NEURODEVELOPMENTAL OUTCOMES AT 4–10 YEARS OF AGE IN CHILDREN BORN AT 22–25 WEEKS GESTATIONAL AGE: AN UPDATED META-ANALYSIS

Abstract BACKGROUND Published data on long-term outcomes are an important resource for clinicians to support expectant parents making perinatal care decisions. OBJECTIVES To update our 2013 meta-analysis with data from recently published, high quality cohorts of 22–25 wk GA infants using relevant definitions of neurodevelopmental disability (NDD). DESIGN/METHODS We used a peer-reviewed electronic search and grey search. Two authors independently reviewed cohorts published after May 2012 with the following inclusion criteria: born ≥1995 in a developed nation, assessed for NDD at 4–10 yrs; prospective data collection, <30% loss to follow-up, consistent definitions for moderate-to-severe (M-S) NDD as per those from EPICure; and results reported by GA. We contacted authors for clarification. Random-effects meta-analysis was used to provide pooled proportions at each GA. Weighted regression was used to examine the relationship between GA and NDD within each study. I2 was used to assess heterogeneity. RESULTS From 2481 titles, 20 full-text articles were reviewed and six (added to the nine from 2013) met inclusion criteria. High heterogeneity at higher GA and wide CIs at lower GA persisted. Results showed rates of M-S NDD in school-age survivors were: 42% (95%CI 23,64%; I2 0%) at 22 wks; 41% (95%CI 31,52%; I2 30%) at 23 wks; 32% (95%CI 25,39%; I2 44%) at 24 wks; and 23% (95%CI 18,29%; I2 60%) at 25 wks GA. The new analysis continued to show a significant decrease in likelihood of M-S NDI between each GA wk (8.1% decrease per wk (95%CI -11.8, -4.5%, p<0.001) but not for likelihood of severe NDD (2.7% decrease per wk (95%CI -6.6, 1.3%), I2 45%, p=0.18). CONCLUSION This high quality data can be used by physicians to support parents during the decision-making process for their infant. Heterogeneity and a small sample size at 22 wk GA remains a concern in the interpretation of the data.

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The Effectiveness and Safety of Chemical Drugs Combined with Acupuncture for Alzheimer’s Disease: A Systematic Review and Meta-Analysis

Acupuncture & Electro-Therapeutics Research ◽

10.3727/036012921x16321477053881 ◽

2021 ◽

Author(s):

Shenghua Yu ◽

Hongjie Liu ◽

Li Xu ◽

Yan Zhang ◽

Yan Ma ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Early Stage ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Risk Of Bias ◽

Disease Assessment ◽

High Quality ◽

Significant Difference

Introduction: Acupuncture has been applied with chemical drugs to treat Alzheimer’s disease (AD) in the clinic. Whether such combination is effective and safe should be studied although it is recommended by some researchers.Methods: To explore the effectiveness and safety of acupuncture combined with the chemical drugs for AD, databases like PubMed, Web of Science were searched to retrieve randomized controlled trials (RCTs) on AD treated with acupuncture and chemical drugs to perform meta-analysis. The risk of bias in each study was assessed using the Cochrane Risk of Bias scale. Meta-analysis was performed using RevMan 5.3.Results: Five studies were included in which only donepezil combined with acupuncture was evaluated. Acupuncture combined with donepezil showed a significant difference in effectiveness rate [RR=1.45, 95% CI (1.19, 1.77), P=0.0002] compared with donepezil. On the comparison of mini-mental state examination (MMSE) score and Alzheimer's disease assessment scale cognitive subscale (ADAS-Cog) score there was no difference. However, after one trial with severe AD patients was removed, acupuncture combined with donepezil showed better effect than donepezil alone. Conclusion: Acupuncture combined with donepezil could work on AD at the early stage or with mild AD, implying that acupuncture could be a complementary therapy for AD at early stage or with mild condition. Besides, scalp acupuncture seems to be more effective on improving cognitive function. However, this conclusion must be considered cautiously, given the small sample size and lack of trials of high quality. Therefore, more high-quality, multicenter, prospective, RCTs with large sample sizes are needed to further clarify the effect of acupuncture combined with chemical drugs for AD.

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Association of N-acetyltransferase-2 Polymorphism with Antituberculosis Induced Hepatotoxicity: A meta-analysis

Current Pharmacogenomics and Personalized Medicine ◽

10.2174/1875692118666210928170636 ◽

2021 ◽

Vol 18 ◽

Author(s):

Nur Farhana Mohamed Noor ◽

Teh Lay Kek ◽

Mohd Arif Mohd Zim ◽

Zamzurina Abu Bakar ◽

Noor Izyani Zakaria ◽

...

Keyword(s):

Statistical Analysis ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Inclusion Criteria ◽

The World ◽

Nat2 Polymorphism ◽

Q Statistic ◽

Quality Assessments ◽

Review Manager

Background: N-acetyltransferase (NAT2) polymorphisms were reported to play important roles in antituberculosis-induced hepatotoxicity (ATDIH). However, the allelic types with increased risks for ATDIH were inconsistent as most studies are of a small sample size. Objective: The objective of the study was to conduct a meta-analysis to identify NAT2 alleles associated with increased risks of ATDIH. Methods: Studies reported on NAT2 polymorphism with the risk of ATDIH were searched systematically in PubMed, Scopus, and the World of Sciences. Studies were included if they fulfilled the inclusion criteria and excluded accordingly. Quality assessments were done using Newcastle-Ottawa Score. Statistical analysis was performed using Review Manager version 5.3. Cochrane Q-statistic test and I2 statistic were used to assess and quantify heterogeneity. Results: A total of 12 studies involving 580 cases and 3129 controls were included. NAT2 polymorphism was significantly associated with the risk of ATDIH with an odd ratio (OR) of 2.76 (1.86 – 4.10, 95% CI). Among the slow acetylators genotypes, NAT2*5/*7 carry the highest risk associated with ATDIH. Conclusion: NAT2 polymorphism was significantly associated with ATDIH.

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S3. DOES SWITCHING OR AUGMENTING HELP WITH ANTIPSYCHOTIC-RELATED SEXUAL DYSFUNCTION: SYSTEMATIC REVIEW

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.069 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S30-S31

Author(s):

Kirsty Allen ◽

Alan Baban ◽

Jasna Munjiza ◽

Sofia Pappa

Keyword(s):

Systematic Review ◽

Sexual Dysfunction ◽

Small Sample Size ◽

Treatment Options ◽

Surrogate Marker ◽

Small Sample ◽

Quality Data ◽

Future Research ◽

High Quality ◽

High Quality Research

Abstract Background Sexual dysfunction is one of the most frequently occurring side-effects of antipsychotic medication, impacting both quality of life and adherence to treatment. Despite this, limited evidence-based guidance on treatment options is available. The aim of this systematic review was to synthesize and analyze the evidence on the management of antipsychotic-related sexual dysfunction, specifically taking note of the more recently developed antipsychotics that have been incorporated Methods EMBASE, Medline, and PsychINFO databases were searched using search terms related to sexual or erectile dysfunction, treatments, and antipsychotics. 2 reviewers independently assessed papers for the inclusion criteria for randomized controlled trials (RCTs) of treatments for antipsychotic-related sexual dysfunction, including adjunctive medications and a switch of antipsychotic. Studies were excluded if participants did not have recorded sexual dysfunction at baseline. Results The primary outcome measure was any change in sexual function. Results 6 RCTs were identified, all of which investigated different interventions; hence, it was not possible to synthesize the data quantitatively. Results were overall limited by small sample size, brief treatment duration, and the potential for bias. 2 studies, one assessing adjunctive sildenafil and the other adjunctive aripiprazole, reported a reduction in antipsychotic-related sexual dysfunction. Discussion Due to the lack of high-quality data, no clinical recommendations can be made. Our findings highlight the paucity of high-quality research in this area, and conjecture that it may be difficult to recruit participants with antipsychotic-related sexual dysfunction. Future research may be necessary to unlock and address these difficulties. Furthermore, fully powered future studies should focus on the management of sexual dysfunction rather than the surrogate marker of hyperprolactinemia.

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The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

Rheumatology International ◽

10.1007/s00296-021-04876-6 ◽

2021 ◽

Author(s):

Peter Cox ◽

Sonal Gupta ◽

Sizheng Steven Zhao ◽

David M. Hughes

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Diseases ◽

Small Sample Size ◽

Meta Analysis ◽

Random Effect ◽

Small Sample ◽

Future Research ◽

Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

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DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis

Acta Endocrinologica ◽

10.1530/eje-16-0297 ◽

2016 ◽

Vol 175 (2) ◽

pp. R65-R80 ◽

Cited By ~ 40

Author(s):

Irina Bancos ◽

Shrikant Tamhane ◽

Muhammad Shah ◽

Danae A Delivanis ◽

Fares Alahdab ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Performance ◽

Small Sample Size ◽

Controlled Trial ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Central Register ◽

Moderate Risk ◽

Adrenal Biopsy ◽

Adrenocortical Carcinomas

ObjectiveTo perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy.MethodsMedline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate.ResultsWe included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6–11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5–3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively.ConclusionsEvidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.

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Mesenchymal Stem Cell Therapy for Acetaminophen-Related Liver Injury: A Systematic Review and Meta-Analysis of Experimental Studies in Vivo

Current Stem Cell Research & Therapy ◽

10.2174/1574888x16666211007092055 ◽

2021 ◽

Vol 16 ◽

Author(s):

Li Wang ◽

Yiwen Zhang ◽

Jiajun Zhong ◽

Yuan Zhang ◽

Shuisheng Zhou ◽

...

Keyword(s):

Systematic Review ◽

Stem Cell ◽

Liver Injury ◽

Mesenchymal Stem Cell ◽

Small Sample Size ◽

Meta Analysis ◽

Experimental Studies ◽

Small Sample ◽

Control Group

Objective: The efficacy of mesenchymal stem cell (MSC) therapy in acetaminophen-induced liver injury has been investigated in animal experiments, but individual studies with a small sample size cannot be used to draw a clear conclusion. Therefore, we conducted a systematic review and meta-analysis of preclinical studies to explore the potential of using MSCs in acetaminophen-induced liver injury. Methods: Eight databases were searched for studies reporting the effects of MSCs on acetaminophen hepatoxicity. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. SYRCLE’s risk of bias tool for animal studies was applied to assess the methodological quality. A meta-analysis was performed by using RevMan 5.4 and STATA/SE 16.0 software. Results: Eleven studies involving 159 animals were included according to PRISMA statement guidelines. Significant associations were found for MSCs with the levels of alanine transaminase (ALT) (standardized mean difference (SMD) − 2.58, p < 0.0001), aspartate aminotransferase (AST) (SMD − 1.75, p = 0.001), glutathione (GSH) (SMD 3.7, p < 0.0001), superoxide dismutase (SOD) (SMD 1.86, p = 0.022), interleukin 10 (IL-10) (SMD 5.14, p = 0.0002) and tumor necrosis factor-α (TNF-α) (SMD − 4.48, p = 0.011) compared with those in the control group. The subgroup analysis showed that the tissue source of MSCs significantly affected the therapeutic efficacy (p < 0.05). Conclusion: Our meta-analysis results demonstrate that MSCs could be a potential treatment for acetaminophen-related liver injury.

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Endoscopic pituitary surgery: a systematic review and meta-analysis

Journal of Neurosurgery ◽

10.3171/2007.12.17635 ◽

2009 ◽

Vol 111 (3) ◽

pp. 545-554 ◽

Cited By ~ 189

Author(s):

Abtin Tabaee ◽

Vijay K. Anand ◽

Yolanda Barrón ◽

David H. Hiltzik ◽

Seth M. Brown ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Pituitary Surgery ◽

Small Sample ◽

Csf Leak ◽

Tumor Control ◽

Published Data ◽

Complication Rates ◽

Short Term ◽

The Impact

Object Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes. Methods The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes. Results Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67–89%). Hormone resolution was achieved in 81% (95% CI 71–91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76–92%) of growth hormone secreting tumors, and 82% (95% CI 70–94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0–4%) for CSF leak and 1% (95% CI 0–2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%. Conclusions The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.

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The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis

10.1101/2022.01.14.22269296 ◽

2022 ◽

Author(s):

Natalie Clinkscales ◽

Katherine Berlouis ◽

Lisa Golds ◽

Angus MacBeth

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Perinatal Period ◽

Small Sample ◽

Treatment Modalities ◽

Cochrane Library ◽

Psychological Interventions ◽

Inclusion Criteria ◽

Compulsive Disorder ◽

Perinatal Anxiety

Background: Anxiety disorders are a relatively common occurring mental health issue during pregnancy and the perinatal period. There is evidence that untreated perinatal anxiety is a risk factor for adverse outcomes for mother and infant. Despite their potential acceptability to users, psychological interventions research for this population is still in its infancy. This systematic review and meta-analysis aimed to comprehensively evaluate the evidence of the effectiveness of psychological interventions for reducing perinatal anxiety. Method: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched included EMBASE, MEDLINE, PsychINFO, MIDIRS, CINAHL and the Cochrane Library. Search terms included: Psychological Therapy, Perinatal Period, Antenatal, Postnatal, Anxiety, Obsessive Compulsive Disorder and Phobia. Results: The search strategy identified 2025 studies. A total of 21 studies published between 2004 and 2021 fulfilled inclusion criteria. Of those, 17 were included in the meta-analysis. Overall results indicated that psychological interventions were more effective than control conditions in reducing symptoms of perinatal anxiety with a medium post treatment effect size. Significant effect sizes were also identified for online, face-to-face, group and guided self-help treatment modalities. Limitations: A small sample of studies are represented and limited to articles published in English. The review was unable to draw specific conclusions about what works (i.e. therapeutic modality/delivery) for whom (i.e. specific diagnoses) due to purposefully broad inclusion criteria. The longer-term effects of psychological interventions for perinatal anxiety and infant outcomes could not be established. Conclusions: This review demonstrates that psychological interventions are effective in reducing symptoms of both anxiety and comorbid anxiety and depression in the antenatal and postnatal periods. The results also demonstrate the efficacy of delivering such interventions in multiple settings, including online, and in group format. Further research is required to optimise treatment delivery to individual needs.

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Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-01044-0 ◽

2022 ◽

Vol 11 (1) ◽

Author(s):

Valerie Wing Yu Wong ◽

Ying Huang ◽

Wan In Wei ◽

Samuel Yeung Shan Wong ◽

Kin On Kwok

Keyword(s):

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Risk Of Bias ◽

Source Control ◽

Resistant Organism ◽

Routine Practice ◽

Post Intervention ◽

Term Care ◽

Mrsa Colonization

Abstract Background Despite clear evidence of benefits in acute-care hospitals, controversy over the effectiveness of IPC measures for MDROs is perceptible and evidence-based practice has not been established. Objective To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. Data sources Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. Eligibility criteria Original and peer-reviewed articles examining the post-intervention effects on MDRO colonization and infections in LTCFs. Interventions (i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and (ii) vertical intervention: active surveillance plus decolonization. Study appraisal and synthesis We employed a random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention duration; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. Results Of 3877 studies identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs)). Studies reported outcomes associated with MRSA (15 studies), vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies were included in the meta-analysis. The pRRs were close to unity regardless of intervention duration (long: RR 0.81 [95% CI 0.60–1.10]; medium: RR 0.81 [95% CI 0.25–2.68]; short: RR 0.95 [95% CI 0.53–1.69]). Vertical interventions in studies with a small sample size showed significant reductions in MRSA colonization while horizontal interventions did not. All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies. Conclusions Our meta-analysis did not show any beneficial effects from IPC interventions on MRSA reductions in LTCFs. Our findings highlight that the effectiveness of interventions in these facilities is likely conditional on resource availability—particularly decolonization and barrier precautions, due to their potential adverse events and uncertain effectiveness. Hence, administrative engagement is crucial for all effective IPC programmes. LTCFs should consider a pragmatic approach to reinforce standard precautions as routine practice and implement barrier precautions and decolonization to outbreak responses only.

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Abstract 181: A Systematic Review of Interventions to Increase tPA Administration

Stroke ◽

10.1161/str.47.suppl_1.181 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Mollie McDermott ◽

Lesli E Skolarus ◽

James F Burke

Keyword(s):

Systematic Review ◽

Public Education ◽

Small Sample Size ◽

Case Reports ◽

Meta Analysis ◽

Experimental Studies ◽

Fixed Effect Model ◽

Small Sample ◽

Eligibility Criteria ◽

Design Elements

Introduction: Rates of tPA administration remain low nationally and globally despite its demonstrated efficacy. We performed a systematic review and meta-analysis of interventions to increase the rate of tPA administration. Methods: We searched PubMed and EMBASE to identify all studies (excluding case reports) published between 1995 and January 8, 2015 documenting interventions to increase the utilization of tPA. We screened each study with pre-specified inclusion and exclusion criteria. Design elements and study data were extracted from eligible studies. The principal summary measure was the percentage change in rate of tPA administration. Fixed and random effects meta-analytic models were built to summarize the effect of intervention compared to control as well as intervention subtypes. Results: Our search yielded 1457 results of which 25 met eligibility criteria. We identified 13 pre-post studies and 11 randomized or quasi-experimental studies. Included studies utilized EMS (n=14), telemedicine (n=6), and public education (n=5). Intervention settings included urban (n=13), rural (n=4), and combined (n=4). In a fixed effect model, tPA administration was significantly higher in the intervention arm across all studies that limited enrollment to ischemic stroke patients (n=14) with a risk ratio (RR) of 1.71. Interventions involving EMS were associated with an increased rate of tPA administration with a RR of 1.51, (95% CI: 1.43-1.59, p<0.0001); promoting public education RR = 2.62, (95% CI: 1.54-4.43, p<0.01); and utilizing telemedicine RR = 2.97, (95% CI: 2.61-3.39, p<0.0001). Conclusions: Interventions to increase tPA use appear to have considerable efficacy. Comparative inferences between intervention types are limited by small sample size and intervention heterogeneity.

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