1
|
Grabitz P, Saksone L, Schorr SG, Schwietering J, Bittlinger M, Kimmelman J. Research encouraging off-label use of quetiapine: A systematic meta-epidemiological analysis. Clin Trials 2024; 21:418-429. [PMID: 38284364 DOI: 10.1177/17407745231225470] [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] [Indexed: 01/30/2024]
Abstract
BACKGROUND Researchers often conduct small studies on testing a drug's efficacy in off-label indications. If positive results from these exploratory studies are not followed up by larger, randomized, double-blinded trials, physicians cannot be sure of a drug's clinical value. This may lead to off-label prescriptions of ineffective treatments. We aim to describe the way clinical studies fostered off-label prescription of the antipsychotic drug quetiapine (Seroquel). METHODS In this systematic meta-epidemiological analysis, we searched EMBASE, MEDLINE, Cochrane CENTRAL and PsycINFO databases and included clinical studies testing quetiapine for unapproved indications between May 1995 and May 2022. We then assessed the frequency with which publications providing low-level evidence suggesting efficacy of quetiapine for off-label indications was not followed up by large, randomized and double-blinded trials within 5 years. RESULTS In total, 176 published studies were identified that reported potential efficacy of quetiapine in at least 26 indications. Between 2000 and 2007, publication of exploratory studies suggesting promise for off-label indications rapidly outpaced publication of confirmatory trials. In the 24 indications with a minimum of 5 years of follow-up from the first positive exploratory study, 19 (79%) were not followed up with large confirmatory trials within 5 years. At least nine clinical practice guidelines recommend the use of quetiapine for seven off-label indications in which published confirmatory evidence is lacking. CONCLUSION Many small, post-approval studies suggested the promise of quetiapine for numerous off-label indications. These findings generally went unconfirmed in large, blinded, randomized trials years after first being published. The imbalance of exploratory and confirmatory studies likely encourages ineffective off-label treatment.
Collapse
Affiliation(s)
- Peter Grabitz
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Lana Saksone
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Gabriele Schorr
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Schwietering
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Merlin Bittlinger
- Department of Equity, Ethics and Policy and Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, QC, Canada
| | - Jonathan Kimmelman
- Department of Equity, Ethics and Policy and Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, QC, Canada
| |
Collapse
|
2
|
Cazzola M, Stolz D, Bafadhel M, Rogliani P. Understanding evidence from randomised controlled trials and meta-analyses: a comparative overview. Eur Respir J 2024; 63:2400694. [PMID: 38816037 DOI: 10.1183/13993003.00694-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/18/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Daiana Stolz
- Department of Pneumology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Mona Bafadhel
- King's Centre of Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| |
Collapse
|
3
|
Carraro G, Tonderski K, Enrich-Prast A. Solid-liquid separation of digestate from biogas plants: A systematic review of the techniques' performance. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 356:120585. [PMID: 38508011 DOI: 10.1016/j.jenvman.2024.120585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/19/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
Digestate processing is a strategy to improve the management of digestate from biogas plants. Solid-liquid separation is usually the primary step and can be followed by advanced treatments of the fractions. The knowledge about the performance of the separators and the quality of the fractions is scattered because of many available techniques and large variability in digestate characteristics. We performed a systematic review and found 175 observations of full-scale solid-liquid separation of digestate. We identified 4 separator groups, 4 digestate classes based on substrate, and distinguished whether chemical conditioners were used. We confirmed the hypothesis that the dominant substrate can affect the efficiency of the digestate separation. Furthermore, the results showed that centrifuges separated significantly more dry matter and total P than screw presses. Use of chemical conditioners in combination with a centrifuge lowered the dry matter concentration in the liquid fraction by 30%. Screw presses consumed 4.5 times less energy than centrifuges and delivered 3.3 tonne ammonium N in the liquid fraction and 0.3 tonne total P in the solid fraction using 1 MWh. The results can provide data for systems analyses of biogas solutions and can support practitioners when choosing among full-scale separator techniques depending on the digestate type. In a broader perspective, this work contributes to the continuous improvement of biogas plants operations and to their role as nutrients recovery sites.
Collapse
Affiliation(s)
- Giacomo Carraro
- Department of Thematic Studies, Environmental Change, Linköping University LiU, 58183, Linköping, Sweden; Biogas Solutions Research Center, Sweden.
| | - Karin Tonderski
- Department of Management and Engineering, Linköping University LiU, 58183, Linköping, Sweden; Biogas Solutions Research Center, Sweden
| | - Alex Enrich-Prast
- Department of Thematic Studies, Environmental Change, Linköping University LiU, 58183, Linköping, Sweden; Biogas Solutions Research Center, Sweden; Institute of Marine Science, Federal University of São Paolo, Santos, Brazil
| |
Collapse
|
4
|
Skeie-Larsen M, Stave R, Grønli J, Bjorvatn B, Wilhelmsen-Langeland A, Zandi A, Pallesen S. The Effects of Pharmacological Treatment of Nightmares: A Systematic Literature Review and Meta-Analysis of Placebo-Controlled, Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:777. [PMID: 36613097 PMCID: PMC9820008 DOI: 10.3390/ijerph20010777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Nightmares are highly prevalent and distressing for the sufferer, which underlines the need for well-documented treatments. A comprehensive literature review and meta-analysis of the effects of different pharmacological placebo-controlled randomized clinical trials, covering the period up to 1 December 2022, was performed. Searches were conducted in PubMed, Embase, Web of Science, PsychInfo, Cinahl, and Google Scholar, resulting in the identification of 1762 articles, of which 14 met the inclusion criteria: pharmacological intervention of nightmares, based on a placebo-controlled randomized trial published in a European language, reporting outcomes either/or in terms of nightmare frequency, nightmare distress, or nightmare intensity, and reporting sufficient information enabling calculation of effect sizes. Most studies involved the effect of the α1-adrenergic antagonist prazosin in samples of veterans or soldiers suffering from posttraumatic stress disorder. Other medications used were hydroxyzine, clonazepam, cyproheptadine, nabilone, and doxazosin. The vast majority of studies were conducted in the USA. The studies comprised a total of 830 participants. The Clinician-Administered PTSD Scale was the most frequently used outcome measure. The results showed an overall effect size of Hedges' g = 0.50 (0.42 after adjustment for publication bias). The synthetic cannabinoid nabilone (one study) showed the highest effect size (g = 1.86), followed by the histamine H1-antagonist hydroxyzine (one study), and prazosin (10 studies), with effect sizes of g = 1.17 and g = 0.54, respectively. Findings and limitations are discussed, and recommendations for future studies are provided.
Collapse
Affiliation(s)
| | - Rebekka Stave
- Department of Psychosocial Science, University of Bergen, 5007 Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medial Psychology, University of Bergen, 5007 Bergen, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, 5007 Bergen, Norway
| | - Ane Wilhelmsen-Langeland
- Bjørgvin District Psychiatric Center, Division of Psychiatry, Haukeland University Hospital, 5021 Bergen, Norway
| | - Amin Zandi
- Faculty of Psychology and Educational Sciences, University of Tehran, Tehran 1417935840, Iran
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, 5007 Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, 5021 Bergen, Norway
| |
Collapse
|
5
|
Kim KY, Shin KY, Chang KA. Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Int J Mol Sci 2022; 23:ijms23020602. [PMID: 35054785 PMCID: PMC8775398 DOI: 10.3390/ijms23020602] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 01/27/2023] Open
Abstract
Stroke is a primary debilitating disease in adults, occurring in 15 million individuals each year and causing high mortality and disability rates. The latest estimate revealed that stroke is currently the second leading cause of death worldwide. Post-stroke cognitive impairment (PSCI), one of the major complications after stroke, is frequently underdiagnosed. However, stroke has been reported to increase the risk of cognitive impairment by at least five to eight times. In recent decades, peripheral blood molecular biomarkers for stroke have emerged as diagnostic, prognostic, and therapeutic targets. In this study, we aimed to evaluate some blood-derived proteins for stroke, especially related to brain damage and cognitive impairments, by conducting a systematic review and meta-analysis and discussing the possibility of these proteins as biomarkers for PSCI. Articles published before 26 July 2021 were searched in PubMed, Embase, the Web of Science, and the Cochrane Library to identify all relevant studies reporting blood biomarkers in patients with stroke. Among 1820 articles, 40 were finally identified for this study. We meta-analyzed eight peripheral biomarker candidates: homocysteine (Hcy), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), uric acid, and glycated hemoglobin (HbA1c). The Hcy, CRP, TC, and LDL-C levels were significantly higher in patients with PSCI than in the non-PSCI group; however, the HDL-C, TG, uric acid, and HbA1c levels were not different between the two groups. Based on our findings, we suggest the Hcy, CRP, TC, and LDL-C as possible biomarkers in patients with post-stroke cognitive impairment. Thus, certain blood proteins could be suggested as effective biomarkers for PSCI.
Collapse
Affiliation(s)
- Ka Young Kim
- Department of Nursing, College of Nursing, Gachon University, Incheon 21936, Korea;
- Neuroscience Research Institute, Gachon University, Incheon 21565, Korea
| | - Ki Young Shin
- Bio-MAX Institute, Seoul National University, Seoul 08826, Korea
- Correspondence: (K.Y.S.); (K.-A.C.)
| | - Keun-A Chang
- Neuroscience Research Institute, Gachon University, Incheon 21565, Korea
- Department of Pharmacology, College of Medicine, Gachon University, Incheon 21936, Korea
- Neuroscience of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology, Gachon University, Incheon 21936, Korea
- Correspondence: (K.Y.S.); (K.-A.C.)
| |
Collapse
|
6
|
Chaikumbung M. Democracy, Culture and Cancer Patients' Willingness to Pay for Healthcare Services: A Meta-analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211024894. [PMID: 34253073 PMCID: PMC8280846 DOI: 10.1177/00469580211024894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer is one of the leading causes of death globally and expenditure associated with cancer is quite high. Efficient resource allocation needs information on economic evaluations of healthcare interventions. The purposes of the study are to provide a comprehensive overview of cancer patients’ willingness to pay (WTP) for healthcare services and to investigate the influence of democracies, culture dimensions, and other factors on WTP. A meta-analysis was conducted using PubMed, Scopus, and Google Scholar to identify all studies of stated preference approach to estimate cancer patients’ WTP healthcare services. A set of criteria was constructed for selecting relevant studies. A total of 79 studies were related to selection criteria and held sufficient information for the purposes of meta-analysis. A total of 393 estimates of WTP from 79 healthcare valuation studies were pooled to identify the links between WTP and influential factors. The findings suggest that values of benefits in healthcare services are higher in more democratic nations, but they are lower in cultural traits that are stronger indulgence and uncertainty avoidance. Further, the types of cancer matter. Compared to breast cancer, WTP is higher for skin cancer, yet lower for liver cancer and lymphoma. A higher national income and public health expenditure increase WTP for healthcare services, while a higher death rate by cancer leads to lower values of healthcare benefits.
Collapse
|
7
|
Won H, Lim J, Noh YH, Yoon I, Yoo HS. Efficacy of Porcine Epidemic Diarrhea Vaccines: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2020; 8:vaccines8040642. [PMID: 33147824 PMCID: PMC7712170 DOI: 10.3390/vaccines8040642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022] Open
Abstract
Porcine epidemic diarrhea (PED) is a devastating disease that causes considerable economic damage to the global pig industry. Although the causative agent, the porcine epidemic diarrhea virus (PEDV), was identified about a half century ago, there is still much debate on the preventive measures against the disease, especially regarding the PED vaccine. Recent reports on PEDV variants make the vaccination for PEDV more confusing. Therefore, we systematically reviewed published articles on PED and vaccines against the disease and performed a meta-analysis of vaccine efficacy based on the clinical signs, fecal score and survival rates. A total of 299 articles on the efficacy of PED vaccines were found online, and 21 articles were selected that fulfilled all the criteria. A meta-analysis was performed on the 21 articles based on the fecal scores and survival rates. This analysis showed the efficacy of PED vaccines, and no significant differences in the efficacy depending on vaccine type (killed vs. live) or administration route (intramuscular vs. oral) were found. The results from our study suggest that any vaccination against PED is a useful strategy to control the disease regardless of the type of vaccine and administration route.
Collapse
Affiliation(s)
- Hokeun Won
- Department of Infectious Diseases, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea; (H.W.); (J.L.)
- ChoongAng Vaccine Laboratories Co., Ltd., Daejeon 34055, Korea; (Y.H.N.); (I.Y.)
| | - Jeonggyo Lim
- Department of Infectious Diseases, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea; (H.W.); (J.L.)
- ChoongAng Vaccine Laboratories Co., Ltd., Daejeon 34055, Korea; (Y.H.N.); (I.Y.)
| | - Yun Hee Noh
- ChoongAng Vaccine Laboratories Co., Ltd., Daejeon 34055, Korea; (Y.H.N.); (I.Y.)
| | - Injoong Yoon
- ChoongAng Vaccine Laboratories Co., Ltd., Daejeon 34055, Korea; (Y.H.N.); (I.Y.)
| | - Han Sang Yoo
- Department of Infectious Diseases, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea; (H.W.); (J.L.)
- Bio-MAX/N-Bio Institute, Seoul National University, Seoul 08826, Korea
- Correspondence: ; Tel.: +82-2-880-1263
| |
Collapse
|
8
|
Muchie KF, Lakew AM, Teshome DF, Yenit MK, Sisay MM, Mekonnen FA, Habitu YA. Epidemiology of preterm birth in Ethiopia: systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:574. [PMID: 32993555 PMCID: PMC7526155 DOI: 10.1186/s12884-020-03271-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Globally, complications of preterm birth are among the most common cause of neonatal mortality. In Ethiopia, the neonatal mortality reduction is not worthy of attention. Hence, this study reviewed the prevalence of preterm birth and factors associated with preterm birth in Ethiopia. Methods The review protocol of this study has been registered in PROSPERO (CRD42017077356). The PRISMA guideline was followed for this review. Studies that assessed the prevalence and/or associated factors of preterm birth in Ethiopia and published from Jan 01, 2009 to Dec 31, 2019 were considered. Studies were searched from the PubMed and Science Direct among medical electronic databases and Google Scholar. Random-effects model was used for detected heterogeneity among studies. Publication bias and sensitivity analysis were assessed. Pooled estimates with its 95% confidence interval were reported using forest plots. The quality of evidence from the review was assessed using GRADE approach. Results Twenty-two studies involving a total of 12,279 participants were included. The overall pooled prevalence of preterm birth in Ethiopia was 10.48% (95% CI: 7.98–12.99). Pooled odds ratio showed rural residence (AOR = 2.34, 95% CI: 1.35–4.05), being anemic (AOR = 2.59, 95% CI: 1.85–3.64), < 4 antenatal care visits (AOR = 2.34, 95%CI: 1.73–3.33), pregnancy induced hypertension (AOR = 3.49, 95% CI: 2.45–4.97), prelabor rapture of membrane (AOR = 4.42, 95% CI: 2.28–8.57), antepartum hemorrhage (AOR = 5.02, 95% CI: 2.90–8.68), multiple pregnancies (AOR = 3.89, 95% CI: 2.52–5.99), past adverse birth outcomes (AOR = 3.24, 95% CI: 2.53–4.15) and chronic illness (AOR = 4.89, 95%CI: 3.12–7.66) were associated with increased likelihood of preterm birth. Further, support during pregnancy was associated with reduced occurrence of preterm birth. Conclusion The pooled national level prevalence of preterm birth in Ethiopia is high. Socio demographic, nutritional, health care, obstetric and gynecologic, chronic illness and medical conditions, behavioral and lifestyle factors are the major associated factors of preterm birth in Ethiopia. This evidence is graded as low grade. Thus, efforts should be intensified to address reported risk factors to relieve the burden of preterm birth in the study setting, Ethiopia.
Collapse
Affiliation(s)
- Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Ayenew Mekonnen
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohanes Ayanaw Habitu
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
9
|
Muchie KF, Lakew AM, Teshome DF, Yenit MK, Sisay MM, Mekonnen FA, Habitu YA. Prevalence and associated factors of preterm birth in Ethiopia: systematic review and meta-analysis protocol. BMJ Open 2020; 10:e035574. [PMID: 32404393 PMCID: PMC7228533 DOI: 10.1136/bmjopen-2019-035574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Preterm birth (PTB) complications are the leading cause of death among neonates globally. The reduction in neonatal mortality is not remarkable in Ethiopia. Therefore, this review will assess the magnitude and associated factors of PTB in Ethiopia. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be followed during the systematic review. We will include all observational studies published from 1 January 2009 to 31 December 2019 that examined the level and/or associated factors of any type of PTB among live births in Ethiopia. Inclusion criteria will be all live births, PTB defined as delivery before 37 weeks gestation. The primary outcome will be PTB <37 weeks, and secondary outcomes including PTB <34, <32 and <28 weeks will be analysed. PubMed and Science Direct databases as well as Google search engine and Google Scholar will be searched. The pooled prevalence of preterm and effect size of association for associated factors will be analysed using the Stata software V.14. The heterogeneity between studies will be measured by I2 statistics. A random-effects model will be used to estimate if heterogeneity detected. Publication bias will be assessed using a funnel plot. Subgroup analysis will be sought based on possible characteristics of the studies, specific morbidity (like pre-eclampsia, hypertension), type of PTB (spontaneous or iotrogenic) and quality of study (high-quality or low-risk). Meta-regression will be considered for major covariates (maternal age and maternal body mass index) related to PTB. Forest plots will be used to present the combined estimate with 95% CIs. The quality of evidence of the outcomes will be assessed with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. ETHICS AND DISSEMINATION No ethical approval is necessary for this systematic review. The findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42017077356.
Collapse
Affiliation(s)
| | - Ayenew Molla Lakew
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Destaw Fetene Teshome
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Malede Mequanent Sisay
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Fantahun Ayenew Mekonnen
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Yohanes Ayanaw Habitu
- Reproductive Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| |
Collapse
|
10
|
Triple Therapy Versus Dual Bronchodilation and Inhaled Corticosteroids/Long-Acting β-Agonists in COPD: Accumulating Evidence from Network Meta-Analyses. Pulm Ther 2019; 5:117-126. [PMID: 32026413 PMCID: PMC6967256 DOI: 10.1007/s41030-019-00102-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Indexed: 11/15/2022] Open
Abstract
Guidelines are mainly based on evidence of well-designed randomized controlled trials (RCTs), but there are limitations to the transferability of conclusions of RCTs to usual care mainly because the patients enrolled in RCTs are selected and not representative of the population encountered in daily practice; moreover, the research environment is substantially different from that of the real world. Because of the scarcity of data generated in large unselected populations in everyday clinical practice, the possibility of using meta-analyses can be considered. Recently, several meta-analyses have attempted to clarify the role of triple therapy containing a long-acting β-agonist (LABA), a long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS) delivered from a single inhaler in chronic obstructive pulmonary disease (COPD), also considering that there is a big difference in the use of triple therapy between what is recommended by COPD guidelines or strategies and the prescriptive behaviour of clinicians. Taking into account the results of the most recent meta-analyses, we believe that triple therapy provides modest clinical benefit in the general COPD population, but in patients on LABA/LAMA combination therapy, who still experience acute exacerbations of COPD (AECOPDs) and have blood eosinophil counts ≥ 300 cells·μl−1, it is of clinical relevance. On the contrary, adding a LAMA to an ICS/LABA combination elicits relevant clinical benefit in the general COPD population, supporting the role of dual bronchodilation therapy for the treatment of COPD. The quantitative synthesis of the currently available clinical evidence seems to suggest that, in patients with COPD already on ICS/LABA combination, the therapy can be improved without an increase of cardiovascular severe adverse events (SAEs) when a LAMA is added to the combination.
Collapse
|
11
|
|
12
|
Complications, patient-reported outcomes, and aesthetic results in immediate breast reconstruction with a dermal sling: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:369-380. [DOI: 10.1016/j.bjps.2018.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022]
|
13
|
Abstract
There are many questions in the literature that remain unanswered due to the paucity of available subjects or the large sample size needed to detect a difference. A meta-analysis consists of integrating together data from multiple studies into one larger data set in order to increase the subject size and power of a paper. In essence, it is a systematic review in which one uses statistical methods to summarize the results of these studies. It is important that a meta-analysis be performed in a systematic and orderly manner with the assistance of a statistician. When carried out correctly, these studies serve as powerful tools to help us better address our knowledge. Because of their complexity, they are prone to bias at multiple levels. This article will discuss the steps involved in performing a meta-analysis, select good studies, as well as explain the statistics conducted in these studies. Furthermore, we will discuss examples from the literature that demonstrate a good meta-analysis.
Collapse
|
14
|
Cazzola M, Calzetta L, Barnes PJ, Criner GJ, Martinez FJ, Papi A, Gabriella Matera M. Efficacy and safety profile of xanthines in COPD: a network meta-analysis. Eur Respir Rev 2018; 27:27/148/180010. [PMID: 29720510 DOI: 10.1183/16000617.0010-2018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/11/2018] [Indexed: 12/23/2022] Open
Abstract
Theophylline can still have a role in the management of stable chronic obstructive pulmonary disease (COPD), but its use remains controversial, mainly due to its narrow therapeutic window. Doxofylline, another xanthine, is an effective bronchodilator and displays a better safety profile than theophylline. Therefore, we performed a quantitative synthesis to compare the efficacy and safety profile of different xanthines in COPD.The primary end-point of this meta-analysis was the impact of xanthines on lung function. In addition, we assessed the risk of adverse events by normalising data on safety as a function of person-weeks. Data obtained from 998 COPD patients were selected from 14 studies and meta-analysed using a network approach.The combined surface under the cumulative ranking curve (SUCRA) analysis of efficacy (change from baseline in forced expiratory volume in 1 s) and safety (risk of adverse events) showed that doxofylline was superior to aminophylline (comparable efficacy and significantly better safety), bamiphylline (significantly better efficacy and comparable safety), and theophylline (comparable efficacy and significantly better safety).Considering the overall efficacy/safety profile of the investigated agents, the results of this quantitative synthesis suggest that doxofylline seems to be the best xanthine for the treatment of COPD.
Collapse
Affiliation(s)
- Mario Cazzola
- Dept of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Dept of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Peter J Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Fernando J Martinez
- Joan and Sanford I. Weill Dept of Medicine, Weill Cornell Medical College, New York - Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Alberto Papi
- Dept of Internal and Cardiorespiratory Medicine, Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Maria Gabriella Matera
- Dept of Experimental Medicine, Unit of Pharmacology, University of Campania Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
15
|
Cazzola M, Calzetta L, Rogliani P, Page C, Matera MG. Impact of doxofylline in COPD: A pairwise meta-analysis. Pulm Pharmacol Ther 2018; 51:1-9. [PMID: 29705620 DOI: 10.1016/j.pupt.2018.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
Doxofylline is an effective bronchodilator for relieving airway obstruction in patients with asthma or chronic obstructive pulmonary disease (COPD), and displays a better safety profile with respect to theophylline. Herein, we performed a pairwise meta-analysis of the currently available data to provide consistent and homogeneous findings on the impact of this xanthine in COPD patients. Results obtained from 820 patients were selected from 20 clinical trials. Meta-regression was performed to examine the source of heterogeneity between-studies and identify potential confounder covariates. The quality of the evidence was assessed by the GRADE system. Doxofylline induced a significant (P < 0.001) increase in forced expiratory volume in 1 s (FEV1) of 8.20% (95%CI 4.00-12.41; I2 93%) and 317 ml (95%CI 19-439; I2 87%) compared with baseline. The total administered dose of doxofylline significantly (P < 0.001) interacted with the size of the effect estimates detected for FEV1. Doxofylline induced a significant (P < 0.001), although moderate, increase in adverse events (AEs) frequency (proportion 0.03, 95%CI 0.02-0.04; I2 88%), but only epigastralgia, nausea, dyspepsia and headache were statistically significant (P < 0.05). The GRADE analysis indicated high quality of evidence (++++) for the impact of doxofylline on FEV1, and moderate quality of evidence (+++) for the safety profile in COPD patients. Doxofylline is an effective and safe medicine when administered to patients with COPD and can be considered as an alternative to theophylline.
Collapse
Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
16
|
Maroufizadeh S, Almasi-Hashiani A, Omani Samani R, Sepidarkish M. Prevalence of retinopathy of prematurity in Iran: a systematic review and Meta-analysis. Int J Ophthalmol 2017; 10:1273-1279. [PMID: 28861355 DOI: 10.18240/ijo.2017.08.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/13/2017] [Indexed: 12/22/2022] Open
Abstract
AIM To estimate overall prevalence of retinopathy of prematurity (ROP) in Iran using a systematic review and Meta-analysis. METHODS A systematic review and Meta-analysis was performed of all published studies pertaining to prevalence of ROP using international and national electronic databases (ISI Web of Sciences, PubMed, Scopus, Google Scholar, SID, MagIran, and IranMedex) from their inception until May 2016 with standard keywords. Begg and Egger tests were used to examine the publication bias and Cochran test and I2 statistics were used to evaluate the statistical heterogeneity. Pooled estimate of the prevalence of ROP were calculated using random effects Meta-analysis. RESULTS The publication bias assumption was rejected by Egger tests with P-value equal to 0.024. The results of Cochran test and I2 statistics revealed substantial heterogeneity (Q=1099.02, df=25, I2=97.7%, P=0.001). The overall prevalence of ROP using the random effect model in Iran was 26.1% (95% CI: 20.3%-31.8%). CONCLUSION The prevalence of ROP is relatively high in Iran. Low birth weight and gestational age are significant risk factors for the disease. Improved care, including oxygen delivery and monitoring, for preterm babies in all facility settings would reduce the number of babies affected with ROP.
Collapse
Affiliation(s)
- Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran 16635-148, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran 16635-148, Iran
| | - Reza Omani Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran 16635-148, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran 16635-148, Iran
| |
Collapse
|
17
|
Fountoulakis KN, Young A, Yatham L, Grunze H, Vieta E, Blier P, Moeller HJ, Kasper S. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines. Int J Neuropsychopharmacol 2017; 20:98-120. [PMID: 27815414 PMCID: PMC5408969 DOI: 10.1093/ijnp/pyw091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/20/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This paper includes a short description of the important clinical aspects of Bipolar Disorder with emphasis on issues that are important for the therapeutic considerations, including mixed and psychotic features, predominant polarity, and rapid cycling as well as comorbidity. METHODS The workgroup performed a review and critical analysis of the literature concerning grading methods and methods for the development of guidelines. RESULTS The workgroup arrived at a consensus to base the development of the guideline on randomized controlled trials and related meta-analyses alone in order to follow a strict evidence-based approach. A critical analysis of the existing methods for the grading of treatment options was followed by the development of a new grading method to arrive at efficacy and recommendation levels after the analysis of 32 distinct scenarios of available data for a given treatment option. CONCLUSION The current paper reports details on the design, method, and process for the development of CINP guidelines for the treatment of Bipolar Disorder. The rationale and the method with which all data and opinions are combined in order to produce an evidence-based operationalized but also user-friendly guideline and a specific algorithm are described in detail in this paper.
Collapse
Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Psychiatric Department, Ludwig Maximilians University, Munich, Germany; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria
| |
Collapse
|
18
|
Barraclough P, af Wåhlberg A, Freeman J, Watson B, Watson A. Predicting Crashes Using Traffic Offences. A Meta-Analysis that Examines Potential Bias between Self-Report and Archival Data. PLoS One 2016; 11:e0153390. [PMID: 27128093 PMCID: PMC4851372 DOI: 10.1371/journal.pone.0153390] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background Traffic offences have been considered an important predictor of crash involvement, and have often been used as a proxy safety variable for crashes. However the association between crashes and offences has never been meta-analysed and the population effect size never established. Research is yet to determine the extent to which this relationship may be spuriously inflated through systematic measurement error, with obvious implications for researchers endeavouring to accurately identify salient factors predictive of crashes. Methodology and Principal Findings Studies yielding a correlation between crashes and traffic offences were collated and a meta-analysis of 144 effects drawn from 99 road safety studies conducted. Potential impact of factors such as age, time period, crash and offence rates, crash severity and data type, sourced from either self-report surveys or archival records, were considered and discussed. After weighting for sample size, an average correlation of r = .18 was observed over the mean time period of 3.2 years. Evidence emerged suggesting the strength of this correlation is decreasing over time. Stronger correlations between crashes and offences were generally found in studies involving younger drivers. Consistent with common method variance effects, a within country analysis found stronger effect sizes in self-reported data even controlling for crash mean. Significance The effectiveness of traffic offences as a proxy for crashes may be limited. Inclusion of elements such as independently validated crash and offence histories or accurate measures of exposure to the road would facilitate a better understanding of the factors that influence crash involvement.
Collapse
Affiliation(s)
- Peter Barraclough
- Centre for Accident Research and Road Safety – Queensland, School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
- * E-mail:
| | | | - James Freeman
- Centre for Accident Research and Road Safety – Queensland, School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Barry Watson
- Centre for Accident Research and Road Safety – Queensland, School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Angela Watson
- Centre for Accident Research and Road Safety – Queensland, School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| |
Collapse
|
19
|
Odeyemi OA. Incidence and prevalence of Vibrio parahaemolyticus in seafood: a systematic review and meta-analysis. SPRINGERPLUS 2016; 5:464. [PMID: 27119068 PMCID: PMC4831955 DOI: 10.1186/s40064-016-2115-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/06/2016] [Indexed: 01/12/2023]
Abstract
Vibrio parahaemolyticus is an important seafood borne human pathogen worldwide due to it occurrence, prevalence and ability to cause gastrointestinal infections. This current study aim at investigating the incidence and prevalence of V. parahaemolyticus in seafood using systematic review-meta-analysis by exploring heterogeneity among primary studies. A comprehensive systematic review and meta-analysis of peer reviewed primary studies reported between 2003 and 2015 for the occurrence and prevalence of V. parahaemolyticus in seafood was conducted using “isolation”, “detection”, “prevalence”, “incidence”, “occurrence” or “enumeration” and V. parahaemolyticus as search algorithms in Web of Science (Science Direct) and ProQuest of electronic bibliographic databases. Data extracted from the primary studies were then analyzed with fixed effect meta-analysis model for effect rate to explore heterogeneity between the primary studies. Publication bias was evaluated using funnel plot. A total of 10,819 articles were retrieved from the data bases of which 48 studies met inclusion criteria. V. parahaemolyticus could only be isolated from 2761 (47.5 %) samples of 5811 seafood investigated. The result of this study shows that incidence of V. parahaemolyticus was more prevalent in oysters with overall prevalence rate of 63.4 % (95 % CI 0.592–0.674) than other seafood. Overall prevalence rate of clams was 52.9 % (95 % CI 0.490–0.568); fish 51.0 % (95 % CI 0.476–0.544); shrimps 48.3 % (95 % CI 0.454–0.512) and mussels, scallop and periwinkle: 28.0 % (95 % CI 0.255–0.307). High heterogeneity (p value <0.001; I2 = 95.291) was observed mussel compared to oysters (I2 = 91.024). It could be observed from this study that oysters harbor V. parahaemolyticus based on the prevalence rate than other seafood investigated. The occurrence and prevalence of V. parahaemolyticus is of public health importance, hence, more studies involving seafood such as mussels need to be investigated.
Collapse
Affiliation(s)
- Olumide A Odeyemi
- Ecology and Biodiversity Centre, Institute for Marine and Antarctic Studies, University of Tasmania, Launceston, Australia
| |
Collapse
|
20
|
Sani NA, Odeyemi OA. Occurrence and prevalence of Cronobacter spp. in plant and animal derived food sources: a systematic review and meta-analysis. SPRINGERPLUS 2015; 4:545. [PMID: 26435891 PMCID: PMC4582040 DOI: 10.1186/s40064-015-1324-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022]
Abstract
Cronobacter species are motile, non-spore forming, Gram negative emerging opportunistic pathogens mostly associated with bacteremia, meningitis, septicemia, brain abscesses and necrotizing enterocolitis in infected neonates, infants and immunocompromised adults. Members of the genus Cronobacter are previously associated with powdered infant formula although the main reservoir and routes of contamination are yet to be ascertained. This study therefore aim to summarize occurrence and prevalence of Cronobacter spp. from different food related sources. A retrospective systematic review and meta-analysis of peer reviewed primary studies reported between 2008 and 2014 for the occurrence and prevalence of Cronobacter spp. in animal and plant related sources was conducted using “Cronobacter isolation”, “Cronobacter detection” and “Cronobacter enumeration” as search terms in the following databases: Web of Science (Science Direct) and ProQuest. Data extracted from the primary studies were then analyzed with meta-analysis techniques for effect rate and fixed effects was used to explore heterogeneity between the sources. Publication bias was evaluated using funnel plot. A total of 916 articles were retrieved from the data bases of which 28 articles met inclusion criteria. Cronobacter spp. could only be isolated from 103 (5.7 %) samples of animal related food while 123 (19 %) samples of plant related food samples harbors the bacteria. The result of this study shows that occurrence of Cronobacter was more prevalent in plant related sources with overall prevalence rate of 20.1 % (95 % CI 0.168–0.238) than animal originated sources with overall prevalence rate of 8 % (95 % CI 0.066–0.096). High heterogeneity (I2 = 84) was observed mostly in plant related sources such as herbs, spices and vegetables compared to animal related sources (I2 = 82). It could be observed from this study that plant related sources serve as reservoir and contamination routes of Cronobacter spp.
Collapse
Affiliation(s)
- Norrakiah Abdullah Sani
- Food Safety and Quality Research Group, School of Chemical Sciences and Food Technology, Faculty of Science and Technology, National University of Malaysia, Bangi, Malaysia
| | - Olumide A Odeyemi
- Food Safety and Quality Research Group, School of Chemical Sciences and Food Technology, Faculty of Science and Technology, National University of Malaysia, Bangi, Malaysia ; Ecology and Biodiversity, Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, Australia
| |
Collapse
|
21
|
He Q, Zhang HH, Avery CL, Lin DY. Sparse meta-analysis with high-dimensional data. Biostatistics 2015; 17:205-20. [PMID: 26395907 DOI: 10.1093/biostatistics/kxv038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/31/2015] [Indexed: 01/10/2023] Open
Abstract
Meta-analysis plays an important role in summarizing and synthesizing scientific evidence derived from multiple studies. With high-dimensional data, the incorporation of variable selection into meta-analysis improves model interpretation and prediction. Existing variable selection methods require direct access to raw data, which may not be available in practical situations. We propose a new approach, sparse meta-analysis (SMA), in which variable selection for meta-analysis is based solely on summary statistics and the effect sizes of each covariate are allowed to vary among studies. We show that the SMA enjoys the oracle property if the estimated covariance matrix of the parameter estimators from each study is available. We also show that our approach achieves selection consistency and estimation consistency even when summary statistics include only the variance estimators or no variance/covariance information at all. Simulation studies and applications to high-throughput genomics studies demonstrate the usefulness of our approach.
Collapse
Affiliation(s)
- Qianchuan He
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Hao Helen Zhang
- Department of Mathematics, The University of Arizona, Tucson, AZ 85721, USA
| | - Christy L Avery
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - D Y Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, USA
| |
Collapse
|
22
|
Thomas RL, Parker GC. Comments on Meta-Analyses in General and in Stem Cell Research: An Overview and Cautionary Advice. Stem Cells Dev 2015; 24:2079-81. [DOI: 10.1089/scd.2015.29000.par] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Ronald L. Thomas
- Carman and Ann Adam Department of Pediatrics, Children's Research Center of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Graham C. Parker
- Carman and Ann Adam Department of Pediatrics, Children's Research Center of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| |
Collapse
|
23
|
Tanriverdi O, Yeniceri N. Importance of meta-analysis and practical obstacles in oncological and epidemiological studies: statistics very close but also far! Asian Pac J Cancer Prev 2015; 16:1303-6. [PMID: 25735371 DOI: 10.7314/apjcp.2015.16.3.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Studies of epidemiological and prognostic factors are very important for oncology practice. There is a rapidly increasing amount of research and resultant knowledge in the scientific literature. This means that health professionals have major challenges in accessing relevant information and they increasingly require best available evidence to make their clinical decisions. Meta-analyses of prognostic and other epidemiological factors are very practical statistical approaches to define clinically important parameters. However, they also feature many obstacles in terms of data collection, standardization of results from multiple centers, bias, and commentary for intepretation. In this paper, the obstacles of meta-analysis are briefly reviewed, and potential problems with this statistical method are discussed.
Collapse
Affiliation(s)
- Ozgur Tanriverdi
- Department of Medical Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey E-mail :
| | | |
Collapse
|
24
|
Vakilian K, Ranjbaran M, Khorsandi M, Sharafkhani N, Khodadost M. Prevalence of preterm labor in Iran: A systematic review and meta-analysis. Int J Reprod Biomed 2015. [DOI: 10.29252/ijrm.13.12.743] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
25
|
Affiliation(s)
- Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Abstract
The concept of meta-epidemiology has been introduced with considering the methodological limitations of systematic review for intervention trials. The paradigm of meta-epidemiology has shifted from a statistical method into a new methodology to close gaps between evidence and practice. Main interest of meta-epidemiology is to control potential biases in previous quantitative systematic reviews and draw appropriate evidences for establishing evidence-base guidelines. Nowadays, the network meta-epidemiology was suggested in order to overcome some limitations of meta-epidemiology. To activate meta-epidemiologic studies, implementation of tools for risk of bias and reporting guidelines such as the Consolidated Standards for Reporting Trials (CONSORT) should be done.
Collapse
Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, JeJu, Korea
| |
Collapse
|
27
|
Duellman T, Warren CL, Matsumura J, Yang J. Analysis of multiple genetic polymorphisms in aggressive-growing and slow-growing abdominal aortic aneurysms. J Vasc Surg 2014; 60:613-21.e3. [PMID: 24801553 DOI: 10.1016/j.jvs.2014.03.274] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The natural history of abdominal aortic aneurysms (AAAs) suggests that some remain slow in growth rate whereas many develop a more accelerated growth rate and reach a threshold for intervention. We hypothesized that different mechanisms are responsible for AAAs that remain slow growing and never become actionable vs the aggressive AAAs that require intervention and may be reflected by distinct associations with genetic polymorphisms. METHODS AAA growth rate was determined from serial imaging data in 168 control and 141 AAA patients with ultrasound or computed tomography imaging studies covering ∼5 years. Genetic polymorphisms all previously reported as showing a significant correlation with AAA with functional effects on the expression or function were determined by analysis of the genomic DNA, including angiotensin 1 receptor (rs5186), interleukin-10 (IL-10; rs1800896), methyl-tetrahydrofolate reductase (rs1801133), low-density lipoprotein receptor-related protein 1 (LRP1; rs1466535), angiotensin-converting enzyme (rs1799752), and several matrix metalloproteinase 9 (MMP-9) single nucleotide polymorphisms. RESULTS Of the AAA patients, 81 were classified as slow AAA growth rate (<3.25 mm/y) vs 60 with aggressive AAA growth rate (>3.25 mm/y, those presenting with a rupture, or those with maximal aortic diameter >5.5 cm [male] or >5.0 cm [female]). Discriminating confounds between the groups were identified by logistic regression. Analyses identified MMP-9 p-2502 single nucleotide polymorphism (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.31-0.94; P = .029) as a significant confound discriminating between control vs slow-growth AAA, MMP-9 D165N (OR, 0.49; 95% CI, 0.26-0.95; P = .035) and LRP1 (OR, 4.99; 95% CI, 1.13-22.1; P = .034) between control vs aggressive-growth AAAs, and methyltetrahydrofolate reductase (OR, 2.99; 95% CI, 1.01-8.86; P = .048), MMP-9 p-2502 (OR, 2.19; 95% CI, 1.05-4.58; P = .037), and LRP1 (OR, 4.96; 95% CI, 1.03-23.9; P = .046) as the statistically significant confounds distinguishing slow-growth AAAs vs aggressive-growth AAAs. CONCLUSIONS Logistic regression identified different genetic confounds for the slow-growth and aggressive-growth AAAs, indicating a potential for different genetic influences on AAAs of distinct aggressiveness. Future logistic regression studies investigating for potential genetic or clinical confounds for this disease should take into account the growth rate and size of the AAA to better identify confounds likely to be associated with aggressive AAAs likely to require intervention.
Collapse
Affiliation(s)
- Tyler Duellman
- Molecular and Cellular Pharmacology Graduate Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | | | - Jon Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Jay Yang
- Molecular and Cellular Pharmacology Graduate Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisc; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
| |
Collapse
|
28
|
Xavier C, Gonzales-Barron U, Paula V, Estevinho L, Cadavez V. Meta-analysis of the incidence of foodborne pathogens in Portuguese meats and their products. Food Res Int 2014. [DOI: 10.1016/j.foodres.2013.11.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
29
|
Gwozdziewycz N, Mehl-Madrona L. Meta-analysis of the use of narrative exposure therapy for the effects of trauma among refugee populations. Perm J 2013; 17:70-6. [PMID: 23596375 DOI: 10.7812/tpp/12-058] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Narrative therapies, especially narrative exposure therapy, are used to treat the effects of trauma in refugees and to prevent psychiatric illness. These methods involve helping the person to tell the story of what happened to them until it no longer elicits anxiety. METHODS We reviewed all quantitative studies related to narrative exposure methods for treating trauma or posttraumatic stress disorder in refugees. We focused on studies with sufficient information to calculate effect sizes and statistical power. RESULTS We found 7 quantitative studies for which effect size and power could be calculated. The total average effect size for all interventions was 0.63 (medium). The average effect size for studies in which interventions were administered by physicians, adequately trained graduate students, or both was 0.53. The effect size for studies in which the counselors were themselves refugees was 1.02. The 95% confidence intervals for the effect sizes of narrative exposure therapy did not reach below 0. CONCLUSION Studies demonstrating the effectiveness of narrative methods have adequate effect sizes and statistical power. Empowering lay counselors to treat their fellow refugees in future studies is warranted.
Collapse
|
30
|
Gonzales-Barron U, Cadavez V, Sheridan JJ, Butler F. Modelling the effect of chilling on the occurrence of Salmonella on pig carcasses at study, abattoir and batch levels by meta-analysis. Int J Food Microbiol 2013; 163:101-13. [DOI: 10.1016/j.ijfoodmicro.2013.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 01/23/2013] [Accepted: 03/02/2013] [Indexed: 11/24/2022]
|
31
|
Rizos CV, Elisaf MS. Metformin and cancer. Eur J Pharmacol 2013; 705:96-108. [PMID: 23499688 DOI: 10.1016/j.ejphar.2013.02.038] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/16/2013] [Accepted: 02/24/2013] [Indexed: 12/13/2022]
Abstract
Type 2 diabetes mellitus is a rising cause of cardiovascular morbidity and mortality. A number of studies have also identified diabetic patients as having increased risk for the development of cancer. Metformin is a widely prescribed antidiabetic drug with an established efficacy coupled with a favorable safety profile and low cost. An increasing number of studies have associated metformin treatment with a decrease of cancer risk. Moreover, metformin has also been associated with improved outcomes in cancer patients. These possible pleiotropic effects of metformin may establish metformin as a cancer prevention and treatment option. However, any favorable effects of metformin on cancer are not always corroborated by clinical trials. Larger studies are expected to better investigate the possible antineoplastic effects of metformin.
Collapse
Affiliation(s)
- Christos V Rizos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | | |
Collapse
|
32
|
Fountoulakis KN, Kasper S, Andreassen O, Blier P, Okasha A, Severus E, Versiani M, Tandon R, Möller HJ, Vieta E. Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci 2012; 262 Suppl 1:1-48. [PMID: 22622948 DOI: 10.1007/s00406-012-0323-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current statement is a systematic review of the available data concerning the efficacy of medication treatment of bipolar disorder (BP). A systematic MEDLINE search was made concerning the treatment of BP (RCTs) with the names of treatment options as keywords. The search was updated on 10 March 2012. The literature suggests that lithium, first and second generation antipsychotics and valproate and carbamazepine are efficacious in the treatment of acute mania. Quetiapine and the olanzapine-fluoxetine combination are also efficacious for treating bipolar depression. Antidepressants should only be used in combination with an antimanic agent, because they can induce switching to mania/hypomania/mixed states/rapid cycling when utilized as monotherapy. Lithium, olanzapine, quetiapine and aripiprazole are efficacious during the maintenance phase. Lamotrigine is efficacious in the prevention of depression, and it remains to be clarified whether it is also efficacious for mania. There is some evidence on the efficacy of psychosocial interventions as an adjunctive treatment to medication. Electroconvulsive therapy is an option for refractory patients. In acute manic patients who are partial responders to lithium/valproate/carbamazepine, adding an antipsychotic is a reasonable choice. The combination with best data in acute bipolar depression is lithium plus lamotrigine. Patients stabilized on combination treatment might do worse if shifted to monotherapy during maintenance, and patients could benefit with add-on treatment with olanzapine, valproate, an antidepressant, or lamotrigine, depending on the index acute phase. A variety of treatment options for BP are available today, but still unmet needs are huge. Combination therapy may improve the treatment outcome but it also carries more side-effect burden. Further research is necessary as well as the development of better guidelines and algorithms for the step-by-step rational treatment.
Collapse
Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6 Odysseos str./1st Parodos Ampelonon str., Pylaia, Thessaloniki, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Soon JM, Baines R, Seaman P. Meta-analysis of food safety training on hand hygiene knowledge and attitudes among food handlers. J Food Prot 2012; 75:793-804. [PMID: 22488073 DOI: 10.4315/0362-028x.jfp-11-502] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research has shown that traditional food safety training programs and strategies to promote hand hygiene increases knowledge of the subject. However, very few studies have been conducted to evaluate the impact of food safety training on food handlers' attitudes about good hand hygiene practices. The objective of this meta-analytical study was to assess the extent to which food safety training or intervention strategies increased knowledge of and attitudes about hand hygiene. A systematic review of food safety training articles was conducted. Additional studies were identified from abstracts from food safety conferences and food science education conferences. Search terms included combinations of "food safety," "food hygiene," "training," "education," "hand washing," "hand hygiene," "knowledge," "attitudes," "practices," "behavior," and "food handlers." Only before- and after-training approaches and cohort studies with training (intervention group) and without training (control group) in hand hygiene knowledge and including attitudes in food handlers were evaluated. All pooled analyses were based on a random effects model. Meta-analysis values for nine food safety training and intervention studies on hand hygiene knowledge among food handlers were significantly higher than those of the control (without training), with an effect size (Hedges' g) of 1.284 (95% confidence interval [CI] ∼ 0.830 to 1.738). Meta-analysis of five food safety training and intervention studies in which hand hygiene attitudes and self-reported practices were monitored produced a summary effect size of 0.683 (95% CI ∼ 0.523 to 0.843). Food safety training increased knowledge and improved attitudes about hand hygiene practices. Refresher training and long-term reinforcement of good food handling behaviors may also be beneficial for sustaining good hand washing practices.
Collapse
Affiliation(s)
- Jan Mei Soon
- School of Agriculture, Royal Agricultural College, Cirencester, Gloucestershire GL7 6JS, UK.
| | | | | |
Collapse
|
34
|
Gonzales-Barron U, Butler F. The use of meta-analytical tools in risk assessment for food safety. Food Microbiol 2011; 28:823-7. [DOI: 10.1016/j.fm.2010.04.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 04/03/2010] [Accepted: 04/10/2010] [Indexed: 10/19/2022]
|
35
|
Hsieh SF, Hu GC, Chuang YC, Chen CY, Hu YN. The Effects and Safety of Exercise Training in Subjects With Chronic Heart Failure—Do Elder Subjects Gain Similar Benefits? INT J GERONTOL 2010. [DOI: 10.1016/j.ijge.2010.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
36
|
Diamond GA, Kaul S. What the Tortoise said to Achilles. Am J Cardiol 2010; 106:593-5. [PMID: 20691322 DOI: 10.1016/j.amjcard.2010.03.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 03/22/2010] [Accepted: 03/22/2010] [Indexed: 11/29/2022]
Abstract
Practitioners and investigators often view clinical trials from very different perspectives-the former in terms of individuals and the latter in terms of groups. The following whimsical dialogue highlights the philosophical foundations of these contrasting perspectives and illustrates their potential impact on patient care and public policy. The title alludes to a piece by Lewis Carroll regarding Zeno's paradox, purportedly proving that the fleet-footed Achilles cannot outrun the plodding Tortoise in a foot race.
Collapse
|
37
|
Schneider AB, Viana MAG, Ron E. Weighing shadows: can meta-analysis help define the risk-benefit ratio of RAI treatment for low-risk thyroid cancer patients? Thyroid 2009; 19:435-6. [PMID: 19415992 DOI: 10.1089/thy.2009.0091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
38
|
Reardon R, Haldeman S. Self-study of values, beliefs, and conflict of interest: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 2009; 32:S29-38. [PMID: 19251071 DOI: 10.1016/j.jmpt.2008.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Observation and survey of values, beliefs, and conflicts of interest. OBJECTIVE To study the values, beliefs, and potential conflicts of interest that the Neck Pain Task Force brought to their deliberations. SUMMARY OF BACKGROUND DATA Researchers' values and beliefs were studied to uncover areas of divergence and to develop guiding principles to assist decision making. METHODS An observer used direct observation and survey of the Neck Pain Task Force, facilitated discussion, and developed a "disclosure tool" to collect information about relationships between researchers, funders, and others with a vested interest in the outcome. RESULTS Clinicians and research methodologists brought different imperatives to the research process. Clinicians focused on offering useful advice, whereas methodologists guarded investigative rigor to ensure that evidence actually supported advice. Group conflict did not polarize along "clinical discipline lines." The Advisory Committee had greater impact when given a clear task and time to work as a group. The Neck Pain Task Force agreed on a set of "guiding principles," which became an overarching doctrine to guide their work. The disclosure questionnaires described relationships between Neck Pain Task Force members and other entities that might have had a financial interest in the topic. CONCLUSION This study describes a process used to assess values, beliefs, and conflicts of interest among members of a scientific task force, and how this was used to create "guiding principles" to assist the research team in deliberations, particularly when conflict arose. Most members of the Neck Pain Task Force had potential conflicts of interest with various stakeholders, but there was marked diffusion of these potential conflicts and no evidence that any funder or other vested interest stakeholder was likely to have a significant impact on the deliberations or conclusions of the Neck Pain Task Force.
Collapse
Affiliation(s)
- Rhoda Reardon
- College of Physicians and Surgeons of Ontario, Ontario, Canada.
| | | |
Collapse
|
39
|
Gonzales Barron U, Bergin D, Butler F. A meta-analysis study of the effect of chilling on prevalence of Salmonella on pig carcasses. J Food Prot 2008; 71:1330-7. [PMID: 18680929 DOI: 10.4315/0362-028x-71.7.1330] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the field of food safety, meta-analysis can be used to combine results of prevalence studies of pathogens at critical stages within the food processing chain so that policy makers can access reliable and concise information on the effectiveness of interventions for controlling and preventing foodborne illnesses in humans. The objective of this work was to demonstrate the applicability of a parametric approach of meta-analysis to the specific case of determining the overall effect of chilling on Salmonella prevalence on pig carcasses. A meta-analysis was performed on each of two parameters measuring effect size for binary outcomes (relative risk and risk difference). Both meta-analyses confirmed that the chilling operation has a significant beneficial effect (P < 0.001) on the reduction of Salmonella prevalence on pig carcasses. Because risk difference is a parameter sensitive to the differences across studies in carcass swab areas and Salmonella detection methods, its meta-analysis highly reflected this heterogeneity (P < 0.001). However, parameterization of relative risk, not being biased by the above sources of variability, did not give rise to heterogeneity among studies and produced a fixed-effects meta-analysis solution, which is deemed more suitable for compilations based on a small number of individual studies (n = 9). Because of the systematic approach of meta-analysis (i.e., individual studies are weighed according to precision) and its reliance for actual data, the output distribution of the relative risk effect size (approximately eN(-0.868,0.166)) merits consideration for inclusion in the chilling stage of quantitative risk assessments modeling the prevalence of this pathogen along the pork production chain.
Collapse
Affiliation(s)
- U Gonzales Barron
- Biosystems Engineering, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | | | | |
Collapse
|
40
|
Matthaiou DK, Panos G, Adamidi ES, Falagas ME. Albendazole versus praziquantel in the treatment of neurocysticercosis: a meta-analysis of comparative trials. PLoS Negl Trop Dis 2008; 2:e194. [PMID: 18335068 PMCID: PMC2265431 DOI: 10.1371/journal.pntd.0000194] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 01/18/2008] [Indexed: 11/18/2022] Open
Abstract
Background Neurocysticercosis, infection of the brain with larvae of Taenia solium (pork tapeworm), is one of several forms of human cysticercosis caused by this organism. We investigated the role of albendazole and praziquantel in the treatment of patients with parenchymal neurocysticercosis by performing a meta-analysis of comparative trials of their effectiveness and safety. Methods and Principal Findings We performed a search in the PubMed database, Cochrane Database of Controlled Trials, and in references of relevant articles. Six studies were included in the meta-analysis. Albendazole was associated with better control of seizures than praziquantel in the pooled data analysis, when the generic inverse variance method was used to combine the incidence of seizure control in the included trials (patients without seizures/[patients×years at risk]) (156 patients in 4 studies, point effect estimate [incidence rate ratio] = 4.94, 95% confidence interval 2.45–9.98). In addition, albendazole was associated with better effectiveness than praziquantel in the total disappearance of cysts (335 patients in 6 studies, random effects model, OR = 2.30, 95% CI 1.06–5.00). There was no difference between albendazole and praziquantel in reduction of cysts, proportion of patients with adverse events, and development of intracranial hypertension due to the administered therapy. Conclusions A critical review of the available data from comparative trials suggests that albendazole is more effective than praziquantel regarding clinically important outcomes in patients with neurocysticercosis. Nevertheless, given the relative scarcity of trials, more comparative interventional studies—especially randomized controlled trials—are required to draw a safe conclusion about the best regimen for the treatment of patients with parenchymal neurocysticercosis. Neurocysticercosis is a parasitic disease caused by the pork tapeworm, Taenia solium, when the larval form of the parasite lodges in the central nervous system. This disease is most commonly found among members of agricultural societies with poor sanitary conditions and economies based on breeding livestock (especially pigs) with low hygiene standards. It is a disease with long history in humans, and the usual therapeutic intervention was surgery until the development of antiparasitic cysticidal agents, the most common being praziquantel and albendazole. T. solium infection can take many different forms in humans, but we concentrated on parenchymal neurocysticercosis with viable cysts. A consensus statement by a panel of experts on the subject supports the use of antiparasitic treatment, but does not indicate either albendazole or praziquantel as the drug of choice for this type of neurocysticercosis, because data from single relevant clinical trials are not conclusive. We conducted a meta-analysis to further evaluate the comparative effectiveness and safety of albendazole and praziquantel for this particular type of neurocysticercosis. The outcomes of our meta-analysis suggest that albendazole is more effective than praziquantel in controlling seizures in affected patients and in leading to the total disappearance of cysts and subsequently cure of patients with neurocysticercosis.
Collapse
Affiliation(s)
| | - Georgios Panos
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- 1st IKA Hospital, Athens, Greece
| | | | - Matthew E. Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
41
|
Noble JH, Sharav VH. Protecting People With Decisional Impairments and Legal Incapacity Against Biomedical Research Abuse. JOURNAL OF DISABILITY POLICY STUDIES 2008. [DOI: 10.1177/1044207307311532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ethical and legal principles are provided for reviewing the ethics of recent cases of biomedical research abuse involving persons with decisional impairments or legal incapacity who were unable to understand the risks and benefits of the research to which they were subjected. Research abuse continues to occur despite guidance from the Nuremburg Code, the Declaration of Helsinki, the U.S. Belmont Report, extensive federal regulations governing human participant research, and several professional and disciplinary codes of ethics with which, the authors believe, the majority of researchers comply. Contributing to research abuse are weaknesses in the institutional review board and research ethics board review process; conflicting opinions about applicable ethical principles; mounting evidence of pervasive conflicts of interest; and dubious conflated research and marketing practices involving researchers, pharmaceutical and medical device manufacturers, and government research sponsors and regulatory agencies. Several recommendations are made to correct identifiable weaknesses and failures in the governance of biomedical research.
Collapse
|
42
|
Schizophrenia, "Just the Facts": what we know in 2008 part 1: overview. Schizophr Res 2008; 100:4-19. [PMID: 18291627 DOI: 10.1016/j.schres.2008.01.022] [Citation(s) in RCA: 215] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 01/28/2008] [Indexed: 01/06/2023]
Abstract
For every disorder, there is a set of established findings and accepted constructs upon which further understanding is built. The concept of schizophrenia as a disease entity has been with us for a little more than a century, although descriptions resembling this condition predate this conceptualization. In 1988, for the inaugural issue of Schizophrenia Research, at the invitation of the founding editors, a senior researcher, since deceased (RJ Wyatt) published a summary of generally accepted ideas about the disorder, which he termed "the facts" of schizophrenia. Ten years later, in conjunction with two of the authors (MSK, RT), he compiled a more extensive set of "facts" for the purpose of evaluating conceptual models or theoretical constructs developed to understand the nature of schizophrenia. On the 20th anniversary of this journal, we update and substantially expand our effort to periodically summarize the current body of information about schizophrenia. We compile a body of seventy-seven representative major findings and group them in terms of their specific relevance to schizophrenia -- etiologies, pathophysiology, clinical manifestations, and treatments. We rate each such "fact" on a 0-3 scale for measures of reproducibility, whether primary to schizophrenia, and durability over time. We also pose one or more critical questions with reference to each "fact", answers to which might help better elucidate the meaning of that finding for our understanding of schizophrenia. We intend to follow this paper with the submission to the journal of a series of topic-specific articles, critically reviewing the evidence.
Collapse
|
43
|
Tandon R, Belmaker RH, Gattaz WF, Lopez-Ibor JJ, Okasha A, Singh B, Stein DJ, Olie JP, Fleischhacker WW, Moeller HJ. World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophr Res 2008; 100:20-38. [PMID: 18243663 DOI: 10.1016/j.schres.2007.11.033] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 10/30/2007] [Accepted: 11/20/2007] [Indexed: 11/25/2022]
Abstract
Data from two major government-funded studies of comparative antipsychotic effectiveness in schizophrenia contradict the widely prevalent belief that the newer second-generation medications are vastly superior to the older first-generation drugs. This has caused uncertainty among patients, clinicians and policy-makers about the relative utility of first- and second- generation antipsychotic agents in its treatment. To reduce confusion and provide a contextual understanding of the new data, the World Psychiatry Association Section on Pharmacopsychiatry comprehensively reviewed the literature on the comparative effectiveness of different antipsychotic treatments for schizophrenia and developed this update. Utilizing data from the approximately 1,600 randomized controlled trials of antipsychotic treatment in schizophrenia, we applied the two indirect and one direct method to comparing the effectiveness of 62 currently-available antipsychotic agents. The subclasses of 51 first-generation and 11 second-generation antipsychotics were both found to be very heterogeneous, with substantial differences in side-effect profiles among members. Second-generation antipsychotic agents were found to be inconsistently more effective than first-generation agents in alleviating negative, cognitive, and depressive symptoms and had a lower liability to cause tardive dyskinesia; these modest benefits were principally driven by the ability of second-generation antipsychotics to provide equivalent improvement in positive symptoms along with a lower risk of causing extrapyramidal side-effects. Clozapine was found to be more efficacious than other agents in treatment-refractory schizophrenia. There were no consistent differences in efficacy among other second-generation antipsychotic agents; if such differences exist, they are likely small in magnitude. Dosing was found to be a key variable in optimizing effectiveness of both first- and second- generation antipsychotic agents. There was enormous individual variability in antipsychotic response and vulnerability to various adverse effects. In contrast to their relatively similar efficacy in treating positive symptoms, there were substantial differences among both first- and second- generation antipsychotic agents with regard to their propensity to cause extrapyramidal, metabolic and other adverse effects; second-generation agents have a lower liability to cause acute extrapyramidal symptoms and tardive dyskinesia along with a tendency to cause greater metabolic side-effects than first-generation agents. Based on these data about the comparative effectiveness of different antipsychotic treatment options, we summarize elements of current best antipsychotic practice for the treatment of schizophrenia and discuss the role of government and the pharmaceutical industry in obtaining and disseminating information which can facilitate best practice.
Collapse
|
44
|
Self-study of values, beliefs, and conflict of interest: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 2008; 33:S24-32. [PMID: 18204395 DOI: 10.1097/brs.0b013e3181642f07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observation and survey of values, beliefs, and conflicts of interest. OBJECTIVE To study the values, beliefs, and potential conflicts of interest that the Neck Pain Task Force brought to their deliberations. SUMMARY OF BACKGROUND DATA Researchers' values and beliefs were studied to uncover areas of divergence and to develop guiding principles to assist decision making. METHODS An observer used direct observation and survey of the Neck Pain Task Force, facilitated discussion, and developed a "disclosure tool" to collect information about relationships between researchers, funders, and others with a vested interest in the outcome. RESULTS Clinicians and research methodologists brought different imperatives to the research process. Clinicians focused on offering useful advice, whereas methodologists guarded investigative rigor to ensure that evidence actually supported advice. Group conflict did not polarize along "clinical discipline lines." The Advisory Committee had greater impact when given a clear task and time to work as a group. The Neck Pain Task Force agreed on a set of "guiding principles," which became an overarching doctrine to guide their work. The disclosure questionnaires described relationships between Neck Pain Task Force members and other entities that might have had a financial interest in the topic. CONCLUSION This study describes a process used to assess values, beliefs, and conflicts of interest among members of a scientific task force, and how this was used to create "guiding principles" to assist the research team in deliberations, particularly when conflict arose. Most members of the Neck Pain Task Force had potential conflicts of interest with various stakeholders, but there was marked diffusion of these potential conflicts and no evidence that any funder or other vested interest stakeholder was likely to have a significant impact on the deliberations or conclusions of the Neck Pain Task Force.
Collapse
|
45
|
Thompson A, Drenos F, Hafez H, Humphries S. Candidate Gene Association Studies in Abdominal Aortic Aneurysm Disease: A Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2008; 35:19-30. [DOI: 10.1016/j.ejvs.2007.07.022] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 07/04/2007] [Indexed: 10/22/2022]
|
46
|
Gonzales DA, Norsworthy KJ, Kern SJ, Banks S, Sieving PC, Star RA, Natanson C, Danner RL. A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity. BMC Med 2007; 5:32. [PMID: 18001477 PMCID: PMC2200657 DOI: 10.1186/1741-7015-5-32] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 11/14/2007] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Meta-analyses of N-acetylcysteine (NAC) for preventing contrast-induced nephrotoxicity (CIN) have led to disparate conclusions. Here we examine and attempt to resolve the heterogeneity evident among these trials. METHODS Two reviewers independently extracted and graded the data. Limiting studies to randomized, controlled trials with adequate outcome data yielded 22 reports with 2746 patients. RESULTS Significant heterogeneity was detected among these trials (I2 = 37%; p = 0.04). Meta-regression analysis failed to identify significant sources of heterogeneity. A modified L'Abbé plot that substituted groupwise changes in serum creatinine for nephrotoxicity rates, followed by model-based, unsupervised clustering resolved trials into two distinct, significantly different (p < 0.0001) and homogeneous populations (I2 = 0 and p > 0.5, for both). Cluster 1 studies (n = 18; 2445 patients) showed no benefit (relative risk (RR) = 0.87; 95% confidence interval (CI) 0.68-1.12, p = 0.28), while cluster 2 studies (n = 4; 301 patients) indicated that NAC was highly beneficial (RR = 0.15; 95% CI 0.07-0.33, p < 0.0001). Benefit in cluster 2 was unexpectedly associated with NAC-induced decreases in creatinine from baseline (p = 0.07). Cluster 2 studies were relatively early, small and of lower quality compared with cluster 1 studies (p = 0.01 for the three factors combined). Dialysis use across all studies (five control, eight treatment; p = 0.42) did not suggest that NAC is beneficial. CONCLUSION This meta-analysis does not support the efficacy of NAC to prevent CIN.
Collapse
Affiliation(s)
- Denise A Gonzales
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kelly J Norsworthy
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Steven J Kern
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Steve Banks
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Pamela C Sieving
- National Institutes of Health Library, National Institutes of Health, Bethesda, MD, USA
| | - Robert A Star
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charles Natanson
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Robert L Danner
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
47
|
Lei X, Peng C, Tian D, Sun J. Meta-analysis and its application in global change research. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s11434-007-0046-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
48
|
Abstract
With the expanding volume of medical literature, meta-analysis, a form of systematic review, has become indispensable for clinicians for evidence-based decision making. While the number of meta-analyses has substantially increased during recent years, there are still controversial issues regarding their methodology, interpretation and clinical application. In this review, the basic concepts of meta-analysis have been discussed from a clinician's perspective in order to facilitate its understanding, appraising and applicability in clinical practice. Although randomised controlled trials are the usual source for meta-analysis, observational studies are also being increasingly considered for meta-analysis. Like every other research design, meta-analysis starts with formulating a question, followed by searching for related data, based on predefined criteria and strategies. Inclusion of studies must be carried out with careful consideration of their quality and assessment of homogeneity using graphical means as well as statistical tools such as Q statistics, I(2) statistics and meta-regression. The pooled effect size is commonly calculated using either a 'fixed effect model' or 'random effect model'. Publication bias and other source of bias should be investigated and the impact of potential confounders should be eliminated as required. Given the above-mentioned considerations, meta-analysis can provide a more precise estimate of an effect size to be used in clinical decision making.
Collapse
Affiliation(s)
- A Khoshdel
- Department of Nephrology, Faculty of Health, John Hunter Hospital, NSW, Australia.
| | | | | |
Collapse
|