Abstract 19720: Jay D. Coffman Early Career Investigator Award: Comparative Efficacy of Initial Endovascular Revascularization vs. Supervised Exercise Training in Patients With Intermittent Claudication: A Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ambarish Pandey ◽  
Subhash Banerjee ◽  
Christian Ngo ◽  
Purav Mody ◽  
Steven Marso ◽  
...  
Keyword(s):  
Exercise Training ◽  
Randomized Controlled Trials ◽  
Intermittent Claudication ◽  
Meta Analysis ◽  
Walking Distance ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Supervised Exercise ◽  
Endovascular Revascularization

Introduction: Current guidelines recommend supervised exercise training (SET) as the initial treatment modality for patients with intermittent claudication (IC), in addition to optimal medical therapy. The role of endovascular revascularization (ER) as a primary treatment option has been controversial. We performed a meta-analysis to compare the efficacy of initial ER vs. initial SET in patients with IC using data from randomized controlled trials. Methods: The primary outcome was treadmill-measured maximum walking distance (MWD) at the end of follow-up. Secondary outcomes included resting ankle brachial index (ABI) and treadmill-measured ischemic claudication distance (ICD) on follow-up. Risk of adverse limb events (revascularization, amputations) was also compared between the two groups. Random effects models were used for all analyses. Results: We included 1,145 patients from nine trials with a mean follow up duration of 13.7 months (42% aortoiliac lesions; 35% stent use; mean baseline ABI 0.64 vs. 0.67 for ER vs. SET). Follow-up MWD was not significantly different between patients undergoing ER vs. SET [Weighted mean difference (WMD) (95% CI): 19.1 m (-79.6 to 117.8 m); publication bias p=0.86]. Metaregression did not identify significant differences based on stent use or presence of aortoiliac disease. ICD was also similar between the two groups [WMD (95% CI): 36.1 m (-99.4 to 171.5 m)]. In contrast, patients undergoing ER had higher resting ABI on follow-up [WMD (95% CI): 0.14 (0.11 to 0.17), p<0.0001]. Adverse limb event rates were similar [5.4% vs. 8.2%, p=0.21]. Conclusion: Compared with initial SET, initial ER significantly improves resting ABI values. Although longer walking distance and lower rates of adverse limb events also appeared favorable for ER, these differences were not statistically significant in these intermediate term studies. Longer-term studies and those incorporating contemporary revascularization techniques are necessary.

The Effect of Unsupervised Home-Based Exercise Training on Physical Functioning Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
pp. 109980042198943
Author(s):  
Mahdi Mahjur ◽  
Ali Asghar Norasteh
Keyword(s):  
Older Adults ◽  
Exercise Training ◽  
Randomized Controlled Trials ◽  
Physical Functioning ◽  
Meta Analysis ◽  
Upper Body ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Home Based ◽  
Body Strength

Background: Exercise training such as balance, aerobic, and resistance training is able to improve physical functioning of older adults. Delivering such exercise regimes at home without supervision may be useful for older adults because they do not have to leave their homes. Objective: This systematic review and meta-analysis of randomized controlled trials aimed to establish the effect of unsupervised home-based exercise training regimes on physical functioning (balance and muscle strength) in older adults. Data sources: PubMed, CINAHL, Medline, Google Scholar, and Scopus databases and reference lists of included investigations were searched. Study selection: Thirteen randomized controlled trials (RCTs) of exercise training impact on balance and upper body strength with concurrent control groups were included in the analysis. Results: Our analyses revealed that in older adults, unsupervised home-based various exercise training was effective in improving measures of proactive balance (mean difference (MD) = −1.37 s; 95% confidence interval (CI), −2.24, −0.51 s; p = 0.002) and balance test battery (MD: 1.80; 95% CI, 0.46, 3.14 s; p = 0.009). There were no significant differences between the experimental and control groups for upper body strength ( p > 0.05). Conclusion: Unsupervised home-based exercise training improves balance in older adults. Future investigations are needed to clarify the mechanisms underlying unsupervised home-based exercise training’s effect on this population’s physical functioning outcomes.

scholarly journals Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiao-Li Chen ◽  
Bei-Lei Zhang ◽  
Chang Meng ◽  
Hui-Bin Huang ◽  
Bin Du
Keyword(s):  
Sensitivity Analysis ◽  
Randomized Controlled Trials ◽  
Critically Ill Patients ◽  
Oxygen Therapy ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Icu Patients ◽  
Randomized Controlled

Abstract Objective Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients. Methods We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Results We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. Conclusions Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.

scholarly journals Inverted internal limiting membrane flap technique versus internal limiting membrane peeling for large macular holes: A meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Ji-Guo Yu ◽  
Jing Wang ◽  
Yi Xiang
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Internal Limiting Membrane ◽  
Controlled Trials ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Flap Technique ◽  
Randomized Controlled ◽  
Macular Holes

Background: Vitrectomy with internal limiting membrane (ILM) peeling is an effective surgical procedure for the treatment of macular holes (MHs). However, there is a possibility of poor postoperative anatomical closure with conventional ILM peeling for MHs larger than 400 μm. Therefore, a novel inverted ILM flap technique was developed for such cases. Objectives: This meta-analysis study was performed to evaluate and compare the anatomical and visual outcomes of the inverted ILM flap technique and ILM peeling in large MHs. Methods: The Cochrane Library, PubMed, and Embase databases were searched to identify randomized controlled trials (RCTs). The trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary outcome measures included MH closure rate and postoperative visual acuity (VA). Subgroup analysis of postoperative VA based on follow-up time was also conducted. Pooled odds ratios (ORs), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated. Statistical analysis was performed using RevMan 5.3 software. Results: Five RCTs with a total of 155 eyes in the inverted ILM flap group and 161 eyes in the ILM peeling group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the inverted ILM flap group was significantly higher than that in the ILM peeling group (OR, 3.10; 95% CI, 1.25 to 7.66; P = 0.01). The postoperative VA was significantly better in the inverted ILM flap group than ILM peeling group (WMD, -0.14; 95% CI, -0.21 to -0.07; P = 0.0002). The subgroup meta-analysis indicated that the postoperative VA was significantly better in the inverted ILM flap group than ILM peeling group (WMD, -0.17; 95% CI, -0.26 to -0.08; P = 0.0004) at the 3-month follow-up. However, no significant difference was observed between the two groups at the 6-month follow-up (WMD, -0.09; 95% CI, -0.20 to 0.02; P = 0.10). Conclusions: Vitrectomy with inverted ILM flap technique showed a higher anatomical closure rate as well as visual gain—although only in the short-term as no difference in visual recovery was found at the 6-month follow-up—than did ILM peeling in large MHs. The inverted ILM flap technique should be considered as a preferred and routine procedure for the treatment of patients with MHs larger than 400 µm.

Exercise Training for Pulmonary Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
pp. 109980042098237
Author(s):  
Alsaeedi L. Albanaqi ◽  
Gholam Rasul Mohammad Rahimi ◽  
Neil A. Smart
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Training ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Mental Component Score ◽  
Physical Component Score ◽  
Controlled Trials ◽  
Component Score ◽  
Randomized Controlled ◽  
Sf 36

Background: Pulmonary hypertension (PH) is a chronic disease with a notable health burden; regular exercise may improve specific health outcome measures. Objective: The objective of this meta-analysis was to estimate the effectiveness of exercise training for PH patients. Data sources: PubMed, CINAHL, SportDiscuss and Google Scholar databases and reference lists of included studies were searched. Study selection: The selection criteria were randomized controlled trials (RCTs) employing an exercise training intervention. Data were extracted from the entered studies for analysis. The primary outcomes were peak oxygen uptake (VO2peak), anaerobic threshold (AT), 6-minute walk distance (6-MWD), and quality of life (QoL) measures (physical component score and mental component score). The analysis included 9 articles with a total of 302 participants: intervention (n = 154), and control (n = 148). Results: In the pooled analysis, improvements were seen in: VO2peak, mean difference (MD) 2.79 ml/kg/min (95% CI 2.00 to 3.59, p < 0.00001); AT, MD 107.83 ml/min (95% CI 39.64 to 176.00, p = 0.002); and 6-MWD, MD 46.67 meters (95% CI 32.39 to 60.96, p < 0.00001). Differences were found in the SF-36 physical component score MD 3.57 (95% CI 2.04 to 5.10, p < 0.00001) and the SF-36 mental component score MD 3.92 (95% CI 1.92 to 5.91, p = 0.001). Conclusion: This meta-analysis demonstrates exercise training has a beneficial effect on fitness, walking performance, and self-reported QoL in PH patients.

Preventive interventions in offspring of parents with mental illness: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 51 (14) ◽  
pp. 2321-2336
Author(s):  
Alice Lannes ◽  
Eric Bui ◽  
Catherine Arnaud ◽  
Jean-Philippe Raynaud ◽  
Alexis Revet
Keyword(s):  
Mental Illness ◽  
Mental Disorders ◽  
Randomized Controlled Trials ◽  
Internalizing Symptoms ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled ◽  
Post Test

AbstractChildren with parents suffering from a psychiatric disorder are at higher risk for developing a mental disorder themselves. This systematic review and meta-analysis of randomized controlled trials aims to evaluate the efficacy of psychosocial interventions to prevent negative mental health outcomes in the offspring of parents with mental illness. Eight electronic databases, grey literature and a journal hand-search identified 14 095 randomized controlled trials with no backward limit to June 2021. Outcomes in children included incidence of mental disorders (same or different from parental ones) and internalizing and externalizing symptoms at post-test, short-term and long-term follow-up. Relative risks and standardized mean differences (SMD) for symptom severity were generated using random-effect meta-analyses. Twenty trials were selected (pooled n = 2689 children). The main therapeutic approaches found were cognitive-behavioural therapy and psychoeducation. A significant effect of interventions on the incidence of mental disorders in children was found with a risk reduction of almost 50% [combined relative risk = 0.53, 95% confidence interval (CI) 0.34–0.84]. Interventions also had a small but significant effect on internalizing symptoms at post-test (SMD = −0.25, 95% CI −0.37 to −0.14) and short-term follow-up (−0.20, 95% CI −0.37 to −0.03). For externalizing symptoms, a decreasing slope was observed at post-test follow-up, without reaching the significance level (−0.11, 95% CI −0.27 to 0.04). Preventive interventions targeting the offspring of parents with mental disorders showed not only a significant reduction of the incidence of mental illness in children, but also a diminution of internalizing symptoms in the year following the intervention.

Exercise training in childhood cancer: A systematic review and meta-analysis of randomized controlled trials

2018 ◽  
Vol 70 ◽  
pp. 154-167 ◽  
Author(s):  
Javier S. Morales ◽  
Pedro L. Valenzuela ◽  
Cecilia Rincón-Castanedo ◽  
Tim Takken ◽  
Carmen Fiuza-Luces ◽  
...  
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Randomized Controlled Trials ◽  
Childhood Cancer ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled
Sign in / Sign up

Export Citation Format

Share Document