Surgery in stage IV melanoma patients: Results from a single institution.

e19035 Background: There is no consensus regarding the appropriate management of melanoma patients at stage IV and resectable metastases. Methods: We conducted a systematic review and meta-analysis to examine the effect of surgery on overall survival (OS) in patients with resectable metastases. The systematic review was performed by searching MEDLINE, EMBASE, Cochrane and ISI Web of Science. The meta-analysis was performed using time-to-event data from which hazard ratios (HRs) and 95% confidence intervals (CIs) of OS were estimated and summary estimates were obtain through random effects model. Heterogeneity and publication bias were investigated by sensitivity analyses and funnel plot regression Results: Thirty-three retrospective studies evaluating survival from resected and unresected metastases were found from 1978 until 2010. In resected patients median follow-up is 1.5 years and 2-year OS is 27% whereas in unresected the median follow-up is 6 months and 2-year OS is 12%. Meta-analysis was carried out on the seven studies reporting information on visceral metastases and including 1,165 patients. We included also 93 patients at stage IV treated at the European Institute of Oncology, Milan, Italy. Surgery has shown an improvement in survival of patients managed with palliative resection of their visceral metastases: the summary estimate suggests a significant decrease in the risk of mortality of 40% for patients who undergo surgery, with no indication of heterogeneity (HR=0.6 (0.45-0.78); I2=0). However we found indication for publication bias (P=0.03) suggesting that small studies published only mainly if they found significant results. Conclusions: Our results suggest the benefit of surgical resection for advanced-stage melanoma. Patients with limited sites and numbers of metastases should be considered for curative resection regardless of the location of the disease.

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Leishmanicidal effects of resveratrol and its derivatives: a systematic review and meta-Analysis

10.21203/rs.3.rs-25274/v1 ◽

2020 ◽

Author(s):

Nasrin Amiri Dashatan ◽

Marzieh Ashrafmansouri ◽

Mehdi Koushki ◽

Nayebali Ahmadi

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Data Extraction ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Protective Effects ◽

Random Effects Models ◽

Important Health ◽

Mean Differences ◽

Meta Analyses

Abstract Background Leishmaniasis is one of the most important health problems worldwide. The evidence has suggested that resveratrol and its derivatives have anti-leishmanial effects; however, the results are inconsistent and inconclusive. The aim of this study was to assess the effect of resveratrol and its derivatives on the Leishmania viability through a systematic review and meta-analysis of available relevant studies. Methods The electronic databases PubMed, ScienceDirect, Embase, Web of Science and Scopus were queried between October 2000 and April 2020 using a comprehensive search strategy. The eligible articles selected and data extraction conducted by two reviewers. Mean differences of IC50 (concentration leading to reduction of 50% of Leishmania) for each outcome was calculated using random-effects models. Sensitivity analyses and prespecified subgroup were conducted to evaluate potential heterogeneity and the stability of the pooled results. Publication bias was evaluated using the Egger’s and Begg’s tests. We also followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for this review. Results Ten studies were included in the meta-analysis. We observed that RSV and its derivatives had significant reducing effects on Leishmania viability in promastigote [24.02 µg/ml; (95% CI 17.1, 30.8); P < 0.05; I2 = 99.8%; P heterogeneity = 0.00] and amastigote [18.3 µg/ml; (95% CI 13.5, 23.2); P < 0.05; I2 = 99.6%; P heterogeneity = 0.00] stages of Leishmania. A significant publication bias was observed in the meta-analysis. Sensitivity analyses showed a similar effect size while reducing the heterogeneity. Subgroup analysis indicated that the pooled effects of leishmanicidal of resveratrol and its derivatives were affected by type of stilbenes and Leishmania species. Conclusions Our findings clearly suggest that the strategies for the treatment of leishmaniasis should be focused on natural products such as RSV and its derivatives. Further study is needed to identify the mechanisms mediating this protective effects of RSV and its derivatives in leishmaniasis.

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Long-term outcomes of psychological interventions on children and young people’s mental health: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0236525 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0236525

Author(s):

Stephen Pilling ◽

Peter Fonagy ◽

Elizabeth Allison ◽

Phoebe Barnett ◽

Chloe Campbell ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Publication Bias ◽

Meta Analysis ◽

Psychosocial Interventions ◽

Long Term Outcomes ◽

Self Harm ◽

The Impact

Background Over 600 RCTs have demonstrated the effectiveness of psychosocial interventions for children and young people’s mental health, but little is known about the long-term outcomes. This systematic review sought to establish whether the effects of selective and indicated interventions were sustained at 12 months. Method We conducted a systematic review and meta-analysis focusing on studies reporting medium term outcomes (12 months after end of intervention). Findings We identified 138 trials with 12-month follow-up data, yielding 165 comparisons, 99 of which also reported outcomes at end of intervention, yielding 117 comparisons. We found evidence of effect relative to control at end of intervention (K = 115, g = 0.39; 95% CI: 0.30–0.47 I2 = 84.19%, N = 13,982) which was maintained at 12 months (K = 165, g = 0.31, CI: 0.25–0.37, I2 = 77.35%, N = 25,652) across a range of diagnostic groups. We explored the impact of potential moderators on outcome, including modality, format and intensity of intervention, selective or indicated intervention, site of delivery, professional/para-professional and fidelity of delivery. We assessed both risk of study bias and publication bias. Conclusions Psychosocial interventions provided in a range of settings by professionals and paraprofessionals can deliver lasting benefits. High levels of heterogeneity, moderate to high risk of bias for most studies and evidence of publication bias require caution in interpreting the results. Lack of studies in diagnostic groups such as ADHD and self-harm limit the conclusions that can be drawn. Programmes that increase such interventions’ availability are justified by the benefits to children and young people and the decreased likelihood of disorder in adulthood.

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Global Incidence of Necrotizing Enterocolitis: a Systematic Review and Meta-Analysis

10.21203/rs.3.rs-17868/v2 ◽

2020 ◽

Author(s):

Amer Alsaied ◽

Nazmul Islam ◽

Lukman Thalib

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Publication Bias ◽

Necrotizing Enterocolitis ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Vlbw Infants ◽

Funnel Plots ◽

Substantial Heterogeneity

Abstract Background: Necrotizing Enterocolitis (NEC) is a major cause of morbidity and mortality in the Neonatal Intensive Care Unit (NICU), yet the global incidence of NEC has not been systematically evaluated. We conducted a systematic review and meta-analysis of cohort studies reporting the incidence of NEC in infants with Very Low Birth Weight (VLBW).Methods: The databases searched included PubMed, MEDLINE, the Cochrane Library, EMBASE and grey literature. Eligible studies were cohort or population-based studies of newborns including registry data reporting incidence of NEC. Data were extracted from the selected papers included incidence of NEC cases and size of population at risk, author and publication details, follow up period covered by the study, location and setting of the study and whether it was VLBW infants or preterm infants. Additionally, risk of bias assessment of the included studies were carried out using a validated tool. Bias adjusted Quality Effect Model (QEM) were used to pool the estimates. In the presence of substantial heterogeneity, Random Effect Models (REM) were used as an additionally sensitivity analyses. The heterogeneity between studies were evaluated using the Cochrane Q statistics and Higgin’s I2 value. Subgroup analysis and meta-regression were used to explore the sources of heterogeneity. Funnel plots as appropriate for ratio measures were used to assess publication bias. Results: A systematic and comprehensive search of databases identified 27 cohort studies reporting the incidence of NEC. The pooled estimate of the global incidence of NEC was 6.0% (95% CI: 4.0%-9.0%). There were substantial heterogeneity (I2 = 100%) between studies. Funnel plots showed no evidence of publication bias.Conclusion: Seven out of 100 of all VLBW infants in NICU are likely to develop NEC. However, there were considerable heterogeneity between studies. High quality studies assessing incidence of NEC along with associated risk factors are warranted.

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Antegrade or Retrograde Approach for the Management of Tandem Occlusions in Acute Ischemic Stroke: Protocol for a Systematic Review and Meta-Analysis

10.21203/rs.3.rs-121897/v1 ◽

2020 ◽

Author(s):

Xiao Zhang ◽

Xuesong Bai ◽

Xue Wang ◽

Wuyang Yang ◽

Jie Wang ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Retrograde Approach ◽

Post Intervention ◽

Tandem Lesions

Abstract BackgroundAcute ischemic stroke (AIS) is a major contributor to global morbidity and mortality, and mechanical thrombectomy (MT) is an effective treatment for AIS. AIS caused by tandem intracranial and extracranial occlusions are not rare. Evidence for optimal MT strategy regarding order of treatment, including antegrade (extracranial first) or retrograde (intracranial first) approach is lacking. Therefore, a systematic review and meta-analysis is necessary to compare the two approaches for optimal management of tandem lesions in AIS.MethodsThis study will be performed with accordance to the PRISMA statement. Major databases including PubMed, Web of Science, Embase, and the Cochrane Library will be used for literature search. Randomized controlled trials and high-quality observational studies will be included. Risk of bias will be assessed using the Cochrane Collaboration criteria or Newcastle–Ottawa Scale according to type of study. Two reviewers will independently screen for eligible studies and perform data extraction. The primary outcomes are successful recanalization at post-intervention, and favorable outcome at 3-month follow-up. Secondary outcomes include duration of onset to arrival, onset to puncture, onset to recanalization, intracerebral hemorrhage, procedure and device related complications and mortality at 3-month follow-up. We will assess heterogeneity using the I2 statistic. Subgroup and sensitivity analyses will be performed to explore the sources of heterogeneity. Specific results will be described in narrative form when insufficient suitable studies are available for meta-analysis.DiscussionThis study will provide a reliable evidence base for antegrade or retrograde approach for the management of tandem lesions in AIS by synthesizing evidence from current pieces of literature comparing the two approaches, and also will provide updated clinical evidence of strategy selection and decision-making for this special group of patients. PROSPERO registration numberCRD42020199093

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Relationship Between Smoking and Pressure Injury Risk: A Systematic Review and Meta-Analysis

Wound Management & Prevention ◽

10.25270/wmp.2021.9.3446 ◽

2021 ◽

Vol 67 (9) ◽

pp. 34-46

Author(s):

Bing-Bing Wu ◽

Dong-Zhou Gu ◽

Jia-Ning Yu ◽

Li-Peng Feng ◽

Rong Xu ◽

...

Keyword(s):

Systematic Review ◽

Regression Analysis ◽

Publication Bias ◽

Injury Risk ◽

Meta Analysis ◽

Sensitivity Analyses ◽

China National Knowledge Infrastructure ◽

Pressure Injury ◽

Meta Regression ◽

Meta Regression Analysis

BACKGROUND: Smoking is a risk factor for many diseases. PURPOSE: This study explored the relationship between current or past smoking and pressure injury (PI) risk through a systematic review and meta-analysis. METHODS: The databases PubMed, Web of Science, and China National Knowledge Infrastructure were searched for the years between 2001 and 2020. Quality of evidence was estimated by the Newcastle-Ottawa Scale. The random effects model was applied to assess the odds ratios (OR) and 95% confidence intervals (CI); pooled adjusted OR and 95% CI, subgroup analysis, publication bias, sensitivity analyses, and meta-regression analysis were performed. RESULTS: Fifteen (15) studies (12 retrospective and 3 prospective) comprising data on 11 304 patients were eligible for inclusion in the review. The meta-analysis demonstrated that smoking increased the risk of PI (OR = 1.498; 95% CI, 1.058-2.122), and the pooled adjusted OR (1.969) and 95% CI (1.406-2.757) confirmed this finding. Publication bias was not detected by funnel plot, Begg’s test (P = .322), or Egger’s test (P = .666). Subgroup analyses yielded the same observations in both retrospective (OR = 1.607; 95% CI, 1.043-2.475) and prospective (OR = 1.218; 95% CI, 0.735-2.017) studies. The results were consistent across sensitivity analyses (OR = 1.07; 95% CI, 1.043-2.475). Relevant heterogeneity moderators were not identified by meta-regression analysis with PI incidence (P = .466), years of patient data included (P = .637), mean patient age (P = .650), and diabetes mellitus diagnosis (P = .509). CONCLUSION: This study found that individuals who are current or formers smokers have an almost 1.5 times higher risk of PI development than do those who do not smoke.

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Effects of neurofeedback versus methylphenidate for the treatment of ADHD: systematic review and meta-analysis of head-to-head trials

Evidence-Based Mental Health ◽

10.1136/ebmental-2019-300088 ◽

2019 ◽

Vol 22 (3) ◽

pp. 111-117 ◽

Cited By ~ 3

Author(s):

Lixia Yan ◽

Siyuan Wang ◽

Yang Yuan ◽

Junhua Zhang

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Comparative Efficacy ◽

Chinese Studies ◽

Registration Number ◽

Mean Differences ◽

Randomised Controlled ◽

Core Symptoms

BackgroundThe comparative efficacy and tolerability of methylphenidate (MPH) and neurofeedback (NF) in individuals with attention-deficit/hyperactivity disorder (ADHD) remains uncertain. This study aimed to fill this gap by means of a systematic review/meta-analysis.MethodsPubMed, OVID, ERIC, Web of Science, ClinialTrials.gov and a set of Chinese databases were searched until 22 August 2018. Standardised mean differences (SMD) were pooled using comprehensive meta-analysis software.Results18 randomised controlled trials (RCTs) were included (778 individuals with ADHD in the NF arm and 757 in the MPH group, respectively; 13 studies in Chinese, five in English). At the study first endpoint, MPH was significantly more efficacious than NF on ADHD core symptoms (ADHD symptoms combined: SMD=−0.578, 95% CI (−1.063 to –0.092)) and on two neuropsychological parameters (inattention:−0.959 (-1.711 to –0.208); inhibition:−0.469 (-0.872 to –0.066)). Dropouts were significantly lower in NF versus MPH (OR=0.412, 0.186 to 0.913). Results were robust to sensitivity analyses, with two important exceptions: removing Chinese studies and non-funded studies, no differences emerged between MPH and NF, although the number of studies was small. At the study follow-up, MPH was superior to NF in some outcomes, but results were inconsistent across raters.ConclusionsDue to the risk of bias of included studies, the results of the sensitivity analysis excluding Chinese and non-funded studies, and the mixed findings on at the follow-up endpoint, further high quality studies are needed to assess the comparative efficacy and acceptability of NF and MPH in individuals with ADHD.Trial registration numberCRD42018090256.

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Sex difference in coronavirus disease (COVID-19): a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-040129 ◽

2020 ◽

Vol 10 (10) ◽

pp. e040129 ◽

Cited By ~ 3

Author(s):

Biruk Beletew Abate ◽

Ayelign Mengesha Kassie ◽

Mesfin Wudu Kassaw ◽

Teshome Gebremeskel Aragie ◽

Setamlak Adane Masresha

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Sex Difference ◽

Meta Analysis ◽

Random Effect ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Secondary Outcome ◽

Men And Women ◽

High Prevalence

ObjectiveTo assess the sex difference in the prevalence of COVID-19 confirmed cases.DesignSystematic review and meta-analysis.SettingPubMed, Cochrane Library and Google Scholar were searched for related information. The authors developed a data extraction form on an Excel sheet and the following data from eligible studies were extracted: author, country, sample size, number of female patients and number of male patients. Using STATA V.14 for analysis, the authors pooled the overall prevalence of men and/or women using a random-effect meta-analysis model. The authors examined the heterogeneity in effect size using Q statistics and I2 statistics. Subgroup and sensitivity analyses were performed. Publication bias was also checked.ParticipantsStudies on COVID-19 confirmed cases were included.InterventionSex (male/female) of COVID-19 confirmed cases was considered.Primary and secondary outcome measuresThe primary outcome was prevalence of COVID-19 among men and women.ResultsA total of 57 studies with 221 195 participants were used in the analysis. The pooled prevalence of COVID-19 among men was found to be 55.00 (51.43–56.58, I2=99.5%, p<0.001). Sensitivity analysis showed the findings were not dependent on a single study. Moreover, a funnel plot showed symmetrical distribution. Egger’s regression test p value was not significant, which indicates absence of publication bias in both outcomes.ConclusionsThe prevalence of symptomatic COVID-19 was found to be higher in men than in women. The high prevalence of smoking and alcohol consumption contributed to the high prevalence of COVID-19 among men. Additional studies on the discrepancies in severity and mortality rate due to COVID-19 among men and women and the associated factors are recommended.

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The Prevalence of Nonadherence in Patients With Resistant Hypertension: A Systematic Review Protocol

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119897196 ◽

2019 ◽

Vol 6 ◽

pp. 205435811989719

Author(s):

Gabrielle Bourque ◽

Julius Vladimir Ilin ◽

Marcel Ruzicka ◽

Alexandra (Sascha) Davis ◽

Swapnil Hiremath

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Resistant Hypertension ◽

Observational Studies ◽

Antihypertensive Medication ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Current Evidence ◽

Treatment Resistant ◽

Medication Nonadherence

Background: Resistant hypertension, usually defined as blood pressure remaining above goal despite the concurrent use of 3 or more antihypertensive agents of different classes, is common (about 10% prevalence) and known to be a risk factor for cardiovascular events. These patients also undergo more screening intensity for secondary hypertension. However, not all patients with apparent treatment-resistant hypertension have true resistant hypertension, with some of them being nonadherent to prescribed pharmacotherapy. The prevalence of nonadherence varies from about 5% to 80% in the published literature. However, the relative contributions of intentional and nonintentional nonadherence are not well described. Nonintentional nonadherence refers to occasional forgetfulness and/or carelessness and can sometimes be related to an inability to follow instructions, because of either cognitive or physical limitations. Intentional nonadherence refers to an active process in which a patient may choose to alter the prescribed medication regimen by discontinuing medications, skipping doses, or modifying doses or dosing intervals. Objective: Our objective is to establish the overall prevalence of nonadherence in the apparent treatment-resistant hypertension population and evaluate the relative contributions of nonintentional and intentional nonadherence subtypes. Design: We will conduct a systematic review and meta-analysis. Setting: We will include observational studies and randomized controlled trials where adherence to antihypertensive medications is measured using a test of adherence, either direct or indirect. Patients: We will include adult human participants aged 18 years or older with a diagnosis of resistant hypertension. Measurements: Data extracted from individual studies will include title, first author, design, country, publication year, funding body, method of assessing adherence to antihypertensive medication, prevalence of medication nonadherence, definition of resistant hypertension, sample size, sex, mean age, and coexistent comorbidities. Methods: A librarian will search the databases Medline, EMBASE, Cochrane, CINAHL, and Web of Science for studies meeting criteria for inclusion. Two reviewers will independently screen the titles and abstracts retrieved and assess the methodological quality of eligible full-text articles using the Cochrane Risk of Bias tool for clinical trials and the Newcastle-Ottawa Scale for observational studies. Summary estimates of prevalence will be generated using pooled analysis using the random-effects method. Subgroup analyses, sensitivity analyses, and evaluation of publication bias will also be performed. Results: The outcomes of interest are the pooled prevalence of nonadherence to antihypertensive medication in apparent treatment-resistant hypertension and the prevalence of nonadherence based on different methods of assessing nonadherence (indirect vs direct), which will allow us to estimate the relative proportion of unintentional and intentional nonadherence subtypes in the overall phenomenon of medication nonadherence. Limitations: Possible limitations of this study include the finding of severe heterogeneity, the limitations of the literature search, publication bias, and the lack of granular data in the published studies for a study-level meta-analysis. Conclusions: This systematic review will provide a synthesis of current evidence on the prevalence of medication nonadherence in apparent treatment-resistant hypertension and on the relative contributions of nonintentional and intentional nonadherence subtypes. These findings will provide clinicians with a better understanding of the factors underlying treatment-resistant hypertension and will serve as a strong research base to guide future research on interventions to address medication nonadherence as well as the nonintentional and intentional subtypes. Trial registration: This protocol has been registered with PROSPERO. We will add registration details once available.

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Depression as a predictor of postoperative delirium after cardiac surgery: a systematic review and meta-analysis

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa277 ◽

2020 ◽

Author(s):

Anna Falk ◽

Jessica Kåhlin ◽

Carolin Nymark ◽

Rebecka Hultgren ◽

Malin Stenman

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Postoperative Delirium ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Total Study Population ◽

Summary Estimate ◽

Increased Risk ◽

Study Population

Abstract OBJECTIVES Depression is common in patients with cardiac disease. The importance of preoperative depression for development of postoperative delirium (POD) following cardiac surgery is not well known. The aim is to provide a summary estimate of depression as a predictor of POD following cardiac surgery. METHODS Systematic search of MEDLINE, EMBASE, Cochrane Library, Web of Science Core Collection and Psycinfo (Ovid) was performed from inception to October 2019, including cohort studies reporting odds ratios (ORs) and 95% confidence intervals (CIs) for POD following cardiac surgery in patients with preoperative depression compared to patients without depression. ORs and 95% CIs for POD were calculated using random-effects meta-analyses. Subgroup and sensitivity analyses were performed. RESULTS Seven studies were included with a combined study population of 2066 patients. The pooled prevalence of POD in the combined study population was 26% and preoperative depression was present in ∼9% of the total study population. All studies showed a positive association between preoperative depression and POD; and in 5 studies, the association was statistically significant. Patients with depression had a pooled OR of 2.31 (95% CI 1.37–3.90) for POD. CONCLUSIONS This systematic review and meta-analysis confirm the findings that the previous association between preoperative depression and increased risk for developing POD reported for other patient groups is found also in cardiac surgery. Depression screening prior to cardiac surgery may be effective in identifying patients at higher risk for POD.

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Systematic review and meta-analysis of evidence on the efficacy of e-cigarette use for sustained smoking and nicotine cessation

10.1101/2020.11.02.20224212 ◽

2020 ◽

Author(s):

E Banks ◽

A Yazidjoglou ◽

S Brown ◽

L Ford ◽

T Zulfiqar ◽

...

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Fixed Effects ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Current Evidence ◽

Cochrane Library ◽

Competing Interests ◽

Evidence Quality

AbstractObjectiveTo systematically review and meta-analyse evidence regarding the efficacy of electronic nicotine delivery systems (ENDS) as smoking cessation aids.Data SourcesPubMed, Scopus, Web of Science, PsycINFO, MEDLINE and Cochrane Library were searched up to February-March 2020 (PROSPERO registration CRD42020170692).Study selectionPublished peer-reviewed randomised controlled trials (RCTs) of the efficacy of ENDS for sustained cessation of combustible tobacco smoking and/or nicotine use, compared with no intervention, placebo or nicotine replacement therapy (NRT) by intention-to-treat, with a minimum of four months follow-up.Data ExtractionData were extracted independently into a pre-specified template. Risk of bias was assessed with the Cochrane Collaboration’s tool and evidence quality rated using GRADE.Data SynthesisFrom 3,973 titles identified, nine RCTs were identified; 330 of 5,445 smokers randomised quit. Smoking cessation did notPublic health consequences differ significantly for randomisation to ENDS versus: no intervention (three studies, random-effects meta-analysis RR 1.95; 95%CI 0.90-4.22); placebo (three studies, 1.61; 0.93-2.78) or NRT (three studies; 1.25; 0.74-2.11). Fixed-effects sensitivity analyses showed significant results for ENDS vs NRT (1.43; 1.10-1.86). Smokers randomised to ENDS were substantially more likely than control to use nicotine at follow-up. Overall evidence quality was low. Considering only studies without potential competing interests further limited evidence but did not materially change conclusions.ConclusionsThere is insufficient evidence that ENDS are efficacious for smoking cessation compared to no intervention, placebo or NRT. Results are promising, particularly for therapeutic use, but vary according to analytic method. ENDS may lead to greater ongoing nicotine exposure than other smoking cessation methods.ImplicationsThis systematic review and meta-analysis consolidates current evidence on the efficacy of ENDS as an aid to sustained smoking and nicotine cessation and considers these findings in the context of potential competing interests. While findings are promising more research - preferably independent of industry funding - is needed to provide robust evidence of the efficacy of ENDS for smoking cessation. Future research should investigate nicotine cessation in addition to smoking cessation.

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