Comparing clinical outcomes of exercise intervetions according to the American college of sports medicine guidelines for strength training to other types of exercise in knee osteoarthritis: a systematic review and meta-analyses

Background: Benefits of phosphate-lowering interventions on clinical outcomes in patients with chronic kidney disease (CKD) are unclear; systematic reviews have predominantly involved dialysis patients. This study aimed to summarize evidence from randomized controlled trials (RCTs) concerning benefits and risks of non-calcium-based phosphate-lowering treatment in non-dialysis CKD. Methods: We conducted a systematic review and meta-analyses of RCTs involving noncalcium-based phosphate-lowering therapy compared to placebo, calcium-based binders, or no study medication, in adults with CKD not on dialysis or post-transplant. RCTs had ≥3 months follow up and outcomes included biomarkers of mineral metabolism, cardiovascular parameters, and adverse events. Outcomes were meta-analyzed using the Sidik-Jonkman method for random effects. Unstandardized mean differences were used as effect sizes for continuous outcomes, with common measurement units and Hedge's g standardized mean differences (SMD) otherwise. Odds ratios were used for binary outcomes. Cochrane risk of bias and GRADE assessment determined the certainty of evidence. Results: Twenty trials involving 2,498 participants (median sample size 120, median follow up 9 months) were eligible for inclusion. Overall, risk of bias was low. Compared with placebo, non calcium-based phosphate binders reduced serum phosphate (12 trials, weighted mean difference -0.37, 95% CI -0.58,-0.15 mg/dL, low certainty evidence) and urinary phosphate excretion (8 trials, SMD -0.61, 95% CI -0.90,-0.31, low certainty evidence), but resulted in increased constipation (9 trials, log odds ratio [OR] 0.93, 95% CI 0.02, 1.83, low certainty evidence) and greater vascular calcification score (3 trials, SMD 0.47, 95% CI 0.17, 0.77, very low certainty evidence). Data for effects of phosphate-lowering therapy on cardiovascular events (log OR 0.51 [95% CI -0.51, 1.17]) and death were scant. Conclusions: Non-calcium-based phosphate-lowering therapy reduced serum phosphate and urinary phosphate excretion, but there was an unclear effect on clinical outcomes and intermediate cardiovascular end-points. Adequately powered RCTs are required to evaluate benefits and risks of phosphate-lowering therapy on patient-centered outcomes.

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A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations

Advances in Rheumatology ◽

10.1186/s42358-018-0033-9 ◽

2018 ◽

Vol 58 (1) ◽

Cited By ~ 9

Author(s):

Alexandro Andrade ◽

Ricardo de Azevedo Klumb Steffens ◽

Sofia Mendes Sieczkowska ◽

Leonardo Alexandre Peyré Tartaruga ◽

Guilherme Torres Vilarino

Keyword(s):

Systematic Review ◽

Strength Training ◽

Clinical Outcomes ◽

Design Considerations

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Effects of caffeine supplementation on muscle endurance, maximum strength, and perceived exertion in adults submitted to strength training: a systematic review and meta-analyses

Critical Reviews in Food Science and Nutrition ◽

10.1080/10408398.2020.1781051 ◽

2020 ◽

pp. 1-14

Author(s):

Taís Tavares Ferreira ◽

João Vitor Farias da Silva ◽

Nassib Bezerra Bueno

Keyword(s):

Systematic Review ◽

Strength Training ◽

Perceived Exertion ◽

Maximum Strength ◽

Muscle Endurance ◽

Meta Analyses

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Effect of storage time of platelet products on clinical outcomes after transfusion: a systematic review and meta-analyses

Vox Sanguinis ◽

10.1111/vox.12494 ◽

2017 ◽

Vol 112 (4) ◽

pp. 291-300 ◽

Cited By ~ 17

Author(s):

A. L. Kreuger ◽

C. Caram-Deelder ◽

J. Jacobse ◽

J.-L. Kerkhoffs ◽

J. G. van der Bom ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Storage Time ◽

Meta Analyses

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Risk factors for adverse clinical outcomes in patients with COVID-19: A systematic review and meta-analysis

10.1101/2020.05.13.20100495 ◽

2020 ◽

Cited By ~ 1

Author(s):

Vanesa Bellou ◽

Ioanna Tzoulaki ◽

Evangelos Evangelou ◽

Lazaros Belbasis

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Clinical Outcomes ◽

Randomized Clinical Trials ◽

Clinical Decision Making ◽

Statistical Significance ◽

Specific Effect ◽

Chronic Obstructive ◽

P Value ◽

Meta Analyses

Importance: COVID-19 is a clinically heterogeneous disease of varying severity and prognosis. Clinical characteristics that impact disease course could offer guidance for clinical decision making and future research endeavors and unveil disease pathways. Objective: To examine risk factors associated with adverse clinical outcomes in patients with COVID-19. Data sources: We performed a systematic review in PubMed from January 1 until April 19, 2020. Study selection: Observational studies that examined the association of any clinical characteristic with an adverse clinical outcome were considered eligible. We scrutinized studies for potential overlap. Data extraction and synthesis: Information on the effect of clinical factors on clinical endpoints of patients with COVID-19 was independently extracted by two researchers. When an effect size was not reported, crude odds ratios were calculated based on the available information from the eligible articles. Study-specific effect sizes from non-overlapping studies were synthesized applying the random-effects model. Main outcome and measure: The examined outcomes were severity and progression of disease, admission to ICU, need for mechanical ventilation, mortality, or a composite outcome. Results: We identified 88 eligible articles, and we performed a total of 256 meta-analyses on the association of 98 unique risk factors with five clinical outcomes. Seven meta-analyses presented the strongest epidemiological evidence in terms of statistical significance (P-value <0.005), between-study heterogeneity (I2 <50%), sample size (more than 1000 COVID-19 patients), 95% prediction interval excluded the null value, and absence of small-study effects. Elevated C-reactive protein (OR, 6.46; 95% CI, 4.85 - 8.60), decreased lymphocyte count (OR, 4.16; 95% CI, 3.17 - 5.45), cerebrovascular disease (OR, 2.84; 95% CI, 1.55 - 5.20), chronic obstructive pulmonary disease (OR, 4.44; 95% CI, 2.46 - 8.02), diabetes mellitus (OR, 2.04; 95% CI, 1.54 - 2.70), hemoptysis (OR, 7.03; 95% CI, 4.57 - 10.81), and male sex (OR, 1.51; 95% CI, 1.30 - 1.75) were associated with risk of severe COVID-19. Conclusions and relevance: Our results highlight factors that could be useful for prognostic model building, help guide patients' selection for randomized clinical trials, as well as provide alternative treatment targets by shedding light to disease pathophysiology.

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Determining the early corticospinal-motoneuronal responses to strength training: a systematic review and meta-analysis

Reviews in the Neurosciences ◽

10.1515/revneuro-2018-0054 ◽

2019 ◽

Vol 30 (5) ◽

pp. 463-476 ◽

Cited By ~ 11

Author(s):

Joel Mason ◽

Ashlyn K. Frazer ◽

Alan J. Pearce ◽

Alicia M. Goodwill ◽

Glyn Howatson ◽

...

Keyword(s):

Systematic Review ◽

Strength Training ◽

Primary Motor Cortex ◽

Meta Analysis ◽

Short Interval ◽

Silent Period ◽

Intracortical Inhibition ◽

Inhibitory Circuits ◽

Intracortical Circuits ◽

Meta Analyses

Abstract Several studies have used transcranial magnetic stimulation to probe the corticospinal-motoneuronal responses to a single session of strength training; however, the findings are inconsistent. This systematic review and meta-analysis examined whether a single bout of strength training affects the excitability and inhibition of intracortical circuits of the primary motor cortex (M1) and the corticospinal-motoneuronal pathway. A systematic review was completed, tracking studies between January 1990 and May 2018. The methodological quality of studies was determined using the Downs and Black quality index. Data were synthesised and interpreted from meta-analysis. Nine studies (n=107) investigating the acute corticospinal-motoneuronal responses to strength training met the inclusion criteria. Meta-analyses detected that after strength training compared to control, corticospinal excitability [standardised mean difference (SMD), 1.26; 95% confidence interval (CI), 0.88, 1.63; p<0.0001] and intracortical facilitation (ICF) (SMD, 1.60; 95% CI, 0.18, 3.02; p=0.003) were increased. The duration of the corticospinal silent period was reduced (SMD, −17.57; 95% CI, −21.12, −14.01; p=0.00001), but strength training had no effect on the excitability of the intracortical inhibitory circuits [short-interval intracortical inhibition (SICI) SMD, 1.01; 95% CI, −1.67, 3.69; p=0.46; long-interval intracortical inhibition (LICI) SMD, 0.50; 95% CI, −1.13, 2.13; p=0.55]. Strength training increased the excitability of corticospinal axons (SMD, 4.47; 95% CI, 3.45, 5.49; p<0.0001). This systematic review and meta-analyses revealed that the acute neural changes to strength training involve subtle changes along the entire neuroaxis from the M1 to the spinal cord. These findings suggest that strength training is a clinically useful tool to modulate intracortical circuits involved in motor control.

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Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

Diseases of the Esophagus ◽

10.1093/dote/doz063 ◽

2019 ◽

Vol 32 (10) ◽

pp. 1-8

Author(s):

P Prasad ◽

M Navidi ◽

A Immanuel ◽

S M Griffin OBE ◽

A W Phillips

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Neoadjuvant Treatment ◽

Length Of Hospital Stay ◽

High Volume ◽

Cochrane Library ◽

Published Data ◽

Meta Analyses ◽

The Impact

SUMMARY Changes in the structure of surgical training have affected trainees’ operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)—this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11–15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

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