scholarly journals Systematic review of interventions to increase the use of arteriovenous fistulae and grafts in incident haemodialysis patients

2021 ◽  
pp. 112972982110069
Author(s):  
Jonathan De Siqueira ◽  
Alexander Jones ◽  
Mohammed Waduud ◽  
Max Troxler ◽  
Deborah Stocken ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
English Language ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Education Programme ◽  
Outcome Data ◽  
Arteriovenous Fistulae ◽  
Structured Education ◽  
Significant Difference

Background: Patients who commence haemodialysis (HD) through arteriovenous fistulae and grafts (AVF/G) have improved survival compared to those who do so by venous lines. Objectives: This systematic review aims to assimilate the evidence for any strategy which increases the proportion of HD patients starting dialysis through AVF/G. Data sources: Medline, Embase, Cochrane Central and Scopus. Study eligibility, participants and interventions: English language studies comparing any educational, clinical or service organisation intervention for adult patients with end stage renal failure and reporting incident AVF/G use. Study appraisal and synthesis: Two reviewers assessed studies for eligibility independently. Outcome data was extracted and reported as relative risk. Reporting was performed with reference to the PRISMA statement. Results: Of 1272 studies, 6 were eligible for inclusion. Studies varied in design and intervention. Formal meta-analysis was not appropriate. One randomised controlled trial and two cohort studies assessed the role of a renal access coordinator. Two cohort studies assessed the implementation of qualitive initiative programmes and one cohort study assessed a national, structured education programme. Results between studies were contradictory with some reporting improvements in incident AVF/G use and some no significant difference. Quality was generally low. Conclusions: It is not possible to reach firm conclusions nor make strategic recommendations. A comprehensive package of care which educates and identifies patients approaching dialysis in a timely manner may improve incident AVF/G use. An unbiased, robust comparison of different strategies for timing AVF/G referral is required.

Biopsy versus resection in the management of malignant gliomas: a systematic review and meta-analysis

2010 ◽  
Vol 112 (5) ◽  
pp. 1020-1032 ◽  
Author(s):  
Abraham Tsitlakidis ◽  
Nicolas Foroglou ◽  
Christos A. Venetis ◽  
Ioannis Patsalas ◽  
Athanasios Hatzisotiriou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Overall Survival ◽  
Malignant Glioma ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Malignant Gliomas ◽  
Karnofsky Performance Scale ◽  
Significant Difference

Object The aim of this study was to answer the question whether quality of life and progression-free and overall survival are increased in adults with supratentorial malignant glioma who are treated with cytoreductive resection as compared with those who only undergo biopsy. Methods A literature search of the electronic databases MEDLINE, EMBASE, and CENTRAL was performed to identify relevant studies published before May 2008. Hand-searching of reference lists of the identified studies and relevant review articles was also performed. A study was considered eligible, regardless of study design (prospective or retrospective), if: 1) quality of life and/or progression-free and/or overall survival was compared among adult patients undergoing biopsy or resection, and 2) patient age and Karnofsky Performance Scale scores were not significantly different among the 2 groups compared. Results One randomized controlled trial and 4 retrospective studies (involving a total of 1111 patients) were found eligible for this systematic review. A meta-analysis of the eligible studies demonstrated a significant increase in overall survival in the patients treated with resection instead of biopsy (hazard ratio 0.61, 95% CI 0.52–0.71, p < 0.0001, fixed-effect model). Although statistical pooling was not feasible, the available data suggest that quality of life was increased in patients treated with resection rather than biopsy, while there did not seem to be any significant difference in progression-free survival between the 2 groups. Conclusions Based on the best available evidence, it appears that cytoreductive resection in adults with supratentorial malignant glioma is associated with improved overall survival as compared with biopsy. However, well-designed prospective studies are needed for more solid conclusions to be drawn.

scholarly journals P547 Safety and efficacy of vedolizumab in the treatment of patients with moderate to severe Ulcerative Colitis: a systematic review and meta-analysis

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S516-S517
Author(s):  
M Khorshid Fasge ◽  
M Alboraie ◽  
W Abbas ◽  
Z E Sayed ◽  
M El-Nady
Keyword(s):  
Systematic Review ◽  
Ulcerative Colitis ◽  
Cohort Studies ◽  
Clinical Response ◽  
Clinical Remission ◽  
Assessment Tool ◽  
Meta Analysis ◽  
P Value ◽  
Severe Ulcerative Colitis ◽  
Significant Difference

Abstract Background To perform a systematic review and meta-analysis discussing the efficacy and safety of vedolizumab (VDZ) treatment in patients with active moderate to severe ulcerative colitis (UC). Methods Using relevant keywords, we searched PubMed, Web of Science, Scopus, and Cochrane Central databases, until June 2020. We included interventional and observational cohort studies which assessed the safety and effectiveness of VDZ 300 mg intravenous infusion, in patients with active moderate to severe UC. We used the Cochrane risk of bias assessment tool and the Newcastle-Ottawa scale to assess the quality of included interventional and cohort studies, respectively. Dichotomous outcomes were pooled as proportion, 95% Confidence interval (CI), and p-value under the random-effects model in the open meta-analyst software. Results We found 10 interventional studies and 35 cohort studies, including 4,794 patients eligible for our review. Most of the included citations were single-arm studies. Our meta-analysis showed that VDZ therapy could induce a significant clinical response in UC patients up to 54 weeks (proportion 0.516, 95% CI [0.453, 0.578], p &lt; 0.001). VDZ was associated with clinically significantly clinical remission and steroid-free clinical remission after 54 weeks (p &lt; 0.0001). Durable clinical remission, histological remission, and endoscopic response rates were maintained in UC patients taking VDZ at the 52nd week. There was no significant difference between VDZ and placebo regarding the incidence of drug-related serious adverse events (p = 0.113) and death rates (p = 0.085). Conclusion Our systematic review and meta-analysis showed that the use of VDZ in patients with active moderate to severe UC was associated with high percentages of clinical response and remission rates in induction and maintenance treatment stages. VDZ seems to be well tolerated in UC patients, apart from some infections and inflammations. Future RCTs should compare VDZ to active treatments for longer follow-up periods with larger sample size.

scholarly journals Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

2015 ◽  
Vol 87 (1) ◽  
pp. 41 ◽  
Author(s):  
Thomas Fonseka ◽  
Kamran Ahmed ◽  
Saied Froghi ◽  
Shahid A. Khan ◽  
Prokar Dasgupta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Radical Cystectomy ◽  
Meta Analysis ◽  
Oncological Outcome ◽  
Outcome Data ◽  
Lymph Node Yield ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Lower Complication ◽  
Open Radical Cystectomy

Objective: To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC) and Robot-assisted Radical Cystectomy (RARC). RARC is to be compared to LRC and ORC and LRC compared to ORC. Material and methods: A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. Results: Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT) compared to LRC with no statistical difference between length of stay (LOS) and estimated blood loss (EBL). RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY) and positive surgical margins (PSM.) LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. Conclusion: RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.

scholarly journals Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions

2015 ◽  
Vol 46 (4) ◽  
pp. 717-730 ◽  
Author(s):  
M. Li ◽  
C. D'Arcy ◽  
X. Meng
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Childhood Maltreatment ◽  
English Language ◽  
Meta Analysis ◽  
Grey Literature ◽  
Depression And Anxiety ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Attributable Fractions

BackgroundLiterature supports a strong relationship between childhood maltreatment and mental illness but most studies reviewed are cross-sectional and/or use recall to assess maltreatment and are thus prone to temporality and recall bias. Research on the potential prospective impact of maltreatment reduction on the incidence of psychiatric disorders is scarce.MethodElectronic databases and grey literature from 1990 to 2014 were searched for English-language cohort studies with criteria for depression and/or anxiety and non-recall measurement of childhood maltreatment. Systematic review with meta-analysis synthesized the results. Study quality, heterogeneity, and publication bias were examined. Initial screening of titles and abstracts resulted in 199 papers being reviewed. Eight high-quality articles met eligibility criteria. Population attributable fractions (PAFs) estimated potential preventive impact.ResultsThe pooled odds ratio (OR) between any type of maltreatment and depression was 2.03 [95% confidence interval (CI) 1.37–3.01] and 2.70 (95% CI 2.10–3.47) for anxiety. For specific types of maltreatment and depression or anxiety disorders, the ORs were: physical abuse (OR 2.00, 95% CI 1.25–3.19), sexual abuse (OR 2.66, 95% CI 1.88–3.75), and neglect (OR 1.74, 95% CI 1.35–2.23). PAFs suggest that over one-half of global depression and anxiety cases are potentially attributable to self-reported childhood maltreatment. A 10–25% reduction in maltreatment could potentially prevent 31.4–80.3 million depression and anxiety cases worldwide.ConclusionThis review provides robust evidence of childhood maltreatment increasing the risk for depression and anxiety, and reinforces the need for effective programs and policies to reduce its occurrence.

scholarly journals Efficacy of Transparent vs. Pressure Dressing in Prevention of Post-Cardiac Catheterization Pain, Discomfort and Hematoma: A Systematic Review and Meta-analysis of RCTs

2021 ◽  
Vol 10 (2) ◽  
pp. 103-110
Author(s):  
Suresh K Sharma ◽  
Kalpana Thakur ◽  
Shiv K Mudgal ◽  
Barun Kumar
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Cardiac Catheterization ◽  
Odds Ratio ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Significant Difference ◽  
Pressure Dressing

ABSTRACT Introduction: There is lack consensus on superiority of transparent vs. pressure dressing for prevention of post-cardiac catheterization pain, discomfort and hematoma. Therefore, we conducted this systematic review and meta-analysis of available RCTs on this subject. Methods: We performed a systematic search of RCTs published between in 2000-2019 in English language using databases including PubMed Medline, EMBASE, CINAHL, Cochrane Library, ERMED Journals, Clinical trials database, DELNET, Google Scholar and Discovery Search. Studies conducted on adult patients with femoral dressing after cardiac catheterization measuring pain, discomfort, hematoma as intended outcomes have been included. Data extraction, critical appraisal, assessment of risk bias was done and decisions on quality were made on mutual consensus. Mantel-Haenszel (MH) and odds ratio for dichotomous variables was calculated by Review Manager 5.3 software. Results: Out of all identified studies, only 5 studies comprising 664 patients fulfilled the inclusion criteria and met the quality assessment. Incidence of discomfort (25, 333) were significantly less in transparent dressing group as compared to pressure dressing group (149, 331); odds ratio 0.10, 95% confidence interval [CI] 0.06-0.15; I2 = 0%, P= 0.00. Four studies reported significantly lower number of pain cases in transparent dressing (17, 203) as compared to pressure dressing (57, 201); odds ratio 0.13, 95% confidence interval [CI] 0.03-0.59; I2 = 47%, P= 0.01). However, incidence of hematoma did not reveal any significant difference between two groups. Conclusion: Transparent dressing is a better option in patients with femoral/groin dressing after cardiac catheterization as it is more effective in prevention of pain and discomfort.

scholarly journals Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis

10.2196/18839 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e18839
Author(s):  
Debaleena Chattopadhyay ◽  
Tengteng Ma ◽  
Hasti Sharifi ◽  
Pamela Martyn-Nemeth
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Virtual Humans ◽  
Conversational Agents ◽  
Desktop Computer ◽  
Cross Sectional ◽  
Head Mounted Display ◽  
Significant Difference

Background Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. Objective The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. Methods Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. Results Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged — simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). Conclusions We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

scholarly journals Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis

2011 ◽  
Vol 198 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Corrado Barbui ◽  
Andrea Cipriani ◽  
Vikram Patel ◽  
José L. Ayuso-Mateos ◽  
Mark van Ommeren
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Outcome Data ◽  
Allocation Concealment ◽  
Controlled Trials ◽  
Minor Depression ◽  
Double Blind ◽  
Significant Difference ◽  
Study Heterogeneity ◽  
Randomised Controlled

BackgroundDepression is a common condition that has been frequently treated with psychotropics.AimsTo review systematically the evidence of efficacy and acceptability of antidepressant and benzodiazepine treatments for patients with minor depression.MethodA systematic review and meta-analysis of double-blind randomised controlled trials comparing antidepressants or benzodiazepines v. placebo in adults with minor depression. Data were obtained from MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Controlled Trials Register and pharmaceutical company websites. Risk of bias was assessed for the generation of the allocation sequence, allocation concealment, masking, incomplete outcome data, and sponsorship bias.ResultsSix studies met inclusion criteria. Three studies compared paroxetine with placebo; fluoxetine, amitriptyline and isocarboxazid were studied in one study each. No studies compared benzodiazepines with placebo. In terms of failures to respond to treatment (6 studies, 234 patients treated with antidepressants and 234 with placebo) no significant difference between antidepressants and placebo was found (relative risk (RR) 0.94, 95% CI 0.81–1.08). In terms of acceptability, data extracted from two studies (93 patients treated with antidepressants and 93 with placebo) showed no statistically significant difference between antidepressants and placebo (RR = 1.06, 95% CI 0.65–1.73). There was no statistically significant between-study heterogeneity for any of the reported analyses.ConclusionsThere is evidence showing there is unlikely to be a clinically important advantage for antidepressants over placebo in individuals with minor depression. For benzodiazepines, no evidence is available, and thus it is not possible to determine their potential therapeutic role in this condition.

Comparison between bovine carotid artery graft and polytetrafluoroethylene graft for haemodialysis vascular access: A systematic review and meta-analysis

2020 ◽  
pp. 112972982092608
Author(s):  
Ioannis D Kostakis ◽  
Ioannis Loukopoulos
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Vascular Access ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Graft Infection ◽  
Mean Difference ◽  
Cochrane Central Register ◽  
Pseudoaneurysm Formation ◽  
Significant Difference

Background: There is a renewed interest in using bovine carotid artery grafts for haemodialysis vascular access after recent advances in conduit manufacturing and endovascular management of access-related complications. Our aim was to summarize the results of the recent studies comparing bovine carotid artery grafts with polytetrafluoroethylene grafts as vascular access for haemodialysis. Methods: A systematic review was conducted for original articles comparing bovine carotid artery with polytetrafluoroethylene grafts for haemodialysis vascular access published between January 2000 and December 2019 searching the databases of Medline, Scopus, Google Scholar, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Results: Four studies were included (one prospective randomized controlled trial and three retrospective studies) with 676 patients in total (bovine carotid artery: 395, polytetrafluoroethylene: 281). There was lower graft infection rate per patient-year in bovine carotid artery grafts (mean difference: −0.03, p < 0.0001). Bovine carotid artery grafts required fewer interventions per patient-year to maintain or restore patency (mean difference: −0.81, p = 0.002). No significant difference was detected regarding pseudoaneurysm formation (p = 0.24), steal syndrome (p = 0.11) or patency rates (primary: 1 year: p = 0.15, 2 years: p = 0.69; primary assisted: 1 year: p = 0.18, 2 years: p = 0.54; secondary: 1 year: p = 0.22, 2 years: p = 0.17). Conclusion: Bovine carotid artery and polytetrafluoroethylene grafts have similar short-term and long-term outcomes, with a possible advantage of bovine carotid artery grafts concerning graft infections and number of required interventions. Thus, bovine carotid artery grafts can be a useful alternative modality for haemodialysis vascular access.

scholarly journals Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003795
Author(s):  
Jacob R. Lepard ◽  
Riccardo Spagiari ◽  
Jacquelyn Corley ◽  
Ernest J. Barthélemy ◽  
Eliana Kim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Road Traffic ◽  
Meta Analysis ◽  
Final Analysis ◽  
High Income ◽  
Total Study Population ◽  
Motorcycle Helmet ◽  
Significant Difference ◽  
Helmet Laws

Background The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. Methods and findings A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle–Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg’s and Egger’s tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case–control study, and 5 pre–post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. Conclusions In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.

scholarly journals Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis (Preprint)

2020 ◽  
Author(s):  
Debaleena Chattopadhyay ◽  
Tengteng Ma ◽  
Hasti Sharifi ◽  
Pamela Martyn-Nemeth
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Virtual Humans ◽  
Conversational Agents ◽  
Desktop Computer ◽  
Cross Sectional ◽  
Head Mounted Display ◽  
Significant Difference

BACKGROUND Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. OBJECTIVE The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. METHODS Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. RESULTS Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged — simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, <i>P</i>=.012), but with evidence of some heterogeneity, <i>I<sup>2</sup></i>=49.3%. There were more cross-sectional (<i>k</i>=15) than longitudinal studies (<i>k</i>=11). The intervention was delivered using a personal computer in most studies (<i>k</i>=18), followed by a tablet (<i>k</i>=4), mobile kiosk (<i>k</i>=2), head-mounted display (<i>k</i>=1), and a desktop computer in a community center (<i>k</i>=1). CONCLUSIONS We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

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