scholarly journals The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis

2021 ◽  
Vol 6 (11) ◽  
pp. e005537
Author(s):  
Jagrati Chopra ◽  
Nkemjika Abiakam ◽  
Hansung Kim ◽  
Cheryl Metcalf ◽  
Peter Worsley ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Meta Analysis ◽  
A Priori ◽  
White Male ◽  
Small Sample ◽  
Protective Equipment ◽  
Significant Heterogeneity ◽  
Anthropometric Data ◽  
Male Population ◽  
Gender Based

IntroductionBlack, Asian and minority ethnic (BAME) people are disproportionately affected by COVID-19. Respiratory protective equipment (RPE) has conventionally been developed for a predominantly white male population that does not represent the healthcare workforce. The literature was reviewed to determine the protection offered to female and BAME users.MethodsFive databases were searched. Eligible studies related to respirator fit in the context of anthropometrics, gender and ethnicity. Meta-analysis was performed for gender-based anthropometric differences. A priori protocol registration was not performed.Results32 studies were included and anthropometric data was extracted from 15 studies. Meta-analysis revealed 14 anthropometric measurements were significantly smaller for females. Mean differences ranged from 0.37 mm to 22.05 mm. Gender-based anthropometric differences did not always translate to lower fit factor scores, with 12 studies reporting worse performance and fit for females and 10 reporting no gender effect. No studies provided disaggregate anthropometric data by ethnic group. Pass rates (PR) were low or moderate in 12 BAME or mixed-ethnicity cohorts. 14 studies reported associations between facial dimensions (FD) and respirator fit. Three comparative studies showed lower PR among selective BAME people. 18 studies reported RPE performance differed with model and design. Most studies did not prespecify inclusion/exclusion criteria. Small sample size and lack of justification or power calculations was a concern. Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance.ConclusionThe literature reports on largely Caucasian or single ethnic populations, and BAME people remain under-represented, limiting comparisons between ethnic groups. Facial anthropometrics vary between gender and likely between ethnicity, which may contribute to lower PR among females and ethnic minorities, particularly Asians. There is a need for studies including a broader spectrum of ethnicities and for consideration of female and BAME users during RPE development.

scholarly journals A content analysis and methodological evaluation of meta-analyses on Turkish samplesTürkiye örnekleminde meta analiz çalışmalarının içerik analizi ve metodolojik değerlendirilmesi

2016 ◽  
Vol 13 (1) ◽  
pp. 713 ◽  
Author(s):  
Gülşah Başol ◽  
Mehmet Fatih Doguyurt ◽  
Seda Demir
Keyword(s):  
Content Analysis ◽  
Small Sample Size ◽  
Meta Analysis ◽  
A Priori ◽  
Small Sample ◽  
Model Choice ◽  
Fixed And Random Effects ◽  
Meta Analyses ◽  
Internal And External Validity ◽  
Methodological Evaluation

<p>This content analysis study aims to methodologically evaluate the appropriateness of meta-analyses, conducted on Turkish samples on a variety of topics. Through an exhausting literature review, 80 meta-analyses were gathered together and coded into a detailed Meta-Analysis Evaluation Form.  The form consisted of 59 items (1 = Not Present, 2 = Present and 3 = Not Mentioned) both regarding the study and substantial characteristics. Two researchers coded the studies and the reliability of the coding of five studies indicated no problems with consistencies of the codings (Kappa= .90). According to the results, the most often encountered problem in meta-analyses was reporting both the fixed and random effects analyses without making a priori decision about the model choice. It was found that 60.0% of the meta-analyses investigated by the current study excluded studies conducted abroad which resulted underrepresentation of the literature.  Furthermore, the studies suffered from a small sample size issues. The methodology (how the studies were selected, coding form, reliability of the codings and etc.) was not explained clearly in more than a quarter of the studies. Therefore, it would be hard to claim that they have sufficient level of internal and external validity. It was hoped that researchers may benefit from the results of the current study to conduct better quality meta-analysis in the future.</p><p> </p><p><strong>Özet</strong></p><p>Bu içerik analizi çalışmasının amacı Türkiye'de yapılan meta analiz çalışmalarının metodolojik değerlendirmesinin yapılmasıdır. Meta Analiz Değerlendirme Formu üzerinden Türkiye literatüründeki 80 meta analiz çalışması kodlanmıştır. Değerlendirme formu çalışmaların künyelerini ve meta analiz yönteminin kullanımındaki çeşitlenmeyi içeren 59 (Evet-Hayır-Belirtilmemiş şeklinde cevaplanabilecek) maddeyi kapsamaktadır. İki araştırmacı kodlamaları gerçekleştirmiş ve öncesinde beş çalışmalık bir pilot çalışma üzerinden kodlamaları arasındaki uyum hesaplanmış ve Kappa katsayısı (Kappa= .90) yeterli düzeyde bulunmuştur. Sonuçlara göre meta analiz çalışmalarındaki en belirgin problem herhangi bir tercihte bulunmaksızın sabit ve rasgele etkiler modellerinin birlikte rapor edilmesidir. Çalışmaların %60'ında yurtdışı çalışmalar dahil edilmeksizin Türkiye örneklemindeki çalışmaları kullanarak meta analiz yapılmıştır. Yurtdışı çalışmalara yer veren meta analizlerde ise sayının çok düşük olduğu dolayısıyla örneklemin temsil ediciliğinin düşük olduğu görülmüştür. Meta analizlerde örneklem büyüklüğünün sayıca çok yetersiz olduğu ya da olmadığı görülmüştür. Çalışmaların dörtte birinden fazlasında metodoloji bölümünde çalışmaların nasıl toplandığı, kodlama formu, kodlamaların güvenirliği gibi konular açıklanmamıştır. Bu durum ilgili meta analiz çalışmalarının güvenirlik ve geçerliğini düşürmektedir. Mevcut değerlendirme çalışmasının, gelecekte meta analiz konusunda çalışacak araştırmacılara metodolojik bakımdan daha kaliteli araştırmalar ortaya koymaları hususunda katkı sağlayacağı beklenmektedir.</p>

Acupuncture for the Treatment of Gastro-Oesophageal Reflux Disease: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 35 (5) ◽  
pp. 316-323 ◽  
Author(s):  
Jiajie Zhu ◽  
Yu Guo ◽  
Shan Liu ◽  
Xiaolan Su ◽  
Yijie Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Reflux Disease ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
Oesophageal Reflux ◽  
Symptom Improvement ◽  
Significant Heterogeneity ◽  
Oesophageal Reflux Disease

Background Gastro-oesophageal reflux disease (GORD) is one of the most common diseases presenting to gastroenterology clinics. Acupuncture is widely used as a complementary and alternative treatment for patients with GORD. Objective To explore the effectiveness of acupuncture for the treatment of GORD. Methods Four English and four Chinese databases were searched through June 2016. Randomised controlled trials investigating the effectiveness of manual acupuncture or electroacupuncture (MA/EA) for GORD versus or as an adjunct to Western medicine (WM) were selected. Data extraction and quality evaluation were performed by two authors independently and RevMan 5.2.0 was used to analyse data. Results A total of 12 trials involving 1235 patients were included. Meta-analyses demonstrated that patients receiving MA/EA combined with WM had a superior global symptom improvement compared with those receiving WM alone (relative risk (RR) 1.17, 95% CI 1.09 to 1.26; p=0.03; six studies) with no significant heterogeneity (I2=0%, p=0.41). Recurrence rates of those receiving MA/EA alone were lower than those receiving WM (RR 0.42,95% CI 0.29 to 0.61; p<0.001; three studies) with low heterogeneity (I2=7%, p=0.34), while global symptom improvement (six studies) and symptom scores (three studies) were similar (both p>0.05). Descriptive analyses suggested that acupuncture also improves quality of life in patients with GORD. Conclusion This meta-analysis suggests that acupuncture is an effective and safe treatment for GORD. However, due to the small sample size and poor methodological quality of the included trials, further studies are required to validate our conclusions. Trial registration number PROSPERO Systematic review registration no. CRD42016041916.

scholarly journals A meta-analysis of the diagnostic accuracy of dengue virus-specific IgA antibody-based tests for detection of dengue infection

2015 ◽  
Vol 144 (4) ◽  
pp. 876-886 ◽  
Author(s):  
K. ALAGARASU ◽  
A. M. WALIMBE ◽  
S. M. JADHAV ◽  
A. R. DEOSHATWAR
Keyword(s):  
Diagnostic Accuracy ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Dengue Infection ◽  
Immunoglobulin A ◽  
Diagnostic Odds Ratio ◽  
Small Sample ◽  
Significant Heterogeneity ◽  
Sample Collection ◽  
Likelihood Ratios

SUMMARYImmunoglobulin A (IgA)-based tests have been evaluated in different studies for their utility in diagnosing dengue infections. In most of the studies, the results were inconclusive because of a small sample size. Hence, a meta-analysis involving nine studies with 2096 samples was performed to assess the diagnostic accuracy of IgA-based tests in diagnosing dengue infections. The analysis was conducted using Meta-Disc software. The results revealed that IgA-based tests had an overall sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios of 73·9%, 95·2%, 66·7, 22·0 and 0·25, respectively. Significant heterogeneity was observed between the studies. The type of test, infection status and day of sample collection influenced the diagnostic accuracy. The IgA-based diagnostic tests showed a greater accuracy when the samples were collected 4 days after onset of symptoms and for secondary infections. The results suggested that IgA-based tests had a moderate level of accuracy and are diagnostic of the disease. However, negative results cannot be used alone for dengue diagnosis. More prospective studies comparing the diagnostic accuracy of combinations of antigen-based tests with either IgA or IgM are needed and might be useful for suggesting the best strategy for dengue diagnosis.

scholarly journals Prognostic effect of lncRNA SNHG7 on cancer outcome: a meta and bioinformatic analysis

BMC Cancer ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Yunyuan Zhang ◽  
Qingwu Tian ◽  
Shifeng Huang ◽  
Qing Wang ◽  
Hongmei Wu ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Prognostic Value ◽  
Digestive System ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
The Cancer Genome Atlas ◽  
Significant Heterogeneity ◽  
Analysis Tool ◽  
Digestive System Cancer

Abstract Background New evidence from clinical and fundamental researches suggests that SNHG7 is involved in the occurrence and development of carcinomas. And the increased levels of SNHG7 are associated with poor prognosis in various kinds of tumors. However, the small sample size was the limitation for the prognostic value of SNHG7 in clinical application. The aim of the present meta-analysis was to conduct a qualitative analysis to explore the prognostic value of SNHG7 in various cancers. Methods Articles related to the SNHG7 as a prognostic biomarker for cancer patients, were comprehensive searched in several electronic databases. The enrolled articles were qualified via the preferred reporting items for systematic reviews and meta-analysis of observational studies in epidemiology checklists. Additionally, an online database based on The Cancer Genome Atlas (TCGA) was further used to validate our results. Results We analyzed 2418 cancer patients that met the specified criteria. The present research indicated that an elevated SNHG7 expression level was significantly associated with unfavorable overall survival (OS) (HR = 2.45, 95% CI: 2.12–2.85, p <0.001). Subgroup analysis showed that high expression levels of SNHG7 were also significantly associated with unfavorable OS in digestive system cancer (HR = 2.31, 95% CI: 1.90–2.80, p <0.001) and non-digestive system cancer (HR = 2.67, 95% CI: 2.12–3.37, p <0.001). Additionally, increased SNHG7 expression was found to be associated with tumor stage and progression (III/IV vs. I/II: HR = 1.76, 95% CI: 1.57–1.98, p <0.001). Furthermore, elevated SNHG7 expression significantly predicted lymph node metastasis (LNM) (HR = 1.98, 95% CI: 1.74–2.26, p <0.001) and distant metastasis (DM) (HR = 2.49, 95% CI: 1.88–3.30, p <0.001) respectively. No significant heterogeneity was observed among these studies. SNHG7 was significantly upregulated in four cancers and the elevated expression of SNHG7 predicted shorter OS in four cancers, worse DFS in five malignancies and worse PFI in five carcinomas based on the validation using the GEPIA on-line analysis tool. Conclusions The present analysis suggests that elevated SNHG7 is significantly associated with unfavorable OS, tumor progression, LNM and DM in various carcinomas, and may be served as a promising biomarker to guide therapy for cancer patients.

scholarly journals Prognostic Effect of lncRNA SNHG7 On Cancer Outcome: A Meta and Bioinformatic Analysis

2021 ◽  
Author(s):  
yunyuan zhang ◽  
Qingwu Tian ◽  
Shifeng Huang ◽  
Qing Wang ◽  
Hongmei Wu ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Prognostic Value ◽  
Digestive System ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Tumor Stage ◽  
Small Sample ◽  
The Cancer Genome Atlas ◽  
Significant Heterogeneity ◽  
Digestive System Cancer

Abstract Background: New evidence from clinical and fundamental researches suggests that SNHG7 is involved in the occurrence and development of carcinomas. And the increase levels of SNHG7 are associated with poor prognosis in various kinds of tumors. However, the small sample size was the limitation for the prognostic value of SNHG7 in clinical application. The aim of the present meta-analysis was to conduct a qualitative analysis to explore the prognostic value of SNHG7 in various cancers. Methods: Articles related to the SNHG7 as a prognostic biomarker for cancer patients, were comprehensive searched in several electronic databases. The enrolled articles were qualified via the preferred reporting items for systematic reviews and meta-analysis of observational studies in epidemiology checklists. Additionally, an online database based on The Cancer Genome Atlas (TCGA) was further used to validate our results.Results: We analyzed 2418 cancer patients that met the specified criteria. The present research indicated that an elevated SNHG7 expression level was significantly associated with unfavorable overall survival (OS) (HR = 2.45, 95% CI: 2.12–2.85, p <0.001). Subgroup analysis showed that high expression levels of SNHG7 were also significantly associated with unfavorable OS in digestive system cancer (HR = 2.31, 95% CI: 1.90–2.80, p <0.001) and non-digestive system cancer (HR = 2.67, 95% CI: 2.12–3.37, p <0.001). Additionally, increased SNHG7 expression was found to be associated with tumor stage and progression (III/IV vs. I/II: HR = 1.76, 95% CI: 1.57–1.98, p <0.001). Furthermore, elevated SNHG7 expression significantly predicted lymph node metastasis (LNM) (HR = 1.98, 95% CI: 1.74–2.26, p <0.001) and distant metastasis (DM) (HR = 2.49, 95% CI: 1.88–3.30, p <0.001) respectively. No significant heterogeneity was observed among these studies. SNHG7 was significantly upregulated in four cancers and the elevated expression of SNHG7 predicted shorter OS in four malignancies and worse DFS in five malignancies based on the validation using the GEPIA cohort.Conclusions: The present analysis suggests that elevated SNHG7 is significantly associated with unfavorable OS, tumor progression, LNM and DM in various carcinomas, and may be used as a promising biomarker to guide therapy for cancer patients.

Replication of the Superstition and Performance Study by

2014 ◽  
Vol 45 (3) ◽  
pp. 239-245 ◽  
Author(s):  
Robert J. Calin-Jageman ◽  
Tracy L. Caldwell
Keyword(s):  
Task Difficulty ◽  
Statistical Power ◽  
Meta Analysis ◽  
A Priori ◽  
Significant Heterogeneity ◽  
Performance Study ◽  
Improve Performance ◽  
Research Designs ◽  
Series Of Experiments ◽  
And Performance

A recent series of experiments suggests that fostering superstitions can substantially improve performance on a variety of motor and cognitive tasks ( Damisch, Stoberock, & Mussweiler, 2010 ). We conducted two high-powered and precise replications of one of these experiments, examining if telling participants they had a lucky golf ball could improve their performance on a 10-shot golf task relative to controls. We found that the effect of superstition on performance is elusive: Participants told they had a lucky ball performed almost identically to controls. Our failure to replicate the target study was not due to lack of impact, lack of statistical power, differences in task difficulty, nor differences in participant belief in luck. A meta-analysis indicates significant heterogeneity in the effect of superstition on performance. This could be due to an unknown moderator, but no effect was observed among the studies with the strongest research designs (e.g., high power, a priori sampling plan).

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

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.

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

2016 ◽  
Vol 175 (2) ◽  
pp. R65-R80 ◽  
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.

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

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.

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

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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