Areti Angeliki Veroniki

• MSc, PhD
• PostDoc Position at St. Michael's Hospital

Systematic reviews with network meta-analysis (NMA) have potential biases in their conduct, analysis, and interpretation. If the results or conclusions of an NMA are integrated into policy or practice without any consideration of risks of bias, decisions could unknowingly be based on incorrect results, which could translate to poor patient outcomes...

Objective The objective of this scoping review will be to describe existing guidance documents or studies reporting on the conduct of meta-analyses in updated systematic reviews (USRs) or living systematic reviews (LSRs). Introduction The rapid increase in the medical literature poses a substantial challenge in keeping systematic reviews up to dat...

Objective To estimate the relative efficacy of individual and combinations of prehabilitation components (exercise, nutrition, cognitive, and psychosocial) on critical outcomes of postoperative complications, length of stay, health related quality of life, and physical recovery for adults who have received surgery. Design Systematic review with ne...

Objective The objectives of this review are to identify barriers/facilitators to designing, maintaining, and utilizing rare disease patient registries (RDPRs); determine whether and how these differ among patient partners, other knowledge users (KUs), and researchers; and chart definitions of rare diseases and RDPRs. Introduction RDPRs are vital t...

CONTEXT There is uncertainty whether acetaminophen and ibuprofen are similar in their effects and safety when used as single or dual (alternating or combined) therapies. OBJECTIVE To assess the comparative efficacy of acetaminophen, ibuprofen alone, alternating, or combined through a systematic review and network meta-analysis. DATA SOURCES Medli...

Network Meta-analysis (NMA) is an advanced statistical method that combines direct evidence (i.e., from head-to-head comparisons) and indirect evidence (i.e., estimated from the direct available evidence) to obtain network estimates. NMAs are helpful to determine the comparative effectiveness of interventions that have not been directly compared an...

Background Cancer treatment–related cognitive impairment (CTRCI) can substantially reduce the quality of life of cancer survivors. Many treatments of CTRCI have been evaluated in randomized controlled trials (RCTs), including psychological interventions, pharmacologic interventions, and other therapies. There is a pressing need to establish the ben...

Recently, Ades and colleagues discussed the controversies and advancements in network meta‐analysis (NMA) over the past two decades, discussing its reliability, assumptions, novel approaches, and provided some useful recommendations for the conduction of NMAs. The present discussion paper builds on the insights by Ades and colleagues, providing a r...

Background Systematic reviews (SRs) are being published at an accelerated rate. Decision-makers may struggle with comparing and choosing between multiple SRs on the same topic. We aimed to understand how healthcare decision-makers (eg, practitioners, policymakers, researchers) use SRs to inform decision-making and to explore the potential role of a...

Objective To compare the cost‐effectiveness of different treatments for cervical intraepithelial neoplasia (CIN). Design A cost‐effectiveness analysis based on data available in the literature and expert opinion. Setting England. Population Women treated for CIN. Methods We developed a decision‐analytic model to simulate the clinical course of...

Objectives To compare the efficacy of influenza vaccines of any valency for adults 60 years and older. Design and setting Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence -Based Medicine database were searched from...

Introduction/Background Around one fifth of endometrial cancers (EC) are diagnosed in premenopausal women. The standard treatment for EC, its precursor: endometrial hyperplasia with atypia (EHA), and unresolved endometrial hyperplasia (EH) is a hysterectomy. Fertility-sparing treatment has more recently been recognised as a viable option for those...

BACKGROUND Although postprocedure blood pressure (BP) correlates with outcome in patients undergoing endovascular thrombectomy (EVT), the optimal target is unknown. METHODS We performed a pilot randomized‐controlled clinical trial enrolling participants with persistently elevated BP after successful EVT. Participants were randomized within 1 hour...

Objective To compare myocarditis/pericarditis risk after COVID-19 mRNA vaccination versus SARS-CoV-2 infection, and to assess if myocarditis/pericarditis risk varies by vaccine dosing interval. Methods In this retrospective cohort study, we used linked databases in Quebec, Ontario, and British Columbia between January 26, 2020, and September 9, 20...

Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted searches in the databases MEDLINE, CINAHL, Emba...

Introduction Network meta-analyses (NMAs) have gained popularity and grown in number due to their ability to provide estimates of the comparative effectiveness of multiple treatments for the same condition. The aim of this study is to conduct a methodological review to compile a preliminary list of concepts related to bias in NMAs. Methods and ana...

Background: Chronic diseases are a leading cause of global morbidity and mortality. In response to this challenge, self-management interventions (SMIs) have emerged as an essential tool in improving patient outcomes. However, the diverse and complex nature of SMIs pose significant challenges in measuring their effectiveness. This work aims to inve...

Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in...

Objectives: To compare the efficacy of influenza vaccines of any valency for adults 60 years and older. Methods: Design: Systematic review with network meta-analysis (NMA) Information sources: MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence Based Medicine database from inception to June 20, 2022. Eligibi...

Data sharing is essential for promoting scientific discoveries and informed decision-making in clinical practice. In 2013, PhRMA/EFPIA recognised the importance of data sharing and supported initiatives to enhance clinical trial data transparency and promote scientific advancements. However, despite these commitments, recent investigations indicate...

Introduction/Background Cervical cancer is the fourth most common malignancy in women worldwide. Current cervical screening programmes use a primary screening test of high-risk HPV (hr-HPV) testing or cytology to identify at risk women. hrHPV testing has a high sensitivity but low specificity for high-grade CIN and Cancer. As a result, DNA methylat...

Introduction/Background The efficacy of HPV vaccination on the risk of recurrent cervical disease related to HPV infection in individuals undergoing local surgical treatment constitutes a matter of debate. Methodology In this study we screened data sources for studies reporting on the risk of recurrent disease related to HPV infection after local...

Background Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults. Methods Design: Systematic review with meta-analysis engaging 17 knowledge users using inte...

Background Randomized controlled trials (RCTs) are a critical component of evidence-based medicine and the evolution of patient care. However, the costs of conducting a RCT can be prohibitive. A promising approach toward reduction of costs and lessening of the burden of intensive and lengthy patient follow-up is the use of routinely collected healt...

Introduction Human papillomavirus (HPV) is necessary but not sufficient for cervical cancer development. During cervical carcinogenesis, methylation levels increase across host and HPV DNA. DNA methylation has been proposed as a test to diagnose cervical intraepithelial neoplasia (CIN); we present a protocol to evaluate the accuracy of methylation...

Purpose: Acute respiratory distress syndrome (ARDS) is common in patients with acute brain injury admitted to the ICU. We aimed to identify factors associated with ARDS in this population. Methods: We searched MEDLINE, Embase, Cochrane Central, Scopus, and Web of Science from inception to January 14, 2022. Three reviewers independently screened...

Background Evidence has shown that private industry-sponsored randomized controlled trials (RCTs) and meta-analyses are more likely to report intervention-favourable results compared with other sources of funding. However, this has not been assessed in network meta-analyses (NMAs). Objectives To (a) explore the recommendation rate of industry-spon...

Objectives: To conduct an evidence map on self-management interventions and patient-relevant outcomes for adults living with overweight/obesity. Methods: Following Arksey and O'Malley methodology, we searched in five electronical databases including randomized controlled trials (RCTs) on SMIs for overweight/obesity. We used the terms "self-manag...

Background The global spread of COVID-19 created an explosion in rapid tests with results in < 1 hour, but their relative performance characteristics are not fully understood yet. Our aim was to determine the most sensitive and specific rapid test for the diagnosis of SARS-CoV-2. Methods Design: Rapid review and diagnostic test accuracy network me...

Background Systematic reviews (SRs) are being published at an accelerated rate. Decision makers are often faced with the challenge of comparing and choosing between multiple SRs on the same topic. We surveyed individuals in the healthcare field to understand what criteria they use to compare and select one or more SRs from multiple on the same topi...

Background Systematic reviews (SRs) are being published at an accelerated rate. Decision makers may struggle with comparing and choosing between multiple SRs on the same topic. We aimed to understand how healthcare decision makers (e.g., practitioners, policymakers, researchers) use SRs to inform decision making, and to explore the role of a propos...

Network meta-analysis (NMA) is an established method for assessing the comparative efficacy and safety of competing interventions. It is often the case that we deal with interventions that consist of multiple, possibly interacting, components. Examples of interventions’ components include characteristics of the intervention, mode (face-to-face, rem...

Objectives Individual participant data (IPD) from randomised controlled trials (RCTs) can be used in network meta-analysis (NMA) to underpin patient care and are the best analyses to support the development of guidelines about the use of healthcare interventions for a specific condition. However, barriers to IPD retrieval pose a major threat. The a...

Introduction Prehabilitation is a high-priority intervention for patients, the public, clinicians and health systems. However, existing knowledge syntheses are generally low quality and do not provide insights regarding the relative efficacy of different prehabilitation components (eg, exercise, nutrition, psychosocial or cognitive interventions)....

Objective To examine the comparative efficacy and complications of long-acting and intermediate-acting insulin for different patient characteristics for type 1 diabetes mellitus (T1DM). Design Systematic review and individual patient data (IPD) network meta-analysis (NMA). Data sources MEDLINE, EMBASE and the Cochrane Central Register of Controll...

Objectives The synthesis of individual patient data (IPD) from randomised clinical trials (RCTs) can strengthen evidence used for decision-making. Network meta-analyses (NMA) modelling IPD usually include non-sponsored or publicly sponsored RCTs. Evidence suggests that IPD sharing may depend on study characteristics, such as funding type, RCT size,...

Objectives Alzheimer’s dementia (AD) is the most common type of dementia. However, it is unclear which cognitive enhancer is optimal for severe AD. Patient-level data from people with AD can be helpful to explore patient-level variation per treatment response. Pooling individual patient data (IPD) from multiple randomised clinical trials (RCTs) of...

Introduction: Network meta-analyses (NMAs) have gained popularity and grown in number due to their ability to provide estimates of comparative effectiveness of multiple treatments for the same condition. The aim of this study is to conduct a methodological review to compile a preliminary list of concepts related to bias in NMAs. Methods and Analysi...

Introduction: Network meta-analyses (NMAs) have gained popularity and grown in number due to their ability to provide estimates of comparative effectiveness of multiple treatments for the same condition. The aim of this study is to conduct a methodological review to compile a preliminary list of concepts related to bias in NMAs. Methods and Analysi...

Background Network meta-analysis (NMA) is increasingly used in guideline development and other aspects of evidence-based decision-making. We aimed to develop a risk of bias (RoB) tool to assess NMAs (RoB NMA tool). An international steering committee recommended that the RoB NMA tool to be used in combination with the Risk of Bias in Systematic rev...

Abstract Objective To explore the efficacy of human papillomavirus (HPV) vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment. Design Systematic review and meta-analysis Data sources PubMed (Medline), Scopus, Cochrane, Web of Science, and ClinicalTrials.gov were...

Background The trade-off between comparative effectiveness and reproductive morbidity of different treatment methods for cervical intraepithelial neoplasia (CIN) remains unclear. We aimed to determine the risks of treatment failure and preterm birth associated with various treatment techniques. Methods In this systematic review and network meta-an...

Objectives Alzheimer’s dementia (AD) is the most common type of dementia. However, it is unclear which cognitive enhancer is optimal for severe AD. Patient-level data from people with AD can be helpful to explore patient-level variation per treatment response. Pooling individual patient data (IPD) from multiple randomised clinical trials (RCTs) of...

Objectives The synthesis of individual patient data (IPD) from randomised clinical trials (RCTs) can strengthen evidence used for decision-making. Network meta-analyses (NMA) modelling IPD usually include non-sponsored or publicly sponsored RCTs. Evidence suggests that IPD sharing may depend on study characteristics, such as funding type, RCT size,...

Background Older adults experience symptoms of depression, leading to suffering and increased morbidity and mortality. Although we have effective depression therapies, physical distancing and other public health measures have severely limited access to in-person interventions. Objective To describe the efficacy of virtual interventions for reducin...

Objective: To examine the comparative efficacy and safety of cognitive enhancers by patient characteristics for managing Alzheimer's dementia (AD). Design: Systematic review and individual patient data (IPD) network meta-analysis (NMA) based on our previously published systematic review and aggregate data NMA. Data sources: MEDLINE, Embase, Co...

Objective: To a) identify methodological and application papers reporting a model developed specifically for diagnostic test accuracy network meta-analysis (DTA-NMA) or a hierarchical meta-regression method for comparing at least three index tests; b) review and summarize the characteristics of the methods and the application papers; and c) compar...

Introduction: Network meta-analysis (NMA) is increasingly used in guideline development and other aspects of evidence-based decision-making. We engaged with stakeholders in early phases of the development of a new tool to assess risk of bias (RoB) in NMA to facilitate its later use and potentially widen its impact. Methods: We surveyed stakeholders...

Background: Network meta-analysis (NMA) is increasingly used in guideline development and other aspects of evidence-based decision-making. We aimed to develop a risk of bias (RoB) tool to assess NMAs (RoB NMA tool). An international steering committee intended the RoB NMA tool to be used in combination with ROBIS (recommend as it was designed to as...

Background The FilmArray Meningitis/Encephalitis(FA/ME) panel brings benefits in clinical practice, but its diagnostic test accuracy (DTA) remains unclear. We aimed to determine the DTA of FA/ME for the aetiological diagnostic in patients with suspected central nervous system(CNS) infection. Methods We performed a systematic review with DTA meta-a...

Background COVID-19 is rapidly spreading causing extensive burdens across the world. Effective vaccines to prevent COVID-19 are urgently needed. Methods and findings Our objective was to assess the effectiveness and safety of COVID-19 vaccines through analyses of all currently available randomized clinical trials. We searched the databases CENTRAL...

Systematic reviews with network meta-analysis that ignore potential dose effects could limit the applicability and validity of review findings. This article aims to help content experts (eg, clinicians), methodologists, and statisticians better understand how to incorporate dose effects in network meta-analysis. Three models are described that make...

The rapid increase in diagnostic and screening techniques has urged the need to choose among multiple diagnostic tests. For the majority of diseases, there is more than a single test available, and studies usually compare a subset of these tests. In such cases, a separate meta-analysis of each test cannot provide a reliable answer on the relative a...

There is a rapid increase in trials assessing healthcare interventions consisting of a combination of drugs (polytherapies) or multiple components. In the latter type of interventions (also known as complex interventions), the aspect of complexity is of paramount importance. For example, nonpharmacological interventions, such as psychological inter...

This volume presents state-of-the art design, analysis and integration approaches for biomedical data including novel statistical models for a comprehensive and powerful synthesis and assessment of scientific evidence. Chapters detail principles of systematic reviews, semi-automated tools for systematic searches, fixed- and random-effects meta-anal...

Background The comparative safety and efficacy between anti-vascular endothelial growth factor agents (anti-VEGFs) and between combined therapies for patients with neovascular age-related macular degeneration (nAMD) is unclear. We conducted a systematic review to examine the comparative safety and efficacy anti-VEGFs for adults with nAMD. Methods...

Objective To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Materials and Methods We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: conve...

Background Network meta-analysis (NMA) has attracted growing interest in evidence-based medicine. Consistency between different sources of evidence is fundamental to the reliability of the NMA results. The purpose of the present study was to estimate the prevalence of evidence of inconsistency and describe its association with different NMA charact...

While the contributing factors leading to endometriosis remain unclear, its clinical heterogeneity suggests a multifactorial causal background. Amongst others, caffeine has been studied extensively during the last decade as a putative contributing factor. In this systematic review and meta-analysis, we provide an overview/critical appraisal of stud...

Background The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for network meta-analysis (NMA) published in 2015 promotes comprehensive reporting in published systematic reviews with NMA. PRISMA-NMA includes 32 items: 27 core items as indicated in the 2009 PRISMA Statement and five items specific to t...

Background and purpose: Evidence about the utility of ultrasound-enhanced thrombolysis (sonothrombolysis) in patients with acute ischemic stroke (AIS) is conflicting. We aimed to evaluate the safety and efficacy of sonothrombolysis in patients with AIS with large vessel occlusion, by analyzing individual patient data of available randomized-contro...

Introduction Social isolation and loneliness in older adults are significant public health issues. Various interventions such as exercise programmes or social activities are used in the management of social isolation and loneliness in older adults. Network meta-analysis (NMA) provides effect estimates for all comparisons by considering the relative...

Background: A variety of minimally invasive treatments are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). However, it is unclear which treatments provide better results. Objectives: Our primary objective was to ass...

Introduction Systematic reviews with network meta-analysis (NMA; ie, multiple treatment comparisons, indirect comparisons) have gained popularity and grown in number due to their ability to provide comparative effectiveness of multiple treatments for the same condition. The methodological review aims to develop a list of items relating to biases in...

Background/objectives: Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in-person cognitive assessments and tests and barriers to virtual cognitive assessment implementation. Design: Systematic review and meta-analysis....

Background: Network meta-analysis (NMA) has attracted growing interest in evidence-based medicine. Consistency between different sources of evidence is fundamental to the reliability of the NMA results. The purpose of the present study was to estimate the prevalence of inconsistency and describe its association with different NMA characteristics. M...

Objective To describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder. Design Systematic review and meta-analysis. Data sources Medline, Embase, the Cochrane...

Background Increasing availability of competing biosimilar alternatives makes it challenging to make treatment decisions. The purpose of this review is to evaluate the comparative efficacy and safety of ultra-long-/long-/intermediate-acting insulin products and biosimilar insulin compared to human/animal insulin in adults with type 1 diabetes melli...

Background COVID-19 is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. This is the second edition of a living systematic review of randomized clinical trials assessing the effects of all treatment interventions for participants in...

Background Clinical interpretation of changes measured on a scale is dependent on knowing the minimum clinically important difference (MCID) for that scale: the threshold above which clinicians, patients, and researchers perceive an outcome difference. Until now, approaches to determining MCIDs were based upon individual studies or surveys of exper...

Introduction: Systematic reviews with network meta-analysis (NMA; i.e., multiple treatment comparisons, indirect comparisons) have gained popularity and grown in number due to their ability to provide comparative effectiveness of multiple treatments for the same condition. The methodological review aims to develop a list of items relating to biases...

Background: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for network meta-analysis (NMA) published in 2015 promotes comprehensive reporting in published systematic reviews with NMA. PRISMA-NMA includes 32 items in total: 27 core items as indicated in the core 2009 PRISMA Statement and five addi...

Objectives To evaluate the comparative clinical effectiveness and safety of dexamethasone versus betamethasone for preterm birth. Data sources The sources searched were MEDLINE, EMBASE, Cochrane Library, LILACS, Clinical Trials.gov, International Clinical Trials Registry Platform without language restrictions until October 2019, along with referen...

Systematic Reviews of diagnostic test accuracy (DTA) studies are increasingly comparing the accuracy of multiple tests to facilitate selection of the best performing test(s). Common approaches to compare multiple tests include multiple meta-analyses or meta-regression with the test type as a covariate. Within-study correlation between tests are typ...

Background COVID-19 is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. This is the second edition of a living systematic review of randomized clinical trials assessing the effects of all treatment interventions for participants in...

Background Clinical interpretation of changes measured on a scale is dependent on knowing the minimum clinically important difference (MCID) for that scale: the threshold above which clinicians, patients, and researchers perceive an outcome difference. Until now, approaches to determining MCIDs were based upon individual studies or surveys of exper...