scholarly journals Interventions for Improving Psychosocial Adjustment in Nursing Home Residents: A Network Meta-Analysis

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 279-279
Author(s):  
Yanyan Zhang ◽  
Huimin Xiao ◽  
Binbin Yong
Keyword(s):  
Art Therapy ◽  
Psychosocial Adjustment ◽  
Group Counseling ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Self Esteem ◽  
Risk Of Bias ◽  
Forest Plot ◽  
Group Reminiscence

Abstract This study aimed to identify the evidence of interventions for improving psychosocial adjustment in older adults relocating to nursing homes. We followed PRISMA-NMA guidelines to conduct a network meta-analysis. 12 electric databases were used to search for eligible randomized controlled trials (RCTs) and clinical trials (CCTs) from inception to August 27th, 2019. Two reviewers independently conducted article screening, data extraction, and risk of bias appraisal with the Revised Cochrane risk-of-bias tool for RCT and Risk Of Bias for CCT. The network plots were plotted to provide a visual representation of the evidence base. Bayesian fixed-effects pairwise and network meta-analysis were exhibited in the forest plot. A Bayesian network meta-analysis was performed on 30 eligible RCTs with 2119 participants, and 12 eligible CCTs with 491 participants. The quality of the most included studies was rated as moderate in RCTs and low in CCTs. Treatment effects showed that compared to conventional treatment, group reminiscence and group counseling resulted in significant improvements in loneliness (MD: 11, 95%, CI: 2.7–17, SUCRA: 99.5%; MD: 7.7, 95%, CI: 0.53–15, SUCRA: 53.9%, respectively). Similar results were obtained for art therapy (MD: 5.5, 95%CI: 0.8–10, SUCRA: 97.3%) in self-esteem. The model fit was good, and the inconsistency was low. Group reminiscence, group counseling, and art therapy are recommended for reducing loneliness and enhance self-esteem in nursing practice.

scholarly journals Systematic review and meta-analysis of the prevalence of coronavirus in the world: One health approach is urgent

2021 ◽  
Author(s):  
Ricardo Faustino ◽  
Miguel Faria ◽  
Monica Teixeira ◽  
Filipe Palavra ◽  
Maria Do Ceu Costa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fixed Effects ◽  
One Health ◽  
Animal Species ◽  
Meta Analysis ◽  
Epidemiological Surveillance ◽  
Forest Plot ◽  
Atypical Pneumonia ◽  
Systematic Analysis ◽  
Different Strains

Coronaviruses have been responsible for major epidemic crises in 2003 with SARS-CoV-1, in 2012 with MERS-CoV and in 2019 with SARS-CoV-2 (COVID-19), causing serious atypical pneumonia in humans. We intend, with this systematic analysis and meta-analysis, to clarify the prevalence of the various strains of coronavirus in different animal species. For this purpose, we carried out an electronic survey using Pubmed's Veterinary Science search tool to conduct a systematic assessment of published studies reporting the prevalence of different strains of coronavirus in different animal species between 2015 and 2020. We conducted different analysis to assess sensitivity, publication bias, and heterogeneity, using random and fixed effects. The final meta-analysis included 42 studies for systematic review and 29 in the meta-analysis. For the geographic regions with a prevalence greater than or equal to 0.20 (Forest plot overall; prevalence = 0.20, p < 0.01, Q = 10476.22 and I2 = 100%), the most commonly detected viruses were: enteric coronavirus (ECoV), pigeon-dominant coronavirus, (PdCoV), Avian coronavirus M41, Avian coronavirus C46, Avian coronavirus A99, Avian coronavirus JMK, MERS-CoV, Bovine coronavirus, Ro-BatCoV GCCDC1, Alphacoronavirus, Betacoronavirus, Deltacoronavirus, Gamacoronavirus and human coronaviruses (HCoVs). The wide presence of different strains of coronavirus in different animal species on all continents demonstrates the great biodiversity and ubiquity of these viruses. The most recent epidemiological crises caused by coronavirus demonstrates our unpreparedness to anticipate and mitigate emerging risks, as well as the need to implement new epidemiological surveillance programs for viruses. Combined with the need to create advanced training courses in One Health, this is paramount in order to ensure greater effectiveness in fighting the next pandemics.

scholarly journals How to read and interpret the results of a Bayesian network meta-analysis: a short tutorial

2019 ◽  
Vol 20 (2) ◽  
pp. 106-115 ◽  
Author(s):  
D. Hu ◽  
A. M. O'Connor ◽  
C. B. Winder ◽  
J. M. Sargeant ◽  
C. Wang
Keyword(s):  
Bayesian Network ◽  
Bayesian Approach ◽  
Probability Distributions ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Forest Plot ◽  
The Novel ◽  
Meta Analyses ◽  
Realistic Data

AbstractIn this manuscript we use realistic data to conduct a network meta-analysis using a Bayesian approach to analysis. The purpose of this manuscript is to explain, in lay terms, how to interpret the output of such an analysis. Many readers are familiar with the forest plot as an approach to presenting the results of a pairwise meta-analysis. However when presented with the results of network meta-analysis, which often does not include the forest plot, the output and results can be difficult to understand. Further, one of the advantages of Bayesian network meta-analyses is in the novel outputs such as treatment rankings and the probability distributions are more commonly presented for network meta-analysis. Our goal here is to provide a tutorial for how to read the outcome of network meta-analysis rather than how to conduct or assess the risk of bias in a network meta-analysis.

scholarly journals Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ashley M. Campbell ◽  
David Rhys Axon ◽  
Jennifer R. Martin ◽  
Marion K. Slack ◽  
Lea Mollon ◽  
...  
Keyword(s):  
Older Adults ◽  
Surgical Procedures ◽  
Odds Ratio ◽  
Fixed Effects ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Forest Plot ◽  
Fixed Effects Model ◽  
Pharmacological Agents ◽  
Delirium Prevention

Abstract Background Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures. Methods A systematic search using PubMed/Medline, Embase, PsycINFO, CINAHL, and references of identified articles published in English between January 1990 and October 2017 was performed. Two independent reviewers screened titles and abstracts, and then extracted data following a full-text review of included articles with consensus generation and bias assessment. Studies reporting outcomes for melatonin or ramelteon use to prevent delirium in postoperative hospitalized patients (mean age ≥ 50 years) were eligible for inclusion. Data were pooled using a fixed-effects model to generate a forest plot and obtain a summary odds ratio for the outcome of interest (delirium incidence). Cochran’s Q and I2 values were used to investigate heterogeneity. Results Of 335 records screened, 6 studies were selected for the qualitative analysis and 6 were included in the meta-analysis (n = 1155). The mean age of patients in included studies ranged from 59 to 84 years. Patients in intervention groups typically received melatonin or ramelteon at daily doses of two to eight milligrams around cardiothoracic, orthopedic, or hepatic surgeries for one to nine days, starting on the evening before or the day of surgery. The incidence of delirium ranged from 0 to 30% in the intervention groups versus 4–33% in the comparator groups, and was significantly reduced in the melatonin group, with a summary effect of the meta-analysis yielding an odds ratio of 0.63 (95% CI 0.46 to 0.87; 0.006; I2 = 72.1%). A one study removed analysis reduced overall odds ratio to 0.310 (95% CI 0.19 to 0.50), while reducing heterogeneity (Cochran’s Q = 0.798, I2 = 0.000). Conclusion Perioperative melatonin reduced the incidence of delirium in older adults in the included studies. While optimal dosing remains an unanswered question, the potential benefit of melatonin and melatonin receptor agonists may make them a reasonable option to use for delirium prevention in older adults undergoing surgical procedures.

P2641Renal and cardiovascular benefits of treatment with angiotensin receptor blockers in patients with hypertension and chronic kidney disease: A systematic review and meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Burnier ◽  
L R Ruilope ◽  
G B Bader ◽  
S D Durg ◽  
P B Brunel
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Forest Plot ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Receptor Blockers ◽  
The Impact

Abstract Background Blood pressure (BP) control is critical in delaying the progression of chronic kidney disease (CKD), which otherwise results in an increased risk of cardiovascular morbidity and mortality. Angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors, are recommended by several guidelines as first-line treatment for patients with hypertension and CKD. Purpose We reviewed and analysed the effect of ARB treatment on BP and renal outcomes (estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria) in patients with hypertension and CKD with or without diabetes, including large clinical trials such as RENAAL and IDNT. Methods MEDLINE, EMBASE, and BIOSIS databases were searched for literature from the earliest available date to July 2017. Randomised (parallel-group) controlled trials of ≥8 weeks assessed the impact of ARBs on systolic/diastolic BP (SBP/DBP), eGFR, SCr, CrCl or proteinuria were included in the analysis. Meta-analysis (post- versus pre-treatment) and meta-regression were conducted in R-statistical software (v3.4.1) using meta- and metafor-packages. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to pool data for an outcome in a single forest plot. The risk of bias (quality) of included studies was assessed by the six items of the Cochrane instrument. Results Of the 165 articles assessed for eligibility, 24 studies were included in the analysis (19 evaluated ARBs as monotherapy, 4 evaluated ARBs in combination with other antihypertensives and 1 evaluated ARBs both as mono- and combination therapy). Treatment with ARBs as monotherapy for ≥8 weeks to <1 year significantly reduced mean office SBP (MD, −12.60 mmHg; 95% CI, −18.53 to −6.67)/DBP (−6.52 mmHg; −11.27 to −1.77) (p<0.01). BP reduction was also significant (p<0.01) with ARB monotherapy for ≥1 year SBP (−14.84 mmHg; −17.82 to −11.85)/DBP (−10.27 mmHg; −12.26 to −8.27). ARBs also significantly reduced SBP/DBP when combined with other antihypertensive treatments for ≥8 weeks to <1 year as well as for ≥1 year (Figure). Moreover, ARBs induced significant reductions (p<0.01) in proteinuria (≥8 weeks to <1 year [MD, −0.6 g/L; 95% CI, −0.93 to −0.26; ≥1 year [−0.9 g/L; −1.22 to −0.59]), but no significant changes in eGFR, CrCl or SCr levels. The beneficial effect of ARBs was maintained overtime with no significant additional impact on SBP change (estimate: 0.025; 95% CI, –0.14 to 0.19) or eGFR (estimate: 0.068; 95% CI, −0.14 to 0.28; p=0.53). The overall risk of bias was judged to be low. Effect of ARBs on blood pressure changes Conclusion Treatment with ARBs effectively and sustainably lowered BP and proteinuria with no significant change in eGFR in patients with hypertension and CKD with or without diabetes.

Systemic therapy for nonmetastatic castrate-resistant prostate cancer (M0 CRPC): A systematic review and network meta-analysis (NMA).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 113-113
Author(s):  
Ellen Cusano ◽  
Richard M. Lee-Ying ◽  
Devon J. Boyne ◽  
Darren Brenner ◽  
Marcus Vaska
Keyword(s):  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Similar Efficacy ◽  
Risk Of Bias ◽  
Fixed Effects Model ◽  
Castrate Resistant Prostate Cancer ◽  
Grade 3 ◽  
Castrate Resistant ◽  
The Cochrane Collaboration

113 Background: The treatment landscape for M0 CRPC has changed following the demonstrated efficacy of new agents in recent randomized control trials (RCT). However, the comparative effectiveness of these novel agents is unknown. This NMA indirectly compared the efficacy and safety of available therapies for M0 CRPC. Methods: A literature search of MEDLINE (Ovid), EBM Reviews, HealthSTAR, PubMed, PubMed Central, CINAHL, and TRIP Database was performed. Studies were screened by two independent reviewers. Hazard ratios (HR) and confidence intervals were extracted for the primary outcome metastasis-free survival (MFS) and the secondary outcomes overall survival (OS) and grade 3 or higher adverse events (AE). Bone MFS was used as a surrogate for MFS when MFS was not reported. Risk of bias was assessed using the Cochrane Collaboration tool. A Bayesian NMA was performed using a fixed-effects model. Results: Four RCT were analyzed (n=5549). Each trial compared either apalutamide (APA), enzalutamide (ENZA), darolutamide (DARO), or denosumab (DENO) plus androgen deprivation therapy (ADT) to placebo plus ADT. Risk of bias was low. For MFS, APA and ENZA had similar efficacy (Table), and Surface Under the Cumulative Ranking Analysis demonstrated a 59% probability that APA was preferred for MFS, followed by ENZA (41%). There was a trend for improved OS for APA, DARO and ENZA, but no meaningful differences between these agents. APA, ENZA, and DARO had a similar risk of AEs and all had a greater risk of AEs compared to DENO. Conclusions: APA and ENZA appear to be the most efficacious treatments for MFS in M0 CRPC, though more data for OS is required. Compared to DARO, APA and ENZA’s demonstrated efficacy is not at the expense of added toxicity.[Table: see text]

Prevention of Healthcare-Associated Pneumonia with Oral Care in Individuals Without Mechanical Ventilation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2015 ◽  
Vol 36 (8) ◽  
pp. 899-906 ◽  
Author(s):  
Asako Kaneoka ◽  
Jessica M. Pisegna ◽  
Keri V. Miloro ◽  
Mel Lo ◽  
Hiroki Saito ◽  
...  
Keyword(s):  
Nursing Home ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Oral Care ◽  
Nursing Home Residents ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Preventive Effect ◽  
Randomized Controlled ◽  
Healthcare Associated

OBJECTIVEEvidence is lacking on the preventive effect of oral care on healthcare-associated pneumonia in hospitalized patients and nursing home residents who are not mechanically ventilated. The primary aim of this review was to assess the effectiveness of oral care on the incidence of pneumonia in nonventilated patients.METHODSWe searched 8 databases (MEDLINE, Embase, CENTRAL, CINAHL, Web of Science, LILACS, ICHUSHI, and CiNii), in addition to trial registries and a manual search. Eligible studies were published and unpublished randomized controlled trials examining the effect of any method of oral care on reported incidence of pneumonia and/or fatal pneumonia. Relative risks (RR) and 95% confidence intervals were calculated. Risk of bias was assessed for eligible studies.RESULTSWe identified 5 studies consisting of 1,009 subjects that met the inclusion criteria. Of these, 2 trials assessed the effect of chlorhexidine in hospitalized patients; 3 studies examined mechanical oral cleaning in nursing home residents. A meta-analysis could only be done on 4 trials; this analysis showed a significant risk reduction in pneumonia through oral care interventions (RRfixed, 0.61; 95% CI, 0.40–0.91; P=.02). The effects of mechanical oral care alone were significant when pooled across studies. (RRfixed, 0.61; 95% CI, 0.40–0.92; P=.02). Risk reduction for fatal pneumonia from mechanical oral cleaning was also significant (RRfixed, 0.41; 95% CI, 0.23–0.71; P=.002). Most studies had a high risk of bias.CONCLUSIONSThis analysis suggests a preventive effect of oral care on pneumonia in nonventilated individuals. This effect, however, should be interpreted with caution due to risk of bias in the included trials.Infect Control Hosp Epidemiol 2015;36(8): 899–906

scholarly journals Metadta: A Stata Command for Meta-analysis and Meta-regression of Diagnostic Test Accuracy Data – A Tutorial.

2021 ◽  
Author(s):  
Victoria Nyawira Nyaga ◽  
Marc Arbyn
Keyword(s):  
Bladder Cancer ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Diagnostic Test Accuracy ◽  
Forest Plot ◽  
Test Accuracy ◽  
Statistical Procedures ◽  
Meta Regression

Abstract BackgroundAlthough statistical procedures for pooling of several epidemiological metrics are generally available in statistical packages, those for meta-analysis of diagnostic test accuracy studies including options for multivariate regression are lacking. Fitting regression models and the processing of the estimates often entails lengthy and tedious calculations. Therefore, packaging appropriate statistical procedures in a robust and user-friendly program is of great interest to the scientific community. Methodsmetadta is a statistical program for pooling of diagnostic accuracy test data in Stata. It implements both the bivariate random-effects and fixed-effects model, allows for meta-regression, and presents the results in tables, a forest plot and/or summary receiver operating characteristic (SROC) plot. For a model without covariates, it also quantifies heterogeneity using an I2 statistic that accounts for the mean-variance relationship, and correlation between sensitivity and specificity, a typical characteristic of diagnostic data. To demonstrate metadta, we applied the program on two published meta-analyses on: 1) the sensitivity and specificity of cytology and other markers including telomerase for primary diagnosis of bladder cancer; and 2) the accuracy of human papillomavirus testing on self-collected versus clinician-collected samples to detect cervical precancer.ResultsWithout requiring a continuity correction, metadta generated a pooled sensitivity and specificity of 0.77 [95% CI: 0.70, 0.82] and 0.91 [95% CI: 0.75, 0.97] respectively of telomerase for the diagnosis of primary bladder cancer. metadta allowed to assess the relative accuracy of human Papilloma virus (HPV) testing on self- versus clinician-taken specimens in matched studies taking into account two covariates. Under the condition of using assays based on target-amplification, HPV tests were similarly sensitive to detect cervical pre-cancer, irrespective of clinical setting. ConclusionThe metadta program implements state of art statistical procedures in an attempt to close the gap between methodological statisticians and systematic reviewers. With metadta, we hope to popularize even further, the use of appropriate statistical methods for diagnostic meta-analysis.

scholarly journals Effect of surface treatment on the mechanical stability of orthodontic miniscrews:

2021 ◽  
Author(s):  
Yousef Al-Thomali ◽  
Sakeenabi Basha ◽  
Roshan Noor Mohamed
Keyword(s):  
Confidence Interval ◽  
Surface Treatment ◽  
Mechanical Stability ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Mean Difference ◽  
Forest Plot ◽  
Total N ◽  
Standard Mean Difference ◽  
Effect Of Surface

ABSTRACT Objectives To provide collective quantitative evidence about the effect of surface treatments on the mechanical stability of orthodontic miniscrews (MSs). Materials and Methods The study was registered in PROSPERO (No. CRD42020209652). The research question was defined according to the PICO (population, intervention, control, and outcomes) format. Various research databases were searched for animal and human studies on effects of surface treatment on the mechanical stability of MSs. Both prospective and retrospective in vivo clinical studies published in English were included. The risk of bias was assessed using SYRCLE's risk of bias tool for animal studies. The meta-analysis was conducted using RevMan 5.4. Results A total of 109 articles were identified; 14 were included in the systematic review, and seven studies with sandblasting, acid etching (SLA) methods of surface treatment were included for meta-analysis. The number of study participants ranged from 6 to 24 (total n = 185), with a mean of 13.2. A total of 949 MSs were used with a mean of 67.8. The overall success rate for surface-treated MSs ranged from 47.9% to 100%. Forest plot of removal torque values showed significantly higher values for SLA surface-treated MSs compared with controls with a standard mean difference of 2.61 (95% confidence interval = 1.49–3.72, I2 = 85%). Forest plot of insertion torque showed a standard mean difference of –6.19 (95% confidence interval = –13.63–1.25, I2 = 98%, P = .10). Conclusions Surface treatment of MSs improved primary and secondary stability with good osseointegration at the bone-implant surface. However, significant heterogeneity across the studies included in the meta-analysis made it difficult to draw conclusions.

Prevalence of Dental Anomalies in Nonsyndromic Individuals with Cleft Lip and Palate: A Systematic Review and Meta-analysis

2012 ◽  
Vol 49 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Patricia Nivoloni Tannure ◽  
Cristiana Aroeira G.R. Oliveira ◽  
Lucianne Copie Maia ◽  
Alexandre R. Vieira ◽  
José Mauro Granjeiro ◽  
...  
Keyword(s):  
Random Effects ◽  
Fixed Effects ◽  
Cleft Lip And Palate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Permanent Teeth ◽  
Cochrane Library ◽  
Tooth Agenesis ◽  
Dental Anomalies ◽  
Oral Clefts

Objective To assess whether individuals born with nonsyndromic oral clefts display a higher frequency of dental anomalies. Design A search of MEDLINE, BIREME, OVID ALL EMB Reviews, and The Cochrane Library was conducted. The methodologic quality of the papers selected was assessed and scored. Papers reporting observational controlled studies of nonsyndromic forms of oral cleft matched for dental anomalies in primary and/or permanent teeth were included without language restrictions. Eligible studies were scored as “A”—low risk of bias, “B”—moderate risk of bias, or “C”—high risk of bias and poor quality. Fixed and random effects models were used to aggregate individual odds ratios (OR) and to derive pooled estimates and 95% confidence intervals. Results Six studies fulfilled our selection criteria and were included in the meta-analysis. Three distinct subgroup analyses were carried out in terms of dental anomalies. In the tooth agenesis meta-analysis, a random effects model was used because of heterogeneity and showed a significant association between tooth agenesis and oral clefts (OR = 12.31; 95% confidence interval [CI] = 3.75 to 40.36). In the remaining analyses, the fixed effects model revealed a positive association between supernumerary (OR = 4.99; 95% CI, 2.58 to 9.64) and crown morphologic abnormalities (OR = 5.69; 95% CI, 3.96 to 8.19) with oral clefts. Most included studies were of low to moderate quality. Conclusion Although general limitations in study design were observed, the evidence suggests that a higher number of dental anomalies in the permanent dentition are noted in individuals born with oral clefts.

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