scholarly journals Systematic Review and Meta-Analysis of the Efficacy of Appropriate Empiric Antibiotic Therapy for Sepsis

2010 ◽  
Vol 54 (11) ◽  
pp. 4851-4863 ◽  
Author(s):  
Mical Paul ◽  
Vered Shani ◽  
Eli Muchtar ◽  
Galia Kariv ◽  
Eyal Robenshtok ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Antibiotic Treatment ◽  
Effect Size ◽  
Observational Studies ◽  
Meta Analysis ◽  
Empiric Antibiotic Therapy ◽  
Clinical Variable ◽  
Empirical Antibiotic Treatment ◽  
All Cause Mortality

ABSTRACT Quantifying the benefit of early antibiotic treatment is crucial for decision making and can be assessed only in observational studies. We performed a systematic review of prospective studies reporting the effect of appropriate empirical antibiotic treatment on all-cause mortality among adult inpatients with sepsis. Two reviewers independently extracted data. Risk of bias was assessed using the Newcastle-Ottawa score. We calculated unadjusted odds ratios (ORs) with 95% confidence intervals for each study and extracted adjusted ORs, with variance, methods, and covariates being used for adjustment. ORs were pooled using random-effects meta-analysis. We examined the effects of methodological and clinical confounders on results through subgroup analysis or mixed-effect meta-regression. Seventy studies were included, of which 48 provided an adjusted OR for inappropriate empirical antibiotic treatment. Inappropriate empirical antibiotic treatment was associated with significantly higher mortality in the unadjusted and adjusted comparisons, with considerable heterogeneity occurring in both analyses (I 2 > 70%). Study design, time of mortality assessment, the reporting methods of the multivariable models, and the covariates used for adjustment were significantly associated with effect size. Septic shock was the only clinical variable significantly affecting results (it was associated with higher ORs). Studies adjusting for background conditions and sepsis severity reported a pooled adjusted OR of 1.60 (95% confidence interval = 1.37 to 1.86; 26 studies; number needed to treat to prevent one fatal outcome, 10 patients [95% confidence interval = 8 to 15]; I 2 = 46.3%) given 34% mortality with inappropriate empirical treatment. Appropriate empirical antibiotic treatment is associated with a significant reduction in all-cause mortality. However, the methods used in the observational studies significantly affect the effect size reported. Methods of observational studies assessing the effects of antibiotic treatment should be improved and standardized.

Determinants of inappropriate empirical antibiotic treatment: systematic review and meta-analysis

2018 ◽  
Vol 51 (4) ◽  
pp. 548-553 ◽  
Author(s):  
Elena Carrara ◽  
Iris Pfeffer ◽  
Oren Zusman ◽  
Leonard Leibovici ◽  
Mical Paul
Keyword(s):  
Systematic Review ◽  
Antibiotic Treatment ◽  
Meta Analysis ◽  
Empirical Antibiotic Treatment

scholarly journals Systematic review and meta-analysis: susceptibility-guided versus empirical antibiotic treatment forHelicobacter pyloriinfection

2015 ◽  
Vol 70 (9) ◽  
pp. 2447-2455 ◽  
Author(s):  
Sheila López-Góngora ◽  
Ignasi Puig ◽  
Xavier Calvet ◽  
Albert Villoria ◽  
Mireia Baylina ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Treatment ◽  
Meta Analysis ◽  
Empirical Antibiotic Treatment

Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness

2021 ◽  
pp. 1-13
Author(s):  
Darin Pauley ◽  
Pim Cuijpers ◽  
Davide Papola ◽  
Clara Miguel ◽  
Eirini Karyotaki
Keyword(s):  
Systematic Review ◽  
Anxiety Disorder ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Wait List ◽  
Digital Interventions ◽  
Significant Difference

Abstract Background Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68–0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: −0.01 to 0.30]. Conclusion The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.

Obesity and mortality in patients with esophageal cancer: A systematic review and meta-analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 20-20
Author(s):  
Arjun Gupta ◽  
Kaustav Majumder ◽  
Nivedita Arora ◽  
Preet Paul Singh ◽  
Siddharth Singh
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Subgroup Analysis ◽  
Observational Studies ◽  
Meta Analysis ◽  
Asia Pacific ◽  
Limited Data ◽  
Inconsistency Index ◽  
All Cause Mortality ◽  
Never Smokers

20 Background: Obesity influences incidence of esophageal cancer (EC) with contrasting impact on esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESC). However, it is unclear whether it influences mortality in patients with EC. We performed a systematic review and meta-analysis to assess the association between obesity and EC mortality. Methods: Through a systematic search of major databases and conference proceedings, up to June 2015, we identified observational studies reporting the association between obesity (premorbid body mass index [BMI] ≥ 30 kg/m2) and all-cause mortality in patients with EC. We estimated summary adjusted hazard ratio (aHR) with 95% confidence intervals (CI), comparing highest BMI category with reference category in each study using random effects model; heterogeneity was measured using the inconsistency index (I2). Results: We identified 8 studies (including 1 pooled cohort study) with 2,784,027 people, of whom 18% were obese. On meta-analysis, compared with EC patients with reference BMI, obese EC patients had aHR for mortality of 0.97 (95% CI, 0.66-1.43), with high heterogeneity (I2 = 88%) after pooling maximally adjusted HRs. On analyzing patients with EAC alone (3 studies), mortality aHR was 1.10 (95% CI, 0.43-2.82), with high heterogeneity (I2 = 95%). Data to separately analyze ESC or to perform subgroup analysis in males vs females, smokers vs never smokers and Asia Pacific vs Western populations was limited. Conclusions: Based on meta-analysis, obesity does not appear to be associated with mortality in patients with EC. However, high heterogeneity and limited data for subgroup analysis limits the interpretation of this analysis. Further prospective studies evaluating mortality in patients with established EC are needed to answer this question. [Table: see text]

Abstract 118: Right Bundle Branch Block and Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ahmad Hazem ◽  
Sunita Sharma ◽  
Amit Sharma ◽  
Cameron Leitch ◽  
Roopalakshmi Sharadanant ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Cardiovascular Mortality ◽  
Observational Studies ◽  
Meta Analysis ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Importance: Right bundle branch block (RBBB) is observed in approximately 5-14% of patients with heart failure (HF). Multiple observational studies have reported the association of RBBB with clinical outcomes in patients with HF. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with HF. Data Sources: We have systematically searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts that described all cause or cardiovascular mortality in patients with RBBB and HF. We excluded studies that reported unadjusted outcome, i.e.: unadjusted event rates. Knowledge synthesis: We pooled reported risk ratio and hazard ratio. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: We found 12 relevant observational studies enrolling over 38,000 patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Included studies had at least a moderate quality. Seven of those evaluated prognosis of patients with RBBB and heart failure. After a mean follow up period of 2.5 years (range: 1-5 years), RBBB was associated with a statistically significant increased risk of all-cause mortality compared to patients with heart failure but no BBB, RR 1.27, 95% CI (1.08-1.50), Figure 1. The other 5 studies evaluated CHF patients receiving cardiac resynchronization therapy (CRT), comparing outcomes of patients with RBBB to those with LBBB. After a mean f/u period of 3 years, patients with RBBB were once again found to have an increased risk of all-cause mortality, RR 1.45, 95% CI 1.12-1.89. Conclusion and Relevance: RBBB in patients with HF is associated with higher all-cause mortality in comparison to patients without inter-ventricular conduction defects, as well as LBBB patients in patients undergoing CRT setting.

Systematic review and meta-analysis of endovascular treatment for acute mesenteric ischaemia

Vascular ◽  
2017 ◽  
Vol 25 (4) ◽  
pp. 430-438 ◽  
Author(s):  
Marawan El Farargy ◽  
Ahmed Abdel Hadi ◽  
Mohamed Abou Eisha ◽  
Khalid Bashaeb ◽  
George A Antoniou
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Odds Ratio ◽  
Observational Studies ◽  
Bowel Resection ◽  
Meta Analysis ◽  
Mesenteric Ischaemia ◽  
Conventional Surgery ◽  
Acute Mesenteric Ischaemia

Introduction Acute mesenteric ischaemia is associated with a significant morbidity and mortality. Endovascular techniques have emerged as a viable alternative treatment option to conventional surgery. Our objective was to conduct a systematic review of the literature and perform a meta-analysis of reported outcomes. Methods Our review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards and the protocol was registered in PROSPERO (CRD42016035667). We searched electronic information sources (MEDLINE, EMBASE, CINAHL, CENTRAL) and bibliographic lists of relevant articles to identify studies reporting outcomes of endovascular treatment for acute mesenteric ischaemia of embolic or thrombotic aetiology. We defined 30-day or in-hospital mortality and bowel resection as the primary outcome measures. We used the Newcastle–Ottawa scale to assess the methodological quality of observational studies. We calculated combined overall effect sizes using random effects models; results are reported as the odds ratio and 95% confidence interval. Results We identified 19 observational studies reporting on a total of 3362 patients undergoing endovascular treatment for acute mesenteric ischaemia. The pooled estimate of peri-interventional mortality was 0.245 (95% confidence interval 0.197–0.299), that of the requirement for bowel resection 0.326 (95% confidence interval 0.229–0.439), and the pooled estimate for acute kidney injury was 0.132 (95% confidence interval 0.082–0.204). Eight studies reported comparative outcomes of endovascular versus surgical treatment for acute mesenteric ischaemia (endovascular group, 3187 patients; surgical group, 4998 patients). Endovascular therapy was associated with a significantly lower risk of 30-day mortality (odds ratio 0.45, 95% confidence interval 0.30–0.67, P = 0.0001), bowel resection (odds ratio 0.45, 95% confidence interval 0.34–0.59, P < 0.00001) and acute renal failure (odds ratio 0.58, 95% confidence interval 0.49–0.68, P < 0.00001). No differences were identified in septic complications or the development of short bowel syndrome. Conclusion Endovascular treatment for acute mesenteric ischaemia is associated with a considerable mortality and requirement of bowel resection. However, endovascular therapy confers improved outcomes compared to conventional surgery, as indicated be reduced mortality, risk of bowel resection and acute renal failure. An endovascular-first approach should be considered in patients presenting with acute mesenteric ischaemia.

Comparing effectiveness of fat burners and thermogenic supplements to diet and exercise for weight loss and cardiometabolic health: Systematic review and meta-analysis

2021 ◽  
pp. 026010602098236
Author(s):  
James E Clark ◽  
Sarah Welch
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Confidence Interval ◽  
Dietary Supplements ◽  
Body Mass ◽  
Effect Size ◽  
Meta Analysis ◽  
Cardiometabolic Health ◽  
Chi Square ◽  
Diet And Exercise

Background: Those who are overfat face an onslaught of advice for losing weight, including using dietary supplements that purport to have fat burning capabilities to achieve a reduced body mass, fat mass and improvement in cardiometabolic health in combination with exercise or diet and exercise regimens. Aim: To examine long-term effectiveness of supplements for both weight loss and improvements in cardiometabolic health for these individuals. Methods: A PRISMA methods of systematic review was conducted from August 2018 through January 2019 using Medline, PubChem, PubMed, EBOSCO CINHAL and SPORTDiscus, and Google Scholar yielding 23,441 returns of which 21 studies (duration greater than 8 weeks with participant populations of BMI greater than 24.9) were included for meta-analysis. Meta-analysis examined pooled effect size and 95% confidence interval for: body mass, fat mass, fat-free mass, total cholesterol, high-density lipoproteins, low-density lipoproteins, resting metabolic rate. Intra-study effect sizes were compared with previously reported results for diet or diet and exercise in a 2x2 chi-square analysis for the number of studies that induced effects greater than or less than the effect size. Results: There is a general trend to show effectiveness (effect size greater than 0.00) for obtaining beneficial changes from use of thermogenic dietary supplements, yet the 95% confidence interval for effect size crossed 0.00 (indicating no benefit). Chi-square comparison to exercise, or combination of diet and exercise, indicates that responses induced from weight-loss supplements were less effective than what is obtained from utilizing exercise, or diet and exercise, without additional weight-loss supplements. Conclusion: There appears to be limited benefit that may be derived from the inclusion of thermogenic dietary supplements to reduce body mass and improve cardiometabolic health for individuals who are overfat.

scholarly journals Effect of Vitamin D Supplementation on Risk of Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Ziyi Li ◽  
Liangzhi Wu ◽  
Junguo Zhang ◽  
Xin Huang ◽  
Lehana Thabane ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Vitamin D ◽  
Confidence Interval ◽  
Protective Effect ◽  
Observational Studies ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Controlled Trials ◽  
Randomized Controlled

Objective: Laboratory findings indicated that vitamin D might have a potent protective effect on breast cancer, but epidemiology studies reported conflicting results. The aim of the study was to conduct a systematic review and meta-analysis to clarify the efficacy of vitamin D supplementation on risk of breast cancer.Methods: MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and abstracts of three major conferences were searched (up to December 8, 2020). Parallel randomized controlled trials (RCTs) examining the efficacy of vitamin D supplementation on risk of breast cancer or change of mammography compared with placebo in females were included. Data were meta-analyzed using a random-effects model. Bayesian meta-analysis was conducted to synthesize the results using data from observational studies as priors.Results: Seven RCTs were identified for effect of vitamin D on risk of breast cancer, with 19,137 females included for meta-analysis. No statistically significant effect of vitamin D on risk of breast cancer was found in classical random-effects meta-analysis (risk ratio = 1.04, 95% confidence interval: 0.84–1.28, p = 0.71). When Bayesian meta-analyses were conducted, results remained non-significant. There was no statistically significant effect of vitamin D on mammography density observed: mean difference = 0.46, 95% confidence interval: −2.06 to 2.98, p = 0.72.Conclusion: There is insufficient evidence to support the efficacy of vitamin D supplementation in breast cancer risk and change of mammography density. The protective effect of vitamin D on risk of breast cancer from previous observational studies may be overestimated.Systematic Review Registration: PROSPERO, identifier CRD42019138718.

scholarly journals Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Awad ◽  
M Mohammed ◽  
M M Zaki ◽  
A I Abushouk ◽  
G Y H Lip ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Prevention ◽  
Older People ◽  
Lower Risk ◽  
Observational Studies ◽  
Meta Analysis ◽  
Case Control ◽  
Current Evidence ◽  
All Cause Mortality ◽  
Statin Use

Abstract Background Current evidence from randomized controlled trials on statins for primary prevention of cardiovascular disease (CVD) in older people, especially those aged &gt;75 years, is still lacking. Purpose We conducted a systematic review and meta-analysis of observational studies to extend the current evidence about association of statin use in older people primary prevention group with risk of CVD and mortality. Methods PubMed, Scopus, and Embase were searched from inception until March 18, 2021. We included observational studies (cohort or nested case-control) that compared statin use vs non-use for primary prevention of CVD in older people aged ≥65 years; provided that each of them reported the risk estimate on at least one of the following primary outcomes: all cause-mortality, CVD death, myocardial infarction (MI), and stroke. Risk estimates of each relevant outcome were pooled as a hazard ratio (HR) with a 95% confidence interval (CI) using the random-effects meta-analysis model. Results Ten observational studies (9 cohort and one case-control study; n=872,845) fulfilled our criteria. The overall combined estimate suggested that statin therapy was associated with a significantly lower risk of all-cause mortality (HR: 0.86 [95% CI: 0.79 to 0.93]), CVD death (HR: 0.80 [95% CI: 0.78 to 0.81]), and stroke (HR: 0.85 [95% CI: 0.76 to 0.94]) and a non-significant association with risk of MI (HR: 0.74 [95% CI: 0.53 to 1.02]). The beneficial association of statins with the risk of all-cause mortality remained significant even at higher ages (&gt;75 years old; HR: 0.88 [95% CI: 0.81 to 0.96]) and in both men (HR: 0.75 [95% CI: 0.74 to 0.76]) and women (HR: 0.85 [95% CI: 0.72 to 0.99]). However, this association with the risk of all-cause mortality remained significant only in those with DM (HR: 0.82 [95% CI: 0.68 to 0.98]) but not in those without DM. Conclusions Statin therapy in older people (aged ≥65 years) without CVD was associated with a 14%, 20% and 15% lower risk of all-cause mortality, CVD death and stroke, respectively. The beneficial association with the risk of all-cause mortality remained significant even at higher ages (&gt;75 years old), in both men and women, and in individuals with DM, but not in those without DM. These observational findings support the need for trials to test benefits of statins in those above 75 years of age. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Results of the meta-analysis

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