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International Journal of Nursing Studies Apr 2023Treatment for depression in people living with HIV has increasingly turned to non-pharmacological treatments due to the adverse reactions of pharmacotherapy. However, it... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treatment for depression in people living with HIV has increasingly turned to non-pharmacological treatments due to the adverse reactions of pharmacotherapy. However, it remains unclear which non-pharmacological treatment is the most effective and acceptable for depression in people living with HIV.
OBJECTIVE
To compare and rank the efficacy and acceptability of different non-pharmacological treatments for depression in people living with HIV.
DESIGN
A systematic review and Bayesian network meta-analysis.
METHODS
We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, PsycArticles, CINAHL, ProQuest, OpenGrey, and international trial registers for published and unpublished studies from their inception to September 1, 2022, and searched key conference proceedings from January 1, 2020, to September 25, 2022. We searched for randomized controlled trials of any non-pharmacological treatments for depression in adults living with HIV (≥18 years old). Primary outcomes were efficacy (mean change scores in depression) and acceptability (all-cause discontinuation). We used a random-effects network meta-analysis model to synthesize all available evidence. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. We registered this study in PROSPERO, number CRD42021244230.
RESULTS
A total of 53 randomized controlled trials were included in this network meta-analysis involving seven non-pharmacological treatments for depression in people living with HIV. For efficacy, mind-body therapy, interpersonal psychotherapy, cognitive-behavioral therapy, supportive therapy, and education were significantly more effective than most control conditions (standardized mean differences ranged from -0.96 to -0.36). Rankings probabilities indicated that mind-body therapy (79%), interpersonal psychotherapy (71%), cognitive-behavioral therapy (62%), supportive therapy (57%), and education (57%) might be the top five most significantly effective treatments for depression in people living with HIV, in that order. For acceptability, only supportive therapy and interpersonal psychotherapy were significantly less acceptable than most control conditions (odds ratios ranged from 1.92 to 3.43). Rankings probabilities indicated that education might be the most acceptable treatment for people living with HIV (66%), while supportive therapy (26%) and interpersonal psychotherapy (10%) might rank the worst. The GRADE assessment results suggested that most results were rated as "moderate" to "very low" for the confidence of evidence.
CONCLUSIONS
Our study confirmed the efficacy and acceptability of several non-pharmacological treatments for depression in people living with HIV. These results should inform future guidelines and clinical decisions for depression treatment in people living with HIV.
Topics: Adolescent; Adult; Humans; Bayes Theorem; Depression; HIV Infections; Network Meta-Analysis; Psychotherapy
PubMed: 36821952
DOI: 10.1016/j.ijnurstu.2023.104452 -
Cancer Medicine Jul 2022Salivary diagnostics and their utility as a nonaggressive approach for breast cancer diagnosis have been extensively studied in recent years. This meta-analysis assesses... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Salivary diagnostics and their utility as a nonaggressive approach for breast cancer diagnosis have been extensively studied in recent years. This meta-analysis assesses the diagnostic value of salivary biomarkers in differentiating between patients with breast cancer and controls.
METHODS
We conducted a meta-analysis and systematic review of studies related to salivary diagnostics published in PubMed, EMBASE, Scopus, Ovid, Science Direct, Web of Science (WOS), and Google Scholar. The articles were chosen utilizing inclusion and exclusion criteria, as well as assessing their quality. Specificity and sensitivity, along with negative and positive likelihood ratios (NLR and PLR) and diagnostic odds ratio (DOR), were calculated based on random- or fixed-effects model. Area under the curve (AUC) and summary receiver-operating characteristic (SROC) were plotted and evaluated, and Fagan's Nomogram was evaluated for clinical utility.
RESULTS
Our systematic review and meta-analysis included 14 papers containing 121 study units with 8639 adult subjects (4149 breast cancer patients and 4490 controls without cancer). The pooled specificity and sensitivity were 0.727 (95% CI: 0.713-0.740) and 0.717 (95% CI: 0.703-0.730), respectively. The pooled NLR and PLR were 0.396 (95% CI: 0.364-0.432) and 2.597 (95% CI: 2.389-2.824), respectively. The pooled DOR was 7.837 (95% CI: 6.624-9.277), with the AUC equal to 0.801. The Fagan's nomogram showed post-test probabilities of 28% and 72% for negative and positive outcomes, respectively. We also conducted subgroup analyses to determine specificity, sensitivity, DOR, PLR, and NLR based on the mean age of patients (≤52 or >52 years old), saliva type (stimulated and unstimulated saliva), biomarker measurement method (mass spectrometry [MS] and non-MS measurement methods), sample size (≤55 or >55), biomarker type (proteomics, metabolomics, transcriptomics and proteomics, and reagent-free biophotonic), and nations.
CONCLUSION
Saliva, as a noninvasive biomarker, has the potential to accurately differentiate breast cancer patients from healthy controls.
Topics: Adult; Biomarkers; Breast Neoplasms; Female; Humans; Middle Aged; Odds Ratio; ROC Curve; Sensitivity and Specificity
PubMed: 35315584
DOI: 10.1002/cam4.4640 -
International Journal of Oral and... Jun 2017The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle-Ottawa scale assessment. The presence of a mandibular third molar decreased the probability of condylar fracture (cross-sectional and case-control studies: odds ratio (OR) 0.26, 95% confidence interval (CI) 0.17-0.40, I=87.8%; case-control studies: OR 0.30, 95% CI 0.16-0.58, I=91.6%). The third molar positions most favourable to condylar fracture according to the Pell and Gregory classification are class A (OR 1.32, 95% CI 1.09-1.61, I=0%) and class I (OR 1.37, 95% CI 1.05-1.77, I=32.8%). Class B (OR 0.69, 95% CI 0.49-0.97, I=56.0%) and class II (OR 0.71, 95% CI 0.57-0.87, I=0%) act as protective factors for condylar fracture. The results suggest that the presence of a mandibular third molar decreases the chance of condylar fracture and that the positions of the third molar most favourable for condylar fracture are classes A and I, with classes B and II acting as protective factors.
Topics: Humans; Mandibular Condyle; Mandibular Fractures; Molar, Third; Risk Factors; Tooth, Impacted
PubMed: 28259600
DOI: 10.1016/j.ijom.2017.02.1265 -
The American Journal on Addictions Jul 2024Probability discounting (PD), which refers to the process of adjusting the value of future probabilities when making decisions, is a method of measuring impulsive... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Probability discounting (PD), which refers to the process of adjusting the value of future probabilities when making decisions, is a method of measuring impulsive decision-making; however, the relationship between PD and nicotine remains unclear. The current study aimed at investigating the significance of PD in individuals who smoke.
METHODS
According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched the PubMed, Embase, PsycINFO, and Web of Science databases for articles comparing individuals who smoke and their tobacco-naïve controls using PD task as outcome measure from inception to May 2023. The main outcome was an overall difference in PD function, while subgroup analysis and meta-regression were conducted to examine the analysis methods and the moderators of PD.
RESULTS
Fourteen studies in total involving 384 individuals who smoke and 493 controls (mean age = 24.32 years, range = 15.1-38.05 years) were analyzed. The effect of smoking on PD was significant (g = 0.51, p = .02). The discounting parameter from the equation, compared to the area under the curve, was more sensitive to estimating PD function (p = .01). Regression analysis showed positive correlations of PD with female percentage, age, and the number of probability options (all p < .04), but not with the number of choices at each probability and maximum reward magnitude (all p > .07). There was no significant publication bias across the eligible studies (p = .09).
CONCLUSION AND SCIENTIFIC SIGNIFICANCE
Our findings, which are the first to demonstrate a smaller PD (i.e., prone to risk-taking) in individuals who smoke, shed light on the appropriate analysis method, gender effect, age, and probability options on the PD function.
Topics: Adolescent; Adult; Female; Humans; Male; Young Adult; Decision Making; Delay Discounting; Impulsive Behavior; Probability; Smoking
PubMed: 38290762
DOI: 10.1111/ajad.13521 -
Medical Decision Making : An... Oct 2022Analyzing and communicating uncertainty is essential in medical decision making. To judge whether risks are acceptable, policy makers require information on the expected...
PURPOSE
Analyzing and communicating uncertainty is essential in medical decision making. To judge whether risks are acceptable, policy makers require information on the expected outcomes but also on the uncertainty and potential losses related to the chosen strategy. We aimed to compare methods used to represent the impact of uncertainty in decision problems involving many strategies, enhance existing methods, and provide an open-source and easy-to-use tool.
METHODS
We conducted a systematic literature search to identify methods used to represent the impact of uncertainty in cost-effectiveness analyses comparing multiple strategies. We applied the identified methods to probabilistic sensitivity analysis outputs of 3 published decision-analytic models comparing multiple strategies. Subsequently, we compared the following characteristics: type of information conveyed, use of a fixed or flexible willingness-to-pay threshold, output interpretability, and the graphical discriminatory ability. We further proposed adjustments and integration of methods to overcome identified limitations of existing methods.
RESULTS
The literature search resulted in the selection of 9 methods. The 3 methods with the most favorable characteristics to compare many strategies were 1) the cost-effectiveness acceptability curve (CEAC) and cost-effectiveness acceptability frontier (CEAF), 2) the expected loss curve (ELC), and 3) the incremental benefit curve (IBC). The information required to assess confidence in a decision often includes the average loss and the probability of cost-effectiveness associated with each strategy. Therefore, we proposed the integration of information presented in an ELC and CEAC into a single heat map.
CONCLUSIONS
This article presents an overview of methods presenting uncertainty in multiple-strategy cost-effectiveness analyses, with their strengths and shortcomings. We proposed a heat map as an alternative method that integrates all relevant information required for health policy and medical decision making.
HIGHLIGHTS
To assess confidence in a chosen course of action, decision makers require information on both the probability and the consequences of making a wrong decision.This article contains an overview of methods for presenting uncertainty in multiple-strategy cost-effectiveness analyses.We propose a heat map that combines the probability of cost-effectiveness from the cost-effectiveness acceptability curve (CEAC) with the consequences of a wrong decision from the expected loss curve.Collapsing of the CEAC can be reduced by relaxing the CEAC, as proposed in this article.Code in Microsoft Excel and R is provided to easily analyze data using the methods discussed in this article.
Topics: Cost-Benefit Analysis; Health Policy; Humans; Probability; Uncertainty
PubMed: 35587181
DOI: 10.1177/0272989X221100112 -
CNS Drugs Sep 2018A broad range of disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) is available. However, the efficacy and safety of traditional DMTs... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A broad range of disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) is available. However, the efficacy and safety of traditional DMTs compared with the recently developed DMTs remain unclear.
OBJECTIVE
Therefore, we have synthesised available evidence of clinical outcomes for DMTs in adults with RRMS.
METHODS
PubMed, Scopus and a manual search were performed. Bayesian network meta-analyses of randomised clinical trials assessing DMTs as monotherapies were conducted. SUCRA and GRADE were used to rank therapies and to assess quality of general evidence, respectively.
RESULTS
Thirty-three studies were included in the meta-analyses. The most effective therapies for the outcome of annualised relapse rate were alemtuzumab (96% probability), natalizumab (96%) and ocrelizumab (85%), compared with all other therapies (hazard ratio versus placebo, 0.31, 0.31 and 0.37, respectively; p < 0.05 for all comparisons) (high-quality evidence). However, no significant differences among these three therapies were found. Discontinuation due to adverse events revealed similarity across all therapies, except for alemtuzumab, which showed less discontinuation when compared with interferon-1a intramuscular (relative risk 0.37; p < 0.05).
CONCLUSION
High-quality evidence shows that alemtuzumab, natalizumab and ocrelizumab present the highest efficacy among DMTs, and other meta-analyses are required regarding adverse events frequency, to better understand the safety of therapies. Based on efficacy profile, guidelines should consider a three-category classification (i.e. high, intermediate and low efficacy).
Topics: Bayes Theorem; Humans; Immunologic Factors; Multiple Sclerosis, Relapsing-Remitting; Network Meta-Analysis
PubMed: 30014314
DOI: 10.1007/s40263-018-0541-5 -
Psychiatry Research Nov 2023Assessing and managing suicide behaviors is highly relevant to individuals with schizophrenia spectrum disorders. Our study aims to assess the association between... (Meta-Analysis)
Meta-Analysis Review
Assessing and managing suicide behaviors is highly relevant to individuals with schizophrenia spectrum disorders. Our study aims to assess the association between adverse childhood experiences and suicidal behaviors in individuals with schizophrenia spectrum disorders. We included observational studies comparing the probability of suicide behaviors in adults with schizophrenia spectrum disorders exposed and unexposed to adverse childhood experiences. Odds ratio estimates were obtained by pooling data using a random-effects pairwise meta-analysis. Standardized criteria were used to assess the strength of the association of the pooled estimate. We found 21 eligible studies reporting outcomes for 6257 individuals from 11 countries. The primary outcome revealed an association between any suicidal behavior and adverse childhood experiences, which resulted "highly suggestive" according to validated Umbrella Criteria. Similarly, a positive association was confirmed for suicidal ideation and suicide attempt and for any subtype of adverse childhood experience. This meta-analysis showed that exposure to adverse childhood experiences strongly increases the probability of suicide behaviors in people with schizophrenia spectrum disorders.
Topics: Adult; Humans; Suicidal Ideation; Schizophrenia; Adverse Childhood Experiences; Suicide, Attempted; Probability
PubMed: 37769371
DOI: 10.1016/j.psychres.2023.115488 -
Head & Neck Dec 2023This systematic review study aims to provide comprehensive data on different radiobiological models, parameters, and endpoints used for calculating the normal tissue... (Review)
Review
This systematic review study aims to provide comprehensive data on different radiobiological models, parameters, and endpoints used for calculating the normal tissue complication probability (NTCP) based on clinical data from head and neck cancer patients treated with conformal radiotherapy. A systematic literature search was carried out according to the PRISMA guideline for the identification of relevant publications in six electronic databases of Embase, PubMed, Scopus, and Google Scholar to July 2022 using specific keywords in the paper's title and abstract. The initial search resulted in 1368 articles for all organs for the review article about the NTCP parameters. One hundred and seventy-eight articles were accepted for all organs with complete parameters for the mentioned models and finally, 20 head and neck cancer articles were accepted for review. Analysis of the studies shows that the Lyman-Kutcher-Burman (LKB) model properly links the NTCP curve parameters to the postradiotherapy endpoints. In the LKB model for esophagus, the minimum, and maximum corresponding parameters were reported as TD = 2.61 Gy with grade ≥3 radiation-induced esophagitis endpoints as the minimum TD and TD = 68 Gy as the maximum ones. n = 0.06, n = 1.04, m = 0.1, and m = 0.65, respectively. Unfortunately, there was not a wide range of published articles on other organs at risk like ear or cauda equina except Burman et al. (Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys Ther. 1991;21:123-135). Findings suggest that the validation of different radiobiological models and their corresponding parameters need to be investigated in vivo and in vitro for developing a more accurate NTCP model to be used for radiotherapy treatment planning optimization.
Topics: Humans; Radiotherapy, Conformal; Probability; Head and Neck Neoplasms; Radiotherapy Planning, Computer-Assisted; Radiobiology; Radiotherapy Dosage
PubMed: 37767820
DOI: 10.1002/hed.27469 -
Nutrition Reviews Jul 2022The importance and benefits of breastfeeding in children are well recognized, and it may improve motor development. Motor skills are fundamental to childhood... (Meta-Analysis)
Meta-Analysis
CONTEXT
The importance and benefits of breastfeeding in children are well recognized, and it may improve motor development. Motor skills are fundamental to childhood development. Although some studies report a positive association between breastfeeding and motor development in children, others have suggested that these differences could be influenced by confounding variables.
OBJECTIVE
To estimate the degree to which breastfeeding duration and exclusivity is associated with motor development in children. Thus, a systematic review of the literature and a meta-analysis was conducted.
DATA SOURCES
MEDLINE (via PubMed), Embase, the Cochrane Database of Systematic Reviews, and the Web of Science databases were systematically searched from inception to June 2021.
DATA EXTRACTION
The most adjusted relative risks (RRs) or odds ratios (ORs) and their corresponding 95% confidence intervals (95% CIs) reported by included studies were used. The "breastfeeding duration" category defined by each study was used as the reference category. Additionally, subgroup analyses were performed based on the duration of breastfeeding.
DATA ANALYSIS
Eighteen published studies were included in the systematic review and 14 studies in the meta-analysis. The results showed that the effect size (ES) for exclusively breastfed vs never breastfed children was 0.86 (95% CI: 0.32, 1.41, I2 = 90.3%), and the ES for children breastfed for any length vs never breastfed children was 0.95 (95% CI: 0.80, 1.10, I2 = 88.0%). The remaining groups studied did not show significant differences in outcomes.
CONCLUSIONS
Although our data suggest that breastfeeding may improve motor development in children, more studies are needed because publication bias has been detected. Nevertheless, our results support the promotion of breastfeeding.
Topics: Breast Feeding; Child; Child Development; Female; Humans; Motor Skills; Odds Ratio; Risk
PubMed: 35325229
DOI: 10.1093/nutrit/nuac013 -
Nutrition (Burbank, Los Angeles County,... Oct 2020The gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) has been regarded as one of the potent risk factors for cardiovascular events and diabetes. In the... (Meta-Analysis)
Meta-Analysis Review
The gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) has been regarded as one of the potent risk factors for cardiovascular events and diabetes. In the current meta-analysis we quantitatively summarized and updated the results of studies regarding the association between TMAO and mortality. A systematic search was performed from PubMed, ProQuest, Scopus, and Embase. All of the studies that evaluated the association between TMAO and mortality were included in the systematic review and meta-analysis. Subgroup analysis and meta-regression were performed to identify the source of heterogeneity. There were 31 230 participants included and the results showed that being in the highest category of TMAO increased the hazard ratio (HR) of mortality by 47%. Moreover, there was a non-linear association between increased TMAO concentrations and HR of mortality. In the current dose-response meta-analysis, we revealed a positive association between TMAO and mortality risk among an adult population.
Topics: Adult; Gastrointestinal Microbiome; Humans; Methylamines; Proportional Hazards Models; Risk Factors
PubMed: 32592979
DOI: 10.1016/j.nut.2020.110856