scholarly journals Prone Positioning in Patients With COVID-19: Analysis of Multicenter Registry Data and Meta-analysis of Aggregate Data

In Vivo ◽  
2021 ◽  
Vol 36 (1) ◽  
pp. 361-370
Author(s):  
ANASTASIOS KOLLIAS ◽  
KONSTANTINOS G. KYRIAKOULIS ◽  
VASILIKI RAPTI ◽  
IOANNIS P. TRONTZAS ◽  
THOMAS NITSOTOLIS ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Aggregate Data ◽  
Registry Data ◽  
Prone Positioning ◽  
Multicenter Registry

scholarly journals Comparing the use of aggregate data and various methods of integrating individual patient data to network meta-analysis and its application to first-line ART

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Steve Kanters ◽  
Mohammad Ehsanul Karim ◽  
Kristian Thorlund ◽  
Aslam H. Anis ◽  
Michael Zoratti ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Evidence Base ◽  
Aggregate Data ◽  
World Health ◽  
Coefficient Estimates ◽  
Two Stage ◽  
Individual Patient Level ◽  
One Stage ◽  
Meta Regression ◽  
Empirical Priors

Abstract Background The 2018 World Health Organization HIV guidelines were based on the results of a network meta-analysis (NMA) of published trials. This study employed individual patient-level data (IPD) and aggregate data (AgD) and meta-regression methods to assess the evidence supporting the WHO recommendations and whether they needed any refinements. Methods Access to IPD from three trials was granted through ClinicalStudyDataRequest.com (CSDR). Seven modelling approaches were applied and compared: 1) Unadjusted AgD network meta-analysis (NMA) – the original analysis; 2) AgD-NMA with meta-regression; 3) Two-stage IPD-AgD NMA; 4) Unadjusted one-stage IPD-AgD NMA; 5) One-stage IPD-AgD NMA with meta-regression (one-stage approach); 6) Two-stage IPD-AgD NMA with empirical-priors (empirical-priors approach); 7) Hierarchical meta-regression IPD-AgD NMA (HMR approach). The first two were the models used previously. Models were compared with respect to effect estimates, changes in the effect estimates, coefficient estimates, DIC and model fit, rankings and between-study heterogeneity. Results IPD were available for 2160 patients, representing 6.5% of the evidence base and 3 of 24 edges. The aspect of the model affected by the choice of modeling appeared to differ across outcomes. HMR consistently generated larger intervals, often with credible intervals (CrI) containing the null value. Discontinuations due to adverse events and viral suppression at 96 weeks were the only two outcomes for which the unadjusted AgD NMA would not be selected. For the first, the selected model shifted the principal comparison of interest from an odds ratio of 0.28 (95% CrI: 10.17, 0.44) to 0.37 (95% CrI: 0.23, 0.58). Throughout all outcomes, the regression estimates differed substantially between AgD and IPD methods, with the latter being more often larger in magnitude and statistically significant. Conclusions Overall, the use of IPD often impacted the coefficient estimates, but not sufficiently as to necessitate altering the final recommendations of the 2018 WHO Guidelines. Future work should examine the features of a network where adjustments will have an impact, such as how much IPD is required in a given size of network.

scholarly journals Incorporating single-arm studies in meta-analysis of randomised controlled trials: a simulation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Janharpreet Singh ◽  
Keith R. Abrams ◽  
Sylwia Bujkiewicz
Keyword(s):  
Simulation Study ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Health Technology ◽  
Small Error ◽  
Aggregate Data ◽  
Controlled Trials ◽  
Real World Data ◽  
Study Heterogeneity ◽  
Randomised Controlled

Abstract Background Use of real world data (RWD) from non-randomised studies (e.g. single-arm studies) is increasingly being explored to overcome issues associated with data from randomised controlled trials (RCTs). We aimed to compare methods for pairwise meta-analysis of RCTs and single-arm studies using aggregate data, via a simulation study and application to an illustrative example. Methods We considered contrast-based methods proposed by Begg & Pilote (1991) and arm-based methods by Zhang et al (2019). We performed a simulation study with scenarios varying (i) the proportion of RCTs and single-arm studies in the synthesis (ii) the magnitude of bias, and (iii) between-study heterogeneity. We also applied methods to data from a published health technology assessment (HTA), including three RCTs and 11 single-arm studies. Results Our simulation study showed that the hierarchical power and commensurate prior methods by Zhang et al provided a consistent reduction in uncertainty, whilst maintaining over-coverage and small error in scenarios where there was limited RCT data, bias and differences in between-study heterogeneity between the two sets of data. The contrast-based methods provided a reduction in uncertainty, but performed worse in terms of coverage and error, unless there was no marked difference in heterogeneity between the two sets of data. Conclusions The hierarchical power and commensurate prior methods provide the most robust approach to synthesising aggregate data from RCTs and single-arm studies, balancing the need to account for bias and differences in between-study heterogeneity, whilst reducing uncertainty in estimates. This work was restricted to considering a pairwise meta-analysis using aggregate data.

scholarly journals Review of Methods for Combining Individual and Aggregate Data in a Meta-Analysis

2016 ◽  
Vol 19 (7) ◽  
pp. A362
Author(s):  
R Kapso Kapnang ◽  
K Thokagevistk ◽  
A Vataire ◽  
S Aballéa
Keyword(s):  
Meta Analysis ◽  
Aggregate Data

Meta-analysis of individual patient data versus aggregate data from longitudinal clinical trials

2009 ◽  
Vol 6 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Ashley P Jones ◽  
Richard D Riley ◽  
Paula R Williamson ◽  
Anne Whitehead
Keyword(s):  
Clinical Trials ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Aggregate Data

Minimally invasive oesophagectomy in the prone versus lateral decubitus position: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Dimitrios Schizas ◽  
Dimitrios Papaconstantinou ◽  
Anastasia Krompa ◽  
Antonios Athanasiou ◽  
Tania Triantafyllou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Meta Analysis ◽  
Lateral Decubitus Position ◽  
Prone Positioning ◽  
Respiratory Complications ◽  
Invasive Esophagectomy ◽  
Postoperative Respiratory Complications ◽  
Lateral Decubitus

Abstract The thoracic phase of minimally invasive esophagectomy was initially performed in the lateral decubitus position (LDP); however, many experts have gradually transitioned to a prone position (PP) approach. The aim of the present systematic review and meta-analysis is to quantitatively compare the two approaches. A systematic literature search of the MEDLINE, Embase, Google Scholar, Web of Knowledge, China National Knowledge Infrastructure and ClinicalTrials.gov databases was undertaken for studies comparing outcomes between patients undergoing minimally invasive esophageal surgery in the PP versus the LDP. In total, 15 studies with 1454 patients (PP; n = 710 vs. LDP; n = 744) were included. Minimally invasive esophagectomy in the PP provides statistically significant reduction in postoperative respiratory complications (Risk ratios 0.5, 95% confidence intervals [CI] 0.34–0.76, P < 0.001), blood loss (weighted mean differences [WMD] –108.97, 95% CI –166.35 to −51.59 mL, P < 0.001), ICU stay (WMD –0.96, 95% CI –1.7 to −0.21 days, P = 0.01) and total hospital stay (WMD –2.96, 95% CI –5.14 to −0.78 days, P = 0.008). In addition, prone positioning increases the overall yield of chest lymph node dissection (WMD 2.94, 95% CI 1.54–4.34 lymph nodes, P < 0.001). No statistically significant difference in regards to anastomotic leak rate, mortality and 5-year overall survival was encountered. Subgroup analysis revealed that the protective effect of prone positioning against pulmonary complications was more pronounced for patients undergoing single-lumen tracheal intubation. A head to head comparison of minimally invasive esophagectomy in the prone versus the LDP reveals superiority of the former method, with emphasis on the reduction of postoperative respiratory complications and reduced length of hospitalization. Long-term oncologic outcomes appear equivalent, although validation through prospective studies and randomized controlled trials is still necessary.

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