed trends, no significant differences were found for mortality (P = 0.18) or aspiration (P = 0.11).
CONCLUSION: Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.
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Murray M, Healy DA, Ferguson J, Bashar K, McHugh S, Clarke Moloney M, Walsh SR. Effect of institutional volume on laparoscopic cholecystectomy outcomes: Systematic review and meta-analysis. World J Meta-Anal 2015; 3:26-35. [DOI: 10.13105/wjma.v3.i1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/02/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine whether institutional laparoscopy cholecystectomy (LC) volume affects rates of mortality, conversion to open surgery, bile leakage and bile duct injury (BDI).
METHODS: Eligible studies were prospective or retrospective cohort studies that provided data on outcomes from consecutive LC procedures in single institutions. Relevant outcomes were mortality, conversion to open surgery, bile leakage and BDI. We performed a Medline search and extracted data. A regression analysis using generalized estimating equations were used to determine the influence of annual institutional LC caseload on outcomes. A sensitivity analysis was performed including only those studies that were published after 1995.
RESULTS: Seventy-three cohorts (127404 LC procedures) were included. Average complication rates were 0.06% for mortality, 3.23% for conversion, 0.44% for bile leakage and 0.28% for bile duct injury. Annual institutional caseload did not influence rates of mortality (P = 0.142), bile leakage (P = 0.111) or bile duct injury (P = 0.198) although increasing caseload was associated with reduced incidence of conversion (P = 0.019). Results from the sensitivity analyses were similar.
CONCLUSION: Institutional volume is a determinant of LC complications. It is unclear whether volume is directly linked to complication rates or whether it is an index for protocolised care.
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Savoia P, Cavaliere G, Fava P. Risk of infectious diseases and cutaneous tumours in solid organ recipients: A meta-analysis of literature. World J Meta-Anal 2015; 3:11-19. [DOI: 10.13105/wjma.v3.i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/08/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare the risk of cutaneous infections and tumours in kidney transplant recipients with data recently published about this topic.
METHODS: In the present work, we evaluated the incidence of bacterial, fungal and viral cutaneous infectious diseases and the development of skin cancers in a cohort of 436 patients who underwent a renal transplantation. The median age at transplantation of our patients was 50 years and the median duration of the immunosuppression was of 7.2 years. Data obtained from our cohort were compared with those obtained by a systematic review of the literature of the last 20 years about the same topic.
RESULTS: Infectious diseases were the most frequent dermatological disorders that were diagnosed after transplantation, affecting about the 16.5% of patients. Herpes virus reactivation occurs in about the 35% of patients and is more common within 6 mo from transplantation, whereas when the immunosuppression is reduced, skin infections are mainly represented by Human Papilloma Virus infections and localized mycosis, such as pityriasis versicolor and superficial candidiasis. Bacterial infections were relatively rare and occur mainly in the first months after transplantation. The cumulative risk to develop skin cancer enhance significantly over the time, as consequence of long-term immunosuppressive regiments. Endogenous and exogenous risk factors, as well as the schedule of immunosuppression can play a role and justify the different incidence of skin cancer in the various series.
CONCLUSION: Skin infections and cancer, commonly diagnosed in transplanted patients, impact on survival and life-quality, justifying the realization of follow-up programs for the early diagnosis and treatment.
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Zheng S, Li YX, Han TT, Zhang Y, Jiang DD, Hu YM. Systematic review and meta-analysis of Statins-Fibrates therapy in diabetic dyslipidemia patients. World J Meta-Anal 2014; 2:194-203. [DOI: 10.13105/wjma.v2.i4.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 06/24/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the efficacy, effect of preventing cardiovascular diseases and safety of statins-fibrates combination therapy in diabetic dyslipidemia patients.
METHODS: We searched the databases of MEDLINE, EMBASE, web of knowledge and Cochrane central register of Controlled Trials for literatures about the coadministration of statins and fibrates as the treatment of patients with dyslipidemia and type 2 diabetes mellitus. We included related randomized controlled trials, controlled clinical trials and cross-sectional studies and excluded animal trials and clinical observations. The primary endpoints outcomes were the concentration of plasma total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C). The secondary outcomes were cardiovascular diseases (CVD) and adverse events.
RESULTS: Ten studies were included in this meta-analysis. For lipid modifying efficacy, the combination of statins and fibrates therapy had more significant effect on reducing TC [P = 0.004, weighted mean difference (WMD) = -8.19, 95%CI: -13.82--2.56] and TG concentration (P < 0.001, WMD = -47.29, 95%CI: -68.66--25.92) and increasing HDL-C concentration (P < 0.00001, WMD = 3.79, 95%CI: 2.25-5.33) when compared with statins monotherapy, while the effect of reducing LDL-C concentration (P = 0.50, WMD = -2.52, 95%CI: -9.76-4.72) was insignificant. To fibrates monotherapy, the combination therapy was more effective on reducing TC (P < 0.00001, WMD = -48.51, 95%CI: -57.14--39.89), TG (P < 0.00001, WMD = -26.07, 95%CI: -30.96--21.18), LDL-C concentration (P < 0.00001, WMD = -45.74, 95%CI: -53.35--38.13) and increasing HDL-C concentration (P = 0.04, WMD = 1.38, 95%CI: 0.04-2.73). For cardiovascular diseases, the coadministration therapy had no significant effect on reducing the incidence of these events when compared with monotherapy (For primary clinical endpoints, P = 0.12, OR = 0.61, 95%CI: 0.33-1.14); for secondary clinical endpoints, P = 0.13, OR = 0.66, 95%CI: 0.38-1.14). For adverse events happened during the follow-up, both the incidence of hepatic-related (alanine aminotransferase and/or aspartate aminotransferase of patients were ≥ 3 times of upper limit of normal) (P = 0.38, OR = 0.55, 95%CI: 0.15-2.06) and muscular-related (myopathy and/or creatine phosphokinase ≥ 3 times of upper limit of normal) adverse events (P = 0.10, OR = 1.62, 95%CI: 0.91-2.86) had no significant difference between these two therapies.
CONCLUSION: The results showed statins-fibrates combination therapy was more effective on lipid modification and well tolerated but there was no significant effect on preventing cardiovascular diseases.
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Dai C, Liu WX, Wang K, Jiang HK, Jiang M, Sun MJ. Alcohol consumption and the risk of Barrett’s esophagus: A meta-analysis. World J Meta-Anal 2014; 2:204-211. [DOI: 10.13105/wjma.v2.i4.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/05/2014] [Accepted: 11/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the possible association between alcohol consumption and Barrett’s esophagus (BE).
METHODS: We performed a systematic literature search of multiple online electronic databases. Inclusion criteria entailed studies about alcohol and BE. Meta-analysis was conducted to evaluate odds ratio (OR) and 95%CIs for the association between alcohol consumption and BE.
RESULTS: Twenty studies comprising 4758 patients with BE were included in the meta-analysis. The risk of BE in patients with alcohol consumption was increased compared with control groups (OR = 1.01; 95%CI: 1.00-1.02), especially in case-control and cohort, European and Asian, and hospital studies, but there was a decreased risk of BE associated with alcohol consumption from American studies (OR = 0.86; 95%CI: 0.77-0.96). At the same time, there was no significant association between BE and alcohol consumption in community studies (OR = 0.97; 95%CI: 0.84-1.12) and the type of alcohol (wine, beer and liquor) studies.
CONCLUSION: Our meta-analysis found that alcohol consumption was associated with an increased risk of BE, especially for European and Asian drinkers.
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Thosani N, Rao B, Batra S, Adeyefa B, Raju GS, Bresalier RS, Banerjee S, Guha S. Diagnostic yield of third eye retroscope on adenoma detection during colonoscopy: A systematic review and meta-analysis. World J Meta-Anal 2014; 2:162-170. [DOI: 10.13105/wjma.v2.i4.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/12/2014] [Accepted: 10/16/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine the diagnostic yield of the “third eye retroscope”, on adenoma detection rate during screening colonoscopy.
METHODS: The “third eye retroscope” when used with standard colonoscopy provides an additional retrograde view to visualize lesions on the proximal aspects of folds and flexures. We searched MEDLINE (PubMed and Ovid), SCOPUS (including MEDLINE and EMBASE databases), Cochrane Database of Systemic Reviews, Google Scholar, and CINAHL Plus databases to identify studies that evaluated diagnostic yield of “third eye retroscope” during screening colonoscopy. DerSimonian Laird random effects model was used to generate the overall effect for each outcome. We evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantified by I2 statistics.
RESULTS: Four distinct studies with a total of 920 patients, mean age 59.83 (95%CI: 56.77-62.83) years, were included in the review. The additional adenoma detection rate (AADR) defined as the number of additional adenomas identified due to “third eye retroscope” device in comparison to standard colonoscopy alone was 19.9% (95%CI: 7.3-43.9). AADR for right and left colon were 13.9% (95%CI: 9.4-20) and 10.7 (95%CI: 1.9-42), respectively. AADR for polyps ≥ 6 mm and ≥ 10 mm were 24.6% (95%CI: 16.6-34.9) and 24.2% (95%CI: 12.9-40.8), respectively. The additional polyp detection rate defined as the number of additional polyps identified due to “third eye retroscope” device in comparison to standard colonoscopy alone was 19.8% (95%CI: 7.9-41.8). There were no complications reported with use of “third eye retroscope” device.
CONCLUSION: The “third eye retroscope” device when used with standard colonoscopy is safe and detects 19.9% additional adenomas, compared to standard colonoscopy alone.
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Lang SS, Sanborn MR, Ju C, Premjee A, Stein SC, Smith MJ. Hydrocephalus after subarachnoid hemorrhage: A meta-analytic comparison of aneurysm treatments. World J Meta-Anal 2014; 2:171-178. [DOI: 10.13105/wjma.v2.i4.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/27/2014] [Accepted: 08/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of developing hydrocephalus.
METHODS: We reviewed the English language literature on the risk of developing hydrocephalus after aneurysm treatment. Data were divided by type of study (randomized controlled trial, cohort trial, nonrandomized comparison, prospectively- and retrospectively-collected observational study). They were also divided by type of aneurysm treatment (microvascular - clipping, or endovascular - coiling). Additional predictive variables collected for each publication were average age, gender distribution, measures of hemorrhage volume and subarachnoid hemorrhage severity, aneurysm locations, time to treatment, duration of follow-up and date of publication. We employed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling. Meta-regression was used to correct pooled results for covariates.
RESULTS: Because indications for the two treatments are different, there is little clinical equipoise for treating most cases. The single randomized, controlled trial dealt with a small subset of ruptured aneurysms. Neither this nor pooled values from other studies which compared the two treatments had the power to demonstrate significant differences between the two treatments. Nor was there an apparent difference when observational data were meta-analytically pooled. However, when meta-regression was used to correct for predictive variables known to differ between the two treatment groups, a highly-significant difference appeared. Coiling is used more commonly in older, sicker patients with aneurysms in certain locations. These cases are more likely to develop hydrocephalus. When corrected for these covariates, the risk of hydrocephalus was found to be significantly lower in coiled vs clipped cases (P = 0.014).
CONCLUSION: Pooled observational data were necessary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.
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Shamliyan TA, Avanesova AA. Russian clinical research policy does not guarantee results availability. World J Meta-Anal 2014; 2:154-161. [DOI: 10.13105/wjma.v2.i4.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/11/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate results availability from clinical studies enrolling Russian subjects and Russian clinical research policy.
METHODS: We analyzed Russian legislation and ethical regulations about drug and devices approval, clinical research registration and the results availability. In August 2012, we searched International Clinical Trials Registry Platform and clinicaltrials.gov to find all registered studies that had an investigational site in the territory of the Russian Federation. To find publication status, we searched the PubMed and Scirus bibliographical databases with trial registration number to find journal publications of the registered studies.
RESULTS: We identified 2062 registered research protocols comprising 2017 international and 45 protocols sponsored by the Russian funding agencies. The number of the studies enrolling Russian subjects increased dramatically from three studies in 2002 to 252 studies in 2012. Most studies (92%) were funded exclusively by industry, were interventions (94.6%), examined drugs (87%) and enrolled exclusively adults (86%) of both genders (89%). Only 383 (19%) of multinational studies and two (4.4%) of exclusively Russian studies were published. Posting of patient outcomes was available for 16% of the trials that recruited trial participants in the Russian territory including one study funded exclusively by Russian sponsors. Investigators terminated 99 studies of 38111 participants and did not provide the results in clinicaltrials.gov or in published manuscripts. Federal laws require clinical study registration and conflict of interest disclosure. However, routine monitoring of compliance to clinical research policy is not available.
CONCLUSION: Russian legislation does not guarantee the availability of clinical research results. Russian legislation should mandate transparent evidence- based market approval of the drugs and devices.
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Martins A, Morgado S, Morgado M. Anti-obesity drugs currently used and new compounds in clinical development. World J Meta-Anal 2014; 2:135-153. [DOI: 10.13105/wjma.v2.i4.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/15/2014] [Accepted: 08/31/2014] [Indexed: 02/05/2023] Open
Abstract
Obesity is a chronic disease which requires treatment. As lifestyle interventions alone hardly ever result in long-term weight loss, pharmacotherapy is an important adjunct to lifestyle measures to improve the induction and maintenance of weight loss. Owing to the limited options currently available for the pharmacological treatment of obesity, it is imperative to develop new safe compounds. This study aims to review the current medications approved by European Medicines Agency and United States Food and Drug Administration (FDA) for the treatment of obesity, focusing essentially on their benefits and risks, as well as on the new drugs which are presently under clinical trials. Moreover, it lists the anti-obesity agents that have been recently withdrawn from the market. A revision of the scientific literature was carried out, through a search on Pubmed for papers published from January 2010 to January 2013. Orlistat (Xenical®) is currently the only long-term pharmacotherapy for obesity available in the European market, as rimonabant and sibutramine were withdrawn in 2008 and 2010, respectively, due to serious psychiatric and cardiovascular adverse effects. Lorcaserin (Belviq®) and the association of phentermine and topiramate (QsymiaTM) were recently approved by FDA. Orlistat suppresses appetite inhibiting gastrointestinal lipase, being its adverse effects mostly gastrointestinal. Lorcaserin activates 5-HT2C receptors, phentermine is a norepinephrine releasing drug, and topiramate is an anticonvulsivant drug with weight loss properties.
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Turkiewicz KL, Allen M, Venetis MK, Robinson JD. Observed communication between oncologists and patients: A causal model of communication competence. World J Meta-Anal 2014; 2:186-193. [DOI: 10.13105/wjma.v2.i4.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/16/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate and test a causal model derived from previous meta-analytic data of health provider behaviors and patient satisfaction.
METHODS: A literature search was conducted for relevant manuscripts that met the following criteria: Reported an analysis of provider-patient interaction in the context of an oncology interview; the study had to measure at least two of the variables of interest to the model (provider activity, provider patient-centered communication, provider facilitative communication, patient activity, patient involvement, and patient satisfaction or reduced anxiety); and the information had to be reported in a manner that permitted the calculation of a zero-order correlation between at least two of the variables under consideration. Data were transformed into correlation coefficients and compiled to produce the correlation matrix used for data analysis. The test of the causal model is a comparison of the expected correlation matrix generated using an Ordinary Least Squares method of estimation. The expected matrix is compared to the actual matrix of zero order correlation coefficients. A model is considered a possible fit if the level of deviation is less than expected due to random sampling error as measured by a chi-square statistic. The significance of the path coefficients was tested using a z test. Lastly, the Sobel test provides a test of the level of mediation provided by a variable and provides an estimate of the level of mediation for each connection. Such a test is warranted in models with multiple paths.
RESULTS: A test of the original model indicated a lack of fit with the summary data. The largest discrepancy in the model was between the patient satisfaction and the provider patient-centered utterances. The observed correlation was far larger than expected given a mediated relationship. The test of a modified model was undertaken to determine possible fit. The corrected model provides a fit to within tolerance as evaluated by the test statistic, χ2 (8, average n = 342) = 10.22. Each of the path coefficients for the model reveals that each one can be considered significant, P < 0.05. The Sobel test examining the impact of the mediating variables demonstrated that patient involvement is a significant mediator in the model, Sobel statistic = 3.56, P < 0.05. Patient active was also demonstrated to be a significant mediator in the model, Sobel statistic = 4.21, P < 0.05. The statistics indicate that patient behavior mediates the relationship between provider behavior and patient satisfaction with the interaction.
CONCLUSION: The results demonstrate empirical support for the importance of patient-centered care and satisfy the need for empirical casual support of provider-patient behaviors on health outcomes.
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Wang YT, Pu H, Yin LL, Chen JY. Using fluorodeoxy-D-glucose-positron emission tomography to monitor neoadjuvant chemotherapy response in sarcoma: A meta-analysis. World J Meta-Anal 2014; 2:212-220. [DOI: 10.13105/wjma.v2.i4.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/25/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To systematically evaluate the accuracy of 18-fluorodeoxy-D-glucose-positron emission tomography (18-FDG PET) to assess response to neoadjuvant chemotherapy in bone and soft tissue sarcomas.
METHODS: Studies published in English language regarding the accuracy of F-18 FDG PET for the indication were retrieved from MEDLINE. The QUADAS tool was utilized for methodological quality appraisal. Relevant data were extracted, and quantitative data synthesis included pooled estimation and subgroup analysis.
RESULTS: A total of fifteen studies involving 420 patients with pathologically confirmed sarcoma were collected. Methodological quality was relatively high. The pooled sensitivity and specificity of PET to predict histopathological response were 87% (95%CI: 81%-91%) and 83% (95%CI: 77%-87%), respectively. Ten studies employed a lower standardized uptake value (SUV) after chemotherapies (mostly 2.5) and/or a higher SUV reduction rate (mostly around 50%) as PET criteria of good response. Subgroup analysis showed that PET exhibited a significantly better specificity in osteosarcoma (OS) and Ewing sarcoma (ES) than in soft-tissue sarcoma (STS) (91% vs 75%, P < 0.05), and a higher specificity in pediatric patients than in adults (90% vs 74%, P < 0.01). PET yielded a lower specificity in ifosfamide-contained chemotherapies than in the alternative regimen (70% vs 97%, P < 0.01).
CONCLUSION: F-18 FDG PET is promising to predict neoadjuvant therapy response in sarcoma, especially in pediatric patients with OS or ES. Certain chemotherapeutic agents could potentially cause false positives of PET.
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Rong GX, Huang L, Gui BJ, Xu AM, Zhang JL, Wang SS. Female-specific vs conventional knee prostheses after total knee arthroplasty: A meta-analysis. World J Meta-Anal 2014; 2:221-227. [DOI: 10.13105/wjma.v2.i4.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/23/2014] [Accepted: 10/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To study whether female-specific prostheses are superior to conventional prostheses after total knee arthroplasty (TKA) by conducting this meta-analysis to evaluate the effects of the 2 different designs.
METHODS: A systematic electronic search was conducted in the databases of PubMed, EMBASE and the Cochrane Library for prospective and retrospective trials. Meta-analysis was performed for the outcomes, including range of motion (ROM), Knee Society score, Hospital for Special Surgery scores (HSS) and complications including deep infection, manipulation under anesthesia (MUA), revisions, anterior knee pain, deep vein thrombosis and overhang rate. Meta-analysis was conducted where applicable. Weighted mean difference (WMD) and odds ratio were calculated according to study type.
RESULTS: Seven studies including 1174 knees were eligible for data extraction and pooled analysis. The overhang rate of female-specific prostheses was significantly lower than the conventional ones (WMD, 3.25; 95%CI: 0.00-0.27; P = 0.001). ROM in the female-specific prostheses group after TKA tended to be greater than the conventional prostheses group; however, with insignificant difference (WMD, 2.48; 95%CI: -0.83-5.78; P = 0.14). HSS (WMD, 0.48; 95%CI: -1.45-0.88; P = 0.63) and complications including deep infection (WMD, 0.39; 95%CI: 0.19-3.08; P =0 .70), MUA (WMD, 1.53; 95%CI: 0.02-1.61; P = 0.13) and revisions (WMD, 0.55; 95%CI: 0.07-4.34; P = 0.13) were all comparable between the two groups with at least 1 year follow-up. Other indexes were revealed to be similar between the two treatments with a descriptive analytical method.
CONCLUSION: Although the overhang rate is lower with female-specific prostheses, the current evidence does not support that female-specific prostheses outweigh conventional ones after TKA.
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Kocak M. Meta-analysis of bivariate P values. World J Meta-Anal 2014; 2:179-185. [DOI: 10.13105/wjma.v2.i4.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/08/2014] [Accepted: 10/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To propose a new meta-analysis method for bivariate P value which account for the paired structure.
METHODS: Studies that look to test two different features from the same sample gives rise to bivariate P value. A relevant example of this is testing for periodicity as well expression from time-course gene expression studies. Kocak et al (2010) uses George and Mudholkar’ (1983) “Difference of Two Logit-Sums” method to pool bivariate P value across independent experiments, assuming independence within a pair. As bivariate P value need not to be independent within a given study, we propose a new meta-analysis approach for pooling bivariate P value across independent experiments, which accounts for potential correlation between paired P-values. We compare the “Difference of Two Logit Sums”method with our novel approach in terms of their sensitivity and specificity through extensive simulations by generating P value samples from most commonly used tests namely, Z test, t test, chi-square test, and F test, with varying sample sizes and correlation structure.
RESULTS: The simulations results showed that our new meta-analysis approach for correlated and uncorrelated bivariate P value has much more desirable sensitivity and specificity features compared to the existing method, which treats each member of the paired P value as independent. We also compare these meta-analysis approaches on bivariate P value from periodicity and expression tests of 4936 S.Pombe genes from 10 independent time-course experiments and we showed that our new approach ranks the periodic, conserved, and cycling genes significantly higher, and detects many more periodic, “conserved” and “cycling” genes among the top 100 genes, compared to the ‘Difference of Two Logit-Sums’ method. Finally, we used our meta-analytic approach to compare the relative evidence in the association of pre-term birth with preschool wheezing versus pre-school asthma.
CONCLUSION: The new meta-analysis method has much better sensitivity and specific characteristics compared to the “Difference of Two-Logit Sums” method and it is not computationally more expensive.
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Lu B, Sun LX, Yan X, Ai ZZ, Xu JZ. Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China. World J Meta-Anal 2014; 2:127-134. [DOI: 10.13105/wjma.v2.i3.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/17/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule (SPN) in China.
METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography (CT) alone, CT plus CT-guided automated cutting needle biopsy (ACNB), CT plus positron emission tomography/computed tomography (PET/CT), CT plus diffusion-weighted magnetic resonance imaging (DWI) plus PET/CT.
RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies (87% vs 81%), with a cost saving of ¥1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies (95% vs 81%), with a cost saving of ¥590 RMB per patient, and reducing unnecessary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy (from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64).
CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.
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