Article

Measuring inconsistency in meta-analyses.

MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR.
BMJ (online) (Impact Factor: 16.38). 10/2003; 327(7414):557-60. DOI: 10.1136/bmj.327.7414.557
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    Islam Y. Elgendy, Tianyao Huo, Ahmed Mahmoud, Anthony A. Bavry
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    ABSTRACT: Background: The best approach for revascularization of multi-vessel coronary disease in patients with STelevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is controversial. Methods:Wesearched the Medline andWeb of Science databases, the Cochrane Register of Controlled Trials, and major conference proceedings for clinical trials that randomized STEMI patients with multi-vessel disease to a complete versus culprit-only revascularization strategy. Random effects summary risk ratios (RR) were constructed using a DerSimonian–Laird model. Results: A total of 6 trials met our selection criteria, which yielded 1,190 patients. The mean follow-up duration was 20.5months. The incidence of major adverse cardiac events was significantly reduced in the complete revascularization group versus the culprit-only revascularization group (RR 0.57, 95% confidence interval (CI) 0.41–0.78, p b 0.001). This was due to a lower risk of urgent revascularization with complete revascularization (RR 0.55, 95% CI 0.35–0.86, p = 0.01). A non-significant reduction was observed with complete versus culprit-only revascularization for the combined outcome of mortality or myocardial infarction (RR 0.56, 95% CI 0.30–1.04,p = 0.06). Conclusion: Complete revascularization of significant coronary lesions at the time of primary PCI in patients with STEMI and multi-vessel diseasewas associatedwith better outcomes. Thiswas primarily due to a reduction in the need for urgent revascularization. Larger trials are needed to determine if complete revascularization reduces death or myocardial infarction.
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    ABSTRACT: In order to quantify the association between use of statins and the risk of all hematological malignancies and of subtypes, we performed a meta-analysis of observational studies. We achieved a MEDLINE/EMBASE comprehensive search for studies published up to August 2014 investigating the association between use of statins and the risk of hematological malignancies, including Hodgkin- and non-Hodgkin lymphoma, leukemia, and myeloma. Fixed- and random-effect models were fitted to estimate the summary relative risk (RR) based on adjusted study-specific results. Between-study heterogeneity was assessed using the Q and I(2) statistics and the sources of heterogeneity were investigated using Deeks' test. Moreover, an influence analysis was performed. Finally, publication bias was evaluated using funnel plot and Egger's regression asymmetry test. Fourteen studies (10 case-control and four cohort studies) contributed to the analysis. Statin use, compared to nonuse of statins, was negatively associated with all hematological malignancies taken together (summary RR 0.86; 95% CI: 0.77-0.96), with leukemia (0.83; 0.74-0.92), and non-Hodgkin lymphoma (0.81; 0.68 to 0.96), but it was not related to the risk of myeloma (0.89; 0.53-1.51). Long-term users of statins showed a statistically significant reduction in the risk of all hematological malignancies taken together (0.78; 0.71-0.87). Statistically significant between-studies heterogeneity was observed for all outcome except for leukemia. Heterogeneity was caused by differences confounding-adjustment level of the included studies only for Myeloma. No significant evidence of publication bias was found. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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    ABSTRACT: Background: An increasing number of mindfulness-based stress reduction (MBSR) studies are being conducted with nonclinical populations, but very little is known about their effectiveness. Objective: To evaluate the efficacy, mechanisms of actions, and moderators of MBSR for nonclinical populations. Data Sources: A systematic review of studies published in English journals in Medline, CINAHL or Alt HealthWatch from the first available date until September 19, 2014. Study Selection: Any quantitative study that used MBSR as an intervention, that was conducted with healthy adults, and that investigated stress or anxiety. Results: A total of 29 studies (n = 2,668) were included. Effect-size estimates suggested that MBSR is moderately effective in pre-post analyses (n = 26; Hedge’s g = .55; 95% CI [.44, .66], p < .00001) and in between group analyses (n = 18; Hedge’s g = .53; 95% CI [.41, .64], p < .00001). The obtained results were maintained at an average of 19 weeks follow-up. Results suggested large effects on stress, moderate effects on anxiety, depression, distress, and quality of life, and small effects on burnout. When combined, changes in mindfulness and compassion measures correlated with changes in clinical measures at post-treatment and at follow-up. However, heterogeneity was high, probably due to differences in the study design, the implemented protocol, and the assessed outcomes. Conclusions: MBSR is moderately effective in reducing stress, depression, anxiety and distress and in ameliorating the quality of life of healthy individuals; however, more research is warranted to identify the most effective elements of MBSR.
    Journal of Psychosomatic Research 03/2015; DOI:10.1016/j.jpsychores.2015.03.009 · 2.84 Impact Factor

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