Abstract 16037: Hybrid Convergent Ablation for Atrial Fibrillation: Updated Systematic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
suvash shrestha ◽  
David DeLurgio ◽  
Andy Kiser ◽  
Saumil Oza ◽  
Yisachar Greenberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Monitoring ◽  
Event Rate ◽  
Meta Analysis ◽  
Adverse Event Rate ◽  
Likelihood Estimator ◽  
Search Terms ◽  
Limited Effectiveness ◽  
One Year ◽  
Meta Analyses

Introduction: Hybrid convergent epicardial/endocardial ablation was developed in response to the limited effectiveness of endocardial catheter ablation for persistent (PersAF) and longstanding PersAF (LSPAF). The objective of this study was to perform a systematic review and meta-analysis of reported safety and efficacy outcomes with convergent procedures. Methods: Predefined search terms were used in PubMed; the initial search was performed in June 2019 and updated in May 2020. Abstracts and full text in English were reviewed for peer-reviewed, primary clinical studies of hybrid convergent procedures in PersAF/LSPAF. Meta-analysis was performed with using a random effects model with a restricted maximum likelihood estimator and forest plots. Heterogeneity was tested using Cochran’s Q-test. Results: The updated search yielded 325 unique results. Two articles from meta-analyses were added. Nineteen articles met inclusion with safety and/or efficacy data. Three overlapping studies were excluded. Results from the randomized CONVERGE trial were added, for a total of 1084 patients in 17 studies; 94% had PersAF or LSPAF. The 30-day major adverse event rate was 3.1% (95% CI 1.9% - 4.3%; n=1084; 17 studies), excluding pericardial effusions (PE) (non-emergent inflammatory response) and 5.1% (95% CI 3.6% - 6.6%) overall. The PEs may be mitigated by anti-inflammatory prophylaxis, pericardial drainage and appropriate patient monitoring. Freedom from AF/atrial arrhythmia at one year or later was 75.0% (95% CI 66.0%-83.9%; n=805; 14 studies) regardless of anti-arrhythmic drugs (AAD) and 64.9% (95% CI 54.7%-75.1%; n=494; 8 studies) off AADs/ absent increased dosage of failed AADs. Heterogeneity across studies was detected for effectiveness (p<0.0001), but not for safety (p=0.12). Conclusions: This meta-analysis shows high efficacy of hybrid convergent ablation at one year, even off AADs, and a reasonable safety in mostly persistent or long-standing persistent AF.

scholarly journals Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1708 ◽  
Author(s):  
Eleanor Busby ◽  
Justine Bold ◽  
Lindsey Fellows ◽  
Kamran Rostami
Keyword(s):  
Systematic Review ◽  
Mood Disorders ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Future Research ◽  
One Year ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Relationship

Gluten elimination may represent an effective treatment strategy for mood disorders in individuals with gluten-related disorders. However, the directionality of the relationship remains unclear. We performed a systematic review of prospective studies for effects of gluten on mood symptoms in patients with or without gluten-related disorders. Six electronic databases (CINAHL, PsycINFO, Medline, Web of Science, Scopus and Cochrane Library) were searched, from inception to 8 August 2018, for prospective studies published in English. Meta-analyses with random-effects were performed. Three randomised-controlled trials and 10 longitudinal studies comprising 1139 participants fit the inclusion criteria. A gluten-free diet (GFD) significantly improved pooled depressive symptom scores in GFD-treated patients (Standardised Mean Difference (SMD) −0.37, 95% confidence interval (CI) −0.55 to −0.20; p < 0.0001), with no difference in mean scores between patients and healthy controls after one year (SMD 0.01, 95% CI −0.18 to 0.20, p = 0.94). There was a tendency towards worsening symptoms for non-coeliac gluten sensitive patients during a blinded gluten challenge vs. placebo (SMD 0.21, 95% CI −0.58 to 0.15; p = 0.25). Our review supports the association between mood disorders and gluten intake in susceptible individuals. The effects of a GFD on mood in subjects without gluten-related disorders should be considered in future research.

scholarly journals The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

Autism ◽  
2020 ◽  
Vol 24 (8) ◽  
pp. 1933-1944 ◽  
Author(s):  
Richard Jenkinson ◽  
Elizabeth Milne ◽  
Andrew Thompson
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Intolerance Of Uncertainty ◽  
Effective Interventions ◽  
Limited Effectiveness ◽  
Autistic People ◽  
High Prevalence ◽  
Weighted Effect Size ◽  
Weighted Effect ◽  
Meta Analyses

The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p < 0.001. The strength of this association was comparable to meta-analyses conducted on neurotypical populations, and therefore, it was concluded intolerance of uncertainty may be an appropriate target for intervention for autistic individuals. However, conclusions were limited due to the small number of relevant studies that were available and due to issues with methodological quality. Lay abstract People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals.

scholarly journals Interventions to Deliver Vaccination to, and Improve Vaccination Rates in, People who are Homeless

2020 ◽  
Vol 3 ◽  
pp. 1-15
Author(s):  
Laura McCosker ◽  
Robert Ware ◽  
Martin J. Downes
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cost Effective ◽  
Exclusion Criteria ◽  
Vaccine Preventable Diseases ◽  
Vaccination Rates ◽  
Search Terms ◽  
Health Related ◽  
Index Terms ◽  
Meta Analyses

Background: In comparison to the general population, people who are homeless have poorer health and health-related outcomes, including for vaccine-preventable diseases. Vaccination is safe, effective and cost-effective, and many vaccination guidelines specifically recommend vaccination in people who are homeless. This systematic review will identify interventions which are effective in delivering vaccination to, and/or at improving vaccination rates in, people who are homeless. Methods/Design: This systematic review is presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches will be undertaken on eight electronic databases, using combinations of search terms and subject headings or index terms. Citation chaining will also be undertaken. Literature will be screened for relevance against inclusion/exclusion criteria firstly by title/abstract and secondly by full text. The selected studies will be assessed for quality using an evidence-based tool appropriate to their methods. Data relevant to the topic will be extracted and examined using meta-analysis and narrative synthesis. Discussion: This systematic review will address an important gap in the literature about vaccination in people who are homeless. The review’s findings are particularly relevant considering the current coronavirus disease (COVID-19) pandemic, which is likely to be managed through vaccination.

Outcomes of North American, Japanese, and European extensive-disease small cell lung cancer (ED-SCLC) patients under irinotecan-platinum or etoposide-platinum therapy: Systematic review and meta-analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e18534-e18534
Author(s):  
Joao Paulo Da S.N. Lima ◽  
Andre Deeke Sasse ◽  
Emma C. Sasse ◽  
Lucas Vieira dos Santos
Keyword(s):  
Systematic Review ◽  
North American ◽  
Meta Analysis ◽  
Geographic Origin ◽  
First Line ◽  
First Line Therapy ◽  
Geographic Origins ◽  
One Year ◽  
Meta Analyses ◽  
The Impact

e18534 Background: Superiority of irinotecan-platinum (IP) regimens over etoposide-platinum (EP) in ED-SCLC has been extensively debated, with ethnic and pharmacogenomics issues hypothesized as causes of the divergent findings. We undertook a systematic review to scrutinize the data according to geographic origin. Methods: Randomized controlled trials comparing first-line EP doublets versus IP in ED-SCLC patients were searched in major meeting proceedings and databases. The outcomes were overall survival (OS), one-year survival, two-year survival, and safety. Meta-analyses were performed using random-effects model. Subgroup analyses and meta-regression were undertaken to compare and measure the impact of geographical origin of study over the estimated effect size. Results: Seven studies (2,029 patients) were included. IP improved OS worldwide (HR = 0.83; 95% CI 0.76-0.92; P>0.001; I²=0%). However, the impact of IP on OS was different according to geographic origin, with relevant benefit for Japanese, little benefit for North American/Australian and intermediate for European patients (P for interaction = 0.029, table 1). One year survival was homogenously improved from 34% with EP to 40% with IP (P=0.006). IP improved two year survival just for Japanese and European patients but not to North American ones (Table). Toxicity was not impacted by trial origin. Conclusions: IP improved survival for both Western and Eastern patients, but seems to exist a gradient of benefit according to geographic origins, with maximal benefit for Japanese, some relevant for European ones and little, if any, for North American/Australian patients. These findings should be taken in account when considering IP or EP as first-line therapy for ED-SCLC patients worldwide. [Table: see text]

What do Patients Want? Correlates of Patient Satisfaction and Treatment Engagement

2017 ◽  
Vol 41 (S1) ◽  
pp. S90-S90
Author(s):  
R. Gearing ◽  
A. Webb
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Psychiatric Treatment ◽  
Meta Analysis ◽  
Treatment Engagement ◽  
Treatment Regimens ◽  
Search Terms ◽  
Competing Interest ◽  
Meta Analyses ◽  
Research Assistants

IntroductionMotivation and ability to engage with treatment may deteriorate or falter if a patient is not satisfied with their protocols or provider. Improving patient satisfaction may more effectively strengthen treatment engagement.Objectives1) Determining what patients want from their provider relationship; and 2) identifying means for a provider to effectively assess and evaluate patient satisfaction in relation to treatment engagement.MethodsA systematic review of published meta-analyses, systematic reviews, and literature reviews between 1996 and 2016 was conducted across three databases (Medline, PsycINFO, CINAHL). Using variations of the search terms patient; satisfaction; medication, medical and psychiatric treatment; and engagement/adherence, a total of 1667 articles were identified. After removing duplications, 1582 articles were independently screened for eligibility (e.g. conceptual focus, methodological limitations) by two research assistants, resulting in the final inclusion of 50 meta-analysis, systematic review, or literature review articles that focused on predictors or barriers to patient satisfaction and/or predictors or barriers affecting engagement/adherence.ResultsBarriers and predictors of patient satisfaction centered on two fundamental domains:– relationship with Provider (sub-factors: multicultural competence, shared decision making, communication skills, continuity of care, empathy) and;– outcomes (sub-factors: therapeutic outcome, patient expectations).Eight treatment engagement/adherence barrier and predictor domains were identified, specifically treatment regimens; illness beliefs, emotional/cognitive factors; financial and logistic; social support; symptom/illness characteristics; demographics and patient-provider relationship.ConclusionsKey findings highlight actions psychiatrists and other clinical providers may consider in addressing barriers and highlighting promoters to improve patient satisfaction and overall engagement and adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Efficacy of Massage Therapy on Pain and Dysfunction in Patients with Neck Pain: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Yong Hong Cheng ◽  
Gui Cheng Huang
Keyword(s):  
Systematic Review ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Neck Pain ◽  
Meta Analysis ◽  
Cervical Vertebrae ◽  
Massage Therapy ◽  
Search Terms ◽  
Valid Evidence ◽  
Meta Analyses

Objective. To systematically evaluate the evidence of whether massage therapy (MT) is effective for neck pain.Methods. Randomized controlled trials (RCTs) were identified through searches of 5 English and Chinese databases (to December 2012). The search terms included neck pain, neck disorders, cervical vertebrae, massage, manual therapy, Tuina, and random. In addition, we performed hand searches at the library of Nanjing University of Traditional Chinese Medicine. Two reviewers independently abstracted data and assessed the methodological quality of RCTs by PEDro scale. And the meta-analyses of improvements on pain and neck-related function were conducted.Results. Fifteen RCTs met inclusion criteria. The meta-analysis showed that MT experienced better immediate effects on pain relief compared with inactive therapies (n=153; standardised mean difference (SMD), 1.30; 95% confidence interval (CI), 0.09 to 2.50;P=0.03) and traditional Chinese medicine (n=125; SMD, 0.73; 95% CI 0.13 to 1.33;P=0.02). There was no valid evidence of MT on improving dysfunction. With regard to follow-up effects, there was not enough evidence of MT for neck pain.Conclusions. This systematic review found moderate evidence of MT on improving pain in patients with neck pain compared with inactive therapies and limited evidence compared with traditional Chinese medicine. There were no valid lines of evidence of MT on improving dysfunction. High quality RCTs are urgently needed to confirm these results and continue to compare MT with other active therapies for neck pain.

Stroke case fatality in sub-Saharan Africa: Systematic review and meta-analysis

2021 ◽  
pp. 174749302199094
Author(s):  
Thierry Adoukonou ◽  
Oyéné Kossi ◽  
Pervenche Fotso Mefo ◽  
Mendinatou Agbétou ◽  
Julien Magne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Risk Of Mortality ◽  
Stroke Case ◽  
Sub Saharan ◽  
One Year ◽  
Few Data ◽  
Meta Analyses

Background The burden of stroke is high in sub-Saharan Africa; however, few data are available on long-term mortality. Objective To estimate over one-month stroke case fatality in sub-Saharan Africa. Methods A systematic review and meta-analysis were performed according to meta-analysis of observational studies in epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42020192439), on five electronic databases (PubMed, Science direct, AJOL, EMBASE, and Web of Sciences). We searched all studies on stroke case fatality over one month in sub-Saharan Africa published between 1st January 2000 and 31st December 2019. Results We included 91 studies with a total of 34,362 stroke cases. The one-month pooled stroke case-fatality rate was 24.1% [95% CI: 21.5–27.0] and 33.2% [95% CI: 23.6–44.5] at one year. At three and five years, the case-fatality rates were respectively 40.1% [95% CI: 20.8–63.0] and 39.4% [95% CI: 14.3–71.5] with high heterogeneity. Hemorrhagic stroke was associated with a higher risk of mortality at one month, but ischemic stroke increased the risk of mortality over six months. Diabetes was associated with poor prognosis at 6 and 12 months with odds ratios of 1.64 [95% CI: 1.22–2.20] and 1.85 [1.25–2.75], respectively. Conclusion The stroke case fatality over one month was very high, compared to case fatalities reported in Western countries and can be explained by a weak healthcare systems and vascular risk factors.

scholarly journals One Year of Evidence on Mental Health in the COVID-19 Crisis - A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Xi Chen ◽  
Jiyao Chen ◽  
Meimei Zhang ◽  
Richard Z. Chen ◽  
Rebecca Kechen Dong ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Healthcare Workers ◽  
Meta Analysis ◽  
Prevalence Rates ◽  
Meta Regression ◽  
One Year ◽  
Meta Analyses ◽  
Frontline Healthcare Workers ◽  
Anxiety Depression

ABSTRACTObjectiveThis paper provides a systematic review and meta-analysis on the prevalence rate of mental health issues of the major population, including general population, general healthcare workers (HCWs), and frontline healthcare workers (HCWs), in China over one year of the COVID-19 crisis.DesignA systematic review and meta-analysis.Data sourcesarticles in PubMed, Embase, Web of Science, and medRxiv up to November 16, 2020, one year after the first publicly known confirmed COVID-19 case.Eligibility criteria and data analysisany COVID-19 and mental disorders relevant English studies with frontline/general healthcare workers, general adult population sample, using validated scales. We pooled data using random-effects meta-analyses to estimate the prevalence rates of anxiety, depression, distress, general psychological symptoms (GPS), insomnia, and PTSD and ran meta-regression to tease out the heterogeneity.ResultsThe meta-analysis includes 131 studies and 171 independent samples. The overall prevalence of anxiety, depression, distress, GPS, insomnia, and PTSD are 11%, 13%, 20%, 13%, 19%, and 20%, respectively. The meta-regression results uncovered several predictors of the prevalence rates, including severity (e.g., above severe vs. above moderate, p<0.01; above moderate vs. above mild, p<0.01) and type of mental issues (e.g., depression vs. anxiety, p=0.04; insomnia vs. anxiety p=0.04), population (frontline HCWs vs. general HCWs, p<0.01), sampling location (Wuhan vs. non-Wuhan, p=0.04), and study quality (p=0.04).LimitationsFirst, we only focus on China population, which may limit the generalizability of the results. Second, 96.2% studies included in this meta-analysis were cross-sectional. Last, since we only included studies published in English, we expect to have a language bias.ConclusionOur pooled prevalence rates are significantly different from, yet largely between, the findings of previous meta-analyses, suggesting the results of our larger study are consistent with, yet fine-tune, the findings of the smaller, previous meta-analyses. Hence, this meta-analysis not only provides a significant update on the mental health prevalence rates in COVID-19 but also suggests the need to update meta-analyses continuously to provide more accurate estimates of the prevalence of mental illness during this ongoing health crisis. While prior meta-analyses focused on the prevalence rates of mental health disorders based on one level of severity (i.e., above mild), our findings also suggest a need to examine the prevalence rates at varying levels of severity. The one-year cumulative evidence on sampling locations (Wuhan vs. non-Wuhan) corroborates the typhoon eye effect theory. Our finding that the prevalence rates of distress and insomnia and those of frontline healthcare workers are higher suggest future research and interventions should pay more attention to those mental outcomes and populations.

scholarly journals Low Protein Intake Is Associated with Frailty in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1334 ◽  
Author(s):  
Hélio Coelho-Júnior ◽  
Bruno Rodrigues ◽  
Marco Uchida ◽  
Emanuele Marzetti
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Protein Intake ◽  
Observational Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Frailty Status ◽  
Search Terms ◽  
Meta Analyses

(1) Background: Several factors have been suggested to be associated with the physiopathology of frailty in older adults, and nutrition (especially protein intake) has been attributed fundamental importance in this context. The objective of this study was to conduct a systematic review and meta-analysis to investigate the relationship between protein intake and frailty status in older adults. (2) Methods: A search of scientific studies was conducted in the main databases (Medline, Scopus, Cochrane library), and in the reference lists of selected articles. The search terms included synonyms and Medical Subject Headings and involved the use of Boolean operators which allowed the combination of words and search terms. Observational studies—cross-sectional and longitudinal—that met the eligibility criteria were included in the review. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects were performed. Publication bias was measured using the Strengthening the Reporting of Observational Studies in Epidemiology instrument. (3) Results: In the final sample, 10 articles, seven cross-sectional and three longitudinal, were included in the present study. Overall, studies investigated a total of 50,284 older adults from three different continents between 2006 and 2018. Four cross-sectional studies were included in the meta-analyses. The results demonstrated that a high protein intake was negatively associated with frailty status in older adults (odds ratio: 0.67, confidence interval = 0.56 to 0.82, p = 0.0001). (4) Conclusions: Our findings suggest that a high consumption of dietary protein is inversely associated with frailty in older adults.

The Effect of L-Carnitine on Mortality Rate in Septic Patients: A Systematic Review and Meta-Analysis on Randomized Clinical Trials

2020 ◽  
Vol 20 ◽  
Author(s):  
Hamed Abdollahi ◽  
Mina Abdolahi ◽  
Mohsen Sedighiyan ◽  
Arash Jafarieh
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Mortality Rate ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Carnitine Supplementation ◽  
Language Restriction ◽  
One Year ◽  
Meta Analyses

Background: Recent clinical trial studies have reported that L-carnitine supplementation can reduce the mortality rate in patients with sepsis, but there are no definitive results in this context. The current systematic review and metaanalysis aimed to evaluate the effect of L-carnitine supplementation on 28-day and one-year mortality in septic patients. Methods: A systemically search conducted on Pubmed, Scopus and Cochrane Library databases up to June 2019 without any language restriction. The publications were reviewed based on Cochrane handbook and preferred reporting items for systematic reviews and meta-analyses (PRISMA). To compare the effects of L-carnitine with placebo, Risk Ratio (RR) with 95% confidence intervals (CI) were pooled according to random effects model. Results: Across five enrolled clinical trials, we found that L-carnitine supplementation reduce one-year mortality in septic patients with SOFA> 12 (RR: 0.68; 95% CI: 0.49 to 0.96; P= 0.03) but had no significant effect on reducing 28-day mortality ((RR: 0.93; 95% CI: 0.68 to 1.28; P= 0.65) compared to placebo. Finally, we observed that based on current trials, Lcarnitine supplementation may not have clinically a significant effect on mortality rate. Conclusions: L-carnitine patients with higher SOFA score can reduce the mortality rate. However, the number of trials, study duration and using dosage of L-carnitine are limited in this context and further large prospective trials are required to clarify the effect of L-carnitine on mortality rate in septic patients.

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