662 Clinical Outcomes from Prospective Randomized Trials on the Proportion of Carbohydrates versus Fat in Enteral Nutrition for Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S176-S176
Author(s):  
Beth A Shields ◽  
Kaitlin A Pruskowski ◽  
James K Aden ◽  
Anthony Basel ◽  
Garrett W Britton ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Burn Injury ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Burn Patients ◽  
Levels Of Evidence ◽  
American Society ◽  
Meta Analyses ◽  
Current Guidelines

Abstract Introduction Multiple organizations have developed guidelines for nutritional support following burn trauma. These guidelines are based on low levels of evidence and largely on expert opinion. We sought to compile randomized controlled trials (RCTs) evaluating clinical outcomes from carbohydrate versus fat in enteral nutrition (EN) for burn patients and then analyze outcomes via meta-analysis and compare these outcomes to current available guidelines. Methods We performed a literature search to identify RCTs evaluating outcomes of burn patients with different proportions of carbohydrate versus fat interventions. Meta-analyses were conducted on outcomes reported by more than one RCT with the DerSimonian and Laird random effects model. Statistical significance was established at α less than 0.05. Meta-analysis results were then evaluated alongside the available guidelines from American Society for Parenteral and Enteral Nutrition (ASPEN) and Society of Critical Care Medicine (SCCM), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the International Society for Burn Injury (ISBI). Results We identified 3 studies meeting our inclusion criteria for RCTs. Meta-analysis showed lower fat, higher carbohydrate EN to be associated with lower incidence of pneumonia (p=0.0005) as well as a reduction in mortality (p=0.04). The ASPEN/SCCM and ISBI guidelines do not specifically address this topic. ESPEN recommends less than 60% carbohydrates and less than 35% fat. However, this is not in accordance with the 46–65% carbohydrate and 12–27% fat with favorable outcomes studied in the 3 identified RCTs. Conclusions As current guidelines are often not based on high levels of evidence, it was important to collect and evaluate all of the available RCTs. Our meta-analysis results of these RCTs demonstrated mortality benefits with lower fat, higher carbohydrate EN in burn patients. Additionally, we found lower rates of pneumonia with lower fat, higher carbohydrate EN. Applicability of Research to Practice Consideration should be made for 12–27% fat, 46–65% carbohydrate EN in burn patients; however, multicentered trials are required before strong recommendations can be made.

40 Implementation of a Nursing-driven Volume-based Enteral Feeding Protocol

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S27-S27
Author(s):  
Kristin Moore ◽  
Cheryl Cooper ◽  
Kayleigh Fagert ◽  
Amalia Cochran ◽  
Sheela S Thomas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Burn Injury ◽  
Burn Patients ◽  
Improvement Project ◽  
Related Data ◽  
Catching Up ◽  
Time Period ◽  
Burn Patient

Abstract Introduction Nutrition in the burn patient is vital to proper wound healing and graft take, counteracting the hypermetabolic response, and improving patient outcomes. Studies support early, aggressive enteral nutrition for burn patients. Enteral nutrition is often interrupted during hospitalization, causing patients to fail to achieve their nutritional goals. To maximize nutritional support for burn patients, our institution implemented a nurse-driven, volume-based enteral infusion protocol (VBP). The goal of this quality improvement project was to compare clinical outcomes and volume of enteral nutrition received by the burn patient pre- and post-VBP. Methods A single-center retrospective analysis was conducted at one adult burn center comparing pre- and post-implementation of a VBP. Patients aged 18–89 years admitted to the SICU for initial management of burn injury between November 2014 – May 2015 (pre-VBP) and June 2015 – January 2016 (post-VBP) were included; for stepdown patients the time period ranged from June 2017 – December 2017 (pre-VBP) and February 2018 – September 2018 (post-VBP). Pertinent demographic and burn-related data were collected. Clinical outcomes included length of stay (LOS), complications as defined by National Burn Repository, duration of mechanical ventilation, percent weight gain or loss, and percent of enteral volume received. Results In the SICU, there were 10 patients pre-protocol and 12 patients post-protocol. When comparing pre-VBP to post-VBP demographics, mean TBSA was 19.6% (1–40.5) vs 24.83% (2–61.5%), with a mean age of 64.4 vs 60.7 years. For clinical outcomes, mean number of complications was 1.6 vs 2, with mean ventilator days of 16.2 vs 16.4, SICU mean length of stay/TBSA 1.99 vs 2.23 days, and hospital mean LOS/TBSA 3.83 vs 2.54 days. Overall prescribed amount of enteral nutrition received pre-VBP was 105% vs post-VBP amount received at 95% (p=0.09). For the step-down unit, there were 8 patients pre-protocol and 6 patients post-protocol. Overall prescribed amount of enteral nutrition received pre-VBP was 83% vs post-VBP amount received at 89% (p=0.3815). Conclusions While clinical outcomes remain unchanged during the evaluation period, our patients met their prescribed enteral nutrition volume requirements when a nurse-driven VBP was initiated. In addition, for non-ICU patients, a trend was seen towards increased tube feeds with VBP. Applicability of Research to Practice Nurse-driven VBPs allow for RNs to adjust the rate of enteral nutrition by “catching up” for interruptions in feeding to meet the patient’s nutritional goals for the day.

Clinical outcomes of cancer patients with COVID-19: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18600-e18600
Author(s):  
Maryam Alasfour ◽  
Salman Alawadi ◽  
Malak AlMojel ◽  
Philippos Apolinario Costa ◽  
Priscila Barreto Coelho ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Small Sample ◽  
Prediction Intervals ◽  
Invasive Ventilation ◽  
Newcastle Ottawa Scale ◽  
Small Sample Sizes ◽  
Meta Analyses

e18600 Background: Patients with coronavirus disease 2019 (COVID-19) and cancer have worse clinical outcomes compared to those without cancer. Primary studies have examined this population, but most had small sample sizes and conflicting results. Prior meta-analyses exclude most US and European data or only examine mortality. The present meta-analysis evaluates the prevalence of several clinical outcomes in cancer patients with COVID-19, including new emerging data from Europe and the US. Methods: A systematic search of PubMED, medRxiv, JMIR and Embase by two independent investigators included peer-reviewed papers and preprints up to July 8, 2020. The primary outcome was mortality. Other outcomes were ICU and non-ICU admission, mild, moderate and severe complications, ARDS, invasive ventilation, stable, and clinically improved rates. Study quality was assessed through the Newcastle–Ottawa scale. Random effects model was used to derive prevalence rates, their 95% confidence intervals (CI) and 95% prediction intervals (PI). Results: Thirty-four studies (N = 4,371) were included in the analysis. The mortality prevalence rate was 25.2% (95% CI: 21.1–29.7; 95% PI: 9.8-51.1; I 2 = 85.4), with 11.9% ICU admissions (95% CI: 9.2-15.4; 95% PI: 4.3-28.9; I 2= 77.8) and 25.2% clinically stable (95% CI: 21.1-29.7; 95% PI: 9.8-51.1; I 2 = 85.4). Furthermore, 42.5% developed severe complications (95% CI: 30.4-55.7; 95% PI: 8.2-85.9; I 2 = 94.3), with 22.7% developing ARDS (95% CI: 15.4-32.2; 95% PI: 5.8-58.6; I 2 = 82.4), and 11.3% needing invasive ventilation (95% CI: 6.7-18.4; 95% PI: 2.3-41.1; I 2 = 79.8). Post-follow up, 49% clinically improved (95% CI: 35.6-62.6; 95% PI: 9.8-89.4; I 2 = 92.5). All outcomes had large I 2 , suggesting high levels of heterogeneity among studies, and wide PIs indicating high variability within outcomes. Despite this variability, the mortality rate in cancer patients with COVID-19, even at the lower end of the PI (9.8%), is higher than the 2% mortality rate of the non-cancer with COVID-19 population, but not as high as what other meta-analyses conclude, which is around 25%. Conclusions: Patients with cancer who develop COVID-19 have a higher probability of mortality compared to the general population with COVID-19, but possibly not as high as previous studies have shown. A large proportion of them developed severe complications, but a larger proportion recovered. Prevalence of mortality and other outcomes published in prior meta-analyses did not report prediction intervals, which compromises the clinical utilization of such results.

715 Early Ambulation for Enhanced Recovery After Burn Surgery: A Systematic Review and Meta-analysis

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S189-S189
Author(s):  
Tomer Lagziel ◽  
Margarita Ramos ◽  
Kevin M Klifto ◽  
Stella Steal ◽  
Julie Caffrey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Burn Patients ◽  
Early Ambulation ◽  
Lengths Of Stay ◽  
Operative Care ◽  
Burn Surgery ◽  
Operative Recovery

Abstract Introduction Accurate models are a fundamental prognostic tool for risk stratification, therapy guidance, resource allocation, and comparative effectiveness research. Enhanced recovery after surgery protocols are developed to increase early post-operative recovery rates in surgical patients. Due to the unique nature of burn injuries and post-operative care, there is a need to develop a protocol unique to burn surgery, enhanced recovery after burn surgery. Methods The PubMed, Embase, Cochrane, and Web of Science databases were systematically searched. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines were strictly followed throughout the study. Search terms were utilized to capture the relevant studies relating to early ambulation of adult burn patients (>18 years of age) and their post-surgical outcomes such as graft take, time to discharge, pain levels, VTEs, and length-of-stay. Results Thirteen of 888 studies retrieved from the search query were eligible for systematic review and meta-analysis. Patients with delayed ambulation, after 5 or more days were found to have increased pain levels at rest (p=0.02) and when ambulating (p=0.08). One study found an increased infection rate in late ambulatory patients (p=0.22). Most results from studies did not have significant data that was relevant to our extraction. For example, only one study assessed pain levels and only three studies notes zero venous thromboembolisms (without statistical significance). Conclusions Limited evidence exists relating to thromboembolic events and time-to-ambulation in post-operative burn patients. There are no significant differences in the number of events between early and late ambulation groups. Early ambulation should be included as part of the ERABS protocol for lower risks of hospital-acquired infections due to shorter lengths-of-stay. Decreased associated pain levels could lead to decreased risk for opioid dependence. Due to limited literature references, these conclusions are immature and more studies should be performed in order to develop more accurate and effective protocols. Applicability of Research to Practice Burn surgery recovery patients are unique. Therefore, specialized protocols must be developed to enhance their post-operative care.

scholarly journals Postoperative outcomes in distal hypospadias: a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture

2019 ◽  
Vol 35 (11) ◽  
pp. 1301-1308 ◽  
Author(s):  
Hans Winberg ◽  
Einar Arnbjörnsson ◽  
Magnus Anderberg ◽  
Pernilla Stenström
Keyword(s):  
Urethral Stricture ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Urethrocutaneous Fistula ◽  
Levels Of Evidence ◽  
Tubularized Incised Plate ◽  
Postoperative Fistula ◽  
Distal Hypospadias ◽  
Based Medicine

Abstract Purpose To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP) repair methods for distal hypospadias. Methods In this meta-analysis, electronic databases were searched for comparative studies on the two techniques. The Oxford Centre for Evidence-based Medicine Levels of Evidence was used to evaluate the included studies. The main outcome measure was the frequency of postoperative fistula and urethral stricture. RevMan 5.3 was used for statistical analyses, with P < 0.05 indicating statistical significance. Results A total of 17 studies, which included 1572 patients, met the inclusion criteria. The frequency of urethrocutaneous fistula did not differ between the Mathieu [115 (13%)] and TIP [90 (13%)] methods [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.6–1.9; P = 0.73)]. Urethral stricture was less frequent after the Mathieu [15 (2%)] method than after the TIP [37 (5%)] method (OR 0.5, 95% CI 0.3–0.8; P < 0.01), even after the subgroup analysis of eight randomized controlled trials was included. Overall, the quality of the included studies was determined to be satisfactory. The levels of evidence on which this review was based ranged from 1b to 2b using the CEBM Levels of Evidence. Conclusion Compared with TIP repair, Mathieu repair for hypospadias had a significantly lower risk for urethral stricture; however, the risk for urethrocutaneous fistula was similar.

scholarly journals Incidence of Respiratory Symptoms for Residents Living Near a Petrochemical Industrial Complex: A Meta-Analysis

2020 ◽  
Vol 17 (7) ◽  
pp. 2474
Author(s):  
Wen-Wen Chang ◽  
Hathaichon Boonhat ◽  
Ro-Ting Lin
Keyword(s):  
Respiratory Symptoms ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Random Effect ◽  
Study Groups ◽  
Industrial Complex ◽  
Residential Exposure ◽  
Increased Risk ◽  
Subgroup Analyses ◽  
Meta Analyses

The air pollution emitted by petrochemical industrial complexes (PICs) may affect the respiratory health of surrounding residents. Previous meta-analyses have indicated a higher risk of lung cancer mortality and incidence among residents near a PIC. Therefore, in this study, a meta-analysis was conducted to estimate the degree to which PIC exposure increases the risk of the development of nonmalignant respiratory symptoms among residents. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to systematically identify, select, and critically appraise relevant research. Finally, we identified 16 study groups reporting 5 types of respiratory symptoms: asthma, bronchitis, cough, rhinitis, and wheezing. We estimated pooled odds ratios (ORs) using random-effect models and investigated the robustness of pooled estimates in subgroup analyses by location, observation period, and age group. We determined that residential exposure to a PIC was significantly associated with a higher incidence of cough (OR = 1.35), wheezing (OR = 1.28), bronchitis (OR = 1.26), rhinitis (OR = 1.17), and asthma (OR = 1.15), although the latter two associations did not reach statistical significance. Subgroup analyses suggested that the association remained robust across different groups for cough and bronchitis. We identified high heterogeneity for asthma, rhinitis, and wheezing, which could be due to higher ORs in South America. Our meta-analysis indicates that residential exposure to a PIC is associated with an increased risk of nonmalignant respiratory symptoms.

Immediate versus wait-and-gradual discontinuation in antipsychotic switching: A meta-analysis

2020 ◽  
Vol 34 (8) ◽  
pp. 914-919
Author(s):  
Hiroyoshi Takeuchi ◽  
Gary Remington
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Outcome Data ◽  
Controlled Trials ◽  
Double Blind ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Meta Analyses ◽  
Switching Strategies

Introduction: In two previous meta-analyses of randomized controlled trials (RCTs) examining antipsychotic switching strategies in patients with schizophrenia, we showed no significant differences in any clinical outcomes between immediate versus gradual and gradual versus wait-and-gradual discontinuation of the pre-switch antipsychotic. In this report, we compared immediate versus wait-and-gradual antipsychotic discontinuation. Methods: We identified five RCTs examining immediate versus wait-and-gradual discontinuation of the pre-switch antipsychotic in antipsychotic switching involving patients with schizophrenia. However, no data were available from one RCT. The following clinical outcome data were extracted and meta-analyzed: study discontinuation, psychopathology, extrapyramidal symptoms, and treatment-emergent adverse events that were reported in two or more of the studies. Results: The meta-analysis included four RCTs involving 351 patients ( n=175 for immediate and n=176 for wait-and-gradual antipsychotic discontinuation). A significant difference was found in study discontinuation due to all causes ( n=4, n=351, risk ratio=1.58, 95% confidence interval 1.15–2.17, p=0.005, I2=0%) between the immediate and wait-and-gradual antipsychotic discontinuation groups, while there was no significant difference in any other clinical outcomes. The group difference in study discontinuation due to all causes remained significant for the studies adopting immediate antipsychotic initiation but not for the studies switching to ziprasidone. Conclusion: Findings suggest that wait-and-gradual antipsychotic discontinuation may be preferable when a more cautious antipsychotic switch is needed. However, further long-term, double-blind RCTs are needed to confirm the present findings.

scholarly journals Association of statin use and clinical outcomes in heart failure patients: a systematic review and meta-analysis

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Agata Bielecka-Dabrowa ◽  
Ibadete Bytyçi ◽  
Stephan Von Haehling ◽  
Stefan Anker ◽  
Jacek Jozwiak ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Meta Analyses ◽  
Statin Use

Abstract Background The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins’ prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF. Methods We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization. Results Finally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72–0.83, P < 0.0001, I2 = 63%), CV mortality (HR 0.82, 95% CI: 0.76–0.88, P < 0.0001, I2 = 63%), and CV hospitalization (HR 0.78, 95% CI: 0.69–0.89, P = 0.0003, I2 = 36%). All-cause mortality was reduced on statin therapy in HF with both EF < 40% and ≥ 40% (HR: 0.77, 95% Cl: 0.68–0.86, P < 0.00001, and HR 0.75, 95% CI: 0.69–0.82, P < 0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79–0.93, P = 0.0003, and HR 0.83, 95% CI: 0.77–0.90, P < 0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64–0.99, P = 0.04 and HR 0.76 95% CI: 0.61–0.93, P = 0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies’ analyses; the effect was also larger and significant for lipophilic than hydrophilic statins. Conclusions In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.

scholarly journals Impact of donor and recipient Epstein-Barr Virus serostatus on outcomes of allogeneic hematopoietic cell transplantation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Michalina Kołodziejczak ◽  
◽  
Lidia Gil ◽  
Rafael de la Camara ◽  
Jan Styczyński
Keyword(s):  
Clinical Outcomes ◽  
Graft Versus Host Disease ◽  
Epstein Barr Virus ◽  
De Novo ◽  
Meta Analysis ◽  
Graft Versus Host ◽  
Hematological Diseases ◽  
Barr Virus ◽  
Epstein Barr ◽  
Meta Analyses

AbstractAllogeneic hematopoietic cell transplant (allo-HCT) is a potentially curative therapeutic strategy that showed encouraging long-term outcomes in hematological diseases. A number of factors can influence post-transplant clinical outcomes. While Epstein-Barr virus (EBV) constitutes a trigger for development of various adverse conditions, no clinical study yet has been powered to assess the effect of EBV serostatus on the clinical outcomes in allo-HCT population. To systematically summarize and analyze the impact of donor and recipient EBV serostatus on transplant outcomes in allo-HCT recipients, meta-analyses were conducted. Selected endpoints were overall survival (OS), relapse-free survival (RFS), relapse incidence (RI), non-relapse mortality (NRM), acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD), and de novo cGVHD. Three studies with 26,650 patients, transplanted for acute leukemias, lymphomas, chronic hematological malignancies, or non-malignant hematological diseases were included in the meta-analysis. In the whole population, with a total of 53,300 donors and recipients, the rate of EBV seropositivity was 85.1%, including 86.6% and 83.6% among transplant recipients and healthy donors, respectively. Donor EBV seropositivity increased the risk of cGVHD by 17%, de novo cGVHD by 14%, and aGHVD by 5%. Recipient EBV seropositivity increased the risk of cGVHD by 12%, de novo cGVHD by 17%; increased NRM by 11%, increased RI by 11%, decreased OS by 14%, and decreased RFS by 11%. In performed meta-analyses, donor and recipient EBV seropositivity was found to have a significant impact on transplant outcomes in patients after allo-HCT.

Determining the Benefits of Rituximab + Chemotherapy for Patients with Untreated Follicular Lymphoma: A Comprehensive Meta-Analysis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3330-3330 ◽  
Author(s):  
Josiah N. Orina ◽  
Christopher R. Flowers
Keyword(s):  
Follicular Lymphoma ◽  
Watchful Waiting ◽  
Meta Analysis ◽  
Single Agent ◽  
Inclusion Criteria ◽  
First Line ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
American Society ◽  
Meta Analyses

Abstract Background: Current guidelines offer numerous options for initiating therapy in patients with untreated, advanced stage follicular lymphoma (FL). Selecting among these options that include watchful waiting, single-agent and combination chemotherapy, monoclonal antibodies, and radioimmunotherapy, remains challenging. Recent data suggest that chemotherapy combined with a monoclonal antibody may alter patterns of relapse and overall survival for pts with FL (Fisher, Blood 2004). While rituximab (R) chemotherapy combinations have become commonly used for untreated pts with FL, to date, the optimal first-line therapy remains undefined. To address this issue, we updated a systematic literature review and performed a meta-analysis of first-line therapy for untreated FL that examined the effect of various chemotherapy regimens combined with R on response rates and survival in patients with untreated FL. Methods: The comprehensive systematic review included searches the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 1, 2003), MEDLINE (1/1996–6/2006), EMBASE (1/1980–7/2006), American Society of Hematology Annual Meeting abstracts (2002–2005), and American Society of Clinical Oncology Annual Meeting abstracts (1995–2006). Each database was searched using combinations of the term follicular lymphoma and the terms for medications and treatment regimens. Inclusion criteria for studies were as follows: 1) Inclusion of patients with untreated stage III/IV FL grades 1, 2, or 3; 2) Intervention with chemotherapy and/or immunotherapy, radioimmunotherapy, or watchful waiting; 3) Reporting in English of the following treatment outcome measures specifically for patients with FL: CR/CR-unconfirmed, overall response rate (OR), and at least one form of survival data. Abstracts subsequently published as papers were excluded. Extracted data included pre-treatment disease status, treatment regimen, median follow-up time, progression free survival, overall survival, CR and OR. The following treatment strategies from peer-review publications were analyzed: single agent R, R-CVP, R-CHOP, and fludarabine-combinations with R (R-Fcom). In meta-analyses of selected studies, we utilized the Mantel-Haenszel (fixed effects model) and DerSimonain and Laird (random effects) methods to calculate the risk difference comparing treatment regimens’ CR/CRu to the spontaneous CR in patients undergoing watchful waiting (4.6%; Ardeshna et al. Lancet, 2003). Results: In total, over 3135 abstracts were reviewed to identify 11 studies meeting the inclusion criteria for this analysis. These studies included data from 3144 patients. Only one study presenting CR data for R-CVP (36%, 95% confidence interval: 28%–44%) met inclusion criteria. The meta-analyses estimated the CR rate associated with single-agent R to be 30% (95% CI: 20%–40%), R-CHOP to be 62% (30%–94%), and R-Fcom to be 85% (76%–94%) (random effects; see Figure). Conclusions: R-CHOP and R-fludarabine combinations appear to produce the highest CR rates for untreated pts with FL. Meta-analysis can aid clinicians in therapeutic decision making as they weight the risks and benefits of various regimens for newly diagnosed pts. Figure Figure

Can Reliance be Placed on a Single Meta-Analysis?

1990 ◽  
Vol 24 (3) ◽  
pp. 405-415 ◽  
Author(s):  
Nathaniel McConaghy
Keyword(s):  
Literature Review ◽  
Effect Size ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Effect Sizes ◽  
Control Groups ◽  
Consistent Finding ◽  
Placebo Controls ◽  
Effect Of Treatment ◽  
Meta Analyses

Meta-analysis replaced statistical significance with effect size in the hope of resolving controversy concerning evaluation of treatment effects. Statistical significance measured reliability of the effect of treatment, not its efficacy. It was strongly influenced by the number of subjects investigated. Effect size as assessed originally, eliminated this influence but by standardizing the size of the treatment effect could distort it. Meta-analyses which combine the results of studies which employ different subject types, outcome measures, treatment aims, no-treatment rather than placebo controls or therapists with varying experience can be misleading. To ensure discussion of these variables meta-analyses should be used as an aid rather than a substitute for literature review. While meta-analyses produce contradictory findings, it seems unwise to rely on the conclusions of an individual analysis. Their consistent finding that placebo treatments obtain markedly higher effect sizes than no treatment hopefully will render the use of untreated control groups obsolete.

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