Treatment outcomes for anorexia nervosa: a systematic review and meta-analysis of randomized controlled trials

2018 ◽  
Vol 49 (4) ◽  
pp. 535-544 ◽  
Author(s):  
Stuart B. Murray ◽  
Daniel S. Quintana ◽  
Katharine L. Loeb ◽  
Scott Griffiths ◽  
Daniel Le Grange
Keyword(s):  
Anorexia Nervosa ◽  
Treatment Effect ◽  
Psychological Symptoms ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Significant Treatment Effect ◽  
Significant Treatment ◽  
Randomized Controlled ◽  
Meta Analyses

AbstractBackgroundTo determine the impact of specialized treatments, relative to comparator treatments, upon the weight and psychological symptoms of anorexia nervosa (AN) at end-of-treatment (EOT) and follow-up.MethodsRandomized controlled trials (RCTs) between January 1980 and December 2017 that reported the effects of at least two treatments on AN were screened. Weight and psychological symptoms were analyzed separately for each study. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and studies were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria and Cochrane risk of bias tool.ResultsWe identified 35 eligible RCTs, comprising data from 2524 patients. Meta-analyses revealed a significant treatment effect on weight outcomes at EOT [g= 0.16, 95% CI (0.05–0.28),p= 0.006], but not at follow-up [g= 0.11, 95% CI (−0.04 to 0.27),p= 0.15]. There was no significant treatment effect on psychological outcomes at either EOT [g= −0.03, 95% CI (−0.14 to 0.08),p= 0.63], or follow-up [g= −0.001, 95% CI (−0.11 to 0.11),p= 0.98]. There was no strong evidence of publication bias or significant moderator effects for illness duration, mean age, year of publication, comparator group category, or risk of bias (allpvalues > 0.05).ConclusionsCurrent specialized treatments are more adept than comparator interventions at imparting change in weight-based AN symptoms at EOT, but not at follow-up. Specialized treatments confer no advantage over comparator interventions in terms of psychological symptoms. Future precision treatment efforts require a specific focus on the psychological symptoms of AN.

scholarly journals Smartphone-Based Self-Monitoring, Treatment, and Automatically Generated Data in Children, Adolescents, and Young Adults With Psychiatric Disorders: Systematic Review (Preprint)

2019 ◽  
Author(s):  
Sigurd Melbye ◽  
Lars Vedel Kessing ◽  
Jakob Eyvind Bardram ◽  
Maria Faurholt-Jepsen
Keyword(s):  
Systematic Review ◽  
Young Adults ◽  
Psychiatric Disorders ◽  
Literature Search ◽  
Risk Of Bias ◽  
Smartphone App ◽  
Controlled Trials ◽  
Self Monitoring ◽  
Randomized Controlled ◽  
Meta Analyses

BACKGROUND Psychiatric disorders often have an onset at an early age, and early identification and intervention help improve prognosis. A fine-grained, unobtrusive, and effective way to monitor symptoms and level of function could help distinguish severe psychiatric health problems from normal behavior and potentially lead to a more efficient use of clinical resources in the current health care system. The use of smartphones to monitor and treat children, adolescents, and young adults with psychiatric disorders has been widely investigated. However, no systematic review concerning smartphone-based monitoring and treatment in this population has been published. OBJECTIVE This systematic review aims at describing the following 4 features of the eligible studies: (1) monitoring features such as self-assessment and automatically generated data, (2) treatment delivered by the app, (3) adherence to self-monitoring, and (4) results of the individual studies. METHODS We conducted a systematic literature search of the PubMed, Embase, and PsycInfo databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a smartphone app to collect automatically generated smartphone-based data, or a smartphone-based system for treatment; (2) had participants who were diagnosed with psychiatric disorders or received treatment for a psychiatric disorder, which was verified by an external clinician; (3) had participants who were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias in each individual study was systematically assessed. RESULTS A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria for inclusion. These studies covered 8 different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, and suicidal behavior. Smartphone-based self-monitoring was used in all but 1 study, and 11 of them reported on the participants’ adherence to self-monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive attitudes toward the use of smartphones for self-monitoring. In 2 studies, automatically generated data were collected. Three studies were randomized controlled trials investigating the effectiveness of smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2 randomized controlled trials, the researchers were blinded for randomization, but the participants were not blinded in any of the studies. All studies were determined to be at high risk of bias in several areas. CONCLUSIONS Smartphones hold great potential as a modern, widely available technology platform to help diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of homogeneity and rigor among studies regarding their methodology and reporting of adherence would facilitate future reviews and meta-analyses.

scholarly journals Risk of malignancies in patients with spondyloarthritis treated with biologics compared with those treated with non-biologics: a systematic review and meta-analysis

2020 ◽  
Vol 12 ◽  
pp. 1759720X2092569
Author(s):  
Yu Heng Kwan ◽  
Ka Keat Lim ◽  
Warren Fong ◽  
Hendra Goh ◽  
Linkai Ng ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Interleukin 17 ◽  
Randomized Controlled ◽  
Risk Of Malignancy ◽  
Meta Analyses ◽  
Analytical Approaches

Background: The aim of our study was to synthesize evidence on the occurrence of malignancy in spondyloarthritis (SpA), from randomized controlled trials (RCTs) comparing biologics with non-biologics and biologics to each other. Methods: We systematically searched Medline, Cochrane Library, EMBASE, Scopus and ClinicalTrials.gov from inception until 31 October 2018. RCTs with ⩾24-week follow-up were included. We extracted data using standardized forms and assessed the risk of bias using the Cochrane Risk of Bias Tool. We performed pair-wise meta-analyses and network meta-analyses to compare the risk of malignancy for each biologics class and SpA type. We reported the Peto odds ratio (OR) of any malignancy along with 95% confidence intervals (95% CI). Bayesian posterior probabilities comparing risk of malignancy of each biologic class with non-biologics were computed as supplementary measures. Results: Fifty-four trials were included; most (44/54) had follow-up <1 year. Among 14,245 patients, 63 developed a malignancy. While most Peto ORs were >1, they had wide 95% CI and p >0.05. The overall Peto OR comparing biologics with non-biologics was 1.42 (95% CI 0.80–2.53). Only interleukin-17 inhibitors in peripheral SpA had p <0.05 (Peto OR 2.77, 95% CI 1.07–7.13); the posterior probability that the risk was higher than non-biologics was 98%. Stratified analyses revealed no consistent trend by prior exposure to biologics, duration of follow-up, study quality, study-arm crossover, analytical approaches and type of malignancy. Conclusions: Our findings indicate no overall elevated risk of malignancy with biologics in SpA. As our meta-analyses are unable to conclude on the long-term risk, long-term pharmacovigilance of biologics in SpA may still be warranted.

Land-based Exercise for Osteoarthritis of the Knee: A Metaanalysis of Randomized Controlled Trials

2009 ◽  
Vol 36 (6) ◽  
pp. 1109-1117 ◽  
Author(s):  
MARLENE FRANSEN ◽  
SARA McCONNELL
Keyword(s):  
Randomized Controlled Trials ◽  
Physical Function ◽  
Knee Pain ◽  
Treatment Effect ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Therapeutic Exercise ◽  
Treatment Benefit ◽  
Randomized Controlled ◽  
Study Methodology

Objective.To determine if clinical guidelines recommending therapeutic exercise for people with knee osteoarthritis (OA) are supported by rigorous scientific evidence. To explore whether the magnitude of treatment benefit reported in randomized controlled trials (RCT) is associated with exercise dosage or study methodology.Methods.We conducted a metaanalysis of RCT comparing some form of land-based therapeutic exercise with a nonexercise group using pain and self-reported physical function outcomes.Results.The 32 included studies provided data on almost 3800 participants. Metaanalysis revealed a beneficial treatment effect: standardized mean difference (SMD) 0.40 [95% confidence interval (CI) 0.30 to 0.50] for knee pain; SMD 0.37 (95% CI 0.25 to 0.49) for physical function. While the pooled beneficial effects of the 9 RCT evaluating exercise programs providing fewer than 12 direct supervision occasions or the 9 RCT judged to have a low risk of bias remained significant and clinically relevant, the magnitude of treatment benefit pooled from these RCT was significantly smaller than the comparator group (12 or more supervision occasions, moderate to high risk of bias, respectively). The mode of treatment delivery (individual treatments, exercise classes, home program) was not significantly associated with the magnitude of treatment benefit.Conclusion.There is evidence that land-based therapeutic exercise has at least short-term benefit in terms of reduced knee pain and physical disability for people with knee OA. The magnitude of the treatment effect was significantly associated with the number of direct supervision occasions provided and study methodology (assessor blinding, adequate allocation concealment).

scholarly journals Assessing the risk of bias in randomized controlled trials in the field of dentistry indexed in the Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) database

2011 ◽  
Vol 129 (2) ◽  
pp. 85-93 ◽  
Author(s):  
Christiane Alves Ferreira ◽  
Carlos Alfredo Salles Loureiro ◽  
Humberto Saconato ◽  
Álvaro Nagib Atallah
Keyword(s):  
Randomized Controlled Trials ◽  
Research Question ◽  
Allocation Concealment ◽  
Risk Of Bias ◽  
Low Risk ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Decision Making Processes ◽  
Meta Analyses

CONTEXT AND OBJECTIVE: Well-conducted randomized controlled trials (RCTs) represent the highest level of evidence when the research question relates to the effect of therapeutic or preventive interventions. However, the degree of control over bias between RCTs presents great variability between studies. For this reason, with the increasing interest in and production of systematic reviews and meta-analyses, it has been necessary to develop methodology supported by empirical evidence, so as to encourage and enhance the production of valid RCTs with low risk of bias. The aim here was to conduct a methodological analysis within the field of dentistry, regarding the risk of bias in open-access RCTs available in the Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) database. DESIGN AND SETTING: This was a methodology study conducted at Universidade Federal de São Paulo (Unifesp) that assessed the risk of bias in RCTs, using the following dimensions: allocation sequence generation, allocation concealment, blinding, and data on incomplete outcomes. RESULTS: Out of the 4,503 articles classified, only 10 studies (0.22%) were considered to be true RCTs and, of these, only a single study was classified as presenting low risk of bias. The items that the authors of these RCTs most frequently controlled for were blinding and data on incomplete outcomes. CONCLUSION: The effective presence of bias seriously weakened the reliability of the results from the dental studies evaluated, such that they would be of little use for clinicians and administrators as support for decision-making processes.

scholarly journals Physical Exercise for Patients Undergoing Hematopoietic Stem Cell Transplantation: Systematic Review and Meta-Analyses of Randomized Controlled Trials

2013 ◽  
Vol 93 (4) ◽  
pp. 514-528 ◽  
Author(s):  
Inge E.P.M. van Haren ◽  
Hans Timmerman ◽  
Carin M. Potting ◽  
Nicole M.A. Blijlevens ◽  
J. Bart Staal ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Data Extraction ◽  
Well Being ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Psychological Well Being ◽  
Hematopoietic Stem ◽  
Exercise Interventions ◽  
Randomized Controlled ◽  
Meta Analyses

Background The treatment-related burden for patients undergoing hematopoietic stem cell transplantation (HSCT) may be relieved by physical exercises. Purpose The purpose of this study was to summarize and analyze the evidence provided by randomized controlled trials (RCTs) on physical exercise interventions among patients with cancer undergoing HSCT. Data Sources PubMed, CINAHL, EMBASE, the Cochrane Library, and PEDro were searched for relevant RCTs up to October 1, 2011. Study Selection Two reviewers screened articles on inclusion criteria and indentified relevant RCTs. Data Extraction Two authors assessed the selected articles for risk of bias. Data extraction was performed by 1 reviewer. Meta-analyses were undertaken to estimate the outcomes quality of life (QOL), psychological well-being and distress, and fatigue. Data Synthesis Eleven studies were included, with study populations consisting of recipients undergoing either an allogeneic or autologous HSCT (n=734). Four studies had low risk of bias. The exercise interventions were performed before, during, and after hospitalization for the HSCT. Different exercise programs on endurance, resistance and/or activities of daily living training, progressive relaxation, and stretching were used. Meta-analyses showed that exercise during hospitalization led to a higher QOL (weighted mean difference=8.72, 95% confidence interval=3.13, 14.31) and less fatigue (standardized mean difference=0.53, 95% confidence interval=0.16, 0.91) in patients with an allogeneic HSCT at the moment of discharge from the hospital. No marked effects were found for psychological well-being and distress. Individual study results suggested significant positive effects on QOL, fatigue, psychological well-being and distress, and physical functioning. Limitations Prevalent shortcomings in the included studies were the heterogeneity among studies and the lack of blinding of participants, personnel, and outcome assessment. Conclusions The results suggest that recipients of HSCT may benefit from physical exercise.

scholarly journals Efficacy of halofuginone products to prevent or treat cryptosporidiosis in bovine calves: a systematic review and meta-analyses

Parasitology ◽  
2020 ◽  
pp. 1-12
Author(s):  
Julii Brainard ◽  
Charlotte C. Hammer ◽  
Paul R. Hunter ◽  
Frank Katzer ◽  
Georgina Hurle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Gain ◽  
Prophylactic Treatment ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Industry Funding ◽  
Calf Health ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Design Experiments

Abstract A prior systematic review on the efficacy of halofuginone (HFG) treatment to prevent or treat cryptosporidiosis in bovine calves was inconclusive. We undertook an updated synthesis and meta-analyses on key outcomes for the treatment of calves with HFG. Evaluated outcomes were oocyst shedding, diarrhoea, mortality and weight gain. Experiments had to describe results for same age animals in contemporary arms. Most doses were 100–150 mcg kg−1 day−1. Results were subgrouped by study design, experiments with the lowest risk of bias and lack of industry funding. Eighteen articles were found that described 25 experiments. Most evidence came from randomized controlled trials in Europe. Significantly lower incidence of oocyst shedding, diarrhoea burden and mortality was reported when treatment started before calves were 5 days old. Most studies reported on outcomes for animals up to at least 28 days old. Publication bias was possible in all outcomes and seemed especially likely for diarrhoea outcomes. Beneficial results when HFG treatment was initiated in calves older than 5 days were also found. Prophylactic treatment to prevent cryptosporidiosis is effective in preventing multiple negative outcomes and is beneficial to calf health and will result in a reduction of environmental contamination by Cryptosporidium oocysts.

Outcomes of Surgical Treatment of Migraines: A Systematic Review & Meta-Analysis

2021 ◽  
pp. 229255032110367
Author(s):  
Adam G. Evans ◽  
Dorian S. Hill ◽  
Andrew E. Grush ◽  
Mauricio A. Downer ◽  
Maryo M. Ibrahim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Migraine Headache ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Headache Frequency ◽  
Randomized Controlled ◽  
Headache Severity ◽  
Meta Analyses ◽  
Migraine Surgery

Background: Migraine surgery at 1 of 6 identified “trigger sites” of a target cranial sensory nerve has rapidly grown in popularity since 2000. This study summarizes the effect of migraine surgery on headache severity, headache frequency, and the migraine headache index score which is derived by multiplying migraine severity, frequency, and duration. Materials and Methods: This is a PRISMA-compliant systematic review of 5 databases searched from inception through May 2020 and is registered under the PROSPERO ID: CRD42020197085. Clinical trials treating headaches with surgery were included. Risk of bias was assessed in randomized controlled trials. Meta-analyses were performed on outcomes using a random effects model to determine the pooled mean change from baseline and when possible, to compare treatment to control. Results: 18 studies met criteria including 6 randomized controlled trials, 1 controlled clinical trial, and 11 uncontrolled clinical trials treated 1143 patients with pathologies including migraine, occipital migraine, frontal migraine, occipital nerve triggered headache, frontal headache, occipital neuralgia, and cervicogenic headache. Migraine surgery reduced headache frequency at 1 year postoperative by 13.0 days per month as compared to baseline ( I2 = 0%), reduced headache severity at 8 weeks to 5 years postoperative by 4.16 points on a 0 to 10 scale as compared to baseline ( I2 = 53%), and reduced migraine headache index at 1 to 5 years postoperative by 83.1 points as compared to baseline ( I2 = 2%). These meta-analyses are limited by a small number of studies that could be analyzed, including studies with high risk of bias. Conclusion: Migraine surgery provided a clinically and statistically significant reduction in headache frequency, severity, and migraine headache index scores. Additional studies, including randomized controlled trials with low risk-of-bias should be performed to improve the precision of the outcome improvements.

scholarly journals Covered versus bare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials

2016 ◽  
Vol 10 (1) ◽  
pp. 32-41 ◽  
Author(s):  
Xingshun Qi ◽  
Yulong Tian ◽  
Wei Zhang ◽  
Zhiping Yang ◽  
Xiaozhong Guo
Keyword(s):  
Overall Survival ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Portosystemic Shunt ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Covered Stents ◽  
Randomized Controlled ◽  
Intrahepatic Portosystemic Shunt ◽  
Meta Analyses

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment option for the management of portal hypertension in liver cirrhosis. Since the introduction of covered stents, shunt patency has been greatly improved. However, it remains uncertain about whether covered stents could improve survival. A meta-analysis of randomized controlled trials has been performed to compare the outcomes of covered versus bare stents for TIPS. Methods: PubMed, EMBASE, and Cochrane Library databases were searched to identify the relevant randomized controlled trials. Overall survival, shunt patency, and hepatic encephalopathy were the major endpoints. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was calculated. Cochrane risk of bias tool was employed. Results: Overall, 119 papers were identified. Among them, four randomized controlled trials were eligible. Viatorr covered stents alone, Fluency covered stents alone, and Viatorr plus Fluency covered stents were employed in one, two, and one randomized controlled trials, respectively. Risk of bias was relatively low. Meta-analyses demonstrated that the covered-stents group had significantly higher probabilities of overall survival (HR = 0.67, 95% CI = 0.50–0.90, p = 0.008) and shunt patency (HR = 0.42, 95% CI = 0.29–0.62, p < 0.0001) than the bare-stents group. Additionally, the covered-stents group might have a lower risk of hepatic encephalopathy than the bare-stents group (HR = 0.70, 95% CI = 0.49–1.00, p = 0.05). The heterogeneity among studies was not statistically significant in the meta-analyses. Conclusions: Compared with bare stents, covered stents for TIPS may improve the overall survival. In the era of covered stents, the indications for TIPS may be further expanded.

scholarly journals Updating Perspectives on Meta-Analyses in the Field of Radiation Oncology

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 117
Author(s):  
In-Soo Shin ◽  
Chai Hong Rim
Keyword(s):  
Rare Diseases ◽  
Radiation Oncology ◽  
Clinical Studies ◽  
Observational Studies ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Future Directions ◽  
Clinical Evaluations ◽  
Randomized Controlled ◽  
Meta Analyses

Meta-analyses have been conventionally performed to extract the firmest conclusions from randomized controlled trials while minimizing the risk of bias. However, the field of oncology does not always allow for collecting the best evidence. Radiation oncology is a discipline where intractable or rare diseases are commonly encountered; hence, more practical data suitable for detailed clinical evaluations are needed. This review discusses new viewpoints regarding meta-analyses by pointing out heterogeneities among clinical studies and issues related to analyzing observational studies, thus clarifying the practical utility of meta-analyses in radiation oncology. Limitations of previous systematic reviews or meta-analyses are also assessed to suggest future directions.

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