Interventions for management of post-stroke depression: A bayesian network meta-analysis of 23 randomized controlled trials

2017 ◽  
Vol 381 ◽  
pp. 163-164
Author(s):  
L. Deng ◽  
S. Qiu ◽  
D. Wang ◽  
M. Liu
Keyword(s):  
Bayesian Network ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Post Stroke Depression

Pharmacological and Psychotherapeutic Interventions for Management of Post-stroke Depression: A Bayesian Network Meta-analysis of 27 Randomized Controlled Trials

2017 ◽  
Vol 41 (S1) ◽  
pp. S69-S70
Author(s):  
L. Deng
Keyword(s):  
Randomized Controlled Trials ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Post Stroke Depression

BackgroundPost-stroke depression (PSD) constitutes an important complication of stroke, leading to great disability as well as increased mortality. Since which treatment for PSD should be preferred are still matters of controversy, we aimed to compare and rank these treatments.MethodsWe did a network meta-analysis to incorporate both direct and indirect evidence from relevant trials by Bayesian random effects model. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Scopus, Embase for randomized controlled trials of different PSD treatments. The primary outcomes were efficacy and tolerability. We assessed the quality of evidence using the GRADE framework.ResultFrom 1347 citations, 27 randomised trials with a total of 1620 participants were included in this network meta-analysis. In terms of primary outcome, only for reboxetione (standardised mean difference [SMD] −12.84, 95% credible interval [CrI] −23.13 to −2.65) and nortriptyline (SMD −7.95, 95% CrI −14.85 to −1.75) enough evidence existed to support superiority compared with placebo. No significant difference was observed in terms tolerability. Considering patient response rate, repetitive transcranial magnetic stimulation (rTMS) was statistically more effective than sertraline plus nimodipine (Relative risk [RR] 5.53, 95% CrI 1.36 to 23.86) and fluoxetine (RR 10.74, 95% CrI 3.55 to 35.97)ConclusionCompared with placebo, reboxetione and nortriptyline offered a clear advantage for PSD patients. rTMS is probably the best option to consider in addition of pharmacological treatment. Nevertheless, doctors need to consider our results together with all known safety and economy information when selecting the strategy for individual patients.Disclosure of interestThe author has not supplied his declaration of competing interest.

scholarly journals Bayesian Network Meta-Analysis of the Effectiveness of Various Interventions for Nontraumatic Osteonecrosis of the Femoral Head

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Ji Wang ◽  
Jing Wang ◽  
Kai Zhang ◽  
Yanfang Wang ◽  
Xuanwen Bao
Keyword(s):  
Femoral Head ◽  
Treatment Failure ◽  
Bayesian Network ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Failure Rates ◽  
Randomized Controlled ◽  
Harris Score ◽  
Fibular Grafting

Objective. To assess the effectiveness of various therapeutic hip preservation strategies on patients with nontraumatic osteonecrosis of the femoral head (ONFH). Design. This is a systematic review of previous literature and in-depth Bayesian network meta-analysis of randomized controlled trials (RCTs) to compare the clinical effect of various operation methods and one physical intervention (extracorporeal shockwave). Data Sources. Electronic literature, for studies published up to December 2017, was collected from PubMed, Medline, and the Cochrane Library. Study Selection. We selected RCTs on patients with ONFH. Treatment methods included extracorporeal shockwave (ESW), core decompression (CD), multiple drilling decompression (DD), vascularized fibular grafting (VFG), free-vascularized fibular grafting (FVFG), inverted femoral head grafting (IFHG), vascular iliac pedicle bone grafting (VIPBG), osteotomy, and tantalum implantation (TI). Outcome. The primary outcome was Harris score; the secondary outcome was Harris hip score (HHS), including total hip arthroplasty requirement (THA) and progression to collapse. Results. A total of 14 randomized controlled trials were investigated. ESW had the highest improvement on Harris score (probability best 52%), followed by VFG (probability was 38%). In the meanwhile, VFG also proved to be superior in reducing the failure rates of treatment (probability lowest 59%), followed by ESW (probability lowest 24%). In femoral necrosis stage-II, VFG achieved the highest probability in preventing treatment failures (52%) and showed better performance in reducing treatment failure rates than CD. Conclusion. ESW therapy (ESWT) is the most effective intervention to improve HHS, and VFG shows superior effect on reducing treatment failure rates.

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