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Measuring inconsistency in meta-analysis
... The value of the I2 statistical test was calculated to test for heterogeneity between studies. An I 2 value ≥ 50% was considered significant heterogeneity [30,31]. A random effects model was adopted. ...
... When heterogeneity was analyzed, by the degree of inconsistency between the results of the studies, there was considerable heterogeneity (I 2 = 99%) [30,31]. ...
... 95% CI; [−5.87 to 0.87]; p = 0.15) and I 2 98% with the withdrawal of one study due to the high risk of bias [32,33] the result of the meta-analysis did not alter the total effect estimate (MD = −3.40, 95% CI; [−9.09 to 2.28]; p = 0.24) and I 2 98%, When heterogeneity was analyzed, by the degree of inconsistency between the results of the studies, there was considerable heterogeneity (I 2 = 98%) [30,31]. ...
Background
Carpal tunnel syndrome (CTS) is characterized as a compressive neuropathy of the median nerve and has several treatments, including photobiomodulation, which can be performed with low-intensity laser therapy (LLLT) and light-emitting diodes (LEDs). Purpose: To carry out a literature review on the effectiveness of low-intensity laser therapy (LLLT) in CTS. Methods: This study is characterized by being a systematic review with metaanalysis. The databases included were PubMed, Embase, Cochrane, the Physiotherapy Evidence Database (PEDro), Scopus and LILACS. Also, gray literature: Google Scholar, OpenGrey and CAPES Theses and Dissertations Catalog. The search was carried out in all databases on October 11, 2023 and updated on June 06, 2024. The risk of bias was assessed using the Cochrane tool, RoB 2, by two blinded reviewers and conflicts were resolved by consensus. The outcomes of interest were pain intensity (Visual analogue scale), strength (handgrip and pinch) and hand functionality (Boston questionnaire, Levine questionnaire, Purdue Pergboard Test). Statistical analysis was carried out using RevMan 5.4.1. Continuous results were expressed as standard mean differences (95% CI), with p-value of < 0.05 considered statistically significant. The value of the I2 statistical test was calculated to test for heterogeneity between studies. A random effects model was adopted. Results: 13 randomized controlled trials were selected from 1.613 records. In the general bias analysis, two studies (15,4%) were considered to have some relevant problems that could interfere with the quality of the study, and three (23,1%) were identified as having a high risk of bias, eight studies (61,5%) were classified as having a low risk of bias. In the meta-analysis, it was possible to observe that there were no advantages of the laser for pain (p = 0.08), nor for handgrip strength (p = 0.11), but it did produce improvements in functionality. Conclusion: It is concluded that LLLT is an effective therapeutic modality in the treatment of CTS, improving functionality; however, despite the studies pointing to advantages for the modality in reducing pain and improving grip strength, the meta-analysis did not show this result. Even so, there is a need for more clinical trials are needed to standardize dosimetry, mainly because the primary studies showed clinical advantages of PBM.
Registration: Open Science Framework (OSF)—https://doi.org/10.17605/OSF.IO/HQCRP.
... The individual effect sizes. According to Higgins et al. (2003) [17], heterogeneity can be described as low (I 2 <25%), moderate (25%≤I 2 ≤75%), and high (I 2 >75%). In addition, studentized residuals and Cook's distance are calculated to examine if any statistical outliers may have a substantial effect on the general effect size. ...
... The individual effect sizes. According to Higgins et al. (2003) [17], heterogeneity can be described as low (I 2 <25%), moderate (25%≤I 2 ≤75%), and high (I 2 >75%). In addition, studentized residuals and Cook's distance are calculated to examine if any statistical outliers may have a substantial effect on the general effect size. ...
... The Q statistic represents the weighted sum of squared differences between studies (Huedo-Medina et al., 2006). However, the Q statistic has relatively low power to detect heterogeneity when a meta-analysis has few estimates (Higgins et al., 2003). An alternative is the I 2 statistic, which is not as susceptible to the influence from the number of estimates in a meta-analysis. ...
... An alternative is the I 2 statistic, which is not as susceptible to the influence from the number of estimates in a meta-analysis. The I 2 statistic represents the percentage of variability in estimates due to true heterogeneity rather than sampling error (Higgins et al., 2003). Guidelines indicate that an I 2 value above 50% indicates substantial heterogeneity (Huedo-Medina et al., 2006). ...
Adulthood is traditionally inferred from the socio-demographic milestones of marriage, parenthood, and having a stable, long-term career. Yet today these milestones are often delayed or unattainable for young people. We conducted a meta-analysis of studies using the Markers of Adulthood scale across the past three decades to assess (a) endorsement rates (%) of marriage, parenthood, and career as markers of adulthood, and (b) whether people think they have reached adulthood. Across 39 samples (N = 17,465), marriage and parenthood were endorsed by a quarter of participants, whereas career was endorsed by 57%, suggesting that in today’s society career defines adult status more than marriage and parenthood. Furthermore, half of emerging adults (aged 18–29 years) considered themselves to have reached adulthood despite traditional milestones of adulthood occurring less frequently and later in life than ever before. Our findings have three main implications for measuring adult status including (1) deemphasise on the socio-demographic milestones of marriage and parenthood; (2) include wider age ranges in research; and (3) explore cultural differences. Reducing the focus on socio-demographic milestones and including more diverse samples will improve our understanding of adulthood and advance adults’ identity development.
... A Cochran Q value greater than the value in the chisquare table (critical value) and a p significance value less than 0.05 indicate that effect sizes are heterogeneously distributed (Hedges & Olkin, 1985). An I2 statistic value greater than 50% indicates a sufficient level of heterogeneity, while a value greater than 75% indicates a high level of heterogeneity (Higgins et al., 2003). When there is a heterogeneous distribution among effect sizes, possible causes are identified through moderators (Rodriguez et al., 2023). ...
... Accordingly, the effect sizes show a heterogeneous distribution. The value of the I 2 statistic (85.352) is greater than 75%, which indicates a high level of heterogeneity (Higgins et al., 2003). It can be stated that approximately 85.35% of the variance between effect sizes is due to real differences in effect sizes and 14.65% is due to sampling error (Huedo-Medina et al., 2006;Li et al., 2021). ...
Predict-observe-explain (POE) is a strategy that has been used in science education for several decades. It is important to determine how effective this strategy is, especially when used in the constructing scientific concepts. In this study, the effect of the POE strategy on students’ science achievement was examined in a meta-analysis. Databases were searched using specific keywords and 35 studies (6 theses and 29 articles) that met the inclusion criteria were found. Hedges’ g and the random effects model were used to calculate effect sizes. As a result, the average effect size (g=0.979, 95% CI: 0.771-1.188, p
... The inconsistency was classified according to the following scale: low (<25%), moderate (25-75%), and high (>75%). 15 We used a random effects meta-regression analysis to assess the heterogeneity of effect between studies with one or more characteristics such as gene, frequency, and timing relative to injury. ...
... In terms of heterogeneity, the reported I 2 res statistic in the meta regression was still 89.11%, indicating high heterogeneity, using the categorization of Higgins et al., 15 even after including gene, frequency, and timing relative to injury as the moderators. In other words, 89.11% of the variability in the residuals was still attributed to the betweenstudy variation, whereas only 10.89% was attributed to the withinstudy variation. ...
Objectives
Sensorineural hearing loss (SNHL) is a disorder characterized by the loss or impairment of cochlear hair cells or the auditory nerve. In recent years, gene therapy has emerged as a promising approach for SNHL treatment. The objective of this study is to evaluate the impact of gene therapy on the restoration or improvement of auditory function in mouse model with loss or impairment of hearing.
Methods
Studies with clear experimental designs, and auditory brainstem response (ABR) analysis as relevant outcome measures were included by searching PubMed, Scopus, and Web of Science databases. The PRISMA guideline was used for abstracting data and assessing data quality and validity. A quantitative synthesis was performed using a random effects model to examine the effect of gene therapy on auditory function in SNHL.
Results
Nine articles including 71 studies meeting the inclusion criteria were identified. These studies explored therapies targeting the TMC1, VGLUT3, USH1C, CLRN1, WHRN, and PJVK genes, with genetic material ranging from 1.8 × 10¹¹ and 1.4 × 10¹⁴ gc/mL being delivered to the inner ear through round window membrane, cochleostomy, or posterior semicircular canal injection methods. The hearing test results showed a significant mean difference of 26.91 dB (95% CI: 22.01–31.85) in favor of the experimental group.
Conclusions
Although promising results have been obtained regarding the potential success of gene therapy in SNHL, further investigation is needed to explore the long‐term effects of gene therapy, treatment response rates, and the relationships between different genetic mutation types.
... Publication bias was assessed by visual inspection of the funnel plot; Egger's test was not feasible due to the small number of studies. Heterogeneity was evaluated using the Cochrane Q test and I 2 statistic [32], with I 2 thresholds of < 25%, 25-75%, and > 75% indicating low, moderate, and high heterogeneity, respectively. Substantial heterogeneity (I 2 > 50%) prompted a meta-regression using a mixed-effects model to explore potential moderators, reporting τ 2 , I 2 , R 2 , β-coefficients, and p-values. ...
Background
The impact of sodium–glucose cotransporter-2 (SGLT2) inhibitors on mortality following myocardial infarction (MI) remains uncertain. Additionally, the role of type 2 diabetes mellitus (T2DM) and heart failure (HF) in modulating the effectiveness of these drugs post-MI are not fully understood. This meta-analysis aimed to assess the association of SGLT2 inhibitors with all-cause mortality in post-MI patients and to explore key moderators influencing this benefit.
Methods
PubMed, Embase, and Scopus were searched for randomized controlled trials (RTCs) and propensity score-matched (PSM) observational studies assessing SGLT2 inhibitors' impact on post-MI mortality. The primary outcome was all-cause mortality. We pooled hazard ratios (HRs) to estimate the intervention's effect on the overall population and stratified studies into early (SGLT2 inhibitors administered within eight weeks post-MI) and delayed treatment trials. Meta-regression assessed the moderating effects of T2DM and HF.
Results
A total of five RCTs and four PSM observational studies involving 26,753 patients (mean [SD] age, 62.9 [10.5] years; 6,406 female [24.0%]; 16,369 T2DM [61.2%]; 13,933 HF [52.1%]) were included. Early and delayed treatment trials comprised 16,165 (60.4%) and 10,588 (39.6%) patients, respectively. SGLT2 inhibitors reduced all-cause mortality following MI (HR 0.79, 95% CI [0.68, 0.91]; p = 0.001; I² = 59%). Stratified analysis demonstrated consistent effects in both early (HR 0.76, 95% CI [0.59, 0.98]; p = 0.03; I² = 65%) and delayed (HR 0.81, 95% CI [0.67, 0.98]; p = 0.03; I² = 60%) treatment. Meta-regression identified T2DM as a significant moderator of the mortality benefit (β = − 0.0049; p = 0.0006).
Conclusion
In this meta-analysis, early and delayed treatment with SGLT2 inhibitors following MI was associated with a significant reduction in all-cause mortality. Furthermore, the presence of T2DM was associated with a greater mortality reduction, while HF was not significantly associated with the outcome.
Graphical Abstract
Association of SGLT2 Inhibitors with Mortality Across the Spectrum of Myocardial Infarction. Data from 26,753 post-MI patients are summarized, including baseline characteristics. The plots represent the pooled hazard ratios (HRs) with 95% confidence intervals (CIs), comparing SGLT2 inhibitors to control (placebo/no treatment), with HRs below 1 favoring SGLT2 inhibitors. The diagram shows early and delayed treatment trial subgroups, presenting the number of participants, the percentage receiving SGLT2 inhibitors, and the respective HRs for mortality. The meta-regression panel highlights T2DM and HF as moderators, reporting β-coefficients (β), p-values, and residual heterogeneity (I²). Negative β (−) indicates that as the percentage of the moderator increases, the HR for mortality decreases. Abbreviations: HF, heart failure; MI, myocardial infarction; SGLT2i, sodium–glucose cotransporter-2 inhibitors; T2DM, type 2 diabetes mellitus.
... Because the heterogeneity between studies was predicted, we employed a randomeffects model that considers the possible clinical diversity and methodologic variation between studies, because it assumes unequal variance between studies and distributes statistical weighting more conservatively. Heterogeneity was measured using the Higgins I² test and a P-value of < 0.1 as being significant, with 0-40% being regarded as minor, 30-60% as moderate, 50-90% as substantial, and 75-100% as considerable heterogeneity [29]. A comparison between Engel I outcome for the HS and HS negative cohort was carried out and expressed as risk ratio (RR) and 95% CI. ...
Epilepsy is a common neurological disease that is treated with medications; however, patients with drug-resistant epilepsy, commonly intractable temporal lobe epilepsy, tend to have better control with surgical treatment. While the mainstay of surgical treatment is anterior temporal lobectomy, it carries risk of potential adverse effects hence minimally invasive techniques are now being used as an alternative to open surgery. This systematic review and meta-analysis compare the efficacy and safety of three of the most used techniques: laser interstitial thermal therapy (LITT), radiofrequency ablation (RFA) and stereotactic radiosurgery (SRS). Multiple databases were searched and PRISMA guidelines were followed to make an indirect meta-analysis using the currently available studies for the three techniques in terms of seizure freedom, risk of major complications and reoperations. Further subgroup analyses were carried out for LITT in terms of follow up periods and seizure freedom in patients with or without hippocampal sclerosis. A total of 42 papers were included in this study with a total of 1675 patients (1303 treated by LITT, 188 treated by RFA and 184 treated by SRS). LITT had the highest rate of seizure freedom (55.0%, CI 51.5 − 58.5%, P = 0.148), and the lowest rates of major complications (2.3%, CI 1.2 − 3.5%, P = 0.070), and reoperations (14.3%, CI 10.4 − 18.3%, P = 0.042) compared to RFA and SRS which had seizure freedom of 46.3% (CI 18.8 − 73.7%, P = 0.000) and 53.8% (CI 44.4 − 63.3%; I^2 = 40.4%, P = 0.098), major complication rate of 3.9% (CI 0.7 − 7.0%; I^2 = 0%, P = 0.458) and 14.3% (CI 3.1 − 25.5%, P = 0.000) and reoperation rate of 28.6% (CI -4.3 − 61.5%, P = 0.000) and 15.4% (CI 6.1 − 24.8%; I^2 = 0%, P = 0.392) respectively. In conclusion, LITT showed the highest rate of seizure freedom and the lowest rate of major complications and reoperations compared to RFA and SRS in single-arm studies of intractable mesial temporal lobe epilepsy. However, the lack of direct comparisons between treatment modalities limits definitive conclusions. Despite this, LITT appears to offer a favorable safety profile, warranting further prospective, comparative studies to validate these findings.
... Then, the random-effects model was applied to calculate the pooled prevalence of childhood asthma and effect estimates for risk factors because it could consider the various underlying factors across the included studies [17,18]. Heterogeneity across the included studies was assessed using the I 2 and Cochran Q statistics, and significant heterogeneity was defined as I 2 > 50.0% or P < 0.10 [19,20]. Sensitivity analysis was performed to determine the risk factors for childhood asthma by sequentially removing individual studies [21]. ...
Background
This study aimed to systematically review and perform a meta-analysis on epidemiological studies in order to estimate the global and regional prevalence and to identify risk factors associated with childhood asthma.
Methods
A comprehensive search of the PubMed, Embase, and Cochrane Library electronic databases was conducted for relevant literature published from their inception to March 31, 2023. The primary endpoint was the prevalence of childhood asthma. Secondary endpoint focused on the identification of risk factors associated with childhood asthma.
Results
A total of 1,547,404 children participated in the 164 studies selected for the meta-analysis. The overall prevalence of childhood asthma was 10.2% (95% CI: 9.5-11.0%), while the prevalence of childhood asthma in Asia, Europe, Latin America, North America, Oceania, Africa, or Eurasia were 10% (95%CI: 7-13%), 9% (95%CI: 7-12%), 14% (95%CI: 9-20%), 13% (95%CI: 12-14%), 23% (95%CI: 19-28%), 11% (95%CI: 7-19%), and 8% (95%CI: 2-27%), respectively. Moreover, the identified risk factors for childhood asthma included older age, male sex, obesity, parental smoking, high education of the mother, premature birth, cesarean section, no breastfeeding, family history of asthma, rhinitis, eczema, pets, high density of road traffic, meat, margarine, fast food, paracetamol use, and antibiotic use.
Conclusion
Childhood asthma is common, and the prevalence of asthma is highest in Oceania, with a lower prevalence in Eurasia. Moreover, the risk factors for childhood asthma were comprehensively identified, and health education should be provided to prevent modifiable factors.
... To determine the overall burden of PG-SGA-defined malnutrition on mortality, we used the adjusted hazard ratio (AHR), when available, and the unadjusted HR, otherwise. This approach follows the guidelines set by the Cochrane Handbook for Systematic Reviews [32]. All the included studies reported HRs with CIs, allowing for the estimation of the standard error [33]. ...
Introduction
Several reviews have highlighted that the Patient‐Generated Subjective Global Assessment (PG‐SGA) is the best diagnostic tool for assessing nutritional status in cancer patients. However, previous meta‐analyses summarizing the prevalence of malnutrition and overall survival in patients with gastrointestinal (GI) cancer are quite limited. This study aims to determine the overall prevalence and association between malnutrition, as defined by the PG‐SGA, and mortality in adults with GI cancer.
Methods
A comprehensive systematic review of articles published from 2005 to 2023 was conducted using Google Scholar, PubMed, Web of Sciences and Scopus. The PRISMA guideline was followed to organize the entire content. A random‐effects meta‐analysis model using R Studio was performed to quantify the pooled proportion and hazard ratios (HRs). Publication bias was assessed using Egger's test and funnel plots. Heterogeneity was evaluated using I ² and Baujat plots. This study was registered in PROSPERO under the protocol number CRD42023465685.
Results
In this study, 46 publications with 23,235 participants were included in the final meta‐analysis. The overall prevalence of malnutrition among adults with GI cancer, as determined by the PG‐SGA, was 61% (95% CI: 51%–70%, I ² = 99%). The pooled prevalence of moderate and severe malnutrition were 38% (95% CI: 31%–45%, I ² = 96%) and 21% (95% CI: 13%–31%, I ² = 98%), respectively. By cancer type, malnutrition was more common in patients with oesophageal cancer (78%, 95% CI: 45%–94%, I ² = 99%) and gastric cancer (75%, 95% CI: 68%–81%, I ² = 87%). Additionally, the overall risk (pooled HR) of malnutrition on mortality among GI cancer patients was 2.02 (95% CI: 1.63%–2.5%, I ² = 23%).
Conclusion
Malnutrition is common in adults with GI cancer and doubles the risk of all‐cause mortality. These results emphasize the importance of ongoing efforts in prevention, early assessment, and intervention for malnutrition to minimize mortality rates.
... This evaluation involved analyzing reports for potential selection bias (random sequence generation and allocation concealment), performance bias (blinding of participants and personnel), measurement bias (blinding of outcome assessment), attrition bias (incomplete outcome data), and reporting bias (selective reporting). In addition, the Newcastle-Ottawa Scale was utilised to evaluate the quality of the observational studies [11]. The assessment focused on aspects such as selection bias (representativeness of the exposed cohort, selection of non-exposed cohort, ascertainment of exposure, and demonstration that the outcome of interest was not present at the start of the study), comparability (comparability of cohorts based on design or analysis), and outcome (assessment of outcome, adequacy of follow-up duration to capture the occurrence of outcomes, and adequacy of cohort follow-up). ...
The growing incidence of obesity has led to a proportionate rise in type 2 diabetes mellitus (T2DM) and its associated complications. We aimed to compare the long-term outcomes of Roux-en-y Gastric Bypass surgery (RYGB) and conventional medical management in T2DM obese patients.
PubMed, Google Scholar, and Clinicaltrial.gov were searched from inception to September 2023. Randomized Controlled Trials (RCTs) and cohort studies were included in this meta-analysis. The primary outcomes were the T2DM remission at 1, 2, 3, and 5 years and the accomplishment of the ADA composite triple treatment goal. The revised Cochrane risk of bias tool 2.0 and New-Castle Ottawa scale were used to assess the quality of the studies. This meta-analysis was registered prospectively on PROSPERO CRD42023466324.
Of the 3,323 studies yielded from our initial search, 22 were included in this evidence analysis, with 5,176 total patients (1,984 and 3,192 patients in RYGB and conventional medical management groups). A significant increase in the accomplishment in the ADA’s composite triple treatment goal was observed in RYGB group as compared to the conventional medical management group (RR 2.41, 95% CI 1.39–4.15, p-value 0.002, I2 35%). Diabetes remission was a clinically successful outcome after 1, 2, 3, and 5 years of the RYGB surgery in the patients (1 year; RR 4.74, 95%CI 2.46–9.12, p-value < 0.00001, I2 0%, 2 years; RR 8.95, 95% CI 1.71–46.71, p-value 0.009, I2 92%3 years; RR 18.18 95%CI 7.57–43.62, p-value < 0.00001, I2 0%, 5 years; RR 0.22, 95% CI 2.31–16.75, p-value 0.0003, I2 = 71%).
The pooled analysis of the given data concluded that the RYGB surgery was more effective in treating T2DM in patients than conventional medical management.
... If weight was provided in a different unit (pounds, stones) we converted it to kg. To examine heterogeneity, we provided the I 2 index [86] in which 50% is indicative of moderate, and 75% is indicative of substantial heterogeneity. We also provide tau 2 (τ²), which is the squared standard deviation of the effect sizes. ...
Background
Emotional eating (EE) is a barrier to the long-term success of weight loss interventions. Psychological interventions targeting EE have been shown to reduce EE scores and weight (kg), though the mechanisms remain unclear. This review and meta-analysis aimed to identify the specific behaviour change techniques (BCTs) associated with improved outcomes.
Methods
This is a review update and extension, with new studies extracted from searches of CINAHL, PsycINFO, MEDLINE and EMBASE 1 January 2022 to 31 April 2023. EE interventions for adults with BMI > 25 kg/m2 were considered for inclusion. Paper screening, extraction, BCT-coding and risk of bias were completed using the Template for Intervention Description and Replication (TIDieR) checklist, Behaviour Change Taxonomy v1 (BCTTv1) and Risk of Bias2 (RoB2)/Risk of Bias In Non-randomised Studies (ROBINS-I) tool. Narrative syntheses and random effects multi-level meta-analyses were conducted.
Results
In total, 6729 participants were included across 47 studies (13 identified in the update). Forty-two studies contributed to the pooled estimate for the impact of interventions on EE (SMD = −0.99 [95% CI: −0.73 to −1.25], p < 0.001). Thirty-two studies contributed to the pooled estimate for the impact of interventions on weight (−4.09 kg [95% CI: −2.76 to −5.43 kg], p < 0.001). Five BCTs related to identity, values and self-regulation were associated with notable improvements to both weight and EE (‘incompatible beliefs’, ‘goal setting outcome’. ‘review outcome goals’, ‘feedback on behaviour’ and ‘pros/cons’).
Conclusion
Implementation and evaluation of the highlighted BCTs are required. Weight management services should consider screening patients for EE to tailor interventions to individual needs.
... The effect size was estimated as the difference between the means of the experimental and treatment groups divided by the overall standard deviation of the selected treatment group. The Der Simonian and Lard test (Chi-square (Q) -statistic) and the Inconsistency index (I2) -Higgins statistic were used to analyse heterogeneity (Higgins et al., 2003). The I2 statistic is the percentage of variance in a meta-analysis that is due to study heterogeneity. ...
Alfalfa (Medicago sativa L.) is a leguminous plant rich in amino acids and micronutrients, making it a potential
feed supplement for poultry. However, its high fiber content may limit its efficacy. This meta-analysis aimed to
evaluate the effects of alfalfa supplementation on broiler performance, including feed intake, weight gain, and
feed conversion ratio (FCR). Articles were selected from Scopus, PubMed Central, and Google Scholar based on
eligibility criteria developed with reference to the Preferred Reporting Items for Systematic Reviews and Me-
ta-Analyses (PRISMA). Written information in English that includes age of animal, form of alfalfa, growth phase,
supplementation level, and evaluation of animal performance (consumption, weight gain, and feed conversion
of broilers). The effect size of the alfalfa supplementation treatment was calculated to estimate the standardized
mean difference (SMD) at 95% Confident Interval (95% CI) using a random effects model (REM). The meta-anal-
ysis included 8 research papers that were eligible. Open Meta-Analyst for Ecology and Evolution (OpenMEE)
software was used for all analyses. The collected results showed that afalfa supplementation decreased feed
consumption (SMD -0.98; P<0.001), decreased body weight (SMD -1.4; P<0.001), but increased feed conversion
value (SMD 0.83; P<0.001). The conclusion of the meta-analysis indicates that alfalfa supplementation as a feed
protein-fibre additive can reduce broiler performance.
... The use of this model was on the basis of an assumption that true variation in the means among retrieved studies existed due to including different sexes, ages, sites of work, and housing conditions (19). Heterogeneity measures (i.e., Cochran's Q test and I2) were calculated from the data with confidence intervals on the basis of Gamma distribution for Q; random effects (20). Furthermore, potential evidence of bias due to the effect of small study was examined by Egger test; a regression-based test for continuous data (21). ...
Our objective in this work was to estimate normal values of biochemical parameters in laboratory animals in Iraq. Values were pooled from studies conducted in Iraqi universities using a meta-analysis approach. Pertinent peer-reviewed published studies were retrieved from the Iraqi Academic Scientific Journals (IASJ) database. Random-effects inverse-variance model was used to obtain pooled means of the parameters from the set of studies qualified for the analysis. Among a total of 460 records identified from IASJ, 264 records were eligible for the statistical analysis, which reported 102 values for different biochemical parameters. The mean of the sample size for normal animals that was used in the studies including in the analysis were 8, 8, and 6 for rats, mice, and rabbits respectively. The mean ± standard deviation of ages (months) was 2.8 ± 1.0, 3.14 ± 1.15, and 9.2 ± 3.3 for rats, mice, and rabbits respectively. In this analysis, we estimated 31, 14, and 15 parameters from 121, 41, and 26 studies of rats, mice, and rabbits correspondingly. The proportion of variance in the parameters for the analyzed studies due to heterogeneity was significant. Evidence of bias in the estimated values due to small studies was found in some parameters. In conclusion, we encourage researchers to consider the values we provided in this analysis and report details of the sample size, number of animals in each group, sex, exact age, and the accurate units for the estimated values in their studies to facilitate further analyses for more reference values in further analyses.
... Statistical heterogeneity was assessed using the DerSimonian-Laird estimator of betweenstudy variance (τ 2 ) and the I 2 statistic. Heterogeneity with a 50% or higher score indicated substantial heterogeneity [18][19][20]. Therefore, the random effect model was used to analyze pooled estimates. ...
Diffractive trifocal intraocular lenses (IOLs) provide good vision at distance, intermediate, and near, but can also cause positive dysphotopsias. This meta-analysis pooled published evidence on visual disturbances after bilateral implantation of the PanOptix (TFNTXX) IOL for patients undergoing cataract surgery.
A systematic literature search was conducted in PubMed and congress presentations from April 2021 to December 2022 to identify studies with patient-reported outcomes on the incidence of visual disturbances (starbursts, halos, glare) post bilateral implantation of PanOptix IOL during cataract surgery. Random-effects meta-analysis was performed to generate pooled proportions for patient-reported visual disturbances with a 95% confidence interval [CI].
Eleven unique studies were included, spanning 580 patients with bilateral implantation of PanOptix IOL from 10 countries with 1 to 12 months follow-up. In summary, 33.6% of patients with bilateral PanOptix implantation experienced glare, 43.9% experienced halos, and 30.4% experienced starbursts. Among these patients, small percentages reported severe glare (2.9%), severe halos (5.4%), and severe starbursts (3.4%). Only 0.8%, 1.4%, and 2.6% of patients found glare, halos, and starbursts, respectively, to be very bothersome.
Halos are the most frequently reported visual disturbances. However, the likelihood of experiencing severe and/or very bothersome visual disturbances (halos, glare, starbursts) is approximately 5% and 3%, respectively, after bilateral implantation of PanOptix IOL. These findings should inform clinical decision-making and treatment choices when selecting the most appropriate IOL implant for cataract surgery.
... We also assessed pooled prevalence by the African region (West, East, or Southern African Region) the study was conducted in, the year or timeline the study was published divided into two categories (2010-2016 and 2017-2022) and assessed the effect of female sex and study sample size on AHD prevalence. To assess between-study heterogeneity for the pooled prevalence, we estimated I 2 statistics expressed as a percentage and Cochrane's Q statistic (p < 0.05) [22]. We assessed the risk of bias across studies using funnel plots and the Eggers test. ...
Background and Aims
Sub‐Saharan Africa drives global HIV‐related mortality, and patients continuously present with advanced HIV disease (AHD) at diagnosis. We describe prevalence, predictors, and treatment outcomes in HIV clients with AHD.
Methods
We systematically reviewed PUBMED, SCOPUS, Web of Science, JSTOR, and CINAHL for relevant studies conducted in Sub‐Saharan Africa from 2010 to 2022. We used a narrative synthesis to describe included studies and a random effect meta‐analysis to determine AHD pooled prevalence. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist guided the reporting, while the Joanna Briggs Institute's quality assessment checklist assessed the quality of included articles. Cochrane's Q and the I² tests assessed heterogeneity between included studies.
Results
We included 24 studies with a sample size of 322,676. Prevalence of AHD ranged from 11.0% to 89.7% with an overall pooled prevalence of 58.7% (95% CI: 51.3%, 66.0%): 66.1% (95% CI: 58.8%, 73.4%) between 2010 and 2016, and 51.2% (95% CI: 37.7%, 64.6%) from 2017 to 2022. Predictors of AHD include male sex, older age (≥ 35), widowed or divorced, unemployment, gap in care of ≥ 12 months before antiretroviral therapy (ART) initiation, no history of HIV testing, and seeking care from a traditional healer before presenting for HIV care. Loss to follow‐up ranged from 6.7%–58.3%, while the proportion of death ranged from 1.8%–13.1%. Predictors of death were being male, advanced age (≥ 50 years), advanced clinical stages, late ART initiation, higher mean log viral load, CD4+ cell count < 50 cells/mm³ and severe anaemia.
Conclusions
The high baseline prevalence of AHD suggests the need for targeted, people‐centred HIV testing in Sub‐Saharan Africa. Country HIV programs should accelerate the implementation of comprehensive HIV services that identify clients at risk of AHD for early enrolment with systems for monitoring the WHO care package for preventing, diagnosing, and treating AHD and associated comorbid conditions.
PROSPERO number: 2022 CRD42022336487.
... Heterogeneity was assessed using the I 2 statistic, which measures the proportion of observed variance across studies and reflects differences in effect sizes (Higgins et al. 2003). According to these authors, I 2 values can be categorized as low (25%), moderate (50%), and high (75%). ...
Several studies have shown the role of proline in stressful conditions. However, no comprehensive compilation has been made addressing different categories such as the intensity of water deficit, tolerance and developmental stage of plants on the response of plants in relation to proline concentration. Here, we investigated through meta-analysis the influence of water deficit on the proline concentration in soybean plants at different drought intensities, plant developmental stages and cultivar susceptibility. A bibliographical search was carried out and 19 research articles were selected, resulting in 82 studies. Data on proline concentration were recorded along with the dispersion measures. The effect measure was calculated as the natural logistic ratio between the treatment group (water deficit) and the control group. Surprisingly we discovered that the proline concentration is not always increased. Under mild stressful conditions, only resistant soybean cultivars had significant effect with increase in proline concentration. Water deficit did not affect the proline concentration in susceptible cultivars, regardless the intensity. Soybean plants under mild drought conditions did not increase proline in the reproductive stage. These findings indicate the importance of performing highly specific experimental studies. Additionally, more complex approaches are required to analyze a larger set of data and different environmental conditions, for a more accurate understanding of proline metabolism in soybean plants under water deficit.
... For continuous outcomes, standardized mean differences (SMD) with 95% confidence intervals (CI) were pooled using an inverse-variance random-effects model. For the assessment of statistical heterogeneity, the Higgins I 2 metric was used with < 50% denoting "low," 50%-75% denoting "moderate," and > 75% denoting "high" heterogeneity [23]. To address high statistical heterogeneity, a leave-one-out sensitivity analysis was conducted by serially omitting each study in the pooled estimate to identify the study contributing the most to the high heterogeneity. ...
Introduction
Psoriasis is a systemic inflammatory disease associated with elevated cardiovascular risk due to inflammatory and oxidative stress. Two‐dimensional speckle‐tracking echocardiography (2D‐STE) can detect both regional and global myocardial strain. Impairment of ventricular strain can assist in the early detection of myocardial dysfunction. Subclinical myocardial dysfunction in psoriasis has not yet been elucidated with inconsistent results.
Methods
A systematic literature search of various databases was conducted to identify studies comparing global longitudinal strain (GLS) and global circumferential strain (GCS) between patients with psoriasis and healthy controls. Standardized mean differences (SMD) with 95% confidence intervals (CI) were pooled using the inverse‐variance random‐effects model in Review Manager Software Version 5.4.1.
Results
Eleven studies with 879 participants (501 patients with psoriasis and 378 healthy controls) were included. Psoriasis was associated with a statistically significant reduction in GLS [SMD: –1.04; 95% CI: –1.45, –0.62; p < 0.00001] and GCS [SMD: –0.66; 95% CI: –1.27, –0.05; p = 0.03] compared to healthy controls.
Conclusion
This study demonstrated that patients with psoriasis are at an elevated risk of subclinical myocardial dysfunction, as shown by the reduced GLS and GCS. Early assessment of subclinical impairment in psoriasis will allow targeted intervention and may mitigate future adverse cardiovascular events. Prospective studies with larger sample sizes are warranted to validate these results.
... We tested for heterogeneity operating two heterogeneity testing methods, namely the Cochran Q test (where the p < 0.05 was considered significant) and the I2 index. I2 values of 75%, 50%, and 25% corresponded to high, moderate, and low levels of heterogeneity, respectively [28]. The publication bias was revealed using a funnel plot and assessed with Begg's and Egger's weighted regression tests [29]. ...
Background and Aim
Pulmonary hydatid disease, caused by Echinococcus granulosus, presents significant clinical challenges, particularly in pediatric populations. Surgical intervention remains the gold standard for treatment, with various techniques employed, including capitonnage and non‐capitonnage methods. This systematic review and meta‐analysis evaluates the efficacy and safety of capitonnage compared to non‐capitonnage techniques in children.
Methods
This systematic review and meta‐analysis followed the PRISMA guidelines to ensure methodological rigor. A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus databases to identify relevant studies. To assess pooled event rates and corresponding 95% confidence intervals for both complications and cure rates, we employed a random‐effects model, allowing for variability among study populations. All statistical analyses were conducted using Comprehensive Meta‐Analysis software (version 3.7).
Results
Thirteen studies met the established inclusion criteria for analysis. The overall complication rate was 46%, with significantly lower rates in the capitonnage group (24%) compared to the non‐capitonnage group (58%). The cure rate was higher in the capitonnage group (83.5%) than in the non‐capitonnage group (65.2%). Meta‐regression analysis indicated that complication rates were influenced by cyst diameter, study publication date, mean age, and type of surgery.
Conclusion
The findings suggest that capitonnage is associated with better outcomes in terms of lower complication rates and higher cure rates. This evidence supports the use of capitonnage as a preferred surgical technique for managing pulmonary hydatid disease in children. Further research is recommended to explore the long‐term outcomes and potential benefits of combining surgical and pharmacological treatments.
... To combine outcomes measured on different scales, we calculated the standardized mean differences (SMD) and 95% confidence intervals (CIs) for continuous variables. Statistical heterogeneity was assessed using the I² statistic, with values exceeding 50% indicating significant heterogeneity [47]. A randomeffects model was used in the presence of significant heterogeneity; otherwise, a fixed-effects model [48]. ...
Objective
To investigate the efficacy of physical activity as a crucial intervention for Autism spectrum disorder (ASD) in clinical settings, we conducted a network meta-analysis to evaluate the effect of various exercise interventions on sociability and communication in individuals with ASD. Our aim was to identify the exercise modalities most conducive to enhancing these essential skills.
Methods
We searched Web of Science, PubMed, Cochrane Library, Scopus, Embase, and searched Chinese databases from inception to April 2024. We included randomized controlled trials that assessed the effects of different exercise types on sociability and communication in individuals with ASD. Network meta-analysis (NMA) was performed using a frequentist approach, and the node-splitting method was applied to assess inconsistency.
Results
We included 38 original studies published between 2009 and 2024, with a total of 1,382 participants analyzed for sociability outcomes. Results indicated that sports games [SMD = 1.12, 95%CI (0.51, 1.73)], combination therapy [SMD = 1.11, 95%CI (0.13, 2.09)], group ball sports [SMD = 1.06, 95%CI (0.37, 1.75)], and outdoor exercise [SMD = 1.02, 95%CI (0.50, 1.55)] were more effective than passive controls. A total of 25 original literatures were included in the analysis of communication ability, involving 904 subjects, and the results showed that combination therapy [SMD = 1.57, 95% CI (0.74, 2.40)], sports games [SMD = 1.01, 95% CI (0.45, 1.56)], group ball games [SMD = 0.85, 95% CI (0.45, 1.26)], outdoor exercise [SMD = 0.79, 95% CI (0.48, 1.11)], and mind-body exercise [SMD = 0.79, 95% CI (0.29, 1.30)], all of which were more effective than passive controls.
Conclusion
Physical exercise plays a significant role in alleviating symptoms and enhancing sociability and communication in individuals with ASD. Our findings highlight that sports games, combination therapy, team ball sports, and outdoor exercise are particularly effective in improving sociability. In terms of communication skills, combination therapy, sports games, team ball sports, outdoor exercise, and mind-body exercise demonstrated the most substantial benefits. These results provide a robust foundation for future interventions aimed at improving the quality of life for individuals with ASD.
... Statistical significance was determined if the 95% cnfidence interval for the pooled HR did not cross the neutral value "1" and the two-tailed p-value was less than 0.05. The Higgins I 2 metric was used to evaluate statistical heterogeneity, with 25-50% cnsidered mild, 50-75% idicating moderate heterogeneity, and > 75% svere heterogeneity [22]. Sensitivity analysis was conducted to evaluate the effect of each study on the overall effect assessment by the "leave-one-out method" [23,24]. ...
Background
Patients with congenital heart disease (CHD) are more likely to experience ischemic and hemorrhagic stroke due to factors such as arrhythmias, residual shunts and related cardiovascular complications. However, guidelines for identifying CHD patients at the highest risk of stroke remain unclear. In this study, we aimed to evaluate the risk of developing stroke in patients with CHD.
Methods
A systematic literature search was performed on PubMed, Scopus, Cochrane, and Embase databases to retrieve studies that evaluated stroke risk in patients with CHD. Random effects model was used to pool the hazard ratios (HR) with 95% confidence intervals (CI). Subgroup analysis was conducted on age, type of stroke, type of study and region. Publication bias was assessed by Egger’s regression test. Statistical significance was set at p < 0.05. All the analysis was performed using R studio V4.3.1.
Results
Eleven studies (5,490,412 participants) were included in this systematic review and meta-analysis. Patients with CHD were at a higher risk of stroke [Pooled HR: 3.25; 95% CI: 2.25, 4.68; p < 0.01; I²: 100%] than the control group. In subgroup analysis, patients with CHD were at a higher risk of ischemic stroke [Pooled HR: 4.45; 95% CI: 2.24, 8.85; p < 0.01; I²: 100%] and hemorrhagic stroke [Pooled HR: 4.70; 95% CI: 1.70, 12.96; p < 0.01; I²: 99%] than the control group.
Conclusion
Our meta-analysis indicates a significantly increased stroke risk in patients with CHD. Subgroup analyses showed higher stroke risk in European regions compared to Asia and USA, and among adults compared to pediatric populations. Future studies should focus on addressing regional and data limitations to better inform clinical strategies for managing stroke risk in CHD patients.
Graphical Abstract
... Heterogeneity among studies was first assessed using the "I2" statistic. An I2 of 0 indicated no heterogeneity and complete homogeneity; an I2 < 50% indicated mild heterogeneity, analyzed using a fixed-effect model; an I2 between 50% and 75% indicated moderate heterogeneity, analyzed using a random-effects model; and an I2 > 75% indicated high heterogeneity, also analyzed using a random-effects model, with sensitivity and subgroup analyses conducted to explore potential sources of heterogeneity (18). When outcome indicators were continuous variables with uniform units, mean difference (MD) and 95% confidence interval (CI) were used for statistical analysis. ...
Objective
This meta-analysis systematically evaluates the influence of small-sided game (SSG) on the counter-movement jump (CMJ) height and 20-meter sprint capabilities of handball players.
Methods
Systematic searches of PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure(CNKI) databases were performed up to February 2024.
Results
A total of 8 studies with 184 participants were included. Meta-analysis demonstrated significant improvements in CMJ (cm) in handball players (Weighted Mean Difference (WMD) = −1.06, 95% CI[−1.99, −0.12], Z = 2.22, P = 0.03). For the 20 m sprint capability, the results were WMD = −0.07, 95% CI[−0.14, 0.01], Z = 1.82, P = 0.07. Subgroup analysis by age: ≥19 years old WMD = −0.02, 95% CI[−0.08, 0.03], and <19 years old WMD = −0.10, 95% CI[−0.21, 0.00], indicating no significant impact on the 20-m (s) performance improvement. Gender subgroup analysis showed male WMD = −0.01, 95% CI[−0.08,0.07] and female WMD = −0.11, 95%CI[−0.19, −0.03; P < 0.05], suggesting better improvement in females.
Conclusion
The present study reveals that SSG training has varying impacts on 20 m sprint performance among handball players of different ages and genders. Specifically, there is no significant improvement in the 20 m sprint performance between players aged <19 and ≥19, while female players show greater improvement in the 20-m (s) compared to male players. These differences could be attributed to the physiological, psychological, and adaptive training differences between athletes of different ages and genders. Although SSG plays an essential role in training handball players, particularly in enhancing lower limb explosive strength and overall game performance, it is recommended to combine SSG with other targeted strength and explosive power training to maximize the enhancement of lower limb explosive power in handball players. Comprehensive training can effectively improve the lower limb explosive strength of athletes while also addressing the development of other key athletic qualities to achieve the best training outcomes. Therefore, coaches should fully consider the individual differences and training needs of athletes when designing training plans, and reasonably allocate the proportion and sequence of SSG with other training methods to maximize training effectiveness.
Background
The association between rheumatoid arthritis (RA) and the risk of developing atrial fibrillation (AF) is well‐established. However, data on the impact of RA on AF recurrence postcatheter ablation (CA) remain unclear. This current study aimed to assess the impact of RA on AF recurrence after catheter‐based pulmonary vein isolation.
Methods
Potentially eligible studies were identified from Medline and EMBASE databases from inception to December 20, 2023. Eligible study must consist of two cohorts of patients with and without RA who underwent catheter ablation for AF. Pooled risk ratio (RR) and 95% CI were calculated using Dersimonian and Laird's random‐effect, generic inverse variance approach.
Results
The meta‐analysis includes three retrospective cohort studies with a total of 700 patients. The pooled analysis found a significantly increased risk of AF recurrence after CA among patients with RA compared to patients without RA with the pooled RR of 1.59 (95% CI, 1.10–2.29, I² 14%). Increased risk of early recurrence (within 90 days) was also observed with the pooled RR of 2.70 (95% CI, 1.74–4.19, I² 0%).
Conclusions
The current study found that patients with RA have a higher risk of AF recurrence after CA for AF, including the risk of early recurrence.
Subjective cognitive decline (SCD) may represent a preclinical manifestation of objective cognitive impairment. This review consolidated existing findings to determine if dual‐tasks objectively differentiate between individuals with SCD, motoric cognitive risk syndrome (MCR), mild cognitive impairment (MCI), and dementia. MEDLINE, Embase, PsycINFO, CENTRAL, AgeLine, and CINAHL were systematically searched for dual‐task studies examining older adults with SCD and analyzed using random‐effects meta‐analyses. Thirteen studies met the inclusion criteria. Within the SCD group, faster gait speed (SMD, 1.35; 95% CI, 0.57–2.13; p = .0007) and longer step length (SMD, 0.85; 95% CI, 0.44–1.26; p < .0001) favored the single compared to dual‐task condition. Faster gait speed was observed in the SCD group compared to MCI (SMD, 0.48; 95% CI, 0.28–0.67; p = .0001). A standardized dual‐task approach is needed to track gait parameters longitudinally, beginning with changes occurring at the SCD stage as these may precede future cognitive impairments.
Highlights
Evidence demonstrates that SCD may be a precursor to dementia.
Faster dual‐task gait speed was observed in the SCD group compared to MCI.
Slower dual‐task gait speed and shorter step length were observed within the SCD group.
Dual‐tasks may help differentiate between preclinical and clinical cognitive decline.
Dual‐tasks should be standardized and changes should be tracked longitudinally.
Importance This network meta-analysis was aimed to evaluate how Ologen will do when combined with different interventions for glaucoma patients. Objective To compare the effectiveness and safety of surgical treatments combined with Ologen and other commonly used treatments for glaucoma. Data Sources and Study Selection This network meta-analysis included randomized or non-randomized controlled trials and retrospective trials that compared interventions concerning Ologen and other treatments for glaucoma. The following databases were searched up to January 1, 2023: PubMed, Embase, Cochrane Library and Web of Science. Data Extraction and Synthesis Data extraction, quality and validity assessing were under the guidelines of 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses'. The demographic character of the included patients and outcomes was extracted independently by 2 investigators. Random-effects model was used to pool the estimate values. Mean outcomes and measures Mean differences for intraocular pressure reduction at 12 months postoperatively and the odds ratios for success rate at the end of follow-up time were the primary and secondary outcome. Measurement of outcomes were reported by 95% credibility intervals, and P < 0.05 was considered statistically significantly. Results This meta-analysis included 35 covering 2477 patients. We discussed 17 interventions, of which 10 had relevant outcomes in intraocular pressure reduction and 17 had relevant outcomes in success rate. When the intraocular pressure reduction was discussed, no pairwise comparison was statistically significant. While for success rate, pairwise comparisons that had statistically significant were detailed in the results and appendix section of this text. The best interventions are as follows: glaucoma drainage device combined with Ologen (success rate, surface under the cumulative ranking = 78.9) and trabeculectomy combined with Ologen (intraocular pressure reduction 12 mouths after surgery, surface under the cumulative ranking = 64). Adverse events were also calculated in details. Conclusion and Relevance Glaucoma drainage device combined with Ologen and trabeculectomy combined with Ologen are the most effective interventions for success rate and intraocular pressure reduction at 12 months postoperatively. However, more clinical studies are still in need to confirm this conclusion and to assess the long-term safety of these interventions. Trial Registration PROSPERO Identifier: CRD42023395804
This is the protocol for a Campbell systematic review. The objectives are as follows. (1) Examine whether secondary and tertiary interventions delivered outside of the criminal justice system are effective at countering the cognitive and behavioural radicalisation of children and adolescents by synthesising evidence relating to relevant primary and secondary outcomes of effectiveness. (2) Examine whether secondary and tertiary interventions delivered outside of the criminal justice system are being implemented as intended by synthesising evidence that captures how interventions are implemented, considering whether they are implemented as expected or in ways that align with their underlying logic. (3) Identify those implementation factors (facilitators and barriers) and moderators that impact how interventions working with children and adolescents are delivered.
Introduction
Sarcopenia and Osteoporosis are two prevalent conditions in the older population and are defined by low strength, muscle quality/volume and low Bone Mineral Density, respectively. When there is a concomitant presence of both, there is a novel musculoskeletal condition called Osteosarcopenia. These conditions adversely affect quality of life and elevate the risk of fractures, disability, and mortality among older individuals. Dysbiosis of the gut microbiota is the impairment of the mutualistic relationship between microorganisms, metabolic products and the host’s immune system. Gut microbiota dysbiosis could be intricately linked to sarcopenia and osteoporosis, shedding light on the complex microbiota-gut-bone-muscle axis. Furthermore, the intestinal microbiota experiences a notable decline in beneficial microorganisms as part of the aging process. The relationship between dysbiosis of the intestinal microbiota in older people and sarcopenia, osteoporosis or osteosarcopenia is still unclear. This review protocol aims to systematically review the literature and compile evidence on the influence of gut microbiota dysbiosis on musculoskeletal function in older people with sarcopenia, osteoporosis or osteosarcopenia.
Methods/Analysis
This systematic review will analyze observational studies that have investigated the relationship between the effects of gut microbiota dysbiosis and sarcopenia, osteoporosis and osteosarcopenia in older people aged 65 and over. Studies will be retrieved from PubMed/MEDLINE, EMBASE, Scopus, Web of Science and the Cochrane Library. Outcome measures will include body composition for diagnosing osteoporosis and screening for sarcopenia/osteosarcopenia by any criteria. Data synthesis will involve quantitative analysis using summary measures. If sufficient studies, homogeneity and heterogeneity analysis will be performed to conduct Meta-analysis and pooled OR, RR and HR measures will be provided.
Background
The incidence of colorectal cancer (CRC) is rising in Iran, but reports vary across different regions due to diverse methods and data sources. This study aimed to conduct a systematic review and meta analysis to provide an overview of the incidence rate of CRC and its trend among Iranians in various provinces.
Materials and Methods
A comprehensive literature search based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist was performed using national and international databases for papers published up to December 2023. CRC incidence rates were extracted from the numbers, crude rates, and age standardized rates (ASRs). A meta analysis was conducted to calculate the incidence rate and 95% confidence intervals (CIs) in subgroups of sex and province.
Results
The initial database search retrieved 1287 papers, with 47 studies meeting the inclusion criteria after further screening. Overall, the trend of CRC incidence has been increasing, although a different pattern was observed in 2008. The pooled incidence rate of CRC was 8.46 (95% CI: 7.16–9.86) per 100,000 population before the publication of the annual continuous reports of the Iranian National Cancer Registry. The latest national data (2014–2017) indicated an ASR of approximately 15 per 100,000 population.
Conclusion
The incidence of CRC in Iran is lower than the global average. However, inconsistent cancer registration policies and gaps in registration have hindered the ability to establish a reliable trend of CRC incidence over time.
Background
Many studies assess aesthetic effectiveness of calcium hydroxylapatite (CaHA), with single-group designs as the most frequently applied designs in practice. This study systematically reviewed CaHA’s effectiveness for aesthetic purposes among these studies.
Methods
A comprehensive search was conducted across 5 bibliographic databases. Single-group studies with at least 10 human adults were included. Summary measures of patients satisfaction and global aesthetic improvement scores were combined using the generalized linear mixed model. This systematic review adhered to the PRISMA reporting standards.
Results
Of 3131 records, 46 single-group studies, majority focused on facial areas (n = 32), were included for final qualitative analysis. A total number of 27 studies were included in the meta-analysis. Findings of the meta-analysis showed that 98% (95% confidence interval [CI], 91%–99%; I ² , 0.0%) of patients were satisfied with the injection results in the facial area and 90% (95% CI, 67%–97%, I ² , 35%) in other treated body areas. Also, patients reported 89% (95% CI, 76%–96%; I ² , 65%) improvement on the global aesthetic improvement scale in facial areas and 94% (95% CI, 75%–99%; I ² , 0.0%) in other treated regions. Similarly, investigators reported global aesthetic improvement in 92% of patients (95% CI, 33%–100%; I ² , 92%) in facial areas and 95% (95% CI, 1%–100%; I ² , 89%) in other treated areas.
Conclusions
Our findings showed aesthetic improvements and satisfaction following CaHA injections in both facial and nonfacial areas. However, studies focusing on nonfacial regions are limited. We recommend more rigorously designed trials to better understand CaHA’s clinical effects.
Background
Various studies have explored the potential association between incense burning and the risk of lung cancer. However, the findings from these studies have been inconsistent.
Objectives
This study aimed to provide a more comprehensive understanding of the relationship between incense burning and lung cancer risk in the Asian population through a meta‐analysis.
Methods
This meta‐analysis, which includes nine case–control studies conducted in Asia and identified through Google Scholar, PubMed, and ScienceDirect up to January 7, 2024, was performed to evaluate the relevant literature. Using a fixed‐effects model, the pooled odds ratio (OR) was calculated to determine the overall association between incense burning and lung cancer.
Results
The results of the meta‐analysis revealed a significant association between incense burning and the development of lung cancer (pooled OR = 1.33, 95% confidence interval [CI]: 1.20–1.48). Furthermore, a subgroup analysis was conducted based on smoking status. It was found that ever‐smokers had a significantly higher risk of developing lung cancer when exposed to incense burning (pooled OR = 1.34, 95% CI: 1.09–1.65). Both hospital‐based case–control studies (pooled OR = 1.28, 95% CI: 1.10–1.48) and population‐based case–control studies (pooled OR = 1.39, 95% CI: 1.21–1.60) yielded significant associations between incense burning and lung cancer. Limitations of this study include the lack of detailed histologic information in most of the selected studies, highlighting the need for future research to include cohort studies that can more accurately assess the association between incense smoke inhalation and specific lung cancer subtypes.
Conclusion
In conclusion, the findings of this meta‐analysis, based on nine case–control studies, suggest that the risk of developing lung cancer among Asians may increase with exposure to incense burning.
BACKGROUND
Helicobacter pylori (H. pylori) is a prevalent pathogen associated with various diseases. Cholelithiasis is also a common condition. H. pylori infection has been identified in the biliary system, suggesting its potential involvement in biliary diseases. However, the specific role of H. pylori in the development of cholelithiasis remains inconclusive.
AIM
To investigate the potential association between H. pylori infection and the development of cholelithiasis.
METHODS
We performed a retrospective study in more than 70000 subjects in health examination center from 3 institutions in the middle, northern and eastern China, from October 2018 to December 2021, to explore the potential association between H. pylori and cholelithiasis through univariate and multivariate analysis. Meanwhile, the influence of H. pylori on biliary-related parameters was investigated. A comprehensive analysis of previous studies concerned about H. pylori and cholelithiasis was also executed.
RESULTS
In our multi-center study, H. pylori was positively associated with cholelithiasis [odds ratio (OR) = 1.103, 95% confidence interval (CI): 1.001-1.216, P = 0.049]. Furthermore, H. pylori patients had less total and direct bilirubin than uninfected patients, while the total cholesterol and low-density lipoprotein cholesterol were more in H. pylori-positive participants (P < 0.05). In the published articles, the cohort studies indicated H. pylori was a risk factor of cholelithiasis (hazard ratio =1.3280, 95%CI: 1.1810-1.4933, P < 0.0001). The pooled results of case-control and cross-sectional studies showed positive association between H. pylori and cholelithiasis in Asia (OR = 1.5993, 95%CI: 1.0353-2.4706, P = 0.034) but not in Europe (OR = 1.2770, 95%CI: 0.8446-1.9308, P = 0.246). Besides, H. pylori was related to a higher choledocholithiasis/cholecystolithiasis ratio (OR = 3.3215, 95%CI: 1.1034-9.9986, P = 0.033).
CONCLUSION
H. pylori is positively correlated with cholelithiasis, choledocholithiasis phenotype particularly, especially in Asia, which may be relevant to bilirubin/cholesterol metabolism. Cohort studies confirm an increased risk of cholelithiasis in H. pylori patients.
The Practice Environment Scale of the Nursing Work Index has been used worldwide to measure nurse work environments. International benchmark values for this scale can assist managers in assessing their work environment. The objective was to conduct a meta‐analysis of this instrument's composite and subscale values across continents, nursing unit types, and time. Studies published up until September 30, 2023 were identified in CINAHL, MEDLINE, and Embase. One‐hundred and sixty publications representing 38 countries were included. Most studies were rated as high certainty and low to moderate risk of bias. The pooled point estimate (2.70) indicated that hospital work environments were modestly positive. The weakest work environment domain was Staffing and Resource Adequacy (2.47). Europe had significantly weaker work environments than Asia and North America. Africa and South America had few studies. Better work environments were reported in neonatal intensive care, as compared to medical surgical and critical care units. A small, positive slope over time, which was detected in the three continents, was significant in North America. To promote evidence‐based management globally, benchmark values are now available by setting and continent.
BACKGROUND
Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood. There is growing evidence that both preterm birth and maternal education levels substantially affect the likelihood of ADHD in children. However, there are limited systematic reviews and meta-analyses examining these associations.
AIM
To systematically review and conduct a meta-analysis on the association of preterm birth and maternal education level on the risk of ADHD in children.
METHODS
We conducted a comprehensive literature search across MEDLINE (PubMed), Web of Science, Embase, and the Cochrane Library, including studies published up to June 17, 2024. Data synthesis was performed using random-effect models, and the quality of studies was assessed using the Newcastle-Ottawa Scale.
RESULTS
This study included twelve studies, which revealed a significant association between premature delivery and an increased risk of ADHD in children [odds ratio (OR) = 2.76, 95% confidence interval (CI): 2.52-3.04, P < 0.001, I² = 1.9%). Conversely, higher maternal education levels were significantly associated with a reduced risk of ADHD in children (OR = 0.59, 95%CI: 0.48-0.73, P < 0.001, I² = 47.1%). Subgroup analysis further indicated that maternal education levels significantly influenced ADHD risk, particularly in studies conducted in China (OR = 0.59, 95%CI: 0.46-0.75, P < 0.001, I² = 81.2%), while no significant association was observed in studies from other regions (OR = 1.25, 95%CI: 0.66-2.40, P = 0.495, I² = 92.3%). The sensitivity analysis confirmed the robustness of our findings, showing no significant publication bias.
CONCLUSION
This study found that preterm birth significantly increases the risk of ADHD in children, while a higher maternal education level serves as a protective factor against ADHD. To reduce the incidence of ADHD in children, public health policies should focus on early intervention for preterm infants and improving maternal education levels.
Background
Endoscopic treatments of symptomatic Zenker’s diverticulum (ZD) include flexible endoscopic septotomy (FES) and, more recently, peroral endoscopic myotomy (Z-POEM). Data comparing these techniques are limited. We conducted a meta-analysis evaluating FES vs. Z-POEM for symptomatic ZD.
Methods
Multiple databases were searched from inception to September 2024. Our primary outcomes were clinical and technical success. Secondary outcomes included adverse events, length of hospital stay (LOS), procedure time, and recurrence. A random-effects model was used, and outcomes were represented as pooled rates, relative risk (RR) and standardized mean difference (SMD), along with 95% confidence intervals (CI).
Results
Seven studies with 580 patients (Z-POEM=274, FES=306) were included. Mean age ranged from 68.9-74.9 years. The diverticulum size was not statistically different between the 2 groups: SMD -3.78 (-11.68 to 4.12), P=0.35. The pooled technical success was similar for Z-POEM and FES: RR 0.99 (95%CI 0.96-1.02; I²=0%); P=0.4. Clinical success rate was significantly higher for Z-POEM compared to FES: RR 1.11 (95%CI 1.04-1.18; I²=16%); P=0.001. There were no statistically significant differences between the 2 treatment modalities in pooled rate of recurrence, adverse events, LOS or procedural time.
Conclusions
Our analysis shows that Z-POEM and FES in the treatment of symptomatic ZD are both associated with high technical success and a good safety profile, and have comparable procedural times and rates of recurrence. Z-POEM may offer higher rates of clinical success at follow up.
Background
Key populations (KP) are highly vulnerable to HIV acquisition and account for 70% of new infections worldwide. To optimize HIV prevention among KP, the World Health Organization recommends the combination of emtricitabine plus tenofovir disoproxil fumarate for pre-exposure prophylaxis (PrEP). However, PrEP failure could be attributed to drug resistance mutations (DRMs) but this is unexplored in sub-Saharan Africa (SSA).
Objectives
We aim to conduct a systematic review that will provide evidence on the prevalence of HIV drug resistance (HIVDR) following PrEP failure among KP in SSA.
Design
This will be a systematic review and meta-analysis of studies conducted in sub-Saharan Africa.
Methods and Analysis
This systematic review will include randomized and non-randomized trials, cohorts, case controls, cross-sectional studies, and case reports evaluating the prevalence of HIVDR following PrEP failure among KP (i.e., gay men and men who have sex with men, female sex workers, transgenders, people who inject drugs, prisoners, and detainees) in SSA. Results will be stratified according to various KP, age groups (adolescents and adults), and geographic locations. Primary outcomes will be “the prevalence of PrEP failure among KP” and “the prevalence of HIVDR after PrEP failure” in SSA. Secondary outcomes would be “the prevalence of DRMs and drug susceptibility” and “the level of adherence to PrEP.” A random-effects model will be used to calculate pooled prevalence if data permit and we will explore potential sources of heterogeneity.
Discussion
Our findings will provide estimates of HIVDR following PrEP failure among KP in SSA. In addition, determinants of PrEP failure and driving factors of the emergence of DRMs will also be investigated. Evidence will help in selecting effective antiretrovirals for use in PrEP among KP in SSA.
Registration
PROSPERO: CRD42023463862.
STUDY QUESTION
Can semen parameters predict long-term health outcomes in men?
SUMMARY ANSWER
There is a lack of evidence to suggest a higher risk of comorbidities in men with poor semen concentration.
WHAT IS KNOWN ALREADY
Male infertility has been long associated with a higher mortality risk and possibly higher chance of developing comorbidities but there has been less focus on semen analysis as a potential predictive factor.
STUDY DESIGN, SIZE, DURATION
We searched PubMed/MEDLINE, EMBASE, and EBM databases from inception to December 2023. MESH term strategy: heading 1 (‘OR’, semen analysis, sperm count, sperm parameter*, male infertility, azoospermia, aspermia, oligospermia, teratozoospermia, asthenozoospermia) ‘AND’ heading 2 (‘OR’, morbidity, mortality, diabetes, cancer, cardiovascular, death, hypertension, stroke, long-term health). We included all studies that analyzed the risk of mortality and/or future development of comorbidities in men with at least one semen analysis. Case series and reviews were excluded.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A narrative synthesis was done for all studies and meta-analysis where possible. Odds ratio (ORs) (95% CI, P-value) were calculated for all men with one suboptimal semen parameter and associated with the risk of a particular outcome. The risk of bias was assessed with QUADAS-2.
MAIN RESULTS AND THE ROLE OF CHANCE
Twenty-one studies were finally included. There was either a high or unclear risk of bias in all studies. The results only allowed for meta-analysis on categories of sperm concentration. We found a 2-fold increase in mortality risk in azoospermic men compared to oligospermic (OR 1.96, 95% CI: 1.29–2.96) and normozoospermic (OR 2.00, 95% CI: 1.23–3.25) groups, but not in oligospermic compared to normozoospermic (OR 1.04, 95% CI: 0.52–2.09). There was no difference in risk of cardiovascular disease in any of the sperm concentration groups (azoospermic-oligospermic OR 0.94, 95% CI: 0.74–1.20, azoospermic-normozoospermic OR 1.11, 95% CI: 0.71–1.75, and oligospermic-normozoospermic OR 1.12, 95% CI: 0.80–1.55). OR for diabetes in azoospermic men was higher only compared to oligospermic (OR 2.16, 95% CI: 1.55–3.01). The risk of all-site cancer was higher in azoospermic men compared to oligospermic (OR 2.16, 95% CI: 1.55–3.01) and normozoospermic (OR 2.18, 95% CI: 1.20–3.96). Only azoospermic men might be at higher risk of testicular cancer when compared to men with normal sperm concentration (OR 1.80, 95% CI: 1.12–2.89).
LIMITATIONS, REASONS FOR CAUTION
Although our pooled analysis shows an increased risk of mortality and all-site cancer risk in azoospermic men, the results show a lack of evidence to suggest a higher risk of comorbidities in men with poor semen concentration. Given the limited available data, the nature of the studies, and the high risk of bias, the results should be interpreted with caution.
WIDER IMPLICATIONS OF THE FINDINGS
There is not enough data to confirm the usability of semen analysis as a predictor of poor long-term health in men, especially within the general population.
STUDY FUNDING/COMPETING INTEREST(S)
No funding was obtained for this study. A.M. has received funding from Merck Serono, Ferring, Gedeon Richter, Pharmasure, and Cook Medical to attend medical conferences; has been a participant in an advisory board for Ferring; and has given an invited lecture for a Merck Serono advisory board. S.N. has received funding for medical conference attendance from Ferring and Cook Medical.
REGISTRATION NUMBER
PROSPERO No. CRD42024507563.
Background
Given the widespread prevalence of breast cancer as a global malignancy, there is a compelling need to delve into its risk determinants.
Objective
This study aims to investigate the potential relationship between indicators of left-handedness and breast cancer, employing systematic review, meta-analysis, and Mendelian randomization methods.
Design
Systematic review and meta-analysis.
Methods
The systematic review and meta-analysis, encompassing case-control and cohort designs, conducted a database search on June 17, 2022, utilizing Medline and Embase. For Mendelian randomization analysis, the exposure variable, left-handedness, was sourced from the UK Biobank. Data for breast cancer outcomes were obtained from two cohorts: the Breast Cancer Association Consortium and the Finnish Biobank (Finngen).
Results
Eight studies were included in the meta-analysis to investigate the correlation between left-handedness and breast cancer in females. The analysis of cohort studies revealed a hazard ratio (HR) of 1.21 (95% confidence interval (CI): 1.01–1.45), whereas case-control studies showed an odds ratio of 0.81 (95% CI: 0.52–1.26). Subgroup analysis indicated an elevated HR in premenopausal left-handed women. However, Mendelian randomization did not confirm a significant association.
Conclusion
Our findings suggest a potential correlation between left-handedness and breast cancer, particularly in premenopausal women. However, due to limited studies and unclear supporting theories, definitive conclusions are premature.
Introduction: Inflammation is associated with tumor initiation, and existing tumors are associated with immune suppression locally and systemically. Cancer treatment is also associated with immune suppression. This review evaluates evidence related to the use of acupuncture for modulation of inflammation and the immune system in cancer patients. Methods: Nine databases were searched for prospective, randomized, controlled trials evaluating the use of acupuncture for modulation of the immune system in cancer patients through March 2024. Only studies involving needle insertion into acupuncture points were included. No language limitations were applied. Studies were assessed for risk of bias (ROB) according to Cochrane criteria. The primary outcomes were levels of immune and inflammatory markers. Results: Of 3607 articles identified, 1526 duplicates were omitted, and 2261 articles were screened. Sixty-four (58 Chinese, 6 English) publications met all inclusion criteria and were evaluated for ROB. Forty-seven studies were rated as unclear ROB, and nine studies were rated as high ROB. However, when the blinding and allocation concealment criteria were removed, 12 studies had low ROB. Fifty-six studies were included in the meta-analysis, which found that acupuncture significantly increased interferon gamma (IFN-γ; P < .01), natural killer (NK) cells (P < .01), immunoglobulin G (IgG; P = .04), immunoglobulin M (IgM; P = .04), CD3 cells (P < .01), CD4 cells (P < .01), and the CD4/CD8 cell ratio (P < .01), and significantly lowered interleukin (IL)-1 (P = .01), IL-4 (P < .01), IL-6 (P < .01), and C-reactive protein (P < .01). Yet except for IFN-γ, there was high heterogeneity of results between studies. No significant differences were found in white blood cells, CD-8, neutrophil levels, IL-2, IL-10, or tumor necrosis factor alpha (TNF-α). Conclusion: The current evidence is insufficient to either support or refute the immunomodulatory effects of acupuncture in cancer patients due to no studies fully meeting the low ROB criterion. The preliminary data, however, are promising. Future studies that are higher powered, with low ROB designs, are warranted.
Background
Increasing evidence suggests that immunophenotypes play a crucial role in Metabolic dysfunction-associated fatty liver disease (MAFLD), but the specific immunophenotypes contributing to its pathogenesis remain unclear.
Objectives
This study aimed to elucidate the causal associations between immunophenotypes and MAFLD and identify the underlying mediation pathways involved.
Design
Mendelian randomization (MR) study.
Methods
This study is a quasi-causal inference analysis using univariable and multivariable MR (UVMR and MVMR). Five MAFLD genome-wide association studies (GWASs) and the largest immunophenotype GWAS were analyzed to assess their causal associations. Two-step MR identified potential mediators and quantified their mediation proportions. Comprehensive MR methods, multiple sensitivity analyses, meta-analyses, and false discovery rate (FDR) further enhanced the robustness of our findings.
Results
Pooled inverse-variance weighted (IVW) estimates in UVMR identified 47 immunophenotypes having a suggestive causal association with MAFLD. After adjusting for FDR, three lymphocyte phenotypes remained significant: CD20 on IgD⁻CD24⁻ B cells (OR: 1.035, pfdr: 0.006), terminally differentiated CD8⁺ T cells %T cells (OR: 1.052, pfdr: 0.006), and CD4 on CD39⁺ secreting CD4⁺ regulatory T cells (OR: 1.036, pfdr: 0.046). Meta-analysis of IVW MVMR estimates with confounders adjustment confirmed that CD20 on IgD⁻CD24⁻ B cells and terminally differentiated CD8⁺ T cells %T cells had significant direct causal associations on MAFLD (pfdr < 0.05). Additionally, two-step MR analysis identified the waist-to-hip ratio as a mediator, accounting for 42.64% of the causal association between CD20 on IgD⁻CD24⁻ B cells and MAFLD.
Conclusion
The causal associations of three lymphocyte phenotypes with increased MAFLD risk were identified in this study. CD20 on IgD⁻CD24⁻ B cells may both directly and indirectly elevate MAFLD risk, while terminally differentiated CD8⁺ T cells have a direct causal relationship with MAFLD. These findings suggest new possibilities for targeted therapies and underscore the potential for personalized immunotherapy in managing MAFLD.
Background
Stroke is a major cause of death and disability worldwide. Despite innovative developments in acute stroke treatment techniques in modern society, many stroke survivors still experience complications, leading to a demand for complementary and alternative medicines, including traditional medicine. Bloodletting at the ear apex (BLEA) is a nonpharmacological intervention used for various diseases, including acute stroke, in traditional medicine in East Asian countries, including China and Korea. This study aimed to evaluate the clinical efficacy of BLEA for acute stroke recovery.
Methods
We searched PubMed, Embase, CENTRAL, AMED, CNKI, KoreaMed, ScienceOn, and OASIS databases for randomized controlled trials (RCTs) evaluating the effect of BLEA on acute stroke recovery. We systematically reviewed the literature published in academic journals up to September 8, 2024 and synthesized the data extracted from the final selected literature. The results of the meta-analysis are presented as mean differences (MDs) with 95% confidence intervals (CIs). The Cochrane Risk of Bias 2 tool and GRADE methodology were used for quality assessment.
Results
Six RCTs with 530 participants were included in this meta-analysis. In patients with acute stroke receiving conventional Western medical treatment, the addition of BLEA significantly improved neurological deficits assessed by the National Institute of Stroke Scale (MD, −2.83; 95% CIs, −4.48 to −1.17), consciousness impairment measured by the Glasgow Coma Scale (MD, 2.75. 95% CIs, 1.72 to 3.78), and motor function assessed by the Fugl-Meyer Assessment (MD, 5.31. 95% CIs, 3.04 to 7.58). It also significantly reduced the length of hospital stay (MD, −7.39; 95% CIs. −8.85 to −5.93).
Conclusion
BLEA may be a promising intervention that provides additional benefits to patients with acute stroke receiving standard western medical care. However, the supporting evidence comes from a few small studies with a high risk of bias and low reporting quality. Future studies with appropriate population sizes and more rigorous methodology are warranted.
Background
A meta‐analysis study was conducted to determine how to predict the effect of postoperative atrial fibrillation after cardiac surgery.
Hypothesis
Long‐term mortality and cardiovascular morbidity are linked to postoperative atrial fibrillation.
Method
Until August 2024, a comprehensive literature study was completed, and 3486 connected studies were revised. The 38 selected studies included 241 299 cardiac surgery participants at the beginning of the study. The odds ratio (OR) and 95% confidence intervals (CIs) were used to look at the effect of atrial fibrillation after heart surgery using two‐sided methods and either a fixed or random model.
Results
Individuals with cardiac surgery with postoperative atrial fibrillation had significantly higher mortality at 1 year (OR, 1.39; 95% CI, 1.12–1.72, p < 0.001), mortality at 5 years (OR, 1.61; 95% CI, 1.33–1.94, p < 0.001), mortality at 10 years (OR, 1.61; 95% CI, 1.39–1.87, p < 0.001), and overall stroke (OR, 1.61; 95% CI, 1.34–1.94, p < 0.001) compared to without postoperative atrial fibrillation.
Conclusions
Individuals with cardiac surgery with postoperative atrial fibrillation had significantly higher mortality at 1 year, mortality at 5 years, mortality at 10 years, and overall stroke compared to those without postoperative atrial fibrillation. To validate this discovery, more research and caution must be implemented when interacting with its values.
Background
Efficient musculoskeletal care is important for health services and society. Surgical conversion rates are a common measure of efficiency, yet normal values and the impact of referrer type are unclear. This information could assist musculoskeletal care, service benchmarking and redesign.
Methods
A systematic review with meta-analysis was undertaken with PubMed, CINAHL and EMBASE databases searched from inception to 12th of October 2024, to identify studies from which musculoskeletal surgical conversion rates could be extracted. Data were categorised according to the professional group responsible for referral (all doctors, general practitioners, sports physicians, allied-health/physiotherapy-led screening services) and methodology used to define surgical conversion. Meta-analysis of pooled data was undertaken.
Results
Twenty-eight studies with a combined total of 5358 patients were included. Pooled data revealed surgical conversion rates of 23% for referrals from all types of doctors (0.23, 95% CI 0.18-0.27), 28% from general practitioners (0.28, 95% CI 0.12-0.52), 61% from allied health physiotherapy-led screening services (0.61, CI 0.50-0.70) and 70% from sports physicians at (0.70, CI 0.64-0.75). A variety of methodological factors impacted surgical conversion rate reporting and heterogeneity.
Conclusions
Musculoskeletal services seeking to improve efficiency through higher surgical conversion rates, should include sports physician and/or physiotherapy-led models of care for referral generation or management.
Diversity is crucial to the success of healthcare teams and inclusive patient care. The emphasis on traditional academic metrics has served as a barrier to the diversification of graduate medical education (GME) programs. Holistic review, defined by the Association of American Medical Colleges as an emphasis on experiences rather than academic metrics, has been proposed as a solution to improve diversity in medical education. However, skepticism about the implementation of holistic review and a lack of data to support that it improves diversity in GME exist. We, therefore, performed a systematic review and meta-analysis aiming to identify the components of holistic review described by programs employing it and quantify its impact on diversity. We hypothesized that programs implementing holistic review would have increased odds of interviewing and matriculating those that are underrepresented in medicine (URiM) and women when compared to those utilizing traditional applicant review.
PubMed and Embase were searched from inception to February 2023 for articles studying holistic review in United States GME programs. Articles were included if they described components of holistic review and/or compared the diversity of traditionally reviewed cohorts to those holistically reviewed. Two authors performed title/abstract screening; any disagreements were adjudicated by a third reviewer. Eligible studies were submitted to full-text screening. The association between holistic review and the proportion of URiM students interviewed/matriculated was assessed using random-effects meta-analysis. In addition, components of holistic review were categorized and described.
Of 201 screened abstracts, 21 articles were included. Four features of holistic review were consistently described by the included studies: (1) incorporating a mission-guided approach to applicant selection, (2) mitigating bias, (3) de-emphasizing academic metrics, (4) commitment to diversity, equity, and inclusion. Six studies compared proportions of URiM students interviewed using holistic versus traditional applicant review; holistic review was associated with increased odds of interviewing URiM students at these programs (pooled OR 2.30, 95% CI 1.19, 4.44; I2 = 85.66%). Five studies reported data on URiMs matriculated into their programs using holistic versus traditional applicant review; holistic review was also associated with increased pooled odds of URiM students matriculating into these programs (pooled OR 2.73, 95% CI 1.25, 5.95; I2 = 22.10%). There was insufficient data to complete meta-analysis on the effect of holistic review on proportions of women interviewed or matriculated into residency programs. The GRADE quality of evidence to support the implementation of holistic review to improve diversity in GME programs based upon the studies included in this review is moderate.
Holistic review is a feasible and effective way to increase diversity in GME programs. This systematic review outlines the different methods by which programs can screen, interview, and rank applicants with a mission-driven lens and increased emphasis on experiences and attributes.
Background
Recent data showed an association between malnutrition and increased all‐cause mortality and thromboembolic risk in patients with atrial fibrillation (AF). However, the impact of malnutrition on the clinical outcomes for patients undergoing catheter ablation for AF is still debated. Our study aimed to examine this relationship using all existing available data.
Methods
We conducted a systematic review of MEDLINE and EMBASE databases from inception to April 2024, analyzing the association between malnutrition, assessed by the Geriatric Nutritional Risk Index (GNRI), and the risk of AF recurrence in patients who underwent catheter ablation for AF, compared to those without malnutrition. Relative Risk (RR) or hazard ratio (HR) and 95% CIs were retrieved from each study and combined using the generic inverse variance method.
Results
We included 3 cohort studies with 1697 participants undergoing AF ablation (10.9%) who had malnutrition indicated by GNRI score below 98. Patients with malnutrition had a higher risk of AF recurrence following catheter ablation for AF compared to those without malnutrition (Pooled RR = 2.74, 95% CI 1.36–5.51, I² = 67%, p = .005).
Conclusions
Our pooled analysis indicates that malnourished patients undergoing catheter ablation for AF have an increased risk of AF recurrence compared to non‐malnourished patients.
Background
This study aimed to assess the impact of the timing of low-dose hydrocortisone adjuvant therapy initiation on clinical outcomes in patients with septic shock by a systematic review and meta-analysis.
Methods
We conducted a comprehensive search of all randomized controlled trials (RCTs) and cohort studies available in the PubMed, Web of Science, and Embase databases. The search included articles published from the founding of these databases until August 1, 2024. The purpose of the search was to compare the results of initiating low-dose hydrocortisone (HC) adjuvant therapy at different time periods. The main reported results included short-term mortality (ICU mortality and hospital mortality) as key outcomes, and secondary outcomes such as the rate of renal replacement treatment continuous renal replacement therapy (CRRT), length of stay in the intensive care unit (ICU), and rate of shock reversal.
Results
Seven trials, with a total of 3063 patients, were included. The main finding of this meta-analysis indicates that the early treatment group, which received low-dose hydrocortisone, had a lower ICU mortality rate compared to the late treatment group. Additionally, the hospital mortality rate in the early treatment group was lower than that in the late treatment group. There was a correlation between the timing of beginning of HC and the short-term mortality of patients with septic shock. The secondary findings indicated that there were no notable disparities in the rates of CRRT, the rate of reversing shock, and the duration of stay in the ICU.
Conclusion
Administering low doses of HC early on can decrease the risk of death in septic shock patients in the short-term mortality. There were no substantial disparities observed in the rate of CRRT, the rate of reversal of shock, and the duration of stay in the ICU. Additional extensive RCTs are required to validate this conclusion.
Background
The association between polymorphisms in the ATP-binding cassette transporter A1 (ABCA1) gene and the risk of developing glaucoma has yielded conflicting results across various studies. This meta-analysis aims to comprehensively assess whether genetic variations in ABCA1 significantly contribute to the susceptibility to glaucoma.
Methods
An extensive search was conducted across major databases, including PubMed, EMBASE, and the China National Knowledge Infrastructure (CNKI), covering all publications from the inception of each database through December 2023. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to quantify the strength of the association between ABCA1 polymorphisms and glaucoma risk.
Results
A significant association was observed between ABCA1 gene polymorphisms and glaucoma risk in the overall analysis, as demonstrated by allele contrast ( P < .001), homozygote comparison ( P < .001), heterozygote comparison ( P < .001), recessive genetic model ( P = .017), and dominant genetic model ( P < .001). Notably, these associations were particularly pronounced in the Asian population, with all models showing statistical significance ( P < .05). However, no significant association was detected in Caucasian or mixed populations, suggesting a potential ethnic specificity in the genetic susceptibility to glaucoma conferred by ABCA1 polymorphisms.
Conclusions
Our findings indicate that ABCA1 polymorphisms may play a role in increasing the risk of glaucoma, specifically within Asian populations. This contrast highlights the importance of considering ethnic background in genetic association studies.
Background & objectives
Although multi-drug therapy has decreased the burden of disease, leprosy is yet to be eliminated. Accelerating progress requires optimal use of existing tools, advanced diagnostic tests, newer drugs, and vaccines. The search for a vaccine with therapeutic and preventive potential is ongoing, but evidence on effectiveness and safety is lacking. This systematic review and meta-analysis will evaluate and compare the clinical efficacy, immunogenicity, and safety of leprosy vaccines in humans.
Methods
In June 2024, three databases were systematically searched with updated search keywords. Randomized controlled trials (RCTs) pertaining to leprosy vaccines for humans which evaluated either therapeutic or prophylactic vaccines in leprosy with a placebo or active comparator arm, with full-text access, were included in the study. There were no restrictions on language, country or date. For the risk of bias assessment in the studies included, the revised Cochrane risk-of-bias 2 tool for RCTs was used. A P value (two-sided) of <0.05 was considered as significant for all tests; however for heterogeneity, a one-sided P value of <0.1 was considered as statistically significant. The quality of generated evidence specific to the desired outcomes were assessed using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation). The study protocol was registered in PROSPERO (ID: CRD42024561651).
Results
A total of 2163 studies were retrieved from different databases. After removing duplicates and full text screening, 12 articles were finally selected. Out of these studies, eight used leprosy vaccines on prophylactic basis, while four used leprosy vaccines on therapeutic basis. In therapeutic use of leprosy vaccine, Ramu’s score was found to be significantly protective [-3.06 (95% confidence interval (CI): -3.96 to -2.16)] among the recipients of the therapeutic leprosy vaccine. Bacterial index was found to be insignificant [-0.26 (95% CI: -1.54 to 1.03)] among the recipients of therapeutic leprosy vaccine. In subgroup analysis among the eight prophylactic vaccine studies, pooled relative risk was found to be 0.61 (95% CI: 0.41 – 0.91).
Interpretation & conclusions
The findings of this meta-analysis suggest that both prophylactic and therapeutic leprosy vaccines were significantly better compared to the placebo. Leprosy vaccine in the form of Mw/ Mycobacterium welchii /MIP along with combination of World Health Organization (WHO) multi-drug therapy (MDT) or Bacillus Calmette-Guerin (BCG) vaccine along with second line treatment with rifampicin were found to be protective among the recipients.
BACKGROUND
Whether patients with compensated cirrhosis and low-level viremia (LLV) of hepatitis B should receive antiviral therapy (AVT) is still controversial, and published results are inconsistent.
AIM
To investigate the link between LLV in compensated cirrhosis and prognosis concerning hepatocellular carcinoma (HCC), decompensation, and liver-related events.
METHODS
The PubMed, EMBASE, and Cochrane Library databases were searched up to March 5, 2023. Outcomes of interest were assessed by pooled hazard ratios (HRs). The study was registered with PROSPERO (CRD42023405345).
RESULTS
Six cohort studies representing 3155 patients were included. Compared with patients with undetectable HBV DNA, patients with LLV was associated with increased risk of HCC (HR: 2.06, 95%CI: 1.36-3.13; Q -statistic-P = 0.07, I 2 = 51%) regardless of receiving AVT or not (AVT group: HR: 3.14; 95%CI: 1.73-5.69; Q -statistic-P = 0.60, I 2 = 0%; un-AVT group: HR: 1.73, 95%CI: 1.09-2.76; Q -statistic-P = 0.11, I 2 = 50%). The pooled results showed no statistical association between LLV and decompensation of cirrhosis (HR: 2.06, 95%CI: 0.89-4.76; Q -statistic-P = 0.04, I 2 = 69%), and liver-related events (HR: 1.84, 95%CI: 0.92-3.67; Q -statistic-P = 0.03, I 2 = 72%), respectively. Grading of Recommendations Assessment, Development and Evaluation assessment indicated moderate certainty for HCC, very low certainty for decompensation of cirrhosis and liver-related clinical events.
CONCLUSION
LLV in compensated cirrhotic patients is associated with increased risk of HCC, higher tendency for hepatic decompensation and liver-related events. Closer screening of HCC should be conducted in this population.
Background
This meta-analysis was conducted to evaluate the impact of high-intensity statin treatment on new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG).
Methods
Four databases were searched for studies that enrolled patients who underwent CABG and investigated the impact of perioperative use of high-intensity statins on the occurrence rate of POAF. The primary outcome was the incidence of POAF. Secondary outcomes were operative mortality and perioperative myocardial infarction (PMI). Publication bias was assessed using a funnel plot and Egger’s test.
Results
Nine articles (eight randomized controlled trials and one non-randomized study: n=3,072) were selected. Rosuvastatin (20 mg) was used in four studies, while atorvastatin (40–80 mg) was used in the other five studies. Reported incidences of POAF in the included studies ranged from 11% to 48.8%. Pooled analyses showed that the incidence of POAF was significantly lower in patients treated with high-intensity statins than in patients in the control group patients (odds ratio, 0.43; 95% CI, 0.27–0.68; P<0.001). Subgroup analyses showed that the impact of high-intensity statins was significant in studies using atorvastatin but not in studies using rosuvastatin. There was no significant subgroup difference in the primary endpoint between studies using a placebo and those using low-dose statins. Secondary outcomes, including operative mortality and the incidence of PMI, were not affected by high-intensity statin treatment.
Conclusions
Perioperative use of high-intensity statins is associated with a 57% reduction in the occurrence of POAF among patients undergoing CABG.
Objective
This study aimed to evaluate the acceptability and effects of internet‐based cognitive behavioral therapy (iCBT) or CBT‐oriented interventions compared with control groups on depressive symptoms, remission of depression, and quality of life (QOL) in adolescents.
Methods
We searched English and Chinese databases for randomized controlled trials up to October 10, 2024 that investigated the effects of iCBT compared with controls in adolescents exhibiting elevated depressive symptoms or diagnosed with depression. Standardized mean differences (SMDs), relative risks (RRs), and 95% confidence intervals were applied to evaluate the pooled effects of outcomes.
Results
A total of 19 RCTs involving 3574 cases were included in this study. We found small effects on depressive symptoms severity at different time points (posttest: SMD = –0.49 [–0.66, –0.33]; 3‐month follow‐up [FU3]: SMD = –0.21 [–0.30, –0.11]; FU6: SMD = –0.18 [–0.35, –0.02]; FU12: SMD = –0.38 [–0.56, –0.20]). We also found a significant effect in depression remission rate at the posttest (RR = 1.74 [1.36, 2.21]) and a significant effect in QOL at the posttest (SMD = 0.30 [0.07, 0.54]). However, the result regarding acceptability was nonsignificant (RR = 1.22 [0.76, 1.97]). No significant publication bias was found in these results.
Conclusion
iCBT or internet‐based CBT‐oriented interventions can effectively reduce depressive symptom severity and improve depression remission rate and QOL in depressed adolescents. These results are preliminary and require further validation through future systematic reviews.
ResearchGate has not been able to resolve any references for this publication.