Abstract MP89: Effectiveness of School Procurement Policies for Improving Dietary Behaviors: A Systematic Review and Meta-analysis

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Renata Micha ◽  
Ioanna Bakogianni ◽  
Dimitra Karageorgou ◽  
Eirini Trichia ◽  
Masha L Shulkin ◽  
...  
Keyword(s):  
Publication Bias ◽  
Vegetable Intake ◽  
Average Duration ◽  
Meta Analysis ◽  
Quality Standards ◽  
Portion Size ◽  
School Meals ◽  
Statistical Heterogeneity ◽  
Competitive Foods ◽  
Meta Regression

Background: School procurement policies - e.g., free/reduced price provision of healthful foods/beverages, quality standards for competitive foods/beverages, or quality standards for school meals - are increasingly being used to promote healthy diets in kids. However, their effectiveness has not been systematically evaluated. Methods: We used MOOSE and PRISMA guidelines to systematically search multiple online databases for original interventions (randomized, quasi-experimental) assessing influence of school procurement policies, alone or as part of multi-component strategies, on dietary intakes in children. Data were extracted independently and in duplicate. Inverse variance-weighted meta-analysis was used to pool estimates. Pre-specified sources of heterogeneity (study design, location; intervention duration, coverage, components; outcome type, ascertainment) were analyzed using meta-regression and subgroup analysis. Funnel plots, Begg’s, and Egger’s tests evaluated potential publication bias. Results: From 6,193 abstracts, 76 interventional studies met inclusion criteria. Many were multicomponent. Thirty-two assessed free/reduced price provision of healthful foods/beverages, mostly in cafeterias or classrooms, with average duration 18 mo. In pooled analysis, free/reduced price provision of fruits and vegetables increased fruit intake by 0.22 servings/d (n=14 studies; 95% CI: 0.10, 0.34) and total fruit and vegetable intake by 0.28 servings/d (n=12; 0.07, 0.49), but not vegetable intake alone (n=8; 0.01 servings/d [-0.03, 0.05]). Twenty-seven interventions evaluated policies on competitive foods/beverages (most often sugar-sweetened beverages), with average duration 23 mo. Strategies included restrictions/bans, quality standards, or both. These interventions reduced sugar-sweetened beverage intake by 0.11 (12-oz) servings/d (n=7; -0.16, -0.05). Thirty-two interventions assessed quality standards for school meals (lunch and/or breakfast), with average follow-up 28 mo. Standards were typically based on types of foods, nutrient content, and/or portion size. Dietary targets varied appreciably, and results were generally inconsistent across studies, with no significant overall pooled effect. Findings for secondary outcomes of food content, food availability, and adiposity will be presented. Statistical heterogeneity in these analyses was variable; meta-regression did not identify significant sources. Little evidence for publication bias was seen. Conclusions: These findings support efficacy of school procurement policies that provide free/reduced price healthful choices or target competitive foods/beverages. Efficacy of quality standards for school meals appears heterogeneous with less consistent benefits. These findings inform policy priorities for improving diets in children.

scholarly journals Performance of 18F-DCFPyL PET/CT Imaging in Early Detection of Biochemically Recurrent Prostate Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Jiale Sun ◽  
Yuxin Lin ◽  
Xuedong Wei ◽  
Jun Ouyang ◽  
Yuhua Huang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Early Detection ◽  
Publication Bias ◽  
Detection Rate ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Recurrent Prostate Cancer ◽  
Pet Ct ◽  
Statistical Heterogeneity

Background: Prostate-specific membrane antigen (PSMA)-targeted 2-(3-{1-carboxy-5-[(6-[18F] fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) positron emission tomography/computed tomography (PET/CT) has shown advantages in primary staging, restaging, and metastasis detection of prostate cancer (PCa). However, little is known about the role of 18F-DCFPyL PET/CT in biochemically recurrent prostate cancer (BRPCa). Hence, we performed a systematic review and meta-analysis to evaluate 18F-DCFPyL PET/CT as first-line imaging modality in early detection of BRPCa.Methods: A comprehensive literature search of PubMed, Web of Science, Embase, and Cochrane Library was conducted until December 2020. The pooled detection rate on a per-person basis and together with 95% confidence interval (CI) was calculated. Furthermore, a prostate-specific antigen (PSA)-stratified performance of detection positivity was obtained to assess the sensitivity of 18F-DCFPyL PET/CT in BRPCa with different PSA levels.Results: A total of nine eligible studies (844 patients) were included in this meta-analysis. The pooled detection rate (DR) of 18F-DCFPyL PET/CT in BRPCa was 81% (95% CI: 76.9–85.1%). The pooled DR was 88.8% for PSA ≥ 0.5 ng/ml (95% CI: 86.2–91.3%) and 47.2% for PSA < 0.5 ng/ml (95% CI: 32.6–61.8%). We also noticed that the regional lymph node was the most common site with local recurrence compared with other sites (45.8%, 95% CI: 42.1–49.6%). Statistical heterogeneity and publication bias were found.Conclusion: The results suggest that 18F-DCFPyL PET/CT has a relatively high detection rate in BRPCa. The results also indicate that imaging with 18F-DCFPyL may exhibit improved sensitivity in BRPCa with increased PSA levels. Considering the publication bias, further large-scale multicenter studies are warranted for validation.

Towards qualification of FDG PET as biomarker of response to neo-adjuvant therapy: A meta-analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22128-e22128
Author(s):  
Andrew D. Vincent ◽  
Saiyada N. F. Rizivi ◽  
Harm van Tinteren ◽  
Ingrid Riphagen ◽  
Otto S. Hoekstra
Keyword(s):  
Publication Bias ◽  
Fdg Pet ◽  
Meta Analysis ◽  
Model Development ◽  
Histopathological Response ◽  
Treatment Type ◽  
Neoadjuvant Systemic Therapy ◽  
Before And After ◽  
Maximal Sensitivity ◽  
Meta Regression

e22128 Background: For FDG PET to qualify as a biomarker of response to cancer therapy beyond proof of principle, the evidence should be aggregated. Methods: A systematic literature search (Jan 1995-May 2011) for studies in solid extracerebral tumors with distinct cohorts of n≥10 patients, PET before and after cytotoxic neoadjuvant systemic therapy (with or without radiotherapy), dichotomized histopathological (PA) response. For model development we selected studies reporting individual or dichotomous aggregated level data, and performed bivariate SROC meta-regression. Results: 52 studies were identified, comprising data from 1,710 patients: rectal (32%), esophageal (21%), sarcoma (20%), breast (13%) and other cancers (14%). Most PET measures were SUVmax (65%) and other SUV measures (32%). Treatment type ChT (38%) and ChRT (62%); 46% were PA responders. The meta-regression indicated a weak increase in specificity for chemotherapy studies over chemoradiotherapy studies (p=0.08), however this disappeared after adjusting for publication bias. High baseline uptake rates improved diagnostic sensitivity (p=0.01). The SROC-AUC after adjusting for publication bias was 0.77. Maximal sensitivity and specificity was achieved with a PET reduction of 60%. Conclusions: There is a moderate association between FDG-PET change and histopathological response. This relation appears to be a function of baseline uptake, which may (at least in part) relate to repeatability issues.

scholarly journals Meta-Analysis of 41 Series Questions the Value of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Hodgkin Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4378-4378
Author(s):  
Armin Rashidi ◽  
Amanda F. Cashen ◽  
Maryam Ebadi
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Quality Assessment ◽  
Hodgkin Lymphoma ◽  
Publication Bias ◽  
Cell Transplantation ◽  
Cumulative Incidence ◽  
Meta Analysis ◽  
Hematopoietic Stem ◽  
Statistical Heterogeneity

Abstract Background: The availability of multiple active new agents for the treatment of relapsed or refractory Hodgkin lymphoma (HL) has brought into question the role of allogeneic stem cell transplantation (allo-SCT). We performed a meta-analysis of allo-SCT outcomes in patients with HL. Methods: Medline and Embase were searched for literature published until June 1, 2015. A 5-category scoring system was used for quality assessment: (i) conditioning regimen, (ii) stem cell source, (iii) donor, (iv) GvHD prophylaxis, and (v) pre-SCT disease status. For these scoring factors, studies received a score of 1 if the information was provided in the report and zero otherwise. Primary endpoints were OS and RFS at 6 months, 1 year, 2 years, and 3 years. Secondary endpoints were the cumulative incidence of relapse (CIR) and NRM. Heterogeneity was studied using the Cochran Q statistic. A random effects model was used in proportion meta-analysis. Publication bias was assessed using funnel plots and Egger test. STATA 13 was used for analysis. P <0.05 was considered statistically significant. Results: 41 series were included (n = 1,831 patients; 13 prospective; 21 multi-center). One study scored 1, two scored 2, one scored 3, nine scored 4, and 28 scored 5 on quality assessment scale. Conditioning was myeloablative (n = 7), reduced-intensity (n = 29), and mixed/unknown (n = 5). Transplants were from an HLA-matched donor in 20 studies, mismatched donor (haploidentical, mismatched unrelated donor, or cord) in 4 studies, and mixed/unknown in others. Median follow-up ranged between 11 and 104 months. There was significant statistical heterogeneity among studies in all outcomes. The pooled estimates (95%CI) for RFS at 1 year and 3 years were 50 (42-57)% and 31 (25-37)%, respectively (Figure 1). The corresponding numbers for OS were 68 (62-74)% and 50 (41-58)%, respectively. The pooled estimates (95%CI) for CIR at 1 year and 3 years were 34 (30-39)% and 46 (40-51)%, respectively. The corresponding numbers for NRM were both 19 (14-24)%. Figure 2 shows reconstructed curves for RFS, OS, CIR, and NRM. In meta-regression, accrual initiation year in 2000 or later was associated with higher 6-month (P=0.012) and 1-year OS (P=0.046). Pre-SCT CR/PR was associated with higher 2-yeasr OS (P=0.047) and 1-year RFS (P=0.016). Previous auto-SCT was associated with higher 1-year OS (P=0.012), 2-year OS (P=0.040), 6-month RFS (P<0.01), and 1-year RFS (P=0.005), and lower 1-year (P<0.001), 2-year (P=0.037), and 3-year NRM (P=0.007), likely reflecting the fitness of patients who have previously tolerated auto-SCT. None of the studied variables were associated with CIR. There was no significant publication bias with the exception of 2-year NRM (P=0.04) and 2-year OS (P=0.02), where there was a lack of small studies with high NRM and low OS. Conclusions: While NRM following allo-SCT reaches a plateau at 1 year, relapse continues to occur, reaching a cumulative incidence of 46% at 3 years. RFS and OS outcomes are also disappointing, with no apparent plateau until 3 years. Less than a third of patients are relapse-free and alive at 3 years after allo-SCT. These results from a large meta-analysis argue against the value of allo-SCT in relapsed/refractory HL. Figure 1. RFS at 6 months, 1 year, 2 years, and 3 years Figure 1. RFS at 6 months, 1 year, 2 years, and 3 years Disclosures No relevant conflicts of interest to declare.

scholarly journals Case fatality rate in COVID-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Chanaka Kahathuduwa ◽  
Chathurika Dhanasekara ◽  
Shao-Hua Chin
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critical Illness ◽  
Publication Bias ◽  
Case Fatality Rate ◽  
Meta Analysis ◽  
Case Fatality ◽  
Severe Illness ◽  
Fatality Rate ◽  
Meta Regression

AbstractBackgroundEstimating the prevalence of severe or critical illness and case fatality of COVID-19 outbreak in December, 2019 remains a challenge due to biases associated with surveillance, data synthesis and reporting. We aimed to address this limitation in a systematic review and meta-analysis and to examine the clinical, biochemical and radiological risk factors in a meta-regression.MethodsPRISMA guidelines were followed. PubMed, Scopus and Web of Science were searched using pre-specified keywords on March 07, 2020. Peer-reviewed empirical studies examining rates of severe illness, critical illness and case fatality among COVID-19 patients were examined. Numerators and denominators to compute the prevalence rates and risk factors were extracted. Random-effects meta-analyses were performed. Results were corrected for publication bias. Meta-regression analyses examined the moderator effects of potential risk factors.ResultsThe meta-analysis included 29 studies representing 2,090 individuals. Pooled rates of severe illness, critical illness and case fatality among COVID-19 patients were 15%, 5% and 0.8% respectively. Adjusting for potential underreporting and publication bias, increased these estimates to 26%, 16% and 7.4% respectively. Increasing age and elevated LDH consistently predicted severe / critical disease and case fatality. Hypertension; fever and dyspnea at presentation; and elevated CRP predicted increased severity.ConclusionsRisk factors that emerged in our analyses predicting severity and case fatality should inform clinicians to define endophenotypes possessing a greater risk. Estimated case fatality rate of 7.4% after correcting for publication bias underscores the importance of strict adherence to preventive measures, case detection, surveillance and reporting.

scholarly journals Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Hany Hasan Elsayed ◽  
Aly Sherif Hassaballa ◽  
Taha Aly Ahmed ◽  
Mohamed Gumaa ◽  
Hazem Youssef Sharkawy
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Publication Bias ◽  
Risk Ratio ◽  
Mortality Risk ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Random Effect ◽  
Meta Regression

Abstract Background: COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries.Methods: CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from June 8 2019 to June 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365Findings: Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p=0.23) (95% CI = 0.94-1.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43-0.76) with persistent heterogeneity (I2 = 98%, p<0.001). Meta-regression showed that outcome from IMV improved with time (p<0.001). Age had no statistically significant effect on mortality (p= 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger's test with p=0.714 and Begg&Mazumdar test with p=0.334Interpretation: The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.

scholarly journals Vancomycin-Resistant Enterococci (VRE) in Nigeria: The First Systematic Review and Meta-Analysis

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 565
Author(s):  
Yusuf Wada ◽  
Azian Binti Harun ◽  
Chan Yean Yean ◽  
Abdul Rahman Zaidah
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Forest Plot ◽  
Funnel Plot ◽  
Vancomycin Resistant Enterococci ◽  
Pooled Prevalence ◽  
Vancomycin Resistant ◽  
Meta Regression ◽  
Leave One Out

Vancomycin-Resistant Enterococci (VRE) are on the rise worldwide. Here, we report the first prevalence of VRE in Nigeria using systematic review and meta-analysis. International databases MedLib, PubMed, International Scientific Indexing (ISI), Web of Science, Scopus, Google Scholar, and African journals online (AJOL) were searched. Information was extracted by two independent reviewers, and results were reviewed by the third. Two reviewers independently assessed the study quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. OpenMeta analyst was used. The random effect was used, and publication bias was assessed using a funnel plot. Between-study heterogeneity was assessed, and the sources were analysed using the leave-one-out meta-analysis, subgroup analysis, and meta-regression. Nineteen studies met the eligibility criteria and were added to the final meta-analysis, and the study period was from 2009–2018. Of the 2552 isolates tested, 349 were VRE, and E. faecalis was reported the most. The pooled prevalence of VRE in Nigeria was estimated at 25.3% (95% CI; 19.8–30.8%; I2 = 96.26%; p < 0.001). Between-study variability was high (t2 = 0.011; heterogeneity I2 = 96.26% with heterogeneity chi-square (Q) = 480.667, degrees of freedom (df) = 18, and p = 0.001). The funnel plot showed no publication bias, and the leave-one-out forest plot did not affect the pooled prevalence. The South-East region had a moderate heterogeneity though not significant (I2 = 51.15%, p = 0.129). Meta-regression showed that all the variables listed contributed to the heterogeneity except for the animal isolate source (p = 0.188) and studies that were done in 2013 (p = 0.219). Adherence to proper and accurate antimicrobial usage, comprehensive testing, and continuous surveillance of VRE are required.

scholarly journals Rectal Cancer: 20% Risk Reduction Thanks to Dietary Fibre Intake. Systematic Review and Meta-Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1579 ◽  
Author(s):  
Vincenza Gianfredi ◽  
Daniele Nucci ◽  
Tania Salvatori ◽  
Giulia Dallagiacoma ◽  
Cristina Fatigoni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Publication Bias ◽  
Dietary Fibre ◽  
Meta Analysis ◽  
P Value ◽  
Computer Search ◽  
Fibre Intake ◽  
Statistical Heterogeneity ◽  
Dietary Fibre Intake

The aim of this systematic review and meta-analysis was to evaluate the association between dietary fibre intake and rectal cancer (RC) risk. In January 2019, a structured computer search on PubMed/Medline, Excerpta Medica dataBASE (EMBASE) and Scopus was performed for studies reporting the results of primary research evaluating dietary fibre intake in women and men as well as the risk of developing RC. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Highest vs. lowest fibre concentrations was compared. The Egger test was used to estimate publication bias. Heterogeneity between studies was evaluated with I2 statistics. The search strategy identified 912 papers, 22 of which were included in our meta-analysis. Having evaluated a total of 2,876,136 subjects, the results suggest a protective effect of dietary fibre intake on RC prevention. The effect Size (ES) was [0.77 (95% CI = 0.66–0.89), p-value = 0.001)]. Moderate statistical heterogeneity (Chi2 = 51.36, df = 21, I2 = 59.11%, p-value = 0.000) was found. However, no publication bias was found, as confirmed by Egger’s linear regression test (Intercept −0.21, t = −0.24, p = 0.816). The findings suggest that dietary fibre intake could be protective against RC, with a clinically relevant reduction of RC risk. Identifying preventive measures to avoid the development of RC, especially by following a healthy lifestyle including healthy diet, is pivotal.

Abstract 14036: Enhanced External Counterpulsation Reduces Blood Pressure in Patients With Chronic Stable Angina: A Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bradley Williams ◽  
Mehak Aggarwal ◽  
Cole Kiser ◽  
Krishnaswami Vijayaraghavan ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Publication Bias ◽  
Stable Angina ◽  
Meta Analysis ◽  
Chronic Stable Angina ◽  
External Counterpulsation ◽  
Statistical Heterogeneity ◽  
The Impact ◽  
Enhanced External Counterpulsation

Background: Hypertension is a modifiable risk factor for ASCVD. Enhanced External Counterpulsation (EECP ® ) is an FDA-approved, non-invasive treatment modality for patients with angina and symptoms of ischemic heart failure. Various studies have demonstrated hemodynamic changes with EECP ® therapy, but the true magnitude of benefit remains unknown. We conducted a meta-analysis to assess the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) post- EECP ® therapy. Methods: A literature search across multiple databases was conducted from its inception to March 2020. Studies evaluating the impact of EECP ® in chronic stable angina patients that reported systolic and diastolic blood pressures were extracted. Human studies published in English, where patients completed 35 hours of EECP ® (administered as 1-hour sessions) were included for analysis. Studies that reported data in multiple arms were treated as individual studies. The weighted mean difference from baseline for SBP and DBP was calculated using the DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed by the I 2 statistic with publication bias evaluated using the Egger bias statistic. Subgroup analyses were performed to assess for clinical heterogeneity. Results: We identified 272 articles, of which 15 unique studies (n=659) reporting data on systolic and diastolic blood pressure were included. Post- EECP ® treatment, SBP decreased by 8.9 mmHg (95% CI 4.0 to 13.7 mmHg, I 2 =87.3%) and DBP reduced by 3.6 mmHg (95% CI 2.1 to 5.0 mmHg, I 2 =38.9%). Patients with a baseline SBP 130 mmHg appear to derive greater benefit (SBP reduced by 13.0 mmHg, 95% CI 8.3 to 17.6, I 2 =70.4%) compared to patients with a baseline SBP<130 (SBP reduced by 3.2 mmHg, 95% CI 0.4 to 6.0, I 2 =25.2). The Egger bias statistic showed no publication bias for the primary endpoints (both p-values>0.33). Conclusion: EECP ® treatment reduced SBP and DBP by over 8 and 3 mmHg respectively. The pleiotropic benefits from EECP ® provide additional hypertension control in patients with chronic stable angina.

Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice

2002 ◽  
Vol 7 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Julian Higgins ◽  
Simon Thompson ◽  
Jonathan Deeks ◽  
Douglas Altman
Keyword(s):  
Clinical Trials ◽  
Systematic Reviews ◽  
Current Practice ◽  
Meta Analysis ◽  
A Priori ◽  
Potential Effect ◽  
Cochrane Reviews ◽  
Study Results ◽  
Statistical Heterogeneity ◽  
Meta Regression

Objective: Heterogeneity between study results can be a problem in any systematic review or meta-analysis of clinical trials. Identifying its presence, investigating its cause and correctly accounting for it in analyses all involve difficult decisions for the researcher. Our objectives were: to collate recommendations on the subject of dealing with heterogeneity in systematic reviews of clinical trials; to investigate current practice in addressing heterogeneity in Cochrane reviews; and to compare current practice with recommendations. Methods: We review guidelines for those undertaking systematic reviews and examine how heterogeneity is addressed in practice in a sample of systematic reviews, and their protocols, from the Cochrane Database of Systematic Reviews. Results: Advice to reviewers is on the whole consistent and sensible. However, examination of a sample of Cochrane protocols and reviews demonstrates that the advice is difficult to follow given the small numbers of studies identified in many systematic reviews, the difficulty of pre-specifying important effect modifiers for subgroup analysis or meta-regression and the unresolved debate concerning fixed versus random effects metaanalyses. There was disagreement between protocols and reviews, often either regarding choice of important potential effect modifiers or due to the review identifying too few studies to perform planned analyses. Conclusion: Guidelines that address practical issues are required to reduce the risk of spurious findings from investigations of heterogeneity. This may involve discouraging statistical investigations such as subgroup analyses and meta-regression, rather than simply adopting a cautious approach to their interpretation, unless a large number of studies is available. The notion of a priori specification of potential effect modifiers for a retrospective review of studies is ill-defined, and the appropriateness of using a statistical test for heterogeneity to decide between analysis strategies is suspect.

scholarly journals A65 ENDOSCOPIST-TARGETED INTERVENTIONS TO OPTIMIZE ADENOMA DETECTION RATE - A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 25-26
Author(s):  
A Arora ◽  
C McDonald ◽  
A Iansavitchene ◽  
M Brahmania ◽  
M Sey
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Detection Rate ◽  
Meta Analysis ◽  
Report Card ◽  
Adenoma Detection Rate ◽  
Report Cards ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Statistical Heterogeneity

Abstract Background Adenoma detection rate (ADR) has emerged as the strongest quality assurance metric that has consistently been shown to be inversely associated with the development of colorectal cancer after colonoscopy. Unfortunately, marked variability in ADR exists among endoscopists. A multitude of interventions targeted at endoscopists to optimize their ADR have been reported, including but not limited to withdrawal time, in room observers, physician report cards, and quality improvement and training programs. However, it is unclear which of them are truly effective. Aims We performed a systematic review and meta-analysis of the literature to evaluate the effectiveness of endoscopist-targeted interventions to improve adenoma detection rate (ADR) or polyp detection rate (PDR). Methods Systematic searches of major databases were conducted through to March 2018 to identify potentially relevant studies. Both randomized controlled trials and observational studies were included. Data for ADR and PDR were analyzed on the log-odds scale using a random-effects meta-analysis model using restricted maximum likelihood (with Mantel-Haenszel fixed-effect meta-analysis used for fewer than 4 studies). Statistical effect-size heterogeneity was assessed using a Chi2 test and quantifying the relative proportion of variation using the I2 statistic. Publication bias was assessed by the Harbord regression test. Results From 4299 initial studies, 24 were included in the systematic review and 13 were included in the meta-analysis representing a total of 55,090 colonoscopies. Physician report card interventions (7 studies) and withdrawal time focused interventions (6 studies) were meta-analyzed. The pooled odds ratio for ADR for report card interventions was 1.31 (95% CI: 1.15, 1.50; p&lt;0.0001), favoring report cards to detect more adenomas. Statistical heterogeneity was detected with substantial relative effect-size variability (Chi2, p&lt;0.0001; I2=80.1%). No statistical evidence of publication bias was found. 6 studies reported data for PDR using withdrawal time focused interventions, with 3 of these reporting data on ADR. The pooled odds ratio for ADR was 1.02 (95% CI: 0.86, 1.22; p=0.81) and for PDR was 1.07 (95% CI: 0.88, 1.31; p=0.51) which were not statistically significant. Statistical heterogeneity was detected in both groups (Chi2, p&lt;0.001; I2=82.2% for ADR and I2=89.4% for PDR) and there was statistical evidence of publication bias. Figures 1 and 2 represent Forest plots for the effect of pre-and post-report card and withdrawal time focused interventions on ADR. Conclusions Our study provides evidence that the distribution of colonoscopy quality report cards to physicians significantly improves overall ADR and should strongly be considered as part of quality improvement programs aimed at optimizing colonoscopy performance. Funding Agencies None

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