Abstract WP336: Global Variation in the Representation of Women in Contemporary Acute Stroke Trials

Introduction: Women have historically been underrepresented in RCTs of cardiovascular disease. We undertook a review of acute stroke RCTs to determine whether women were equitably represented and whether any sex disparity varied across geographic region. Methods: We searched for papers describing primary results of acute stroke RCTs published 2013-2018 in 9 major journals and abstracted the proportion of trial participants that were women (PPW). We then searched for incidence studies from the geographic regions in which trial enrollment took place and estimated the proportion of incident strokes occurring in women (PSW) in each region (i.e., North America, Europe, Asia Pacific, Multiple Regions). We quantified the representation of women using the enrollment disparity difference (EDD) calculated as the absolute difference between the two proportions (i.e., PSW - PPW). An EDD greater than 0 indicated a disparity in favor of men. We pooled EDDs from individual RCTs using random effects meta-analysis to estimate overall and region-specific disparities. Results: Among 60 trials the PPW ranged from 33.8% to 56.9% (median 44.7%). The overall pooled EDD was 0.07 (95% CI=0.06-0.08, Q p<0.001, I 2 =85.8%) (Figure), indicating that 7% more men were included in the trials, relative to the underlying incidence. A statistically significant EDD existed in all regions; the magnitude was largest for RCTs with enrollment from Asia Pacific (EDD=0.11, 95% CI=0.10-0.13) and Multiple Regions (EDD=0.10, 95% CI=0.08-0.12) and smallest among North American and European trials (EDD 0.04 and 0.06, respectively). All region-specific summary estimates showed significant between study heterogeneity apart from Asia (Q p=0.102, I 2 =38.4%). Conclusions: Women were underrepresented globally in contemporary acute stroke RCTs; the magnitude of the disparity differed between regions. Future research should focus on trial eligibility criteria that may contribute to this disparity.

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Chasing the Anchor: A Systematic Review and Meta-analysis of Perceptual Anchoring Deficits in Developmental Dyslexia

10.31234/osf.io/amzpj ◽

2020 ◽

Author(s):

Kurt D Shulver ◽

Nicholas A Badcock

Keyword(s):

Systematic Review ◽

Reading Ability ◽

English Language ◽

Prediction Interval ◽

Meta Analysis ◽

Visual Assessment ◽

Individual Performance ◽

Future Research ◽

Significant Heterogeneity ◽

Eligibility Criteria

We report the results of a systematic review and meta-analysis investigating the relationship between perceptual anchoring and dyslexia. Our goal was to assess the direction and degree of effect between perceptual anchoring and reading ability in typical and atypical (dyslexic) readers. We performed a literature search of experiments explicitly assessing perceptual anchoring and reading ability using PsycInfo (Ovid, 1860 to 2020), MEDLINE (Ovid, 1860 to 2019), EMBASE (Ovid, 1883 to 2019), and PubMed for all available years up to June (2020). Our eligibility criteria consisted of English-language articles and, at minimum, one experimental group identified as dyslexic - either by reading assessment at the time, or by previous diagnosis. We assessed for risk of bias using an adapted version of the Newcastle-Ottawa scale. Six studies were included in this review, but only five (n = 280 participants) were included in the meta-analysis (we were unable to access the necessary data for one study).The overall effect was negative, large and statistically significant; g = -0.87, 95% CI [-1.47, 0.27]: a negative effect size indicating less perceptual anchoring in dyslexic versus non-dyslexic groups. Visual assessment of funnel plot and Egger’s test suggest minimal bias but with significant heterogeneity; Q (4) = 9.70, PI (prediction interval) [-2.32, -0.58]. The primary limitation of the current review is the small number of included studies. We discuss methodological limitations, such as limited power, and how future research may redress these concerns. The variability of effect sizes appears consistent with the inherent variability within subtypes of dyslexia. This level of dispersion seems indicative of the how we define cut-off thresholds between typical reading and dyslexia populations, but also the methodological tools we use to investigate individual performance.

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Prevalence and associated factors of active smoking among individuals living with hypertension and/or diabetes in Africa: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2016-015444 ◽

2017 ◽

Vol 7 (10) ◽

pp. e015444 ◽

Cited By ~ 3

Author(s):

Guy S Wafeu ◽

Aurel T Tankeu ◽

Francky Teddy A Endomba ◽

Jobert Richie Nansseu ◽

Arnaud D Kaze ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Geographic Region ◽

Future Research ◽

P Value ◽

Published Data ◽

Final Report ◽

Active Smoking ◽

Analysis Model ◽

Factors Associated

IntroductionTobacco use significantly increases cardiovascular complications in people living with hypertension and/or diabetes. We aim to summarise data on the prevalence and factors associated with active smoking in these conditions in Africa.Method and analysisWe will search PubMed, Embase, Google Scholar and African Journals Online for relevant abstracts of studies on active smoking in individuals living with diabetes and/or hypertension published from 1 January 2000 to 31 December 2016, with no language restriction. Additionally, relevant unpublished papers and conference proceedings will be checked, as well as references of included articles. Two investigators will independently screen, select studies, extract data and assess the risk of bias in each study. Data will be analysed using Stata software (Stata V.14, Texas, USA). The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of smoking across studies. Also, we will assess factors associated to smoking. Heterogeneity of studies will be evaluated by the χ2 test on Cochrane’s Q statistic. Funnel plots analysis and Egger’s test will be done to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa). A p value less than 0.05 will be considered significant for factors associated to smoking.Ethics and disseminationThis study is based on published data, and therefore ethical approval is not a requirement. This systematic review and meta-analysis is expected to serve as a basis for designing cost-effective interventions to reduce and prevent smoking in patients with diabetes and/or hypertension, and as a guide for future research based on the remaining gaps. The final report of this study in the form of a scientific paper will be published in peer-reviewed journals. Findings will further be presented at conferences and submitted to relevant health authorities.

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The Impact of Childhood Psychological Maltreatment on Mental Health Outcomes in Adulthood: A Protocol for a Systematic Review and Meta-Analysis

10.21203/rs.3.rs-102460/v1 ◽

2020 ◽

Author(s):

Zhuoni Xiao ◽

Mina Murat Baldwin ◽

Franziska Meinck ◽

Ingrid Obsuth ◽

Aja Louise Murray

Keyword(s):

Mental Health ◽

Systematic Review ◽

Emotional Abuse ◽

Meta Analysis ◽

Psychological Maltreatment ◽

Future Research ◽

Long Term Effects ◽

Post Traumatic Stress ◽

Eligibility Criteria ◽

The Impact

Abstract Background: Research suggests that childhood psychological maltreatment (i.e., emotional abuse and emotional neglect) is associated with mental and physical health problems that persist into adulthood, for example anxiety, depression, post-traumatic stress disorder (PTSD), suicidal ideation, and aggression; however, a systematic review and meta-analysis of the existing literature would help clarify the magnitude and moderators of these associations, and the extent to which they may be affected by publication bias, as well as the methodological strengths and weakness of studies in this area.Method: Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline will be employed to structure the review. Several searches will be carried out via databases including Web of Science, Medline, PubMed, PsycINFO, Applied Social Science Index and Abstract, ERIC and EMBASE. Empirical peer reviewed research articles that fit pre-specified eligibility criteria will be included in the review. This review will include literature written in either English or Chinese. Two independent reviewers will screen and assess studies for inclusion in the review as well as extract the data, with consensus reached through discussion in cases of discrepancy. A third reviewer will be consulted to resolve any discrepancies that cannot be resolved through discussion between the original reviewers. The relevant Newcastle-Ottawa scales will be used for assessing the quality of studies. If a sufficient number of comparable studies are retrieved, a meta-analysis will be conducted using a random effects model. Discussion: This systematic review will provide an understanding of the long-term effects of childhood psychological maltreatment on adult mental health, which adds to previous reviews focusing primarily on the effects of physical and sexual abuse. The results of the review will help inform clinical practice in approaches to treating those with a history of psychological maltreatment in childhood. The gaps and weaknesses in the evidence identified will also inform recommendations for future research.

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Epidemiology of High Ankle Sprains: A Systematic Review

Foot & Ankle Specialist ◽

10.1177/1938640020916266 ◽

2020 ◽

Vol 13 (5) ◽

pp. 420-430

Author(s):

Akilesh Anand Prakash

Keyword(s):

Systematic Review ◽

Injury Severity ◽

Meta Analysis ◽

Injury Rate ◽

Future Research ◽

Assessment Procedure ◽

Ankle Sprains ◽

Eligibility Criteria ◽

Study Heterogeneity ◽

Diagnostic Modalities

Syndesmotic sprains or high ankle sprains are reported to be associated with increasing morbidity and time loss. The aim of this study was to critically appraise literature on epidemiology of syndesmotic sprains through systematic review of published literatures. A systematic review was conducted online for literature published in English using PubMed and Google Scholar, as per PRISMA guidelines up to April 30, 2019. Predefined eligibility criteria were applied, and the data thus compiled were analyzed. A total of 26 studies were found to be eligible, of which three-fourths involved sporting population. Considerable inconsistency in assessment procedure reporting, injury and injury severity definition with variable unit measures used to describe incidence or injury rate was observed. Meta-analysis and intra- and intersports comparison could not be performed owing to the study heterogeneity and methodological variability. There is a need for standardization in future research, specifically with regard to injury assessment and reporting, demanding heightened awareness and improved diagnostic modalities, as injury epidemiology is integral to the overall injury-prevention conundrum. Levels of Evidence: Systematic review, Level III

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Abstract WMP2: Trevo 2000: Real-World Experience in the First 1247 Patients

Stroke ◽

10.1161/str.48.suppl_1.wmp2 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mandy J Binning ◽

Ronald F Budzik ◽

Blaise W Baxter ◽

Bruno M Bartolini ◽

David S Liebeskind ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Real World ◽

Stent Retriever ◽

Future Research ◽

Real World Data ◽

Open Label ◽

Eligibility Criteria ◽

Secondary Endpoints ◽

Stent Retrievers

Objective: The Trevo Registry is designed to assess real world outcomes of the Trevo Retriever in patients experiencing ischemic stroke. This is the largest prospective study for acute stroke intervention, with 1247 patients currently enrolled and 90 day outcomes in 1021 patients. The primary endpoint is revascularization status based on post-procedure TICI score and secondary endpoints include 90-day mRS, 90-day mortality, neurological deterioration at 24 hours and device/procedure related adverse events. Methods: The study is a prospective, open-label, consecutive enrollment, multi-center, international registry of patients undergoing mechanical thrombectomy for acute stroke using the Trevo stent retriever as the initial device. Enrollment is expected to reach 2000 subjects at up to 100 sites. Results: As of August 13, 2016 a total of 1247 patients were enrolled. The median NIHSS at admission was 16 (IQR 11-20). Most patients (66.2%) were treated at >/= 6 hours from last known normal with a median procedure time of 50 minutes (32-77). The occlusion site was M1 or M2 in 74.5%. General anesthesia was employed in 46.6% of procedures. TICI 2b or 3 revascularization was 92.8% with an average of 1.6 passes with the device. Median NIHSS at 24 hours and discharge was 6 and 4 respectively. Fifty-five percent of patients had mRS ≤2 at 3 months and the overall mortality rate was 15.4%. Patients treated after 8 hours of symptom onset had a 94.9% revascularization rate and 52.8% mRS ≤2 at 3 months. The symptomatic ICH rate was 1.2%. Patients who met the revised AHA criteria for thrombectomy were found to have 58.4% mRS 0-2 at 90 days. Conclusions: The Trevo Retriever Registry represents the first real world data with stent retriever use in the era of clinical trials showing the overwhelming benefit of stent retrievers to treat acute ischemic stroke. Due to the fact that this data represents real world use of the Trevo Retriever, (e.g. subjects pre-stroke mRS >1 (16.5%) and those treated 6-24 hours after stroke symptoms (33.8%), this data cannot be compared to the results from recent trials with restricted eligibility criteria. Future subgroup analysis of this large cohort will help to identify areas of future research to enhance outcomes further with this treatment modality.

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The incidence of postoperative heterotopic ossification in cervical disc arthroplasty--A systematic review and meta-analysis

10.21203/rs.2.11474/v2 ◽

2019 ◽

Author(s):

Guo Yingjun ◽

Chen Jiali ◽

Hao Liu ◽

Meng Yang ◽

Ding Chen ◽

...

Keyword(s):

Heterotopic Ossification ◽

Theoretical Basis ◽

Meta Analysis ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Future Research ◽

Common Disease ◽

Eligibility Criteria ◽

Grade Iii

Abstract Background: Heterotopic ossification has become a common disease after CDA, which has attracted much attention. Understanding the law of its occurrence and development can provide theoretical basis for the formulation of HO prevention strategies. To acquire the objective data and the change rule of HO incidence, a meta-analysis of all available evidence was performed. Methods: A search of the literature was conducted on Pubmed/MEDLINE, EMBASE, and Web of Science. Relevant studies including incidence-relative data of HO were selected according to eligibility criteria. Results: 52 studies were eligible and finally included and the quality assessment showed a relative high score of them. The results of the analysis reminded us that the incidence of HO increased with the extension of follow-up time, both based on the number of cases and the number of segments, and the increase mainly occurred after 6 years. Grade III-IV HO showed us a positive correlation with follow-up time (R2=0.218), while Grade I-II HO did not change a lot in different follow-up time points. Conclusions: The follow-up time after CDA should be long enough, so as to ensure the true clinical results. HO occurs all the postoperative time and Grade I-II HO will gradually develop into Grade III-IV, while continuous new HO keeps the number of Grade I-II in a dynamic balance. Through this study, we can preliminarily define the relatively objective incidence and change rule of HO, which provides data basis and theoretical basis for the future research of HO prevention strategy.

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The Effectiveness of Non-pharmacological Treatments for Vestibular and Oculomotor Deficits in Post-concussive Syndrome: a Protocol for a Systematic Review and Meta-analysis

10.21203/rs.3.rs-750941/v1 ◽

2021 ◽

Author(s):

Stella R Sheeba ◽

Rocco Cavaleri ◽

Simon J Summers ◽

Cherylea J Browne

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Function ◽

Meta Analysis ◽

Vestibular Function ◽

Future Research ◽

Random Effects Model ◽

Pharmacological Treatments ◽

Pharmacological Interventions ◽

Eligibility Criteria

Abstract Background: Concussion is a form of mild traumatic brain injury (mTBI) that disrupts brain function. Although symptoms are mostly transient, recovery can be delayed and result in post-concussive syndrome (PCS). Vestibular and oculomotor deficits are among the most debilitating impairments associated with PCS. Non-pharmacological interventions provide treatment with limited side effects in comparison to pharmacological interventions. The aim of this review is to synthesise and evaluate the effectiveness of non-pharmacological interventions that have been used to target vestibular and oculomotor deficits in PCS.Methods: Advanced searches will be conducted in electronic databases to identify articles eligible for inclusion. Studies employing non-pharmacological treatments for vestibular and/or oculomotor dysfunction in PCS will be included if they meet the eligibility criteria. Outcomes will be those pertaining to measures of oculomotor and vestibular function, in addition to adverse events. Meta-analysis will be undertaken using a random effects model followed by an assessment of clinical significance for each outcome as published in literature. Discussion: While non-pharmacological interventions are used commonly to treat vestibular and oculomotor deficits in PCS, the effectiveness of these treatments is yet to be completely elucidated. The present review will explore the effectiveness of non-pharmacological treatments for vestibular and oculomotor deficits in PCS to inform practice and future research.Systematic review registration: PROSPERO CRD42021254720

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Associations of childhood exposure to malaria with cognition and behaviour outcomes: a systematic review protocol

10.21203/rs.3.rs-19683/v3 ◽

2020 ◽

Author(s):

ANDREW SENTOOGO SSEMATA ◽

JACQUELLINE ANN NAKITENDE ◽

SIMON KIZITO ◽

ELIZABETH C WHIPPLE ◽

PAUL BANGIRANA ◽

...

Keyword(s):

Systematic Review ◽

Malaria Infection ◽

Meta Analysis ◽

Interrupted Time Series ◽

Bibliographic Databases ◽

Future Research ◽

Control Group ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Cross Sectional

Abstract Background: Malaria is one of the major contributing risk factors for poor development of children living in low- and middle- income countries (LMICs). However, little is known about the specific domains of cognition and behaviour that are impacted by malaria, the extent of these deficits, and the different types of the malaria spectrum that are associated with these deficits. The objective of this systematic review is to determine the association of the different type of malaria infection on cognition and behavioural outcomes among children living in LMICs. Methods and analysis: We will systematically search online bibliographic databases including MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO (via EBSCO), Embase and The Cochrane Central Register of Controlled Trials (CENTRAL) as well as Google Scholar and bibliographies of pertinent articles. We will include studies with a comparison group (e.g., clinical trials, cohort, observational, cross-sectional case–control and controlled before and after or interrupted–time–series studies) involving children under 18 years of age living in LMICs, as determined by World Bank Criteria, with either an active malaria infection or history of malaria. Included articles must also measure cognitive and/or behaviour outcomes determined by standardized psychological assessments (questionnaire-based scales and or neurocognitive assessments). Studies will be excluded if they are not in English, lack a control group, take place in a high-income country, or if a standardized instrument was not used. Two reviewers will independently review all articles to determine if they meet eligibility criteria. Any conflicts will be resolved after discussion with a third reviewer. When a list of included articles is finalized, two reviewers will extract data to populate and then cross check within an electronic table. Risk of bias and the strength of evidence and recommendations will be assessed independently using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and a final score will be given upon consensus. For sufficiently homogeneous data on measured outcomes in multiple studies, we will investigate the possibility of pooling data to perform a meta-analysis. Discussion: This systematic review will evaluate the evidence of the association of malaria on the cognitive and behavioural outcomes. Findings from this planned review will generate insight on the domains affected by the different forms malaria infection and may inform subsequent malaria interventions and future research in paediatric care.Systematic review registration: This systematic review has been registered under the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020154777)

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Abstract 28: The Representation of Women in Randomized Clinical Trials of Acute Stroke (2010-2020)

Stroke ◽

10.1161/str.52.suppl_1.28 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Brent W Strong ◽

Julia Pudar ◽

Amanda G Thrift ◽

Gustavo de los Campos ◽

Virginia J Howard ◽

...

Keyword(s):

Acute Stroke ◽

Random Effects ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Geographic Location ◽

Therapeutic Interventions ◽

Eligibility Criteria ◽

Novel Treatments ◽

Subgroup Analyses ◽

Stroke Type

Introduction: The inadequate enrollment of women in RCTs represents a threat to trial generalizability and potential inequities in access to novel treatments. We sought to determine whether women were under-enrolled in contemporary acute stroke trials. Methods: We searched MEDLINE for completed RCTs published in one of nine major journals between 2010 and 2020. Eligible studies were phase 2 or 3 trials undertaken to test therapeutic interventions within one month of stroke onset. For each trial we calculated the proportion of trial participants that were women (PPW). We used Global Burden of Disease (GBD) data to estimate the expected proportion of strokes occurring in women in the underlying stroke populations (PSW). We matched individual estimates from the GBD data to each trial based on geographic location, year, and stroke type. To quantify disparities, we calculated the enrollment disparity difference (EDD), defined as EDD = PSW - PPW. A positive EDD indicates that women were under-represented in the trial. We used random effects meta-analysis to pool individual EDDs and conducted subgroup analyses. Results: We identified 115 trials that met eligibility criteria. The random effects summary EDD was 0.053 (95% CI = 0.040, 0.053), indicating that women were under-enrolled in acute stroke trials by 5% relative to their representation in the underlying stroke population. However, there was substantial between-trial variability in the EDD (I 2 =84.4%). In subgroup analyses, the EDD was similar across subgroups except for stroke type (figure); trials that only included subarachnoid hemorrhages enrolled women in excess of their representation in the underlying population (summary EDD = -0.117 [95% CI = -0.150, -0.084]). Conclusions: Overall, women were modestly under-represented in contemporary acute stroke trials compared to their representation among all strokes. Further study is needed to elucidate factors driving sex differences in enrollment between RCTs.

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