The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies

2020 ◽  
Author(s):  
jingjie zhao ◽  
xinliang xu ◽  
Hualin Jiang ◽  
yi ding
Keyword(s):  
Virtual Reality ◽  
Meta Analysis ◽  
Mean Difference ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Subgroup Analyses ◽  
Degree Of Satisfaction ◽  
Meta Regression ◽  
Standardized Mean Difference ◽  
Anatomy Teaching

Abstract Virtual reality (VR) is an innovation that permits the individual to discover and operate three-dimensional (3D) environment to gain practical understanding instantly. Recently, VR has been advanced as an encouraging tool in the course of clinical college. This research aimed to examine the general efficiency of VR for teaching medical anatomy. We executed a meta-analysis of randomized regulated studies of the performance of VR anatomy education. We browsed 5 databases from the year 1990 to 2019. Ultimately, 15 randomized controlled trials with a teaching outcome measure analysis were included. Tow authors separately chosen studies, extracted information, and examined the risk of bias. The primary outcomes were examination scores of the students. Secondary outcomes were the degree of satisfaction of the students. Random-effects models were used for the pooled evaluations. Standardized mean difference (SMD) was applied to assess the systematic results. The heterogeneity was determined by I2 statistics, and then was investigated by meta-regression and subgroup analyses. In this review, we screened and included fifteen randomized controlled researches (816 students). The pooled analysis of primary outcomes showed that VR improves test scores comparing with other approaches (standardized mean difference [SMD]= 0.53; 95% CI 0.09–0.97; I2= 87.8%). The high homogeneity indicated that the studies were different from each other. Therefore, we carried out meta-regression as well as subgroup analyses using 7 variables (year, country, learners, course, intervention, comparator, and duration). We found that VR improves postintervention test score of anatomy comparing with other types of teaching methods. Although the findings have high internal validity and limited, because of that anatomy teaching in medical universities appears to becoming a dilemma, VR may act as an efficient way to improve the learners’ level of anatomy knowledge. Future research should assess other factors like degree of satisfaction, cost-effectiveness, and adverse reactions when evaluating the teaching effectiveness of VR in anatomy.

Efficacy of Adjuvant Magnesium for Posttonsillectomy Morbidity in Children: A Meta-analysis

2017 ◽  
Vol 158 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Hye Kyung Cho ◽  
In Joon Park ◽  
Ho Young Yoon ◽  
Se Hwan Hwang
Keyword(s):  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Mean Difference ◽  
Local Administration ◽  
Control Group ◽  
Analgesic Requirement ◽  
Administration Routes ◽  
Randomized Controlled Studies ◽  
Subgroup Analyses ◽  
Standardized Mean Difference

Objectives The perioperative administration of magnesium is known to reduce postoperative morbidities in adults, such as pain, agitation, and laryngospasm. The objective is to assess the effects of perioperative magnesium as the adjuvant to tonsillectomy as compared with tonsillectomy in children. Data Source Five databases (PubMed, SCOPUS, Embase, Web of Science, Cochrane). Method Two authors independently searched databases up to January 2017. We compared perioperative magnesium administration (magnesium groups) with no administration of magnesium (control group). The following outcomes were measured: postoperative pain intensity, analgesics administration, or other morbidities (laryngospasm, agitation, postoperative bleeding) in the postoperative 24 hours. Additionally, to evaluate the discrepancy of effects according to different administration routes, subgroup analyses regarding effects according to systemic or local administration of magnesium were performed. Results Nine prospective randomized controlled studies (n = 615) that evaluated the effect of magnesium in children having undergone tonsillectomy met inclusion criteria. Compared with control group, the time for first analgesic requirement was significantly delayed in magnesium groups (standardized mean difference = 0.75; 95% CI, 0.20-1.31; P = .0079). Laryngospasm (log odds ratio = −1.09; 95% CI,−2.11 to −0.07; P = .0362) and agitation score (standardized mean difference = −0.67; 95% CI, −0.97 to −0.36; P < .0001) in the recovery room also significantly decreased in magnesium groups. In subgroup analyses regarding pain and laryngospasm-related measurements, local administration of magnesium was shown to be more effective at reducing postoperative morbidities. Conclusions Perioperative magnesium regardless of route may offer pain, agitation, and laryngospasm relief without adverse effects in pediatric tonsillectomy. Based on the high heterogeneity of results within some parameters, further studies need to be performed to affirm these results.

scholarly journals Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Zigang Liu ◽  
Yongmei Zhao ◽  
Ming Lei ◽  
Guancong Zhao ◽  
Dongcheng Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Ischemic Preconditioning ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Subgroup Analyses ◽  
Meta Regression

Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies

2021 ◽  
pp. 1357633X2110477
Author(s):  
Ita Daryanti Saragih ◽  
Santo Imanuel Tonapa ◽  
Carolyn M. Porta ◽  
Bih-O Lee
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Sexual Health ◽  
Condom Use ◽  
Self Efficacy ◽  
Meta Analysis ◽  
Mean Difference ◽  
Adolescent Sexual Health ◽  
Randomized Controlled ◽  
Standardized Mean Difference

Introduction Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents. Methods A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis. Results A total of 15 studies ( N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08–0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23–0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31–0.92). Discussion Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.

scholarly journals Current Evidence of Mesenchymal Stem Cells Use in the Treatment of Tendon Disorders: A Systematic Review, Meta-analysis, and Meta-regression of Prospective Clinical Studies

2020 ◽  
Author(s):  
Woo Sup Cho ◽  
Sun Gun Chung ◽  
Won Kim ◽  
Chris H. Jo ◽  
Shi-Uk Lee ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Clinical Studies ◽  
Meta Analysis ◽  
Mean Difference ◽  
Efficacy And Safety ◽  
Cell Dose ◽  
Human Tendon ◽  
Meta Regression ◽  
Standardized Mean Difference

Abstract Purpose: Although several studies with animals have reported the effects of mesenchymal stem cells (MSCs) for tendon regeneration, little is known about the efficacy and safety of MSCs in human tendon disorders. We performed this meta-analysis to evaluate the efficacy and safety of MSC therapy in patients with tendon disorders enrolled in prospective clinical studies.Methods: We systematically searched prospective clinical studies investigating the effects of MSCs administration on human tendon disorders with at least a 6-month follow-up period on PubMed-Medline, Embase, and Cochrane Library databases. The primary outcome of interest was the change in pain on motion related to tendon disorders. We performed a pairwise meta-analysis using the fixed-effects model to assess treatment response, which was calculated by the standardized mean difference. Meta-regression analyses were performed to assess the relationship between MSCs dose and pooled effect sizes in each cell dose.Results: Four prospective clinical trials investigating the effect of MSCs on tendon disorders were retrieved. MSCs showed significant pooled effect size (overall Hedge’s g pooled standardized mean difference (SMD) = 1.868; 95% confidence interval [CI], 1.274–2.462; P < 0.001). The treatment with MSCs improved all the aspects analyzed, i.e. pain, functional scores, radiologic parameters (magnetic resonance image or ultrasonography), and arthroscopic findings. In the meta-regression analysis, there was a significant cell dose-dependent response in pain relief (Q = 9.06, P = 0.029). While three studies reported mild adverse events after MSCs injection, these were not severe and relieved spontaneously.Conclusions: Our meta-analysis revealed that MSC therapy may improve pain, function, radiologic, and arthroscopic parameters in patients with tendon disorders. Due to the small number of studies in this meta-analysis and considering the increasing MSCs applications, there is a strong need for large-scale randomized controlled trials to confirm the long-term functional improvement as well as the adverse effects of MSC therapies in tendon disorders.

scholarly journals Toxicities of PD-1/PD-L1 Inhibitors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Xiangy Kong ◽  
Li Chen ◽  
Ryan J Sullivan ◽  
Zhihong Qi ◽  
Yulu Liu ◽  
...  
Keyword(s):  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Treatment Regimens ◽  
Randomized Controlled ◽  
Subgroup Analyses ◽  
Meta Regression ◽  
Drug Type ◽  
Grade 3 ◽  
And Control

Background: Immunotherapy, especially immune-checkpoint inhibitors (PD-1 and PD-L1 inhibitors), is now one of the mainstays of cancer treatment. Several studies have analyzed treatment-related toxicities of immunotherapy. However, small sample size, rough and unspecific stratification, and lack of comparison (pure sing-arm studies) are common limitations. Detailed organ- and system-specific toxicities remain not clear enough. Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and others (CNKI), from database inception to Mar 31, 2020, for randomized controlled trials (RCTs) related to PD-1/PD-L1 inhibitors that had available toxicity data. We excluded non-randomized trials. The primary endpoint was to assess the difference in the incidences of toxicities between cancer patients who did and did not receive PD-1/PD-L1 inhibitors. We calculated the pooled relative risks (RRs) and corresponding 95% confidence intervals (95% CIs) using a random-effects model and assessed the heterogeneity between different groups. The subgroup analyses were conducted based on toxicity grade (severity), system and organ, treatment regimens in the intervention arm and control arm, PD-1/PD-L1 inhibitor drug type, and cancer histotype. We applied the five-point Jadad ranking system to evaluate the quality of the selected studies. We performed multivariate meta-regression analyses to explore the proportion of between-study variance. Results: A total of 29 eligible RCTs including 8067 patients were selected for the meta-analysis based on specified inclusion and exclusion criteria. Patients treated with PD-1/PD-L1 inhibitors were at lower risks of overall toxicities (all grades: RR 0.91, 95% CI 0.89-0.92; grade 3~4: RR 0.76, 95% CI 0.74-0.78), including gastrointestinal toxicity (all grades: RR 0.68, 95% CI 0.60-0.77; grade 3~4: RR 0.71, 95% CI 0.43-1.20), hematologic toxicity (all grades: RR 0.66, 95% CI 0.51-0.85; grade 3~4: RR 0.55, 95% CI 0.37-0.83), and treatment event leading to discontinuation (all grades: RR 0.78, 95% CI 0.72-0.84; grade 3~4: RR 0.58, 95% CI 0.49-0.67); but were at higher risks for respiratory toxicity (all grades: RR 1.74, 95% CI 1.33-2.28; grade 3~4: RR 1.92, 95% CI 1.45-2.55) and endocrine toxicity (all grades: RR 1.70, 95% CI 0.62-4.69; grade 3~4: RR 1.29, 95% CI 0.45-3.69). The subgroup analyses indicated that when compared with the control, toxicity comparison tendency for PD-1/PD-L1 inhibitors varied with the toxicity grade, affected system and organ, treatment regimens in the intervention arm and control arm, drug type, and cancer histotype. The male-female ratio was a statistically significant variable in the Meta-Regression analysis (I2=89.1,τ2=0.01, and P=0.001). Conclusion: For most toxicity types based on system and organ, the incidence proportions for patients in the intervention arm were lower than those in the control arm, which suggested the general safety of PD-1/PD-L1 inhibitors against conventional chemotherapy and CTLA-4 inhibitors. However, for some specific toxicities including respiratory, cutaneous, and endocrine toxicities, the case was the opposite. The toxicity grade, system and organ, treatment regimens, drug type, and cancer histotype were all influencing factors. To our knowledge, this was by far the most comprehensive meta-analysis of RCTs on toxicities of immune-checkpoint inhibitors. Future research should focus on taking effective targeted measures to decrease the risks of different toxicities for different patient populations.

The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 44 (5) ◽  
pp. 341-354
Author(s):  
Saeed Shahabi ◽  
Kamran Bagheri Lankarani ◽  
Seyed Taghi Heydari ◽  
Maryam Jalali ◽  
Sulmaz Ghahramani ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Meta Analysis ◽  
Mean Difference ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled ◽  
Lateral Elbow ◽  
Standardized Mean Difference ◽  
Lateral Elbow Tendinopathy

Background: Lateral elbow tendinopathy, also known as “tennis elbow” or “lateral epicondylitis,” is a common disease leading to pain in the lateral side of the elbow and disability during hand gripping. A counterforce brace is one of the most conventional treatments. However, its effects on outcomes remain inconclusive. Objectives: To investigate the effects of counterforce braces on pain in subjects with lateral elbow tendinopathy. Grip strength was reviewed as a secondary outcome. Study design: Systematic review and meta-analysis of randomized controlled trials. Methods: PubMed, Embase, Scopus, Web of Science, CENTRAL, PEDro, ProQuest, RECAL, and RehabData were searched from January 1, 1995, through June 15, 2019. Results: Seventeen studies were included with a total of 1145 participants. A small improvement in pain over the short term (standardized mean difference −0.02; 95% confidence interval: −0.85 to 0.80) and a moderate-to-large improvement in pain in subjects 45 years or younger (standardized mean difference −0.86; 95% confidence interval: −2.45 to 0.72) in favor of the brace versus physiotherapy interventions were found. In contrast, over the long-term physiotherapy interventions (standardized mean difference 1.17; 95% confidence interval: −0.00 to 2.34), wrist splint (standardized mean difference 0.35; 95% confidence interval: −0.07 to 0.76), and laser therapy (standardized mean difference 0.58; 95% confidence interval: −0.44 to 1.59) had better effects on pain improvement versus the brace. Conclusion: The results indicated that physiotherapy interventions compared to counterforce braces have better effects, especially over the long-term. However, counterforce braces may have better effects on pain in younger people (<45 years old) over the short term (<6 weeks). Clinical relevance The results suggest that counterforce bracing is a reasonable strategy to alleviate pain over the short term. However, the subgroup analysis suggests that factors such as age may have a role in their effectiveness.

Benefits of virtual reality balance training for patients with Parkinson’s disease: A systematic review, meta-analysis, and meta-regression of a randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Jinlong Wu ◽  
Hui Zhang ◽  
Ziyan Chen ◽  
Ruijia Fu ◽  
Hao Yang ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Methodological Quality ◽  
Quality Evaluation ◽  
Meta Analysis ◽  
Balance Training ◽  
Randomized Controlled ◽  
Vr Training ◽  
Balance Ability ◽  
Meta Regression ◽  
The Impact

BACKGROUND Virtual reality (VR) balance training are increasingly being pursued in biomedical research and specifically with respect to investigating the balance ability with VR .However, Existing systematic reviews have found inconsistent conclusions about the efficacy of VR in improving balance in parkinson’s disease patients (PD). OBJECTIVE To evaluate the impact of VR balance training on the balance ability of patients with PD. METHODS All major databases, including Web of Science, PubMed, Scopus, China National Knowledge Infrastructure (CNKI) and Wanfang, were searched to identify all relevant studies published in English or Chinese since September 15th, 2010. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation. RESULTS 16 randomized controlled trials were analyzed (N = 583 patients with PD), with the methodological quality evaluation score ranging from 5 to 8 points. A random effects model was selected to combine effect sizes. Meta-analysis showed that the balance ability of PD was significantly improved after VR training compared with the control group.(standardized mean difference(SMD) = 2.127, 95% confidence interval [CI] = 1.202 - 3.052, P < 0.01, I2 = 95.1, df = 15). It is worth noting that intervention platform may be the main reason for heterogeneity. Meta regression analysis showed that no training program could predict the impact of VR training (P = 0.567-0.938) on PD balance ability. CONCLUSIONS The present meta-analysis verifies the potential rehabilitative effects of VR balance training for Parkinson disease.

scholarly journals Effect of atorvastatin treatment on circulating adiponectin: a meta-analysis of randomized controlled trials

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Xiaoyu Liu ◽  
Wei Zhang ◽  
Ming Zhao ◽  
Guowei Jia ◽  
Rongguo Sun
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Controlled Trials ◽  
Atorvastatin Treatment ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Subgroup Analyses ◽  
Study Characteristics ◽  
Meta Regression

Abstract Background Influences of atorvastatin on atherosclerosis and glycemic metabolism may be related to its potential impact on circulating adiponectin, an adipocyte that exerts anti-inflammatory, ant-atherosclerotic, and anti-oxidative effects. However, results of previous randomized controlled trials (RCTs) were not consistent. We performed a meta-analysis of RCTs to systematic evaluate the influence of atorvastatin on circulating adiponectin. Methods Relevant studies were identified via search of electronic databases of PubMed, Embase, and Cochrane’s Library. A random-effect model was applied to pool the results via incorporating the potential heterogeneity. Predefined meta-regression and subgroup analyses were used to evaluate the influences of study characteristics on the outcome. Results Fourteen datasets from ten RCTs including 931 patients were included. Pooled results showed that atorvastatin did not significantly affect circulating adiponectin as compared with controls (weighed mean difference = − 0.27 μg/mL, 95% confidence interval: − 0.89 to 0.35 μg/mL, p = 0.39). Results of univariate meta-regression analyses showed that study characteristics including number of patients, mean age, proportion of male patients, body mass index, dose of atorvastatin, or treatment duration did not significantly affect the outcome (p all > 0.05). Moreover, subgroup analyses showed that atorvastatin did not significantly affect circulating adiponectin in studies stratified according to these study characteristics (p all > 0.05). Conclusions Atorvastatin treatment does not significantly affect circulating adiponectin. Influences of atorvastatin on atherosclerosis and glycemic metabolism are not likely to be mediated by modulation of circulating adiponectin.

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