Efficacy of psychotherapies and pharmacotherapies for Bulimia nervosa

2018 ◽  
Vol 49 (6) ◽  
pp. 898-910 ◽  
Author(s):  
Jennifer Svaldi ◽  
Florian Schmitz ◽  
Julia Baur ◽  
Andrea S. Hartmann ◽  
Tanja Legenbauer ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Primary Outcome ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Random Effects Models ◽  
Self Help ◽  
Fixed And Random Effects ◽  
Significant Impairment ◽  
Meta Analyses

AbstractBackgroundBulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological, nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the efficacy of these interventions in up to 19 different interventions.MethodsDatabase search terms were combined for BN and RCTs from database inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome variables. Retrieved RCTs were meta-analyzed using fixed and random effects models.ResultsRCT (79 trials; 5775 participants) effects post-treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help, pharmacotherapy, and combined therapies.ConclusionsMost psychological and pharmacological interventions revealed to be effective in BN treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration, CBT can be recommended as the best intervention for the initial treatment of BN.

scholarly journals Weekend effects of admission and surgery in acute aortic syndrome

2021 ◽  
Author(s):  
Chao Song ◽  
YunLong Fan ◽  
ShiXiong Wei ◽  
Shengli Jiang
Keyword(s):  
Primary Outcome ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Weekend Effect ◽  
Acute Aortic Syndrome ◽  
Random Effects Models ◽  
Acute Aortic Syndromes ◽  
Increased Risk ◽  
Fixed And Random Effects ◽  
All Cause Mortality

Background: The weekend effect is a phenomenon characterized by increased early all-cause mortality among patients hospitalized or undergoing surgery over the weekend for emergencies. Objectives: With this meta-analysis we aimed to determine whether weekend hospitalization/surgery due to acute aortic syndromes (AAS) is associated with increased early all-cause mortality. Methods：Major electronic databases were searched for studies published up to October 2020 reporting early all-cause mortality rates for admissions/operations on weekends versus weekdays. Data were pooled using fixed- and random-effects models. The primary outcome of the study was early all-cause mortality after weekend versus weekday. Results: All the included studies were retrospective, comparative or cohort studies enrolling patients admitted or underwent surgery for AAS and reported early all-cause mortality after weekend (including holiday) versus weekday. A total of 18 studies including a total of 252807 patients were identified. This meta-analysis showed a significant increase in the early all-cause mortality for patients admitted/conducted surgery for AAS on weekends compare with weekdays (fixed-effect: OR 1.1;95% CI 1.06-1.14;P＜0.00001). Conclusion: Weekend admission/surgery for AAS is associated with a increased risk of early all-cause mortality.

scholarly journals Efficacy of psychological treatments for patients with schizophrenia and relevant negative symptoms: A meta-analysis

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Marcel Riehle ◽  
Mara Cristine Böhl ◽  
Matthias Pillny ◽  
Tania Marie Lincoln
Keyword(s):  
Negative Symptoms ◽  
Primary Outcome ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cognitive Remediation ◽  
Target Population ◽  
Therapeutic Approaches ◽  
Treatment As Usual ◽  
Psychological Treatments ◽  
Meta Analyses

Background Recent meta-analyses on the efficacy of psychological treatments for the negative symptoms of schizophrenia included mostly trials that had not specifically targeted negative symptoms. To gauge the efficacy of such treatments in the target patient population – namely people with schizophrenia who experience negative symptoms – we conducted a meta-analysis of controlled trials that had established an inclusion criterion for relevant negative symptom severity. Method We conducted a systematic literature search and calculated random-effects meta-analyses for controlled post-treatment effects and for pre-post changes within treatment arms. Separate analyses were conducted for different therapeutic approaches. Our primary outcome was reduction in negative symptoms; secondary outcomes were amotivation, reduced expression, and functioning. Results Twelve studies matched our inclusion criteria, testing Cognitive Behavioral Therapy (CBT) vs. treatment-as-usual (k = 6), Cognitive Remediation (CR) vs. treatment-as-usual (k = 2), CBT vs. CR (k = 2), and Body-oriented Psychotherapy (BPT) vs. supportive group counseling and vs. Pilates (k = 1 each). Accordingly, meta-analyses were performed for CBT vs. treatment-as-usual, CR vs. treatment-as-usual, and CBT vs. CR. CBT and CR both outperformed treatment-as-usual in reducing negative symptoms (CBT: Hedges’ g = -0.46; CR: g = -0.59). There was no difference between CBT and CR (g = 0.12). Significant pre-post changes were found for CBT, CR, and to a lesser extent for treatment-as-usual, but not for BPT. Conclusion Although effects for some approaches are promising, more high-quality trials testing psychological treatments for negative symptoms in their target population are needed to place treatment recommendations on a sufficiently firm foundation.

scholarly journals Effects of dutasteride on prostate cancer incidence: A systematic review and meta-analysis

2020 ◽  
Vol 11 (4) ◽  
pp. 7266-7270
Author(s):  
Gyeong-Eun Min ◽  
Haesoo Kim ◽  
Da Eun Lee ◽  
Kisok Kim
Keyword(s):  
Prostate Cancer ◽  
Random Effects ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Adult Males ◽  
Fixed Effects Model ◽  
Random Effects Models ◽  
Benign Prostate Hypertrophy ◽  
Fixed And Random Effects ◽  
Meta Analyses

5-Alpha-reductase inhibitors (5-ARIs) are used in the treatment of benign prostate hypertrophy (BPH). 5-ARIs, such as finasteride and dutasteride, suppress the biosynthesis of dihydrotestosterone (DHT), a precursor of androgen, which is closely related to the incidence of prostate cancer (PCa). A previous meta-analysis demonstrated a relationship between finasteride use and the incidence of PCA. However, there have been no meta-analyses on the relationship between PCa and dutasteride alone. This meta-analysis was performed to examine the prevalence of PCa in adult males taking dutasteride. We searched PubMed for reports regarding PCa risk and dutasteride use. The study was conducted according to the PRISMA guidelines for systematic reviews and meta-analyses. The analytic hierarchy process (AHP) method was used to weight the studies. Odds ratios (ORs), 95% confidence intervals (CIs), and P-values were calculated using fixed- and random-effects models. A total of eight articles were included in the meta-analysis. The overall OR for both the fixed- and random-effects models was 0.669 and the 95% CI for the random-effects model (0.526–0.851; P = 0.006) was wider than that for the fixed effects model (0.548–0.817; P < 0.001). This study confirmed that the incidence of PCa was significantly reduced by taking dutasteride.

scholarly journals To which extent are per-and poly-fluorinated substances associated to metabolic syndrome?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Maryam Zare Jeddi ◽  
Rozita Soltanmohammadi ◽  
Giulia Barbieri ◽  
Aline S. C. Fabricio ◽  
Gisella Pitter ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
General Population ◽  
Meta Analysis ◽  
Small Body ◽  
Epidemiological Studies ◽  
Cross Sectional ◽  
Random Effects Models ◽  
Epidemiologic Evidence ◽  
Adults And Children ◽  
Meta Analyses

Abstract Exposure to per- and polyfluoroalkyl substances (PFAS), ubiquitous persistent environmental contaminants, has led to substantial global concern due to their potential environmental and human health effects. Several epidemiological studies have assessed the possible association between PFAS exposure and risk of metabolic syndrome (MetS), however, the results are ambiguous. The aim of this study was to assess the current human epidemiologic evidence on the association between exposure to PFAS and MetS. We performed a systematic search strategy using three electronic databases (PubMed, Scopus, and Web of Science) for relevant studies concerning the associations of PFAS with MetS and its clinical relevance from inception until January 2021. We undertook meta-analyses where there were five or more studies with exposure and outcomes assessments that were reasonably comparable. The pooled odd ratios (ORs) were calculated using random effects models and heterogeneity among studies was assessed by I2 index and Q test. A total of 12 cross-sectional studies (10 studies on the general population and two studies in the occupational settings) investigated the association between PFAS exposure and MetS. We pooled data from seven studies on the general population for perfluorooctanoic acid (PFOA) and perfluorooctanesulfonate (PFOS) and five studies for perfluorohexanesulfonate (PFHxS) and perfluorononanoic acid (PFNA). Predominately, most studies reported no statistically significant association between concentrations of PFAS and MetS. In the meta-analysis, the overall measure of effect was not statistically significant, showing no evidence of an association between concentrations of PFOA, PFOS, PFNA, and PFHxS and the risk of MetS. Based on the results of the meta-analysis, current small body of evidence does not support association between PFAS and MetS. However, due to limited number of studies and substantial heterogeneity, results should be interpreted with caution. Further scrutinizing cohort studies are needed to evaluate the association between various and less well-known PFAS substances and their mixture with MetS and its components in both adults and children in different settings.

scholarly journals Comparison of the efficacy of hematopoietic stem cell mobilization regimens: a systematic review and network meta-analysis of preclinical studies

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Chengxin Luo ◽  
Li Wang ◽  
Guixian Wu ◽  
Xiangtao Huang ◽  
Yali Zhang ◽  
...  
Keyword(s):  
Standard Dose ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Preclinical Studies ◽  
Mice Model ◽  
Short Term ◽  
Hematopoietic Stem ◽  
Support Unit ◽  
Meta Analyses

Abstract Background Mobilization failure may occur when the conventional hematopoietic stem cells (HSCs) mobilization agent granulocyte colony-stimulating factor (G-CSF) is used alone, new regimens were developed to improve mobilization efficacy. Multiple studies have been performed to investigate the efficacy of these regimens via animal models, but the results are inconsistent. We aim to compare the efficacy of different HSC mobilization regimens and identify new promising regimens with a network meta-analysis of preclinical studies. Methods We searched Medline and Embase databases for the eligible animal studies that compared the efficacy of different HSC mobilization regimens. Primary outcome is the number of total colony-forming cells (CFCs) in per milliliter of peripheral blood (/ml PB), and the secondary outcome is the number of Lin− Sca1+ Kit+ (LSK) cells/ml PB. Bayesian network meta-analyses were performed following the guidelines of the National Institute for Health and Care Excellence Decision Support Unit (NICE DSU) with WinBUGS version 1.4.3. G-CSF-based regimens were classified into the SD (standard dose, 200–250 μg/kg/day) group and the LD (low dose, 100–150 μg/kg/day) group based on doses, and were classified into the short-term (2–3 days) group and the long-term (4–5 days) group based on administration duration. Long-term SD G-CSF was chosen as the reference treatment. Results are presented as the mean differences (MD) with the associated 95% credibility interval (95% CrI) for each regimen. Results We included 95 eligible studies and reviewed the efficacy of 94 mobilization agents. Then 21 studies using the poor mobilizer mice model (C57BL/6 mice) to investigate the efficacy of different mobilization regimens were included for network meta-analysis. Network meta-analyses indicated that compared with long-term SD G-CSF alone, 14 regimens including long-term SD G-CSF + Me6, long-term SD G-CSF + AMD3100 + EP80031, long-term SD G-CSF + AMD3100 + FG-4497, long-term SD G-CSF + ML141, long-term SD G-CSF + desipramine, AMD3100 + meloxicam, long-term SD G-CSF + reboxetine, AMD3100 + VPC01091, long-term SD G-CSF + FG-4497, Me6, long-term SD G-CSF + EP80031, POL5551, long-term SD G-CSF + AMD3100, AMD1300 + EP80031 and long-term LD G-CSF + meloxicam significantly increased the collections of total CFCs. G-CSF + Me6 ranked first among these regimens in consideration of the number of harvested CFCs/ml PB (MD 2168.0, 95% CrI 2062.0−2272.0). In addition, 7 regimens including long-term SD G-CSF + AMD3100, AMD3100 + EP80031, long-term SD G-CSF + EP80031, short-term SD G-CSF + AMD3100 + IL-33, long-term SD G-CSF + ML141, short-term LD G-CSF + ARL67156, and long-term LD G-CSF + meloxicam significantly increased the collections of LSK cells compared with G-CSF alone. Long-term SD G-CSF + AMD3100 ranked first among these regimens in consideration of the number of harvested LSK cells/ml PB (MD 2577.0, 95% CrI 2422.0–2733.0). Conclusions Considering the number of CFC and LSK cells in PB as outcomes, G-CSF plus AMD3100, Me6, EP80031, ML141, FG-4497, IL-33, ARL67156, meloxicam, desipramine, and reboxetine are all promising mobilizing regimens for future investigation.

scholarly journals Association between insulin resistance and post-ischaemic stroke outcome in patients without diabetes: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044771
Author(s):  
Jeremiah Hadwen ◽  
Woojin Kim ◽  
Brian Dewar ◽  
Tim Ramsay ◽  
Alexandra Davis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Insulin Resistance ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Stroke Outcome ◽  
Post Stroke ◽  
Meta Analyses

IntroductionInsulin resistance is an independent risk factor for atherosclerosis, coronary artery disease and ischaemic stroke. Currently, insulin resistance is not usually included in post-stroke risk stratification. This systematic review and meta-analysis intends to determine if available scientific knowledge supports an association between insulin resistance and post-stroke outcomes in patients without diabetes.Methods and analysisThe authors will conduct a literature search in Medline, Embase, Web of Science and Cochrane Central. The review will include studies that assess the association between elevated insulin homeostasis model of insulin resistance (HOMA-IR) and post-stroke outcome (functional outcome and recurrent stroke). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines will be used. The primary outcome will be post-stroke functional outcome (Modified Rankin Scale), and the secondary outcome will be recurrent ischaemic stroke. Comparison of outcome will be made between highest and lowest HOMA-IR range (as defined in each article included in this systematic review). Risk of bias will be assessed qualitatively. Meta-analysis will be performed if sufficient homogeneity exists between studies. Heterogeneity of outcomes will be assessed by I².Ethics and disseminationNo human or animal subjects or samples were/will be used. The results will be published in a peer-reviewed journal, and will be disseminated at local and international neurology conferences.PROSPERO registration numberCRD42020173608.

Meta-analysis of effect sizes reported at multiple time points: A multivariate approach

2012 ◽  
Vol 9 (5) ◽  
pp. 610-620 ◽  
Author(s):  
Thomas A Trikalinos ◽  
Ingram Olkin
Keyword(s):  
Random Effects ◽  
Treatment Effects ◽  
Multivariate Analyses ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Multiple Time ◽  
Time Points ◽  
Fixed And Random Effects ◽  
Multiple Time Points ◽  
Meta Analyses

Background Many comparative studies report results at multiple time points. Such data are correlated because they pertain to the same patients, but are typically meta-analyzed as separate quantitative syntheses at each time point, ignoring the correlations between time points. Purpose To develop a meta-analytic approach that estimates treatment effects at successive time points and takes account of the stochastic dependencies of those effects. Methods We present both fixed and random effects methods for multivariate meta-analysis of effect sizes reported at multiple time points. We provide formulas for calculating the covariance (and correlations) of the effect sizes at successive time points for four common metrics (log odds ratio, log risk ratio, risk difference, and arcsine difference) based on data reported in the primary studies. We work through an example of a meta-analysis of 17 randomized trials of radiotherapy and chemotherapy versus radiotherapy alone for the postoperative treatment of patients with malignant gliomas, where in each trial survival is assessed at 6, 12, 18, and 24 months post randomization. We also provide software code for the main analyses described in the article. Results We discuss the estimation of fixed and random effects models and explore five options for the structure of the covariance matrix of the random effects. In the example, we compare separate (univariate) meta-analyses at each of the four time points with joint analyses across all four time points using the proposed methods. Although results of univariate and multivariate analyses are generally similar in the example, there are small differences in the magnitude of the effect sizes and the corresponding standard errors. We also discuss conditional multivariate analyses where one compares treatment effects at later time points given observed data at earlier time points. Limitations Simulation and empirical studies are needed to clarify the gains of multivariate analyses compared with separate meta-analyses under a variety of conditions. Conclusions Data reported at multiple time points are multivariate in nature and are efficiently analyzed using multivariate methods. The latter are an attractive alternative or complement to performing separate meta-analyses.

scholarly journals Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Simantiris ◽  
AS Antonopoulos ◽  
A Angelopoulos ◽  
P Papanikolaou ◽  
EK Oikonomou ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Vascular Inflammation ◽  
Composite Endpoint ◽  
Imaging Biomarkers ◽  
Secondary Outcome ◽  
Incremental Prognostic Value

Abstract Funding Acknowledgements Type of funding sources: None. Background Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance. Methods We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome. Results We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. &lt;5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with &lt;5% cumulative event incidence, D) Conclusions The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication. Abstract Figure.

Novel oral anticoagulats for the treatment of left ventricle thrombosis: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Serenelli ◽  
F Vitali ◽  
R Pavasini ◽  
E Tonet ◽  
G Pompei ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Ventricular Thrombus

Abstract Funding Acknowledgements Type of funding sources: None. Background novel oral anticoagulants (NOACs) are not guideline-recommanded treatment for left ventricular thrombus.  Purpose: the aim of this meta-analysis is to compare NOACs versus vitamin-K atagonsits (VKAs) efficacy in treating left ventricular thrombus (LVT). Methods: we systematically searched MEDLINE, Cochrane Library, Biomed Central, and Web of Science for trials comparing NOACs versus VKAs in the setting of LVT. Five studies, out of the 74 initially selected after first screening, were included in the meta-analysis. For the development of this meta-analysis, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. The shortlisted studies were retrieved as full articles and appraised independently by two unblinded reviewers. The Mantel-Haensel method with a random effect model was used for the pooled analysis. The primary outcome was the occurrence of stroke and systemic embolism. Secondary outcome was occurrence of left ventricular thrombosis resolution during treatment.  Results: 707 patients were included in the analysis for the primary outcome. Of these, 230 were treated with NOACs and 477 with VKAs. The pooled OR for the primary outcome was 0.71 (95% CI 0.18-2.86, I2 67%), thus showing similar effect in term of ischaemic protection. A total of 698 patients, 228 on NOACs and 470 on VKAs were included in the analysis of the secondary outcome. The pooled OR for the secondary outcome pooled OR 0.97, 95% CI 0.56-1.68, I2 46%. Conclusions and Relevance: NOACs seem to have a similar efficacy profile compare to VKAs and so they should be considered as an alternative treatment for left ventricular thrombosis. Large prospective randomized clinical trials are needed to confirm this exploratory finding. Abstract Figure 1

Sign in / Sign up

Export Citation Format

Share Document