Effect of Foot Reflexology Intervention on Depression, Anxiety, and Sleep Quality in Adults: A Meta-Analysis and Metaregression of Randomized Controlled Trials

Objectives. The aim of this study was to conduct a systematic review, meta-analysis, and metaregression to determine the current best available evidence of the efficacy and safety of foot reflexology for adult depression, anxiety, and sleep quality. Methods. Electronic databases (PubMed, ClinicalKey, ScienceDirect, EMBASE, PsycINFO, and the Cochrane Library) were searched till August, 10, 2020, and the validity of the eligible studies was critically appraised. Randomized controlled trials comparing foot reflexology groups with control groups for adult depression, anxiety, and sleep quality were included. Twenty-six eligible studies were included to assess the effect of foot reflexology intervention on the reducing symptoms of depression and anxiety and improving quality of sleep, respectively, as the primary outcome. Results. Twenty-six randomized controlled trials involving 2,366 participants met the inclusion criteria. The meta-analyses showed that foot reflexology intervention significantly improved adult depression (Hedges’ g = −0.921; 95% CI: −1.246 to −0.595; P < 0.001), anxiety (Hedges’ g = −1.237; 95% CI −1.682 to −0.791; P < 0.001), and sleep quality (Hedges’ g = −1.665; 95% CI −2.361 to −0.970; P < 0.001). Metaregression reveals that an increase in total foot reflexology time (P = 0.002) and duration (P = 0.01) can significantly improve sleep quality. Conclusions. Foot reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, high quality and rigorous design RCTs in specific population, along with an increase in participants, and a long-term follow-up are recommended in the future.

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Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab026 ◽

2021 ◽

Vol 8 (2) ◽

Author(s):

Khalid Eljaaly ◽

Monique R Bidell ◽

Ronak G Gandhi ◽

Samah Alshehri ◽

Mushira A Enani ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Random Effects Models ◽

Randomized Controlled ◽

Colistimethate Sodium ◽

Meta Analyses ◽

Risk Ratios ◽

Number Needed To Harm

Abstract Background Nephrotoxicity is a known adverse effect of polymyxin antibiotics, including colistin. Although previous meta-analyses have aimed to characterize colistin-associated nephrotoxicity risk relative to other antibiotics, included studies were observational in nature with high risk of confounding and heterogeneity. We conducted this systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to evaluate the incidence of nephrotoxicity associated with colistin versus minimally nephrotoxic antibiotics. Methods We searched PubMed, EMBASE, Cochrane Library, and 3 trial registries for RCTs comparing the nephrotoxicity of colistin to nonpolymyxin antibiotics. Randomized controlled trials that used aminoglycosides were excluded. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The study outcome was the rate of nephrotoxicity. Results Five RCTs with a total of 377 patients were included. Most patients received colistin for pneumonia in the intensive care unit, and the comparators were β-lactam-based regimens. Colistimethate sodium was dosed at 9 million units/day (300 mg/day of colistin base activity), with administration of a loading dose in 4 studies. The nephrotoxicity incidence in patients who received colistin was 36.2% (95% CI, 23.3% to 51.3%). The nephrotoxicity rate was significantly higher in the colistin arm than comparators (RR, 2.40; 95% CI, 1.47 to 3.91; P ≤ .001; I2 = 0%), and the number needed to harm was 5. Findings persisted upon one-study-removed-analysis. Conclusions This meta-analysis of RCTs found a colistin-associated nephrotoxicity rate of 36.2% and an increase in this risk compared with β-lactam-based regimens by 140%. Colistin should be regarded as a last-line agent and safer alternatives should be considered when possible.

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Dose-dependent effect of nuts on blood pressure: a systematic review and meta-analysis of randomized controlled trials

10.1101/2021.05.21.21257564 ◽

2021 ◽

Author(s):

Ahmad Jayedi ◽

Tauseef Ahmad Khan ◽

Amin Mirrafiei ◽

Bahareh Jabbarzadeh ◽

Yasaman Hosseini ◽

...

Keyword(s):

Blood Pressure ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Dependent Effect ◽

Randomized Controlled ◽

Long Term Follow Up ◽

Meta Analyses ◽

Dose Dependent ◽

Dose Dependent Effect

Objective: Traditional pairwise meta-analyses indicated that nuts consumption can improve blood pressure. We iamed to determine the dose-dependent effect of nuts on systolic (SBP) and diastolic blood pressure (DBP) in adults. Methods: A systematic search was undertaken in PubMed, Scopus, and ISI Web of Science till March 2021. Randomized controlled trials (RCT) evaluating the effects of nuts on SBP and DBP in adults were included. We estimated change in blood pressure for each 20 g/d increment in nut consumption in each trial and then, calculated mean difference (MD) and 95%CI using a random-effects model. We estimated dose-dependent effect using a dose-response meta-analysis of differences in means. The certainty of evidence was rated using the GRADE instrument, with the minimal clinically important difference being considered 2 mmHg. Results: A total of 31 RCTs with 2784 participants were included. Each 20 g/d increase in nut consumption reduced SBP (MD: -0.50 mmHg, 95%CI: -0.79, -0.21; I2 = 12%, n = 31; GRADE = moderate certainty) and DBP (MD: -0.23 mmHg, 95%CI: -0.38, -0.08; I2 = 0%, n = 31; GRADE = moderate certainty). The effect of nuts on SBP was more evident in patients with type 2 diabetes (MD: -1.31, 95%CI: -2.55, -0.05; I2 = 31%, n = 6). The results were robust in the subgroup of trials with low risk of bias. Levels of SBP decreased proportionally with the increase in nuts consumption up to 40 g/d (MD40g/d: -1.60, 95%CI: -2.63, -0.58), and then appeared to plateau with a slight upward curve. A linear dose-dependent reduction was seen for DBP, with the greatest reduction at 80 g/d (MD80g/d: -0.80, 95%CI: -1.55, -0.04). Conclusions: The available evidence provides a good indication that nut consumption can result in a small improvement in blood pressure in adults. Well-designed trials are needed to confirm the findings in long term follow-up.

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Do Docosahexaenoic and Eicosapentaenoic Acids Have Similar Effects on Inflammation Markers? Pairwise and Network Meta-Analyses of Randomized Controlled Trials

Current Developments in Nutrition ◽

10.1093/cdn/nzaa045_118 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 485-485

Author(s):

Cécile Vors ◽

Janie Allaire ◽

Sonia Blanco Mejia ◽

Tauseef Khan ◽

John Sievenpiper ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Outcome Data ◽

Cochrane Library ◽

Controlled Trials ◽

Eligibility Criteria ◽

Randomized Controlled ◽

Tnf Α ◽

Mean Differences ◽

Meta Analyses

Abstract Objectives The aim of this study was to compare the effect of DHA and EPA on several markers of systemic inflammation by pairwise and network meta-analyses of randomized controlled trials (RCTs). Methods MEDLINE, EMBASE and The Cochrane Library were searched through September 2019. We included RCTs of ≥ 7 days that directly compared the effects of DHA with EPA and RCTs of indirect comparisons, in which the effects of DHA or EPA were assessed individually compared with a control fatty acid. Differences in circulating concentrations of CRP, IL-6, TNF-α and adiponectin were the primary outcome. Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic) in the pairwise meta-analysis. Inconsistency and transitivity were evaluated in the network meta-analysis. The certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results Eligibility criteria were met by 5 RCTs (N = 411) for the pairwise meta-analysis and 20 RCTs (N = 1231) for the network meta-analysis. In the pairwise meta-analysis, DHA and EPA had similar effects on plasma CRP (MDDHA vs. EPA = 0.14 mg/L [95% CI −0.57, 0.85]; I2 = 61%), IL-6 (MDDHA vs. EPA = 0.10 pg/mL [−0.15, 0.34]; I2 = 40%) and TNF-α (MDDHA vs. EPA = −0.10 pg/mL [−0.37, 0.18]; I2 = 40%). The effects of DHA and EPA on plasma CRP (MDDHA vs. EPA = −0.33 mg/L [−0.75, 0.10]), IL-6 (MDDHA vs. EPA = 0.09 pg/mL [−0.12, 0.30]) and TNF-α (MDDHA vs. EPA = −0.02 pg/mL [−0.25, 0.20]) were also similar according to the network meta-analysis. DHA and EPA had similar effects on plasma adiponectin in the network meta-analysis. Conclusions The present pairwise and network meta-analyses comparing EPA to DHA suggest that DHA and EPA do not differentially modify systemic markers of subclinical inflammation. Funding Sources The authors have no funding to report.

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Effect of music interventions on anxiety during labor: a systematic review and meta-analysis of randomized controlled trials

PeerJ ◽

10.7717/peerj.6945 ◽

2019 ◽

Vol 7 ◽

pp. e6945 ◽

Cited By ~ 2

Author(s):

Hsin-Hui Lin ◽

Yu-Chen Chang ◽

Hsiao-Hui Chou ◽

Chih-Po Chang ◽

Ming-Yuan Huang ◽

...

Keyword(s):

Blood Pressure ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Anxiety Reduction ◽

Cochrane Library ◽

Controlled Trials ◽

Pregnancy Anxiety ◽

Randomized Controlled ◽

Anxiety Levels ◽

Meta Analyses

Background Anxiety is commonly experienced during the delivery process and has shown to have adverse effects on maternal and infant health outcomes. Music interventions tend to reduce the effects of anxiety in diverse populations, are low cost, are easily accessible, and have high acceptability. The aim of this review and meta-analysis was to assess the effectiveness of music interventions in reducing anxiety levels among women during labor. Methods Seven databases from inception to the end of December, 2018, without any language or time restriction including Embase, PubMed, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, PsycINFO, Airiti Library, and PerioPath: Index to Taiwan Periodical Literature were searched using key terms related to pregnancy, anxiety, and music. Randomized controlled trials that assessed the effect of music during labor and measured anxiety levels as an outcome were included. Meta-analyses were conducted to assess anxiety reduction following a music intervention compared to that after placebo treatment. Results A total of 14 studies that investigated a total of 1,310 participants were included in this review. The meta-analyses indicated that those in the intervention group had a significant decrease in anxiety scores (standardized mean difference = −2.40, 95% confidence interval (CI) [−3.29 to −1.52], p < 0.001; I2 = 97.66%), heart rate (HR) (difference in means = −3.04 beats/min, 95% CI [−4.79 to −1.29] beats/min, p = 0.001; I2 = 0.00%), systolic blood pressure (SBP) (difference in means = −3.71 mmHg, 95% CI [−7.07 to −0.35] mmHg, p = 0.031; I2 = 58.47%), and diastolic blood pressure (DBP) (difference in means = −3.54 mmHg, 95% CI [−5.27 to −1.81] mmHg, p < 0.001; I2 = 0.00%) as compared to the women in the control group. Conclusions Music interventions may decrease anxiety scores and physiological indexes related to anxiety (HR, SBP, and DBP). Music interventions may be a good non-pharmacological approach for decreasing anxiety levels during labor.

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Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽

10.3390/healthcare9040479 ◽

2021 ◽

Vol 9 (4) ◽

pp. 479

Author(s):

Tatiana Sidiropoulou ◽

Kalliopi Christodoulaki ◽

Charalampos Siristatidis

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Randomized Controlled Trials ◽

Success Rate ◽

Meta Analysis ◽

Controlled Trials ◽

Technical Failure ◽

Obese Patients ◽

Randomized Controlled ◽

Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

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Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽

10.3390/cancers13122984 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2984

Author(s):

Stepan M. Esagian ◽

Christos D. Kakos ◽

Emmanouil Giorgakis ◽

Lyle Burdine ◽

J. Camilo Barreto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Curative Intent ◽

Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

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Effect of Rosa damascena on improvement of adults’ sleep quality: A systematic review and meta-analysis of randomized controlled trials

Sleep Medicine ◽

10.1016/j.sleep.2021.07.017 ◽

2021 ◽

Author(s):

Mohammad Sadegh Ghorbani Rami ◽

Morteza Nasiri ◽

Mohammad Sadegh Aghili Nasab ◽

Zohre Jafari ◽

Mahya Torkaman ◽

...

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Rosa Damascena ◽

Randomized Controlled

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Effect of Probiotic Consumption on Immune Response in Athletes: A Meta-analysis

International Journal of Sports Medicine ◽

10.1055/a-1463-3303 ◽

2021 ◽

Author(s):

Rahele Tavakoly ◽

Amir Hadi ◽

Nahid Rafie ◽

Behrouz Talaei ◽

Wolfgang Marx ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Monocyte Count ◽

Randomized Controlled ◽

Immunological Markers ◽

Online Databases ◽

Immunological Effects

AbstractThe possible effect of probiotic interventions on immunological markers in athletes is inconclusive. Therefore, to synthesize and quantitatively analyze the existing evidence on this topic, systematic literature searches of online databases PubMed, Scopus, Cochrane Library, and ISI Web of Sciences was carried out up to February 2021 to find all randomized controlled trials (RCTs) concerning the immunological effects of probiotics in athletes. In the random-effects model, weighted mean difference (WMD) and 95% confidence interval (CI) explained the net effect. The authors assessed the likelihood of publication bias via Egger’s and Begg’s statistics. A total of 13 RCTs (836 participants) were retrieved. Probiotic consumption reduced lymphocyte T cytotoxic count significantly (WMD=−0.08 cells×109/L; 95% CI: −0.15 to −0.01; p=0.022) with evidence of moderate heterogeneity (I 2=59.1%, p=0.044) and monocyte count when intervention duration was ≤ 4 weeks (WMD=−0.08 cells×109/L; 95% CI: −0.16 to −0.001; I 2=0.0%). Furthermore, leukocyte count was significantly elevated (WMD=0.48 cells×109/L; 95% CI: 0.02 to 0.93; I 2=0.0%) when multi-strain probiotics were used. Probiotic supplements may improve immunological markers, including lymphocyte T cytotoxic, monocyte, and leukocyte in athletes. Further randomized controlled trials using diverse strains of probiotics and consistent outcome measures are necessary to allow for evidence-based recommendations.

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Early Versus Routine Stoma Closure in Patients With Colorectal Resection: A Meta-Analysis of 7 Randomized Controlled Trials

Surgical Innovation ◽

10.1177/1553350620907812 ◽

2020 ◽

Vol 27 (3) ◽

pp. 291-298

Author(s):

Yinyin Guo ◽

Yanxin Luo ◽

Hui Zhao ◽

Liangliang Bai ◽

Juan Li ◽

...

Keyword(s):

Colorectal Surgery ◽

Randomized Controlled Trials ◽

Bowel Obstruction ◽

Meta Analysis ◽

Cochrane Library ◽

Wound Complications ◽

Controlled Trials ◽

Stoma Closure ◽

Randomized Controlled ◽

Significant Difference

Background. A substantial proportion of patients undergoing colorectal surgery receive a temporary stoma, and the timing for stoma closure remains unclear. The aim of this study was to evaluate the safety and feasibility of early stoma closure (ESC) compared with routine stoma closure (RSC) after colorectal surgery. Methods. We comprehensively searched PubMed, Embase, and the Cochrane Library for randomized controlled trials that compared ESC and RSC after colorectal surgery. Results. A total of 7 randomized controlled trials with 814 enrolled patients were identified for this meta-analysis. There were no significant differences between the ESC and RSC groups regarding the complications of stoma closure (26.8% and 16.6%, respectively; odds ratio [OR]: 1.30; 95% confidence interval [CI]: 0.89-1.90; P = .17). A subgroup analysis was conducted by Clavien-Dindo grade of complication, and no significant difference was observed in any subgroup ( P > .05). However, the ESC group had a significantly higher risk of wound complications than the RSC group (17.6% and 7.8%, respectively; OR: 2.61; 95% CI: 1.43-4.76; P = .002), and the RSC group had more cases of small bowel obstruction than the ESC group (3.1% and 8.4%, respectively; OR: 0.37; 95% CI: 0.15-0.87; P = .02). Conclusions. ESC is a safe and effective therapeutic approach in patients who have undergone colorectal surgery; it is associated with a reduced risk of bowel obstruction but a higher risk of wound complications.

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COVID-19 and Vitamin D (Co-VIVID Study): a systematic review and meta-analysis of randomized controlled trials

10.1101/2021.08.22.21262216 ◽

2021 ◽

Author(s):

Seshadri Reddy Varikasuvu ◽

Balachandar Thangappazham ◽

Hemanth Raj

Keyword(s):

Vitamin D ◽

Randomized Controlled Trials ◽

Literature Search ◽

Meta Analysis ◽

Statistical Significance ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Individual Outcomes ◽

Vitamin D Levels

Background: Vitamin D levels have been reported to be associated with COVID-19 susceptibility, severity and mortality events.. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the use of vitamin D intervention on COVID-19 outcomes. Methods: Literature search was conducted using PubMed, Cochrane library, and ClinicalTrials.gov databases (latest search on August 5, 2021). We included RCTs reporting the use of vitamin D intervention to control/placebo group in COVID-19. Two independent researchers did literature search, abstracted data, and the risk of bias assessment. Results: A total of 6 RCTs with 551 COVID-19 patients were included. The overall collective evidence pooling all the outcomes across all RCTs indicated the beneficial use of vitamin D intervention in COVID-19 (relative risk, RR = 0.60, 95% CI 0.40 to 0.92, Z=2.33, p=0.02, I2 = 48%). However, no statistical significance was observed for individual outcomes of ICU care (RR = 0.11, 95% CI 0.15 to 1.30, Z=1.48, p=0.14, I2 = 66%) and mortality (RR = 0.78, 95% CI 0.25 to 2.40, Z=0.66, p=0.02, I2 = 33%), though decreased rates were noted. The rates of RT-CR positivity was significantly decreased in the intervention group as compared to the non-vitamin D groups (RR = 0.46, 95% CI 0.24 to 0.89, Z=2.31, p=0.02, I2 = 0%). Conclusion: COVID-19 patients supplemented with vitamin D are more likely to demonstrate fewer rates of ICU admission, mortality events and RT-PCR positivity. However, no statistical significance has been achieved for individual outcomes of ICU and deaths. More RCTs and completion of ongoing trials largely needed to precisely establish the association between vitamin D use and COVID-19.

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