scholarly journals Systematic review and meta-analyses of trendelenburg and prone position on intraocular pressure in adult patients undergoing surgery

2019 ◽  
Author(s):  
◽  
Sharon Ann Van Wicklin
Keyword(s):  
Intraocular Pressure ◽  
Prone Position ◽  
Vision Loss ◽  
Meta Analysis ◽  
Adult Patients ◽  
Trendelenburg Position ◽  
Time Points ◽  
Comprehensive Search ◽  
Meta Analyses ◽  
Difference Effect

Background. Patients undergoing surgery in the Trendelenburg and prone positions may be at risk for postoperative vision loss associated with increased intraocular pressure. The purpose of this dissertation research is to estimate the magnitude of the increase in intraocular pressure at specific perioperative time points in adult patients undergoing surgery in the Trendelenburg and prone positions. Methods. Comprehensive search strategies were used to identify eligible studies for two meta-analyses and to address the research questions. For each meta-analysis, standardized mean difference effect sizes were calculated for selected perioperative time points. Results. Using a random effects model, the meta-analysis examining the effect of Trendelenburg position, showed that intraocular pressure decreased significantly after induction and before arousal. Intraocular pressure increased significantly after abdominal insufflation and during Trendelenburg position. The meta-analysis examining the effect of prone position, showed that intraocular pressure increased significantly between induction of anesthesia and up to 10 minutes of prone position and continued to increase significantly until the end of the prone position. Conclusions. Intraocular pressure increases of the magnitude found in this research demonstrate the need for implementing interventions to reduce the risk for postoperative vision loss in patients undergoing surgery in the Trendelenburg and prone positions.

Meta-analysis of effect sizes reported at multiple time points: A multivariate approach

2012 ◽  
Vol 9 (5) ◽  
pp. 610-620 ◽  
Author(s):  
Thomas A Trikalinos ◽  
Ingram Olkin
Keyword(s):  
Random Effects ◽  
Treatment Effects ◽  
Multivariate Analyses ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Multiple Time ◽  
Time Points ◽  
Fixed And Random Effects ◽  
Multiple Time Points ◽  
Meta Analyses

Background Many comparative studies report results at multiple time points. Such data are correlated because they pertain to the same patients, but are typically meta-analyzed as separate quantitative syntheses at each time point, ignoring the correlations between time points. Purpose To develop a meta-analytic approach that estimates treatment effects at successive time points and takes account of the stochastic dependencies of those effects. Methods We present both fixed and random effects methods for multivariate meta-analysis of effect sizes reported at multiple time points. We provide formulas for calculating the covariance (and correlations) of the effect sizes at successive time points for four common metrics (log odds ratio, log risk ratio, risk difference, and arcsine difference) based on data reported in the primary studies. We work through an example of a meta-analysis of 17 randomized trials of radiotherapy and chemotherapy versus radiotherapy alone for the postoperative treatment of patients with malignant gliomas, where in each trial survival is assessed at 6, 12, 18, and 24 months post randomization. We also provide software code for the main analyses described in the article. Results We discuss the estimation of fixed and random effects models and explore five options for the structure of the covariance matrix of the random effects. In the example, we compare separate (univariate) meta-analyses at each of the four time points with joint analyses across all four time points using the proposed methods. Although results of univariate and multivariate analyses are generally similar in the example, there are small differences in the magnitude of the effect sizes and the corresponding standard errors. We also discuss conditional multivariate analyses where one compares treatment effects at later time points given observed data at earlier time points. Limitations Simulation and empirical studies are needed to clarify the gains of multivariate analyses compared with separate meta-analyses under a variety of conditions. Conclusions Data reported at multiple time points are multivariate in nature and are efficiently analyzed using multivariate methods. The latter are an attractive alternative or complement to performing separate meta-analyses.

Systematic review and meta-analysis of opioid use at 3, 6 and 12 months post-operatively by opioid naïve orthopaedic surgery patients

2021 ◽  
Vol 17 (6) ◽  
pp. 517-529
Author(s):  
Karen-leigh Edward, PhD, BN, GDipPsychology ◽  
Beata Stanley, BPharm ◽  
Lisa Collins, PhD ◽  
Amanda Norman, BA ◽  
Yvonne Bonomo, MBBS, FRACP, PhD, FAChAM ◽  
...  
Keyword(s):  
Systematic Review ◽  
Strong Evidence ◽  
Meta Analysis ◽  
Significant Proportion ◽  
Opioid Use ◽  
Time Points ◽  
Post Surgery ◽  
Potential Factors ◽  
Meta Analyses ◽  
Orthopedic Patients

Background and objective: There is evidence that opioid initiation post-surgery is contributing to the problem of chronic misuse and/or abuse of over the counter medications in the community, and that orthopedic patients may be particularly at risk. The aim of the systematic review with meta-analysis was to identify research that examined opioid use at 3, 6, and 12 months post-operatively by previously opioid naïve orthopedic surgery patients.Design, databases, and data treatment: A searched review with meta-analysis was undertaken. Eight databases were search. Meta-analyses conducted at all three time points (3 months, 6 months, and 12 months).Results: The search yielded 779 records, and after screening, 13 papers were included in meta-analysis. Results provide strong evidence that post-operative opioid use amongst the opioid naïve is a real effect (7 percent at 3 months, 4 percent at 6 months, and 2 percent at 12 months). A Z-test for overall effect revealed strong evidence that this proportion was nonzero for opioid use at 3, 6, and 12 months (p 0.001 for all time points). A small but significant proportion of opioid naïve patients who are prescribed opioids remain on these medications up to 12 months post-operatively.Conclusions: The nature of the studies included in the meta-analysis were varied, hence subanalyses regarding surgery type, characteristics of the patient group or other potential factors that might influence the progression to longer term opioid use after these surgeries could not be explored. Given this, further research in this area should explore such specific orthopedic subgroups.

Sinus Radiological Findings in General Asymptomatic Populations: A Systematic Review of Incidental Mucosal Changes

2021 ◽  
pp. 019459982110350
Author(s):  
Basil Razi ◽  
Adam Perkovic ◽  
Raquel Alvarado ◽  
Anna Stroud ◽  
Jacqueline Ho ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Meta Analysis ◽  
Population Groups ◽  
Bibliographic Search ◽  
Comprehensive Search ◽  
Mucosal Changes ◽  
Meta Analyses ◽  
Asymptomatic Subjects ◽  
Mucosal Thickening ◽  
Retention Cysts

Objective To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology. Data Sources Medline (1996-present) and Embase (1974-present) were searched on March 14, 2020, to identify articles that reported radiological sinus mucosal findings in asymptomatic population groups. Bibliographic search of included studies was conducted to identify additional articles. Review Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search strategy was formulated and articles screened to extract data reporting Lund-Mackay (LM) score, presence of mucous retention cysts, and maxillary mucosal thickening. A random-effects model was used in meta-analysis. Results A total of 950 articles were identified, of which 33 manuscripts met the inclusion criteria. The included studies involved 16,966 sinonasally asymptomatic subjects. The mean LM score was 2.24 (95% CI, 1.61-2.87), and an LM score of ≥4 in 14.71% (95% CI, 6.86-24.82%) was present across all general asymptomatic population groups. Mucous retention cysts were noted in 13% (95% CI, 8.33-18.55%) and maxillary mucosal thickening of ≥2 mm in 17.73% (95% CI, 8.67-29.08%). Conclusion The prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.

scholarly journals Relevance of hMLH1 -93G>A, 655A>G and 1151T>A polymorphisms with colorectal cancer susceptibility: a meta-analysis based on 38 case-control studies

2018 ◽  
Vol 64 (10) ◽  
pp. 942-951 ◽  
Author(s):  
Mohammad Zare ◽  
Jamal Jafari-Nedooshan ◽  
Mohammadali Jafari ◽  
Hossein Neamatzadeh ◽  
Seyed Mojtaba Abolbaghaei ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Susceptibility ◽  
Meta Analysis ◽  
Asian Population ◽  
Case Control ◽  
Biomedical Literature ◽  
Case Control Studies ◽  
Increased Risk ◽  
Comprehensive Search ◽  
Meta Analyses

SUMMARY OBJECTIVE: There has been increasing interest in the study of the association between human mutL homolog 1 (hMLH1) gene polymorphisms and risk of colorectal cancer (CRC). However, results from previous studies are inconclusive. Thus, a meta-analysis was conducted to derive a more precise estimation of the effects of this gene. METHODS: A comprehensive search was conducted in the PubMed, EMBASE, Chinese Biomedical Literature databases until January 1, 2018. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of the association. RESULTS: Finally, 38 case-control studies in 32 publications were identified met our inclusion criteria. There were 14 studies with 20668 cases and 19533 controls on hMLH1 −93G>A, 11 studies with 5,786 cases and 8,867 controls on 655A>G and 5 studies with 1409 cases and 1637 controls on 1151T>A polymorphism. The combined results showed that 655A>G and 1151T>A polymorphisms were significantly associated with CRC risk, whereas −93G>A polymorphism was not significantly associated with CRC risk. As for ethnicity, −93G>A and 655A>G polymorphisms were associated with increased risk of CRC among Asians, but not among Caucasians. More interestingly, subgroup analysis indicated that 655A>G might raise CRC risk in PCR-RFLP and HB subgroups. CONCLUSION: Inconsistent with previous meta-analyses, this meta-analysis shows that the hMLH1 655A>G and 1151T>A polymorphisms might be risk factors for CRC. Moreover, the −93G>A polymorphism is associated with the susceptibility of CRC in Asian population.

Does Mindfulness Training Without Explicit Ethics-Based Instruction Promote Prosocial Behaviors? A Meta-Analysis

2020 ◽  
Vol 46 (8) ◽  
pp. 1247-1269 ◽  
Author(s):  
Daniel R. Berry ◽  
Jonathan P. Hoerr ◽  
Selena Cesko ◽  
Amir Alayoubi ◽  
Kevin Carpio ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Mindfulness Training ◽  
Selective Reporting ◽  
Single Session ◽  
Based Instruction ◽  
Meta Analyses ◽  
Scholarly Discourse ◽  
Contemplative Traditions ◽  
Difference Effect ◽  
Prosocial Action

Scholarly discourse has raised concerns about the gravitas of secular mindfulness trainings in promoting prosocial outgrowths, as these trainings lack ethics-based concepts found in contemplative traditions. Random-effects meta-analyses were conducted to test whether mindfulness trainings absent explicit ethics-based instructions promote prosocial action. There was a range of small to medium standardized mean difference effect sizes of mindfulness training on overt acts of prosociality when compared with active and inactive controls, k = 29, N = 3,100, g = .426, 95% confidence interval (CI)( g) = [.304, .549]. Reliable effect size estimates were found for single-session interventions that measured prosocial behavior immediately after training. Mindfulness training also reliably promotes compassionate (but not instrumental or generous) helping and reliably reduces prejudice and retaliation. Publication bias analyses indicated that the reliability of these findings was not wholly dependent on selective reporting. Implications for the science of secular mindfulness training on prosocial action are discussed.

Meta-analysis: A 12-step program

2003 ◽  
Author(s):  
L. Streiner David
Keyword(s):  
Meta Analysis ◽  
Effect Sizes ◽  
Prevalence Rates ◽  
Global Estimate ◽  
Different Types ◽  
Comprehensive Search ◽  
Meta Analyses ◽  
Explicit Criteria ◽  
Step Program

Meta-analysis is a technique for combining the results of many studies in a rigorous and systematic manner, to allow us to better assess prevalence rates for different types of gambling and determine which interventions have the best evidence regarding their effectiveness and efficacy. Meta-analysis consists of (a) a comprehensive search for all available evidence; (b) the use of applying explicit criteria for determining which articles to include; (c) determination of an effect size for each study; and (d) the pooling of effect sizes across studies to end up with a global estimate of the prevalence or the effectiveness of a treatment. This paper begins with a discussion of why meta-analyses are useful, followed by a 12-step program for conducting a meta-analysis. This program can be used both by people planning to do such an analysis, as well as by readers of a meta-analysis, to evaluate how well it was carried out.

scholarly journals Intravitreal Dexamethasone Implants versus Intravitreal Anti-VEGF Treatment in Treating Patients with Retinal Vein Occlusion: A Meta-analysis

2018 ◽  
Author(s):  
Qian Shi ◽  
Lixiong Gao ◽  
Lijun Zhou ◽  
Chunyu Tian ◽  
Na Li ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Retinal Vein Occlusion ◽  
Macular Oedema ◽  
Vision Loss ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
First Choice ◽  
Intravitreal Dexamethasone

Abstract Background: Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment. Results: Four articles assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = -10.59, P < 0.00001) and more CST decrease (MD = -86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema. Conclusions: Anti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients. Keywords: dexamethasone intravitreal implant, anti-VEGF treatment, retinal vein occlusion, meta-analysis

Associations between anger and chronic primary pain: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Tomonori Adachi ◽  
Keiko Yamada ◽  
Haruo Fujino ◽  
Kiyoka Enomoto ◽  
Masahiko Shibata
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Negative Emotion ◽  
Data Extraction ◽  
Meta Analysis ◽  
Perceived Injustice ◽  
Qualitative Synthesis ◽  
Action Tendency ◽  
Comprehensive Search ◽  
Meta Analyses

Abstract Objectives Anger is a negative emotion characterized by antagonism toward someone or something, is rooted in an appraisal or attribution of wrongdoing, and is accompanied by an action tendency to undo the wrongdoing. Anger is prevalent in individuals with chronic pain, especially those with chronic primary pain. The associations between anger and pain-related outcomes (e.g., pain intensity, disability) have been examined in previous studies. However, to our knowledge, no systematic review or meta-analysis has summarized the findings of anger-pain associations through a focus on chronic primary pain. Hence, we sought to summarize the findings on the associations of anger-related variables with pain and disability in individuals with chronic primary pain. Methods All studies reporting at least one association between anger-related variables and the two pain-related outcomes in individuals with chronic primary pain were eligible. We searched electronic databases using keywords relevant to anger and chronic primary pain. Multiple reviewers independently screened for study eligibility, data extraction, and methodological quality assessment. Results Thirty-eight studies were included in this systematic review, of which 20 provided data for meta-analyses (2,682 participants with chronic primary pain). Of the included studies, 68.4% had a medium methodological quality. Evidence showed mixed results in the qualitative synthesis. Most anger-related variables had significant positive pooled correlations with small to moderate effect sizes for pain and disability. Conclusions Through a comprehensive search, we identified several key anger-related variables associated with pain-related outcomes. In particular, associations with perceived injustice were substantial.

Efficacy and Tolerability of Prostaglandin-Timolol Fixed Combinations: A Meta-Analysis of Randomized Clinical Trials

2011 ◽  
Vol 22 (1) ◽  
pp. 5-18 ◽  
Author(s):  
Florent Aptel ◽  
Michel Cucherat ◽  
Philippe Denis
Keyword(s):  
Clinical Trials ◽  
Intraocular Pressure ◽  
Relative Risk ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Conjunctival Hyperemia ◽  
Time Points ◽  
Curve Change ◽  
The Mean ◽  
The Individual

Purpose To evaluate the intraocular pressure (IOP)-lowering effects and tolerability of the 3 prostaglandin-timolol fixed combinations (PG-timolol FCs). Methods Clinical trials comparing directly the PG-timolol FCs or comparing the PG-timolol FCs to their individual components were thoroughly searched. The main outcome measures were efficacy assessed by IOP (taken at 9 AM, noon, 4 PM, and over the mean diurnal curve) change at 3 months (or after 1 to 6 months of treatment if no data were available at month 3) from baseline and tolerability assessed by the incidence of conjunctival hyperemia. Results Twenty trials were identified (n=4684 patients). Intraocular pressure reduction was usually greater with the 3 PG-timolol FCs than the individual PG (mean difference [MD] 0.00 mmHg to 2.59 mmHg; p>0.1 to p<0.001). The incidence of hyperemia was significantly less with latanoprost- and bimatoprost-timolol FCs than with the individual PG (relative risk = 0.66 and 0.61; p=0.05 and p<0.001). From direct comparisons, IOP reduction was significantly greatest with bimatoprost-timolol FC, at 9 AM, 4 PM, and over the mean diurnal curve compared to latanoprost-timolol FC (MD = 0.90 mmHg to 1.48 mmHg; p<0.001) and at all time points compared to travoprost-timolol FC (MD = 0.66 mmHg to 0.90 mmHg; p<0.001). The incidence of hyperemia was not significantly less with latanoprost-timolol FC than with bimatoprost-timolol FC (relative risk = 1.32; p>0.1). Conclusions The 3 PG-timolol FCs provide a greater IOP reduction and lower incidence of hyperemia than the 3 PGs alone. The direct comparisons suggest a greater efficacy of the bimatoprost-timolol FC compared with latanoprost- and travoprost-timolol FCs.

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