1
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Chen J, Huang J, Li X. The impact of omentoplasty on the reduction of overall complications in liver surgery: an analysis using prediction interval. Int J Surg 2024; 110:5931-5932. [PMID: 38775619 PMCID: PMC11392190 DOI: 10.1097/js9.0000000000001693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/13/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Jiajun Chen
- Stomatological Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China
| | - Jiao Huang
- Stomatological Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China
| | - Xinyi Li
- Stomatological Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China
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2
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Peng Q, Zhang L. Assessing the Evidence for Erector Spinae Plane Block in Spine Surgery. Clin J Pain 2024; 40:560-561. [PMID: 38863200 DOI: 10.1097/ajp.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Affiliation(s)
- Qing Peng
- Department of Orthopedics, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
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3
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Zhang X, Zheng X, Gao R, Wang Y, Wei T, Zang Z, Zhu L, Li Q, Zhang Y, Liu F. Role of diet in the risks of esophageal adenocarcinoma and squamous cell carcinoma: an updated umbrella review. Eur J Nutr 2024; 63:1413-1424. [PMID: 38689010 DOI: 10.1007/s00394-024-03393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE This updated umbrella review aimed to evaluate the evidence regarding the associations between dietary factors and the risks of esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC). METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify relevant studies. The quality of the included meta-analyses was evaluated using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). For each association, the number of cases, random effects pooled effect size, 95% confidence intervals (CIs), heterogeneity, 95% prediction interval (PrI), small-study effect, and excess significance bias were recalculated to determine the evidence level. RESULTS We identified 33 meta-analyses describing 58 dietary factors associated with ESCC and 29 meta-analyses describing 38 dietary factors associated with EAC. There was convincing evidence regarding the association of 2 dietary factors (areca nut and high alcohol) with the risk of ESCC. There was highly suggestive evidence regarding the association of only 1 dietary factor (healthy pattern) with the risk of ESCC. There was suggestive evidence regarding the association of 11 dietary factors with the risk of ESCC, including fruit, citrus fruit, vegetables, pickled vegetables, maté tea, moderate alcohol, hot beverages and foods, hot tea, salt, folate, and vitamin B6. There was convincing evidence regarding the association of one dietary factor (vitamin B6) with the risk of EAC. There was suggestive evidence regarding the association of 4 dietary factors with the risk of EAC, including processed meat, dietary fibre, carbohydrate, and vitamin B12. The convincing evidence regarding the associations between dietary factors and the risks of ESCC and EAC remained robust in sensitivity analyses. CONCLUSIONS This umbrella review highlighted convincing evidence regarding the associations of areca nut and high alcohol with a higher risk of ESCC. Additionally, an association between vitamin B6 and a decreased risk of EAC was observed. Further research is needed to examine the dietary factors with weak evidence regarding their associations with ESCC and EAC.
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Affiliation(s)
- Xiaorui Zhang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Xite Zheng
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Ran Gao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Yijie Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Tong Wei
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Zhaoping Zang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Lingyan Zhu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Quanmei Li
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Yijun Zhang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China
| | - Fen Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China.
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4
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Hung KC, Kao CL, Hung IY, Chen IW. Serious games for chronic pain management in older adults: A promising but uncertain intervention. J Clin Nurs 2024; 33:3324-3325. [PMID: 38500229 DOI: 10.1111/jocn.17133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - I-Yin Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
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5
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Chen IW, Kao CL, Yew M, Hung KC. Nurse-led self-care interventions improve quality of life: A meta-analysis with prediction intervals. J Clin Nurs 2024; 33:2804-2805. [PMID: 38519841 DOI: 10.1111/jocn.17123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Ming Yew
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
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6
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Chen IW, Weng HL, Hung KC. Use of prediction interval to explore the relationship between psychological pain and suicidality. J Affect Disord 2024; 354:321-322. [PMID: 38508453 DOI: 10.1016/j.jad.2024.03.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/03/2024] [Accepted: 03/16/2024] [Indexed: 03/22/2024]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Hsiu-Lan Weng
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
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7
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Sun CK, Chen IW, Tsai IT, Hung KC. Robotic-assisted retroperitoneal lymph node dissection for testicular cancer: benefit and limitation. Int J Surg 2024; 110:3948-3949. [PMID: 38348828 PMCID: PMC11175718 DOI: 10.1097/js9.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City
| | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City
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8
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Moran JL, Linden A. Problematic meta-analyses: Bayesian and frequentist perspectives on combining randomized controlled trials and non-randomized studies. BMC Med Res Methodol 2024; 24:99. [PMID: 38678213 PMCID: PMC11056075 DOI: 10.1186/s12874-024-02215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE In the literature, the propriety of the meta-analytic treatment-effect produced by combining randomized controlled trials (RCT) and non-randomized studies (NRS) is questioned, given the inherent confounding in NRS that may bias the meta-analysis. The current study compared an implicitly principled pooled Bayesian meta-analytic treatment-effect with that of frequentist pooling of RCT and NRS to determine how well each approach handled the NRS bias. MATERIALS & METHODS Binary outcome Critical-Care meta-analyses, reflecting the importance of such outcomes in Critical-Care practice, combining RCT and NRS were identified electronically. Bayesian pooled treatment-effect and 95% credible-intervals (BCrI), posterior model probabilities indicating model plausibility and Bayes-factors (BF) were estimated using an informative heavy-tailed heterogeneity prior (half-Cauchy). Preference for pooling of RCT and NRS was indicated for Bayes-factors > 3 or < 0.333 for the converse. All pooled frequentist treatment-effects and 95% confidence intervals (FCI) were re-estimated using the popular DerSimonian-Laird (DSL) random effects model. RESULTS Fifty meta-analyses were identified (2009-2021), reporting pooled estimates in 44; 29 were pharmaceutical-therapeutic and 21 were non-pharmaceutical therapeutic. Re-computed pooled DSL FCI excluded the null (OR or RR = 1) in 86% (43/50). In 18 meta-analyses there was an agreement between FCI and BCrI in excluding the null. In 23 meta-analyses where FCI excluded the null, BCrI embraced the null. BF supported a pooled model in 27 meta-analyses and separate models in 4. The highest density of the posterior model probabilities for 0.333 < Bayes factor < 1 was 0.8. CONCLUSIONS In the current meta-analytic cohort, an integrated and multifaceted Bayesian approach gave support to including NRS in a pooled-estimate model. Conversely, caution should attend the reporting of naïve frequentist pooled, RCT and NRS, meta-analytic treatment effects.
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Affiliation(s)
- John L Moran
- The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia.
| | - Ariel Linden
- Department of Medicine, School of Medicine, University of California, San Francisco, USA
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Chen J, He XY. Comment on: Effects of virtual reality-based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta-analysis. J Clin Nurs 2024. [PMID: 38616563 DOI: 10.1111/jocn.17167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Jing Chen
- Department of Rehabilitation Medicine, Department of Nursing, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xu-Ying He
- Department of Rehabilitation Medicine, Department of Nursing, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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Pozza A, Ragucci F, Angelo NL, Pugi D, Cuomo A, Garcia-Hernandez MD, Rosa-Alcazar AI, Fagiolini A, Starcevic V. Worldwide prevalence of obsessive-compulsive symptoms during the COVID-19 pandemic: A systematic review and meta-analysis. J Psychiatr Res 2024; 172:360-381. [PMID: 38452635 DOI: 10.1016/j.jpsychires.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
During the COVID-19 pandemic governments worldwide implemented contagion-containing measures (i.e., physical distancing, hand sanitizing, mask wearing and quarantine). The similarities between these measures and obsessive-compulsive phenomenology (e.g., contamination concerns and repetitive washing and/or checking) led to inquiries about the frequency with which obsessive-compulsive symptoms (OCS) were encountered during the COVID-19 pandemic. We conducted a systematic review and meta-analysis to ascertain the prevalence of OCS in individuals of any age during the pandemic (i.e., any obsessive-compulsive symptoms that are clinically significant as shown by a score above the cut-off score of a scale, without necessarily fulfilling the diagnostic threshold for a diagnosis of OCD). A systematic search of relevant databases identified 35 studies, which were included in the systematic review following our inclusion and exclusion criteria. Most of the studies were conducted in adults from the general population and adopted an online assessment method, with 32 studies being eligible for meta-analysis. The meta-analysis resulted in a 20% average prevalence of OCS during the pandemic, with very high heterogeneity among the included studies (I2 99.6%). The highest prevalence of OCS was found in pregnant women (36%, n = 5), followed by individuals diagnosed with COVID-19 (22%, n = 4) and general population (22%, n = 19), undergraduates (21%, n = 5), and healthcare workers (5%, n = 5). The prevalence rates of OCS were higher in Asia (26%, n = 17) and North America (25%, n = 3) than in Europe (13%, n = 12) and Africa (7%, n = 4). Among the studies included, rates appeared higher in certain countries, though this difference did not reach statistical significance and was limited by very few studies conducted in certain countries. When compared to pre-pandemic rates, there seemed to be higher rates of OCS during the COVID-19 pandemic in Asia, Europe, and pregnant women. These findings are discussed considering the impact of the pandemic and contagion-containing measures on the perception and reporting of OCS, and susceptibility of the vulnerable population groups to experiencing OCS during the pandemic.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; Psychology Unit, Department of Mental Health, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - Federica Ragucci
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Nicole Loren Angelo
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Daniele Pugi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alessandro Cuomo
- Department of Molecular and Developmental Medicine, Division of Psychiatry, University of Siena, Siena, Italy; Psychiatry Unit, Department of Mental Health, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Ana Isabel Rosa-Alcazar
- Department of Personality, Assessment & Psychological Treatment, University of Murcia, Murcia, Spain
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, Division of Psychiatry, University of Siena, Siena, Italy; Psychiatry Unit, Department of Mental Health, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Australia
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11
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Chen IW, Lin HJ, Hung KC. Comment on effect of massage therapy on sleep quality in critically ill patients. J Clin Nurs 2024; 33:1586-1587. [PMID: 38131460 DOI: 10.1111/jocn.16977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Hsiu-Jung Lin
- Department of Anesthesiology, E-Da Cancer Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
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12
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Borg SJ, Cameron CM, Luetsch K, Rolley A, Geraghty T, McPhail S, McCreanor V. Prevalence of opioid use in adults with spinal cord injury: A systematic review and meta-analysis. J Spinal Cord Med 2024:1-19. [PMID: 38466869 DOI: 10.1080/10790268.2024.2319384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To determine the prevalence, reported harms and factors associated with opioid use among adults with spinal cord injury (SCI) living in the community. STUDY DESIGN Systematic review and meta-analysis. METHODS Comprehensive literature searches were conducted in PubMed (MEDLINE), EMBASE, CINAHL, Web of Science and Scopus for articles published between 2000 and 2023. Risk of bias was assessed using a prevalence-specific tool. Random-effects meta-analyses were conducted to pool prevalence data for any context of opioids. Sensitivity and subgroup analyses were also performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study protocol was registered via Prospero (CRD42022350768). RESULTS Of the 4969 potential studies, 38 were included in the review. Fifty-three percent of studies had a low risk of bias, with a high risk of bias in 5% of studies. The pooled prevalence for the 38 studies included in the meta-analysis (total cohort size of 50,473) across any opioid context was 39% (95% confidence interval [CI], 32-47). High heterogeneity was evident, with a prediction interval twice as wide as the 95% CI (prediction interval, 7-84%). Mean or median opioid dose was unreported in 95% of studies. Opioid dose and factors related to opioids were also rarely explored in the SCI populations. CONCLUSIONS Results should be interpreted with caution based on the high heterogeneity and imprecise pooled prevalence of opioids. Contextual details including pain, cohort-specific injury characteristics and opioid dosage were inconsistently reported, indicating a clear need for additional studies in a population at greater risk of experiencing opioid-related adverse effects.
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Affiliation(s)
- Samantha J Borg
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Australia
| | - Cate M Cameron
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Australia
| | - Karen Luetsch
- School of Pharmacy, University of Queensland, Woolloongabba, Australia
| | - Adam Rolley
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Australia
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- Department of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
| | - Victoria McCreanor
- Hunter Medical Research Institute, New Lambton Heights, Australia
- University of Newcastle, Newcastle, Australia
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Hung KC, Tsai IT, Sun CK. Assessing the survival advantage of deferred cytoreductive nephrectomy using a prediction interval. Int J Surg 2024; 110:1832-1833. [PMID: 38126397 PMCID: PMC10942196 DOI: 10.1097/js9.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City
| | - I-Ting Tsai
- Department of Emergency Medicine, E-Da Hospital
- School of Medicine, College of Medicine
| | - Cheuk-Kwan Sun
- School of Medicine, College of Medicine
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
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Hung KC, Chen IW, Sun CK. Concerns over prognosis prediction for non-small cell lung cancers using major pathological response. Int J Surg 2024; 110:1868-1869. [PMID: 38126278 PMCID: PMC10942198 DOI: 10.1097/js9.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
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15
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Hung KC, Lin HJ, Chen IW. New-onset neurodegenerative diseases following SARS-CoV-2 infection: An analysis of prediction interval. J Med Virol 2024; 96:e29563. [PMID: 38506221 DOI: 10.1002/jmv.29563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Hsiu-Jung Lin
- Department of Anesthesiology, E-Da Cancer Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan city, Taiwan
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Chen IW, Yu TS, Hung KC. Outcomes of Concurrent Hiatus Hernia Repair with Different Bariatric Surgery Procedures. Obes Surg 2024; 34:1036-1037. [PMID: 38183596 DOI: 10.1007/s11695-023-07047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Ting-Sian Yu
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No.901, ChungHwa Road, YungKung Dist, Tainan City, 71004, Taiwan.
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Chen IW, Kao CL, Hung KC. Re: 'The effect of antibiotic therapy for Clostridioides difficile infection on mortality and other patient-relevant outcomes' by Stabholz et al. Clin Microbiol Infect 2024:S1198-743X(24)00056-9. [PMID: 38331255 DOI: 10.1016/j.cmi.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
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Chen IW, Wang WT, Hung KC. The Impact of Endoscopic Sleeve Gastroplasty on HbA1c Improvement. Obes Surg 2024; 34:681-682. [PMID: 38127256 DOI: 10.1007/s11695-023-07008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Wei-Ting Wang
- Department of Anesthesiology, E-Da Hospital, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004, Taiwan.
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Wang WT, Chen IW, Hung KC. Inspiratory muscle training for COVID-19: Benefits appear promising but findings remain uncertain. J Med Virol 2024; 96:e29387. [PMID: 38235839 DOI: 10.1002/jmv.29387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Wei-Ting Wang
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan city, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
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20
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Chen IW, Kao CL, Hung KC. Comment to: The effect of surgical repair of hiatal hernia (HH) on pulmonary function. Hernia 2023:10.1007/s10029-023-02948-z. [PMID: 38123831 DOI: 10.1007/s10029-023-02948-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No.901, ChungHwa Road, YungKung Dist, Tainan, 71004, Taiwan.
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21
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Williams ZJ, Schaaf R, Ausderau KK, Baranek GT, Barrett DJ, Cascio CJ, Dumont RL, Eyoh EE, Failla MD, Feldman JI, Foss-Feig JH, Green HL, Green SA, He JL, Kaplan-Kahn EA, Keçeli-Kaysılı B, MacLennan K, Mailloux Z, Marco EJ, Mash LE, McKernan EP, Molholm S, Mostofsky SH, Puts NAJ, Robertson CE, Russo N, Shea N, Sideris J, Sutcliffe JS, Tavassoli T, Wallace MT, Wodka EL, Woynaroski TG. Examining the latent structure and correlates of sensory reactivity in autism: a multi-site integrative data analysis by the autism sensory research consortium. Mol Autism 2023; 14:31. [PMID: 37635263 PMCID: PMC10464466 DOI: 10.1186/s13229-023-00563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these "supra-modal" traits in the autistic population. METHODS Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a "general response pattern" factor for each supra-modal construct and determine the added value of "modality-specific response pattern" scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO, and SEEK (sub)constructs. RESULTS All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses supported the validity of a supra-modal HYPER construct (ωH = .800) but not a supra-modal HYPO construct (ωH = .653), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ωH = .800; 4/7 modalities). Modality-specific subscales demonstrated significant added value for all response patterns. Meta-analytic correlations varied by construct, although sensory features tended to correlate most with other domains of core autism features and co-occurring psychiatric symptoms (with general HYPER and speech HYPO demonstrating the largest numbers of practically significant correlations). LIMITATIONS Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to caregiver report of observable behaviors and excluded multisensory items that reflect many "real-world" sensory experiences. CONCLUSION Of the three sensory response patterns, only HYPER demonstrated sufficient evidence for valid interpretation at the supra-modal level, whereas supra-modal HYPO/SEEK constructs demonstrated substantial psychometric limitations. For clinicians and researchers seeking to characterize sensory reactivity in autism, modality-specific response pattern scores may represent viable alternatives that overcome many of these limitations.
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Affiliation(s)
- Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Room 8310, Nashville, TN, 37232, USA.
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA.
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA.
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Roseann Schaaf
- Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
- Jefferson Autism Center of Excellence, Farber Institute of Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karla K Ausderau
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin-Madison, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Grace T Baranek
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - D Jonah Barrett
- Neuroscience Undergraduate Program, Vanderbilt University, Nashville, TN, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carissa J Cascio
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachel L Dumont
- Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ekomobong E Eyoh
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | | | - Jacob I Feldman
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Room 8310, Nashville, TN, 37232, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - Jennifer H Foss-Feig
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heather L Green
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shulamite A Green
- Department of Psychiatry and Biobehavioral Sciences, University of California - Los Angeles, Los Angeles, CA, USA
| | - Jason L He
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Elizabeth A Kaplan-Kahn
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bahar Keçeli-Kaysılı
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Room 8310, Nashville, TN, 37232, USA
| | - Keren MacLennan
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Psychology, Durham University, Durham, UK
| | - Zoe Mailloux
- Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elysa J Marco
- Department of Neurodevelopmental Medicine, Cortica Healthcare, San Rafael, CA, USA
| | - Lisa E Mash
- Division of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth P McKernan
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sophie Molholm
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicolaas A J Puts
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Caroline E Robertson
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Natalie Russo
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Nicole Shea
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, Kaleida Health, Buffalo, NY, USA
| | - John Sideris
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - James S Sutcliffe
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Teresa Tavassoli
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Mark T Wallace
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Ericka L Wodka
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Tiffany G Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Room 8310, Nashville, TN, 37232, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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22
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Characterizing Interoceptive Differences in Autism: A Systematic Review and Meta-analysis of Case-control Studies. J Autism Dev Disord 2023; 53:947-962. [PMID: 35819587 PMCID: PMC9832174 DOI: 10.1007/s10803-022-05656-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/13/2023]
Abstract
Interoception, the body's perception of its own internal states, is thought to be altered in autism, though results of empirical studies have been inconsistent. The current study systematically reviewed and meta-analyzed the extant literature comparing interoceptive outcomes between autistic (AUT) and neurotypical (NT) individuals, determining which domains of interoception demonstrate robust between-group differences. A three-level Bayesian meta-analysis compared heartbeat counting performance, heartbeat discrimination performance, heartbeat counting confidence ratings, and self-reported interoceptive attention between AUT and NT groups (15 studies; nAUT = 467, nNT = 478). Autistic participants showed significantly reduced heartbeat counting performance [g = - 0.333, CrI95% (- 0.535, - 0.138)] and higher confidence in their heartbeat counting abilities [g = 0.430, CrI95% (0.123, 0.750)], but groups were equivalent on other meta-analyzed outcomes. Implications for future interoception research in autism are discussed.
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23
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Brini S, Brudasca NI, Hodkinson A, Kaluzinska K, Wach A, Storman D, Prokop-Dorner A, Jemioło P, Bala MM. Efficacy and safety of transcranial magnetic stimulation for treating major depressive disorder: An umbrella review and re-analysis of published meta-analyses of randomised controlled trials. Clin Psychol Rev 2023; 100:102236. [PMID: 36587461 DOI: 10.1016/j.cpr.2022.102236] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/15/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We re-analysed data from published meta-analyses testing the effects of Transcranial Magnetic Stimulation (TMS) on Major Depressive Disorder (MDD) in adults. We applied up-to-date meta-analytic techniques for handling heterogeneity including the random-effects Hartung-Knapp-Sidik-Jonkman method and estimated 95% prediction intervals. Heterogeneity practices in published meta-analyses were assessed as a secondary aim. STUDY DESIGN AND SETTING We performed systematic searches of systematic reviews with meta-analyses that included randomised controlled trials assessing the efficacy, tolerability, and side effects of TMS on MDD. We performed risk of bias assessment using A MeaSurement Tool to Assess Reviews (AMSTAR) 2 and re-analysed meta-analyses involving 10 or more primary studies. RESULTS We included 29 systematic reviews and re-analysed 15 meta-analyses. Authors of all meta-analyses interpreted findings to suggest TMS is safe and effective for MDD. Our re-analysis showed that in 14 out of 15 meta-analyses, the 95% prediction intervals included the null and captured values in the opposite effect direction. We also detected presence of small-study effects in some meta-analyses and 24 out of 25 systematic reviews received an AMSTAR 2 rating classed as critically low. CONCLUSION Authors of all included meta-analyses interpreted findings to suggest TMS is safe and effective for MDD despite lack of comprehensive investigation of heterogeneity. Our re-analysis revealed the direction and magnitude of treatment effects vary widely across different settings. We also found high risk of bias in the majority of included systematic reviews and presence of small-study effects in some meta-analyses. Because of these reasons, we argue TMS for MDD may not be as effective and potentially less tolerated in some populations than current evidence suggests.
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Affiliation(s)
- S Brini
- Division of Health Services Research and Management School of Health Sciences, City, University of London, London, United Kingdom.
| | - N I Brudasca
- Division of Health Services Research and Management School of Health Sciences, City, University of London, London, United Kingdom
| | - A Hodkinson
- National Institute for Health Research (NIHR), School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - K Kaluzinska
- Jagiellonian University Medical College, Faculty of Medicine, Students' Scientific Group of Systematic Reviews, Kraków, Poland
| | - A Wach
- Jagiellonian University Medical College, Faculty of Medicine, Students' Scientific Group of Systematic Reviews, Kraków, Poland
| | - D Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - A Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
| | - P Jemioło
- AGH University of Science and Technology, Kraków, Poland
| | - M M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
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24
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Qin X, Chen J, Jia G, Yang Z. Dietary Factors and Pancreatic Cancer Risk: An Umbrella Review of Meta-Analyses of Prospective Observational Studies. Adv Nutr 2023; 14:451-464. [PMID: 36849084 DOI: 10.1016/j.advnut.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
Dietary factors may be associated with the occurrence of pancreatic cancer. This umbrella review aimed to review and grade the evidence for the associations between dietary factors and pancreatic cancer risk. We searched PubMed, EMBASE, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and CINAHL for eligible literature. We included meta-analyses of randomized controlled trials (RCTs) or prospective observational studies. We used AMSTAR-2, a measurement tool to assess systematic reviews, to evaluate the methodological quality of the included meta-analyses. For each association, we calculated the summary effect size, 95% CI, heterogeneity, number of cases, 95% prediction interval, small-study effect, and excess significance bias. The protocol for this review was registered in the PROSPERO database (CRD42022333669). We included 41 meta-analyses of prospective observational studies describing 59 associations between dietary factors and pancreatic cancer risk. None of the retrieved meta-analyses included RCTs. No association was supported by convincing or highly suggestive evidence; however, there was suggestive evidence of a positive association between fructose intake and pancreatic cancer risk. There was weak evidence for an inverse association of nuts intake or adherence to the Mediterranean diet with pancreatic cancer incidence, and for positive associations between a higher intake of red meat or heavy alcohol intake and pancreatic cancer incidence. The remaining 54 associations were nonsignificant. Consistent with the American Institute for Cancer Research review, this umbrella review found that regular consumption of nuts and reduced intake of fructose, red meat, and alcohol were associated with a lower risk of pancreatic cancer. Emerging weak evidence supported an inverse association between adherence to the Mediterranean diet and pancreatic cancer risk. As some associations were rated as weak and most were considered nonsignificant, further prospective studies are needed to investigate the role of dietary factors and risk of pancreatic cancer. Adv Nutr 2023;xx:xx-xx.
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Affiliation(s)
- Xianpeng Qin
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Chen
- Department of Obstetrics and Gynecology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Guiqing Jia
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhou Yang
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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25
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Burfield M, Sayers M, Buhmann R. The association between running volume and knee osteoarthritis prevalence: A systematic review and meta-analysis. Phys Ther Sport 2023; 61:1-10. [PMID: 36809693 DOI: 10.1016/j.ptsp.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
There is conflicting evidence regarding whether regular running is associated with knee osteoarthritis prevalence. Previous evidence reports lower knee osteoarthritis prevalence in recreational runners compared with professionals (with a higher training volume) and controls (who have a lower training volume). The aim of this systematic review and meta-analysis was to determine if weekly running volume is associated with knee osteoarthritis prevalence. Four databases (PubMed, Web of Science, Scopus and SPORTDiscus) were searched from earliest record to November 2021. Included studies must i) recruit participants who ran regularly and recorded weekly running volume; ii) include a control group (running <8 km per week); iii) record knee osteoarthritis prevalence (either by radiological imaging or self-reported diagnosis from a doctor or physiotherapist). Study bias was assessed using the Newcastle-Ottawa Scale (NOS). Pooled effects were estimated using a random effects model. Odds ratios with 95% prediction and confidence intervals are reported. Nine observational case control studies with a total of 12,273 participants (1272 runners) were included in the meta-analysis. Most of the included studies were rated as having a very high (n = 2) or high (n = 3) risk of bias on the Newcastle Ottawa Scale. There was no difference in knee osteoarthritis prevalence between runners and controls (OR = 0.97, 95% CI = 0.56 to 1.68). Runners undertaking 8-32.1 km (OR = 1.17, 95% CI = 0.77 to 1.80), 32.2-48 km (OR = 1.04, 95% CI = 0.48 to 2.31) or > 48 km per week (OR = 0.62, 95% CI = 0.35 to 1.10) did not exhibit higher knee osteoarthritis prevalence compared with controls. It is unclear whether running volume is associated with increased knee osteoarthritis prevalence, future large-scale, high quality prospective studies are required.
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Affiliation(s)
- M Burfield
- School of Health and Behavioural Sciences, Australian Catholic University, Brisbane, Australia
| | - M Sayers
- School of Health and Behaviour Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - R Buhmann
- School of Health and Behaviour Sciences, University of the Sunshine Coast, Maroochydore, Australia.
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26
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Willems RPJ, van Dijk K, Vehreschild MJGT, Biehl LM, Ket JCF, Remmelzwaal S, Vandenbroucke-Grauls CMJE. Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis. THE LANCET. INFECTIOUS DISEASES 2023; 23:719-731. [PMID: 36731484 DOI: 10.1016/s1473-3099(22)00811-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Carriers of multidrug-resistant bacteria are at risk of infections with these bacteria; the precise size of this risk is unclear. We aimed to quantify the effect of gut colonisation on subsequent risk of infection with multidrug-resistant bacteria. METHODS We performed a systematic review and meta-regression analysis. We searched PubMed, Embase, Web of Science Core Collection, and Google Scholar for follow-up studies published from Jan 1, 1995, to March 17, 2022, that measured the incidence of infections with multidrug-resistant Gram-negative bacteria (MDR-GNB) and from Jan 1, 1995, to March 15, 2022, that measured the incidence of infections with vancomycin-resistant enterococci (VRE). We included original cohort studies and case-control studies that used incidence-density sampling, included 50 or more patients with enteric colonisation or positive urinary samples as a surrogate marker of colonisation, or both, and analysed infections clearly preceded by colonisation. We did not use any language restrictions. We excluded studies not reporting length of follow-up. Summary data were extracted and independently cross-verified by two authors. Carriage was defined as MDR-GNB or VRE, detected in faecal or urinary cultures. Our primary outcomes were cumulative incidence and incidence density of infection in patients colonised by multidrug-resistant bacteria. To estimate pooled incidences, general linearised mixed-effects meta-regressions were used, adjusting for varying follow-up durations. This study is registered with PROSPERO, CRD42020222415. FINDINGS Of the 301 studies identified, 44 studies (26 on MDR-GNB, 14 on VRE, and four on both MDR-GNB and VRE) from 14 countries were retained for qualitative synthesis, 40 of which were analysed with meta-regression, comprising data for 14 049 patients colonised with multidrug-resistant bacteria. The pooled cumulative incidence of infection was 14% (95% CI 10-18; p<0·0001) at a median follow-up time of 30 days for MDR-GNB (845 cases of infection in 9034 patients colonised) and 8% (5-13; p<0·0001) at 30 days for VRE (229 cases of infection in 4747 patients colonised). Infection incidence density (4·26 infections per 1000 patient-days; 95% CI 1·69-6·82) and cumulative incidence of infection (19%, 95% CI 15-25; p<0·0001; 602 cases of infection in 4547 patients colonised) were highest for carbapenem-resistant Gram-negative bacteria at 30 days. Risk of bias was rated low to moderate. INTERPRETATION The risk of infection was substantial, with the highest risk for patients colonised with carbapenem-resistant Gram-negative bacteria and the lowest in patients with VRE. These data might help to guide prophylactic and treatment decisions and form a valuable resource for planning clinical trials on targeted prevention. FUNDING The Netherlands Organization for Health Research and Development.
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Affiliation(s)
- Roel P J Willems
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam Infection and Immunity Institute, Amsterdam, Netherlands.
| | - Karin van Dijk
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam Infection and Immunity Institute, Amsterdam, Netherlands
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany; German Centre of Infection Research (partner site Bonn-Cologne), Cologne, Germany; Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Lena M Biehl
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany; German Centre of Infection Research (partner site Bonn-Cologne), Cologne, Germany
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sharon Remmelzwaal
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Christina M J E Vandenbroucke-Grauls
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam Infection and Immunity Institute, Amsterdam, Netherlands; Department of Clinical Medicine and Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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27
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Williams ZJ, Schaaf R, Ausderau KK, Baranek GT, Barrett DJ, Cascio CJ, Dumont RL, Eyoh EE, Failla MD, Feldman JI, Foss-Feig JH, Green HL, Green SA, He JL, Kaplan-Kahn EA, Keçeli-Kaysılı B, MacLennan K, Mailloux Z, Marco EJ, Mash LE, McKernan EP, Molholm S, Mostofsky SH, Puts NAJ, Robertson CE, Russo N, Shea N, Sideris J, Sutcliffe JS, Tavassoli T, Wallace MT, Wodka EL, Woynaroski TG. Examining the Latent Structure and Correlates of Sensory Reactivity in Autism: A Multi-site Integrative Data Analysis by the Autism Sensory Research Consortium. RESEARCH SQUARE 2023:rs.3.rs-2447849. [PMID: 36712092 PMCID: PMC9882639 DOI: 10.21203/rs.3.rs-2447849/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these "supra-modal" traits in the autistic population. Methods Leveraging a combined sample of 3,868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a "general response pattern" factor for each supra-modal construct and determine the added value of "modality-specific response pattern" scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO and SEEK (sub)constructs. Results All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses unambiguously supported the validity of a supra-modal HYPER construct (ω H = .800), whereas a coherent supra-modal HYPO construct was not supported (ω H = .611), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ω H = .799; 4/7 modalities). Within each sensory construct, modality-specific subscales demonstrated substantial added value beyond the supra-modal score. Meta-analytic correlations varied by construct, although sensory features tended to correlate most strongly with other domains of core autism features and co-occurring psychiatric symptoms. Certain subconstructs within the HYPO and SEEK domains were also associated with lower adaptive behavior scores. Limitations: Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to parent-report of observable behaviors and excluded multisensory items that reflect many "real-world" sensory experiences. Conclusion Psychometric issues may limit the degree to which some measures of supra-modal HYPO/SEEK can be interpreted. Depending on the research question at hand, modality-specific response pattern scores may represent a valid alternative method of characterizing sensory reactivity in autism.
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Gokhale S, Taylor D, Gill J, Hu Y, Zeps N, Lequertier V, Teede H, Enticott J. Hospital length of stay prediction for general surgery and total knee arthroplasty admissions: Systematic review and meta-analysis of published prediction models. Digit Health 2023; 9:20552076231177497. [PMID: 37284012 PMCID: PMC10240873 DOI: 10.1177/20552076231177497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/06/2023] [Indexed: 06/08/2023] Open
Abstract
Objective Systematic review of length of stay (LOS) prediction models to assess the study methods (including prediction variables), study quality, and performance of predictive models (using area under receiver operating curve (AUROC)) for general surgery populations and total knee arthroplasty (TKA). Method LOS prediction models published since 2010 were identified in five major research databases. The main outcomes were model performance metrics including AUROC, prediction variables, and level of validation. Risk of bias was assessed using the PROBAST checklist. Results Five general surgery studies (15 models) and 10 TKA studies (24 models) were identified. All general surgery and 20 TKA models used statistical approaches; 4 TKA models used machine learning approaches. Risk scores, diagnosis, and procedure types were predominant predictors used. Risk of bias was ranked as moderate in 3/15 and high in 12/15 studies. Discrimination measures were reported in 14/15 and calibration measures in 3/15 studies, with only 4/39 externally validated models (3 general surgery and 1 TKA). Meta-analysis of externally validated models (3 general surgery) suggested the AUROC 95% prediction interval is excellent and ranges between 0.803 and 0.970. Conclusion This is the first systematic review assessing quality of risk prediction models for prolonged LOS in general surgery and TKA groups. We showed that these risk prediction models were infrequently externally validated with poor study quality, typically related to poor reporting. Both machine learning and statistical modelling methods, plus the meta-analysis, showed acceptable to good predictive performance, which are encouraging. Moving forward, a focus on quality methods and external validation is needed before clinical application.
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Affiliation(s)
- Swapna Gokhale
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Quality Planning and Innovation Unit, Eastern Health, Box Hill, Victoria, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Box Hill, Victoria, Australia
| | - Jaskirath Gill
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Yanan Hu
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Nikolajs Zeps
- Graduate Research Industry Partnerships (GRIP) Program, Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
- Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Box Hill, Australia
| | - Vincent Lequertier
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Villeurbanne, France
- Univ. Lyon, INSA Lyon, Univ Lyon 2, Université Claude Bernard Lyon 1, Lyon, France
| | - Helena Teede
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Graduate Research Industry Partnerships (GRIP) Program, Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Joanne Enticott
- Faculty of Medicine, Nursing, and Health Sciences, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Graduate Research Industry Partnerships (GRIP) Program, Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
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Qin X, Jia G, Zhou X, Yang Z. Diet and Esophageal Cancer Risk: An Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies. Adv Nutr 2022; 13:2207-2216. [PMID: 36041184 PMCID: PMC9776643 DOI: 10.1093/advances/nmac087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 01/29/2023] Open
Abstract
Diet may play an important role in the occurrence of esophageal cancer (EC). The aim of this umbrella review was to grade the evidence for the association between dietary factors and EC risk. A protocol for this review was registered with the PROSPERO database (CRD42021283232). Publications were identified by searching PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL databases. Only systematic reviews and meta-analyses of observational studies (cohort studies, case-cohort studies, nested case-control studies) were eligible. AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) was used to assess the methodological quality of included systematic reviews. For each association, random-effects pooled effect size, 95% CI, number of cases, 95% prediction interval, heterogeneity, small-study effect, and excess significance bias were calculated to grade the evidence. From 882 publications, 107 full-text articles were evaluated for eligibility, and 20 systematic reviews and meta-analyses describing 32 associations between dietary factors and EC risk were included in the present umbrella review. By assessing the strength and validity of the evidence, 1 association (positively associated with alcohol intake) was supported by highly suggestive evidence and 1 (inversely associated with calcium intake) showed a suggestive level of evidence. Evidence for 7 associations was weak (positively associated with red meat and processed-meat intake; inversely associated with whole grains, fruits, green leafy vegetables, green tea, and zinc intake). The remaining 23 associations were nonsignificant. In conclusion, the findings of this umbrella review emphasize that habitually consuming calcium, whole grains, fruits, green leafy vegetables, green tea, and zinc and reducing alcohol, red meat, and processed-meat intake are associated with a lower risk of EC. Since this umbrella review included only observational study data and some of the associations were graded as weak, caution should be exercised in interpreting these relations.
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Affiliation(s)
- Xianpeng Qin
- Department of Gastrointestinal Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Guiqing Jia
- Department of Gastrointestinal Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaogang Zhou
- Department of Gastrointestinal Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhou Yang
- Address correspondence to ZY (E-mail: )
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Hermelink R, Leitzmann MF, Markozannes G, Tsilidis K, Pukrop T, Berger F, Baurecht H, Jochem C. Sedentary behavior and cancer-an umbrella review and meta-analysis. Eur J Epidemiol 2022; 37:447-460. [PMID: 35612669 PMCID: PMC9209390 DOI: 10.1007/s10654-022-00873-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
Several systematic reviews and meta-analyses have summarized the association between sedentary behavior (SB) and cancer. However, the level of evidence and the potential for risk of bias remains unclear. This umbrella review summarized the current data on SB in relation to cancer incidence and mortality, with a particular emphasis on assessing the risk of bias. We searched PubMed, Web of Science and Cochrane Database for systematic reviews and meta-analyses on the association between SB and cancer incidence and mortality. We also searched for recent observational studies not yet included in existing meta-analyses. We re-calculated summary risk estimates for cancer incidence and mortality using random effects models. We included 14 meta-analyses covering 17 different cancer sites from 77 original studies. We found that high SB levels increase the risk for developing ovarian, endometrial, colon, breast, prostate, and rectal cancers, with relative risks of 1.29 (95% confidence interval (CI) = 1.08-1.56), 1.29 (95% CI = 1.16-1.45), 1.25 (95% CI = 1.16-1.33), 1.08 (95% CI = 1.04-1.11), 1.08 (95% CI = 1.00-1.17), and 1.07 (95% CI = 1.01-1.12), respectively. Also, we found an increased risk of cancer mortality of 1.18 (95% CI = 1.09-1.26). Most associations between SB and specific cancer sites were supported by a "suggestive" level of evidence. High levels of SB are associated with increased risk of several types of cancer and increased cancer mortality risk.
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Affiliation(s)
- Rafael Hermelink
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. .,Department of Internal Medicine II-Gastroenterology, University Hospital Munich, Munich, Germany.
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece.,Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Kostas Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece.,Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
| | - Tobias Pukrop
- Department of Haematology and Internal Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Felix Berger
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Machado P, Morgado M, Raposo J, Mendes M, Silva CG, Morais N. Effectiveness of exercise training on cancer-related fatigue in colorectal cancer survivors: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2022; 30:5601-5613. [PMID: 35107601 DOI: 10.1007/s00520-022-06856-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the effects of exercise training on cancer-related fatigue (CRF) in colorectal cancer survivors. METHODS Randomized controlled trials published between 1 January 2010 and 19 October 2020, selected through online search conducted in PubMed, Scopus, Web of Science, SPORTDiscus and PEDro databases, were included. Eligible trials compared the effect of exercise training interventions, versus non-exercise controls on CRF, in colorectal cancer survivors, during or after treatment. The methodological quality of individual studies was analysed using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI) were calculated. RESULTS Six trials involving 330 colorectal cancer patients met the inclusion criteria and presented reasonable to good methodological quality. An overall small-to-moderate effect of exercise training on CRF was found (SMD = - 0.29: 95% CI: [- 0.53; - 0.06]; p = 0.01; PI: [- 0.63; 0.04]; low-quality evidence). Subgroup analysis revealed moderate effects of exercise interventions performed during chemotherapy (SMD = - 0.63; 95% CI: [- 1.06; - 0.21]; p = 0.003) and small, non-significant effects, when exercise training was performed after cancer treatment (SMD = - 0.14; 95% CI: [- 0.43; 0.14]; p = 0.32). Steady improvements were achieved when a combination of aerobic plus resistance exercise was used, in interventions lasting 12 to 24 weeks. CONCLUSION Exercise training could be regarded as a supportive therapy for the clinical management of CRF in colorectal cancer patients undergoing chemotherapy, but further studies are necessary to clarify the effects of exercise interventions on CRF after cancer treatment.
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Affiliation(s)
- Pedro Machado
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal. .,University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal. .,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.
| | - Miguel Morgado
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - João Raposo
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - Marco Mendes
- School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - Cândida G Silva
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.,Coimbra Chemistry Centre, Institute of Molecular Sciences (CQC-IMS), Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Nuno Morais
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,Saúde Positiva, Clínica de Saúde Física e Mental, Aveiro, Portugal.,School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.,Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic of Leiria, Marinha Grande, Portugal
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Cruz-Lemini M, Vázquez JC, Ullmo J, Llurba E. Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 226:S1126-S1144.e17. [PMID: 34301348 DOI: 10.1016/j.ajog.2020.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Evidence on the impact of low-molecular-weight heparin, alone or in combination with low-dose aspirin, for the prevention for preeclampsia in high-risk patients is conflicting. OBJECTIVE We conducted a meta-analysis of studies published to assess the effectiveness of low-molecular-weight heparin for the prevention of preeclampsia and other placenta-related complications in high-risk women. DATA SOURCES A systematic search was performed to identify relevant studies, using the databases PubMed and Cochrane Central Register of Controlled Trials, without publication time restrictions. STUDY ELIGIBILITY CRITERIA Randomized controlled trials comparing treatment with low-molecular-weight heparin or unfractionated heparin (with or without low-dose aspirin), in high-risk women, defined as either history of preeclampsia, intrauterine growth restriction, fetal demise, or miscarriage or being at high risk after first-trimester screening of preeclampsia. STUDY APPRAISAL AND SYNTHESIS METHODS The systematic review was conducted according to the Cochrane Handbook guidelines. The primary outcome was the development of preeclampsia. We performed prespecified subgroup analyses according to combination with low-dose aspirin, low-molecular-weight heparin type, gestational age when treatment was started, and study population (patients with thrombophilia, at high risk of preeclampsia or miscarriage). Secondary outcomes included small for gestational age, perinatal death, miscarriage, and placental abruption. Pooled odds ratios with 95% confidence intervals were calculated using a random-effects model. Quality of evidence was assessed using the grading of recommendations assessment, development, and evaluation methodology. RESULTS A total of 15 studies (2795 participants) were included. In high-risk women, treatment with low-molecular-weight heparin was associated with a reduction in the development of preeclampsia (odds ratio, 0.62; 95% confidence interval, 0.43-0.90; P=.010); small for gestational age (odds ratio, 0.61; 95% confidence interval, 0.44-0.85; P=.003), and perinatal death (odds ratio, 0.49; 95% confidence interval, 0.25-0.94; P=.030). This reduction was stronger if low-molecular-weight heparin was started before 16 weeks' gestation (13 studies, 2474 participants) for preeclampsia (odds ratio, 0.55; 95% confidence interval, 0.39-0.76; P=.0004). When only studies including low-dose aspirin as an intervention were analyzed (6 randomized controlled trials, 920 participants), a significant reduction was observed in those with combined treatment (low-molecular-weight heparin plus low-dose aspirin) compared with low-dose aspirin alone (odds ratio, 0.62; 95% confidence interval, 0.41-0.95; P=.030). Overall, adverse events were neither serious nor significantly different. Quality of evidence ranged from very low to moderate, mostly because of the lack of blinding, imprecision, and inconsistency. CONCLUSION Low-molecular-weight heparin use was associated with a significant reduction in the risk of preeclampsia and other placenta-mediated complications in high-risk women and when treatment was started before 16 weeks' gestation. Combined treatment with low-dose aspirin was associated with a significant reduction in the risk of preeclampsia compared with low-dose aspirin alone. However, there exists important clinical and statistical heterogeneity, and therefore, these results merit confirmation in large well-designed clinical trials.
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Zhang W, Liu Y, Yu J, Li D, Jia Y, Zhang Q, Gao Y, Wan Z, Wei W. Exercise improves sleep quality in older adults: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e047555. [PMID: 35105610 PMCID: PMC8804655 DOI: 10.1136/bmjopen-2020-047555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/07/2022] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sleep disturbance is a common problem among the elderly and is associated with physical and mental health. Exercise has been reported as an alternative therapeutic strategy for people with sleep disturbances. However, this topic has not been systematically reviewed for older adults. This study was conducted to provide a protocol to systematically evaluate the effects of exercise on sleep quality in the elderly. METHODS AND ANALYSIS An electronic search of the PubMed, Embase and Cochrane Library databases will be performed with no language restrictions, and data extraction will be performed by two independent reviewers. The reviewers will discuss and resolve any differences, and a third reviewer will be consulted in cases of uncertainty. Randomised controlled trials will be selected. The primary outcome will be an objective measurement of sleep quality (eg, polysomnography). The secondary outcomes will be self-reported sleep quality (using the Pittsburgh Sleep Quality Index scale), and adverse events (such as falls and fractures). RevMan V.5.3.5 and Stata V.16.0 software will be used for meta-analysis. If the heterogeneity tests show slight or no statistical heterogeneity, the fixed effects model will be used; in other cases, the random effect model will be used for data synthesis. ETHICS AND DISSEMINATION The protocol does not require ethical approval. The findings will be disseminated in peer-reviewed publications and journals. PROSPERO REGISTRATION NUMBER CRD42021287980.
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Affiliation(s)
- Wei Zhang
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- School of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Yi Liu
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- School of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Jing Yu
- School of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Dongze Li
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Jia
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qin Zhang
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- School of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Yongli Gao
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- School of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Institute of Disaster Medicine, Sichuan University, Chengdu, People's Republic of China
- Nursing Key Laboratory of Sichuan Province, Chengdu, People's Republic of China
| | - Zhi Wan
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wei Wei
- Department of Emergency Medicine, Disaster Medical Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Impellizzeri FM, McCall A, van Smeden M. Why methods matter in a meta-analysis: a reappraisal showed inconclusive injury preventive effect of Nordic hamstring exercise. J Clin Epidemiol 2021; 140:111-124. [PMID: 34520846 DOI: 10.1016/j.jclinepi.2021.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The Nordic hamstring exercise (NHE) has been strongly recommended to reduce hamstring injuries in previous meta-analyses (50% reduction in risk of injury). To underline the importance and impact of adopting appropriate methodology for evidence synthesis, we revisited the study selection, reanalyzed and updated the findings of the most recent meta-analysis. STUDY DESIGN AND SETTING Only randomized control trials (RCT) using NHE as one of the prevention arms were selected. Summary effects for risk ratios (RR) for original studies included in the earlier meta-analysis, and new studies identified (update), were re-estimated under the random-effects model and presented with 95% confidence intervals (CI) and prediction intervals (PI). Tentative recommendations were provided according to the Grading of Recommendations Assessment, Development and Evaluation. RESULTS Only five RCTs out of the 15 studies included in the earlier meta-analysis randomized to NHE. Our update revealed one additional RCT. The point estimate (RR) for the five RCTs previously considered RCTs was 0.56 (95% CI, 0.20-1.52; 95% PI, 0.06-5.14, parametric, and 0.13-1.80, nonparametric). After the update, the RR was 0.59 (95% CI, 0.27-1.29; 95% PI 0.10-3.29, parametric, and 0.17-1.52, nonparametric). CONCLUSION Contrary to the conclusions of a recent meta-analysis, as well as earlier meta-analyses, by using more appropriate methodology, the evidence underpinning the protective effect of NHE so far remains inconclusive and mostly derived from high risk of bias RCTs. At best, only conditional recommendation can be provided (for soccer) and future RCTs are warranted.
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Affiliation(s)
| | - Alan McCall
- University of Technology, Faculty of Health, Sydney, New South Wales, Australia; Arsenal Performance and Research Team, Arsenal Football Club, London, UK
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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Butler-Laporte G, Lawandi A, Schiller I, Yao M, Dendukuri N, McDonald EG, Lee TC. Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2: A Systematic Review and Meta-analysis. JAMA Intern Med 2021; 181:353-360. [PMID: 33449069 PMCID: PMC7811189 DOI: 10.1001/jamainternmed.2020.8876] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/05/2020] [Indexed: 01/09/2023]
Abstract
Importance Nasopharyngeal swab nucleic acid amplification testing (NAAT) is the noninvasive criterion standard for diagnosis of coronavirus disease 2019 (COVID-19). However, it requires trained personnel, limiting its availability. Saliva NAAT represents an attractive alternative, but its diagnostic performance is unclear. Objective To assess the diagnostic accuracy of saliva NAAT for COVID-19. Data Sources In this systematic review, a search of the MEDLINE and medRxiv databases was conducted on August 29, 2020, to find studies of diagnostic test accuracy. The final meta-analysis was performed on November 17, 2020. Study Selection Studies needed to provide enough data to measure salivary NAAT sensitivity and specificity compared with imperfect nasopharyngeal swab NAAT as a reference test. An imperfect reference test does not perfectly reflect the truth (ie, it can give false results). Studies were excluded if the sample contained fewer than 20 participants or was neither random nor consecutive. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed for the systematic review, with multiple authors involved at each stage of the review. To account for the imperfect reference test sensitivity, we used a bayesian latent class bivariate model for the meta-analysis. Main Outcomes and Measures The primary outcome was pooled sensitivity and specificity. Two secondary analyses were performed: one restricted to peer-reviewed studies, and a post hoc analysis limited to ambulatory settings. Results The search strategy yielded 385 references, and 16 unique studies were identified for quantitative synthesis. Eight peer-reviewed studies and 8 preprints were included in the meta-analyses (5922 unique patients). There was significant variability in patient selection, study design, and stage of illness at which patients were enrolled. Fifteen studies included ambulatory patients, and 9 exclusively enrolled from an outpatient population with mild or no symptoms. In the primary analysis, the saliva NAAT pooled sensitivity was 83.2% (95% credible interval [CrI], 74.7%-91.4%) and the pooled specificity was 99.2% (95% CrI, 98.2%-99.8%). The nasopharyngeal swab NAAT had a sensitivity of 84.8% (95% CrI, 76.8%-92.4%) and a specificity of 98.9% (95% CrI, 97.4%-99.8%). Results were similar in secondary analyses. Conclusions and Relevance These results suggest that saliva NAAT diagnostic accuracy is similar to that of nasopharyngeal swab NAAT, especially in the ambulatory setting. These findings support larger-scale research on the use of saliva NAAT as an alternative to nasopharyngeal swabs.
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Affiliation(s)
- Guillaume Butler-Laporte
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montréal, Québec, Canada
| | - Alexander Lawandi
- Department of Critical Care Medicine, National Institutes of Health, Clinical Center, Bethesda, Maryland
| | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Mandy Yao
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Emily G. McDonald
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
- Division of General Internal Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Todd C. Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montréal, Québec, Canada
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
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Tjeertes EK, van Fessem JM, Mattace-Raso FU, Hoofwijk AG, Stolker RJ, Hoeks SE. Influence of Frailty on Outcome in Older Patients Undergoing Non-Cardiac Surgery - A Systematic Review and Meta-Analysis. Aging Dis 2020; 11:1276-1290. [PMID: 33014537 PMCID: PMC7505262 DOI: 10.14336/ad.2019.1024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/24/2019] [Indexed: 12/21/2022] Open
Abstract
Frailty is increasingly recognized as a better predictor of adverse postoperative events than chronological age. The objective of this review was to systematically evaluate the effect of frailty on postoperative morbidity and mortality. Studies were included if patients underwent non-cardiac surgery and if frailty was measured by a validated instrument using physical, cognitive and functional domains. A systematic search was performed using EMBASE, MEDLINE, Web of Science, CENTRAL and PubMed from 1990 - 2017. Methodological quality was assessed using an assessment tool for prognosis studies. Outcomes were 30-day mortality and complications, one-year mortality, postoperative delirium and discharge location. Meta-analyses using random effect models were performed and presented as pooled risk ratios with confidence intervals and prediction intervals. We included 56 studies involving 1.106.653 patients. Eleven frailty assessment tools were used. Frailty increases risk of 30-day mortality (31 studies, 673.387 patients, risk ratio 3.71 [95% CI 2.89-4.77] (PI 1.38-9.97; I2=95%) and 30-day complications (37 studies, 627.991 patients, RR 2.39 [95% CI 2.02-2.83). Risk of 1-year mortality was threefold higher (six studies, 341.769 patients, RR 3.40 [95% CI 2.42-4.77]). Four studies (N=438) reported on postoperative delirium. Meta-analysis showed a significant increased risk (RR 2.13 [95% CI 1.23-3.67). Finally, frail patients had a higher risk of institutionalization (10 studies, RR 2.30 [95% CI 1.81- 2.92]). Frailty is strongly associated with risk of postoperative complications, delirium, institutionalization and mortality. Preoperative assessment of frailty can be used as a tool for patients and doctors to decide who benefits from surgery and who doesn't.
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Affiliation(s)
- Elke K.M Tjeertes
- Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Joris M.K van Fessem
- Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Francesco U.S Mattace-Raso
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Anton G.M Hoofwijk
- Department of Surgery, Zuyderland Medical Center, Geleen, the Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sanne E Hoeks
- Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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37
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Kim TL, Jeong GH, Yang JW, Lee KH, Kronbichler A, van der Vliet HJ, Grosso G, Galvano F, Aune D, Kim JY, Veronese N, Stubbs B, Solmi M, Koyanagi A, Hong SH, Dragioti E, Cho E, de Rezende LFM, Giovannucci EL, Shin JI, Gamerith G. Tea Consumption and Risk of Cancer: An Umbrella Review and Meta-Analysis of Observational Studies. Adv Nutr 2020; 11:1437-1452. [PMID: 32667980 PMCID: PMC7666907 DOI: 10.1093/advances/nmaa077] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/17/2020] [Accepted: 06/11/2020] [Indexed: 01/15/2023] Open
Abstract
Tea is one of the most widely consumed beverages, but its association with cancer risk remains controversial and unclear. We performed an umbrella review to clarify and determine the associations between tea consumption and various types of cancer by summarizing and recalculating the existing meta-analyses. Meta-analyses of observational studies reporting associations between tea consumption and cancer risk were searched on PubMed and Embase. Associations found to be statistically significant were further classified into levels of evidence (convincing, suggestive, or weak), based on P value, between-study heterogeneity, prediction intervals, and small study effects. Sixty-four observational studies (case-control or cohort) corresponding to 154 effect sizes on the incidence of 25 types of cancer were included. Forty-three (27.9%) results in 15 different types of cancer were statistically significant. When combining all studies on the same type of cancer, 19 results in 11 different types of cancer showed significant associations with lower risk of gastrointestinal tract organ cancer (oral, gastric, colorectal, biliary tract, and liver cancer), breast cancer, and gynecological cancer (endometrial and ovarian cancer) as well as leukemia, lung cancer, and thyroid cancer. Only the reduced risk of oral cancer in tea-consuming populations (OR = 0.62; 95% CI: 0.55, 0.72; P value < 10-6) was supported by convincing evidence. Suggestive evidence was found for 6 results on biliary tract, breast, endometrial, liver, and oral cancer. To summarize, tea consumption was shown to have protective effects on some types of cancer, particularly oral cancer. More well-designed prospective studies are needed with consideration of other factors that can cause biases.
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Affiliation(s)
- Tai Lim Kim
- Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Gwang Hun Jeong
- College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea,Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Hans J van der Vliet
- Department of Medical Oncology, Amsterdam UMC, VU University, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, Catania, Italy
| | - Fabio Galvano
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, Catania, Italy
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK,Department of Nutrition, Bjørknes University College, Oslo, Norway,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK,Positive Ageing Research Institute, Faculty of Health, Social Care, Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Marco Solmi
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Barcelona, Spain,ICREA, Barcelona, Spain
| | - Sung Hwi Hong
- Yonsei University College of Medicine, Severance Hospital, Seoul, Korea,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Leandro F M de Rezende
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo, Brazil
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Gabriele Gamerith
- Internal Medicine V, Department of Hematology & Oncology, Medical University Innsbruck, Innsbruck, Austria
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Lee KH, Seong HJ, Kim G, Jeong GH, Kim JY, Park H, Jung E, Kronbichler A, Eisenhut M, Stubbs B, Solmi M, Koyanagi A, Hong SH, Dragioti E, de Rezende LFM, Jacob L, Keum N, van der Vliet HJ, Cho E, Veronese N, Grosso G, Ogino S, Song M, Radua J, Jung SJ, Thompson T, Jackson SE, Smith L, Yang L, Oh H, Choi EK, Shin JI, Giovannucci EL, Gamerith G. Consumption of Fish and ω-3 Fatty Acids and Cancer Risk: An Umbrella Review of Meta-Analyses of Observational Studies. Adv Nutr 2020; 11:1134-1149. [PMID: 32488249 PMCID: PMC7490175 DOI: 10.1093/advances/nmaa055] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/05/2019] [Accepted: 04/21/2020] [Indexed: 12/20/2022] Open
Abstract
Multiple studies have suggested that ω-3 fatty acid intake may have a protective effect on cancer risk; however, its true association with cancer risk remains controversial. We performed an umbrella review of meta-analyses to summarize and evaluate the evidence for the association between ω-3 fatty acid intake and cancer outcomes. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to December 1, 2018. We included meta-analyses of observational studies that examined associations between intake of fish or ω-3 fatty acid and cancer risk (gastrointestinal, liver, breast, gynecologic, prostate, brain, lung, and skin) and determined the level of evidence of associations. In addition, we appraised the quality of the evidence of significant meta-analyses by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We initially screened 598 articles, and 15 articles, including 57 meta-analyses, were eligible. Among 57 meta-analyses, 15 reported statistically significant results. We found that 12 meta-analyses showed weak evidence of an association between ω-3 fatty acid intake and risk of the following types of cancer: liver cancer (n = 4 of 6), breast cancer (n = 3 of 14), prostate cancer (n = 3 of 11), and brain tumor (n = 2 of 2). In the other 3 meta-analyses, studies of endometrial cancer and skin cancer, there were no assessable data for determining the evidence levels. No meta-analysis showed convincing, highly suggestive, or suggestive evidence of an association. In the sensitivity analysis of meta-analyses by study design, we found weak associations between ω-3 fatty acid intake and breast cancer risk in cohort studies, but no statistically significant association in case-control studies. However, the opposite results were found in case of brain tumor risk. Although ω-3 fatty acids have been studied in several meta-analyses with regard to a wide range of cancer outcomes, only weak associations were identified in some cancer types, with several limitations. Considering the nonsignificant or weak evidence level, clinicians and researchers should cautiously interpret reported associations between ω-3 fatty acid consumption and cancer risks.
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Affiliation(s)
- Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Jin Seong
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gaeun Kim
- Keimyung University College of Nursing, Daegu, Republic of Korea
| | - Gwang Hun Jeong
- College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunbong Park
- Yonsei University Graduate School, Department of Nursing, Seoul, Republic of Korea
| | - Eunyoung Jung
- Yonsei University Graduate School, Department of Nursing, Seoul, Republic of Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Michael Eisenhut
- Department of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, United Kingdom
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,South London and Maudsley NHS Foundation Trust, London, United Kingdom,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Marco Solmi
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain,ICREA, Barcelona, Spain
| | - Sung Hwi Hong
- Yonsei University College of Medicine, Seoul, Republic of Korea,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Louis Jacob
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - NaNa Keum
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Food Science and Biotechnology, Dongguk University, Goyang, Republic of Korea
| | - Hans J van der Vliet
- Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University, Amsterdam, The Netherlands
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Shuji Ogino
- Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Mingyang Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sun Jae Jung
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Trevor Thompson
- Department of Psychology, University of Greenwich, London, United Kingdom
| | - Sarah E Jackson
- Department of Behavioral Science and Health, University College London, London, United Kingdom
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Lin Yang
- Department of Cancer Epidemiology and Cancer Prevention, Alberta Health Services, Calgary, Canada,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Hans Oh
- School of Social Work, University of Southern California, CA, USA
| | - Eun Kyoung Choi
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea,Address correspondence to EKC (e-mail: )
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea,Address correspondence to JIS (e-mail: )
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gabriele Gamerith
- Internal Medicine V, Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
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Borenstein M. Research Note: In a meta-analysis, the I 2 index does not tell us how much the effect size varies across studies. J Physiother 2020; 66:135-139. [PMID: 32307309 DOI: 10.1016/j.jphys.2020.02.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023] Open
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40
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Wang CC, Lee WC. Evaluation of the Normality Assumption in Meta-Analyses. Am J Epidemiol 2020; 189:235-242. [PMID: 31781756 DOI: 10.1093/aje/kwz261] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 01/22/2023] Open
Abstract
Random-effects meta-analysis is one of the mainstream methods for research synthesis. The heterogeneity in meta-analyses is usually assumed to follow a normal distribution. This is actually a strong assumption, but one that often receives little attention and is used without justification. Although methods for assessing the normality assumption are readily available, they cannot be used directly because the included studies have different within-study standard errors. Here we present a standardization framework for evaluation of the normality assumption and examine its performance in random-effects meta-analyses with simulation studies and real examples. We use both a formal statistical test and a quantile-quantile plot for visualization. Simulation studies show that our normality test has well-controlled type I error rates and reasonable power. We also illustrate the real-world significance of examining the normality assumption with examples. Investigating the normality assumption can provide valuable information for further analysis or clinical application. We recommend routine examination of the normality assumption with the proposed framework in future meta-analyses.
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Affiliation(s)
- Chia-Chun Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
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41
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Wang CC, Lee WC. A simple method to estimate prediction intervals and predictive distributions: Summarizing meta-analyses beyond means and confidence intervals. Res Synth Methods 2019; 10:255-266. [PMID: 30835918 DOI: 10.1002/jrsm.1345] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 01/01/2019] [Accepted: 02/27/2019] [Indexed: 01/23/2023]
Abstract
A systematic review and meta-analysis is an important step in evidence synthesis. The current paradigm for meta-analyses requires a presentation of the means under a random-effects model; however, a mean with a confidence interval provides an incomplete summary of the underlying heterogeneity in meta-analysis. Prediction intervals show the range of true effects in future studies and have been advocated to be regularly presented. Most commonly, prediction intervals are estimated assuming that the underlying heterogeneity follows a normal distribution, which is not necessarily appropriate. In this article, we provide a simple method with a ready-to-use spreadsheet file to estimate prediction intervals and predictive distributions nonparametrically. Simulation studies show that this new method can provide approximately unbiased estimates compared with the conventional method. We also illustrate the advantage and real-world significance of this approach with a meta-analysis evaluating the protective effect of vaccination against tuberculosis. The nonparametric predictive distribution provides more information about the shape of the underlying distribution than does the conventional method.
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Affiliation(s)
- Chia-Chun Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Cancer Center, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
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42
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Affiliation(s)
- Lanjing Zhang
- Department of Pathology, University Medical Center of Princeton, Plainsboro, New Jersey, USA; Department of Biological Sciences, Rutgers University, Newark, New Jersey, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA; Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - Fauze Maluf-Filho
- Department of Gastroenterology of University of São Paulo, Institute of Cancer of University of São Paulo, São Paulo, Brazil
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43
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Different evidence summaries have implications for contextualizing findings of meta-analysis of diagnostic tests. J Clin Epidemiol 2019; 109:51-61. [PMID: 30654146 DOI: 10.1016/j.jclinepi.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/19/2018] [Accepted: 01/08/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate diagnostic tests, analysts use meta-analyses to provide inputs to parameters in decision models. Choosing parameter estimands from meta-analyses requires understanding the meta-analytic and decision-making contexts. STUDY DESIGN AND SETTING We expand on an analysis comparing positron emission tomography (PET), PET with computed tomography (PET/CT), and conventional workup (CW) in women with suspected recurrent breast cancer. We discuss Bayesian meta-analytic summaries (posterior mean over a set of existing studies, posterior estimate in an existing study, posterior predictive mean in a new study) used to estimate diagnostic test parameters (prevalence, sensitivity, specificity) needed to calculate quality-adjusted life years in a decision model contextualizing PET, PET/CT, and CW. RESULTS The mean and predictive mean give similar estimates, but the latter displays greater uncertainty. Namely, PET/CT outperforms CW on average but may not do better than CW when implemented in future settings. CONCLUSION Selecting estimands for decision model parameters from meta-analyses requires understanding the relationship between decision settings and meta-analysis studies' settings, specifically whether the former resemble one or all study settings or represents new settings. We provide an algorithm recommending appropriate estimands as input parameters in decision models for diagnostic tests to obtain output parameters consistent with the decision context.
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Veroniki AA, Jackson D, Bender R, Kuss O, Langan D, Higgins JP, Knapp G, Salanti G. Methods to calculate uncertainty in the estimated overall effect size from a random‐effects meta‐analysis. Res Synth Methods 2018; 10:23-43. [DOI: 10.1002/jrsm.1319] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/23/2018] [Accepted: 08/13/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Areti Angeliki Veroniki
- Li Ka Shing Knowledge InstituteSt. Michael's Hospital Toronto Canada
- Department of Primary Education, School of EducationUniversity of Ioannina Ioannina Greece
| | - Dan Jackson
- MRC Biostatistics UnitStatistical Innovation Group AstraZeneca, Cambridge UK
| | - Ralf Bender
- Department of Medical BiometryInstitute for Quality and Efficiency in Health Care Cologne Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes CenterLeibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf Germany
- Institute of Medical StatisticsHeinrich Heine University Düsseldorf Düsseldorf Germany
| | - Dean Langan
- Institute of Child HealthUniversity College London London UK
| | - Julian P.T. Higgins
- Population Health Sciences, Bristol Medical SchoolUniversity of Bristol Bristol UK
| | - Guido Knapp
- Department of StatisticsTU Dortmund University Dortmund Germany
| | - Georgia Salanti
- Institute of Social and Preventive MedicineUniversity of Bern Bern Switzerland
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Riva N, Puljak L, Moja L, Ageno W, Schünemann H, Magrini N, Squizzato A. Multiple overlapping systematic reviews facilitate the origin of disputes: the case of thrombolytic therapy for pulmonary embolism. J Clin Epidemiol 2018; 97:1-13. [DOI: 10.1016/j.jclinepi.2017.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/25/2017] [Accepted: 11/13/2017] [Indexed: 01/08/2023]
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Choi E, Park H, Lee K, Park J, Eisenhut M, van der Vliet H, Kim G, Shin J. Body mass index and 20 specific cancers: re-analyses of dose–response meta-analyses of observational studies. Ann Oncol 2018; 29:749-757. [DOI: 10.1093/annonc/mdx819] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Kelley GA, Kelley KS. Exercise and cancer-related fatigue in adults: a systematic review of previous systematic reviews with meta-analyses. BMC Cancer 2017; 17:693. [PMID: 29058631 PMCID: PMC5651567 DOI: 10.1186/s12885-017-3687-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/12/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Conduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise (aerobic, strength or both) on cancer-related-fatigue (CRF) in adults with any type of cancer. METHODS Systematic reviews with meta-analyses of previous randomized controlled trials published through July of 2016 were included by searching six electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI), number needed-to-treat (NNT) and percentile improvements were calculated. RESULTS Sixteen studies representing 2 to 48 SMD effect sizes per analysis (mean ± SD, 7 ± 8, median = 5) and 37 to 3254 participants (mean ± SD, 633 ± 690, median = 400) were included. Length of training lasted from 3 to 52 weeks (mean ± SD, 14.6 ± 3.1, median = 14), frequency from 1 to 10 times per week (mean ± SD, 3.4 ± 0.8, median = 3), and duration from 10 to 120 min per session (mean ± SD, 44.3 ± 5.5, median = 45). Adjusted AMSTAR scores ranged from 44.4% to 80.0% (mean ± SD, 68.8% ± 12.0%, median = 72.5%). Overall, mean SMD improvements in CRF ranged from -1.05 to -0.01, with 22 of 55 meta-analytic results (52.7%) statistically significant (non-overlapping 95% CI). When PI were calculated for results with non-overlapping 95% CI, only 3 of 25 (12%) yielded non-overlapping 95% PI favoring reductions in CRF. Number needed-to-treat and percentile improvements ranged from 3 to 16 and 4.4 to 26.4, respectively. CONCLUSIONS A lack of certainty exists regarding the benefits of exercise on CRF in adults. However, exercise does not appear to increase CRF in adults. TRIAL REGISTRATION PROSPERO Registration # CRD42016045405 .
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Affiliation(s)
- George A. Kelley
- Meta-Analytic Research Group, School of Public Health, Department of Biostatistics, Director, WVCTSI Clinical Research Design, Epidemiology, and Biostatistics (CRDEB) Program, PO Box 9190, Robert C. Byrd Health Sciences Center, Room 2350-A, Morgantown, West Virginia 26506-9190 USA
| | - Kristi S. Kelley
- Meta-Analytic Research Group, School of Public Health, Department of Biostatistics, PO Box 9190, Robert C. Byrd Health Sciences Center, Room 2350-B, Morgantown, West Virginia 26506-9190 USA
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Kelley GA, Kelley KS. Exercise and sleep: a systematic review of previous meta-analyses. J Evid Based Med 2017; 10:26-36. [PMID: 28276627 PMCID: PMC5527334 DOI: 10.1111/jebm.12236] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 09/20/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Conduct a systematic review of previous meta-analyses on exercise and sleep outcomes in adults and a meta-analysis of studies nested within these meta-analyses. METHODS Meta-analyses of randomized controlled exercise interventions were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality of meta-analyses was assessed using AMSTAR and quality of evidence using GRADE. Random-effects models were used to pool results from the individual studies included in each meta-analysis. RESULTS Three meta-analyses representing 950 adults were included. Methodological quality ranged from 36% to 64% while quality of evidence was very low to low. Statistically significant improvements (P ≤ 0.05) were observed for the apnea-hypopnea index (AHI), overall sleep quality, global score, subjective sleep, and sleep latency. The number-needed-to-treat (NNT) and percentile improvements ranged from 4 to 7 and from 18.1 to 26.5, respectively. When overall sleep quality results from individual studies nested within different meta-analyses were pooled, statistically significant standardized mean difference (SMD) improvements were observed (-0.50, 95% CI -0.72 to -0.28). The NNT and percentile improvement were 7 and 19, respectively. CONCLUSIONS Exercise improves selected sleep outcomes in adults. To increase public health reach, a large, well-designed, and more inclusive meta-analysis is needed.
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Affiliation(s)
- George A Kelley
- Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Kristi Sharpe Kelley
- Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA
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Abstract
OBJECTIVES Evaluating the variation in the strength of the effect across studies is a key feature of meta-analyses. This variability is reflected by measures like τ(2) or I(2), but their clinical interpretation is not straightforward. A prediction interval is less complicated: it presents the expected range of true effects in similar studies. We aimed to show the advantages of having the prediction interval routinely reported in meta-analyses. DESIGN We show how the prediction interval can help understand the uncertainty about whether an intervention works or not. To evaluate the implications of using this interval to interpret the results, we selected the first meta-analysis per intervention review of the Cochrane Database of Systematic Reviews Issues 2009-2013 with a dichotomous (n=2009) or continuous (n=1254) outcome, and generated 95% prediction intervals for them. RESULTS In 72.4% of 479 statistically significant (random-effects p<0.05) meta-analyses in the Cochrane Database 2009-2013 with heterogeneity (I(2)>0), the 95% prediction interval suggested that the intervention effect could be null or even be in the opposite direction. In 20.3% of those 479 meta-analyses, the prediction interval showed that the effect could be completely opposite to the point estimate of the meta-analysis. We demonstrate also how the prediction interval can be used to calculate the probability that a new trial will show a negative effect and to improve the calculations of the power of a new trial. CONCLUSIONS The prediction interval reflects the variation in treatment effects over different settings, including what effect is to be expected in future patients, such as the patients that a clinician is interested to treat. Prediction intervals should be routinely reported to allow more informative inferences in meta-analyses.
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Affiliation(s)
- Joanna IntHout
- Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), Nijmegen, The Netherlands
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Humanities and Sciences, Stanford, California, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Maroeska M Rovers
- Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), Nijmegen, The Netherlands
| | - Jelle J Goeman
- Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), Nijmegen, The Netherlands
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Papageorgiou SN, Kutschera E, Memmert S, Gölz L, Jäger A, Bourauel C, Eliades T. Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta-analysis. Eur J Orthod 2016; 39:176-187. [DOI: 10.1093/ejo/cjw041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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