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JBJS Reviews Feb 2019Evidence with regard to antibiotic prophylaxis for patients with open fractures of the extremities is limited. We therefore conducted a systematic survey addressing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence with regard to antibiotic prophylaxis for patients with open fractures of the extremities is limited. We therefore conducted a systematic survey addressing current practice and recommendations.
METHODS
We included publications from January 2007 to June 2017. We searched Embase, MEDLINE, CINAHL, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews for clinical studies and surveys of surgeons; WorldCat for textbooks; and web sites for guidelines and institutional protocols.
RESULTS
We identified 223 eligible publications that reported 100 clinical practice patterns and 276 recommendations with regard to systemic antibiotic administration, and 3 recommendations regarding local antibiotic administration alone. Most publications of clinical practice patterns used regimens with both gram-positive and gram-negative coverage and continued the administration for 2 to 3 days. Most publications recommended prophylactic systemic antibiotics. Most recommendations suggested gram-positive coverage for less severe injuries and administration duration of 3 days or less. For more severe injuries, most recommendations suggested broad antimicrobial coverage continued for 2 to 3 days. Most publications reported intravenous administration of antibiotics immediately.
CONCLUSIONS
Current practice and recommendations strongly support early systemic antibiotic prophylaxis for patients with open fractures of the extremities. Differences in antibiotic regimens, doses, and durations of administration remain in both practice and recommendations. Consensus with regard to optimal practice will likely require well-designed randomized controlled trials.
CLINICAL RELEVANCE
The current survey of literature systematically provides surgeons' practice and the available expert recommendations from 2007 to 2017 on the use of prophylactic antibiotics in the management of open fractures of extremities.
Topics: Administration, Intravenous; Anti-Bacterial Agents; Antibiotic Prophylaxis; Fractures, Open; Humans; Practice Guidelines as Topic; Publications; Randomized Controlled Trials as Topic; Surveys and Questionnaires
PubMed: 30724762
DOI: 10.2106/JBJS.RVW.17.00197 -
Blood Advances Jun 2019The terminology applied to autoimmune hemolytic anemia (AIHA) seems inconsistent. We aimed to evaluate the consistency of definitions used for diagnosis and treatment.... (Comparative Study)
Comparative Study
The terminology applied to autoimmune hemolytic anemia (AIHA) seems inconsistent. We aimed to evaluate the consistency of definitions used for diagnosis and treatment. In this systematic review of literature from January 2006 to December 2015, we assessed heterogeneity in the definition of AIHA and its subtypes, refractory disease, disease phase, severity, criteria for treatment response, and response durability. A Medline search for anemia, hemolytic, autoimmune was supplemented with keyword searches. Main exclusions were conference abstracts, animal and non-English studies, and studies with <10 cases. Of 1371 articles retrieved, 1209 were excluded based on titles and abstracts. Two authors independently reviewed 10% and 16% of abstracts and full papers, respectively. After full-paper review, 84 studies were included. AIHA was most frequently (32 [52%] of 61) defined as hemolytic anemia with positive direct antiglobulin test (DAT) and exclusion of alternatives, but 10 of 32 also recognized DAT-negative AIHA. A lower threshold for diagnosis of DAT-negative AIHA was observed in literature on chronic lymphocytic leukemia. Definitions of anemia, hemolysis, and exclusion criteria showed substantial variation. Definitions of primary/secondary cold agglutinin disease/syndrome were not consistent. Forty-three studies provided criteria for treatment response, and other than studies from 1 center, these were almost entirely unique. Other criteria were rarely defined. Only 7, 0, 3, 2, 2, and 3 studies offered definitions of warm AIHA, paroxysmal cold hemoglobinuria, mixed AIHA, AIHA severity, disease phase, and refractory AIHA, respectively. Marked heterogeneity in the time period sampled indicates the need to standardize AIHA terminology.
Topics: Anemia, Hemolytic, Autoimmune; Coombs Test; Erythrocytes; Hemoglobinuria, Paroxysmal; Hemolysis; Humans; Immunoglobulin G; Publications; Severity of Illness Index; Terminology as Topic
PubMed: 31235526
DOI: 10.1182/bloodadvances.2019000036 -
The Cochrane Database of Systematic... Jan 2021Smoking is a leading cause of disease and death worldwide. In people who smoke, quitting smoking can reverse much of the damage. Many people use behavioural... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Smoking is a leading cause of disease and death worldwide. In people who smoke, quitting smoking can reverse much of the damage. Many people use behavioural interventions to help them quit smoking; these interventions can vary substantially in their content and effectiveness.
OBJECTIVES
To summarise the evidence from Cochrane Reviews that assessed the effect of behavioural interventions designed to support smoking cessation attempts and to conduct a network meta-analysis to determine how modes of delivery; person delivering the intervention; and the nature, focus, and intensity of behavioural interventions for smoking cessation influence the likelihood of achieving abstinence six months after attempting to stop smoking; and whether the effects of behavioural interventions depend upon other characteristics, including population, setting, and the provision of pharmacotherapy. To summarise the availability and principal findings of economic evaluations of behavioural interventions for smoking cessation, in terms of comparative costs and cost-effectiveness, in the form of a brief economic commentary.
METHODS
This work comprises two main elements. 1. We conducted a Cochrane Overview of reviews following standard Cochrane methods. We identified Cochrane Reviews of behavioural interventions (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials) for smoking cessation by searching the Cochrane Library in July 2020. We evaluated the methodological quality of reviews using AMSTAR 2 and synthesised data from the reviews narratively. 2. We used the included reviews to identify randomised controlled trials of behavioural interventions for smoking cessation compared with other behavioural interventions or no intervention for smoking cessation. To be included, studies had to include adult smokers and measure smoking abstinence at six months or longer. Screening, data extraction, and risk of bias assessment followed standard Cochrane methods. We synthesised data using Bayesian component network meta-analysis (CNMA), examining the effects of 38 different components compared to minimal intervention. Components included behavioural and motivational elements, intervention providers, delivery modes, nature, focus, and intensity of the behavioural intervention. We used component network meta-regression (CNMR) to evaluate the influence of population characteristics, provision of pharmacotherapy, and intervention intensity on the component effects. We evaluated certainty of the evidence using GRADE domains. We assumed an additive effect for individual components.
MAIN RESULTS
We included 33 Cochrane Reviews, from which 312 randomised controlled trials, representing 250,563 participants and 845 distinct study arms, met the criteria for inclusion in our component network meta-analysis. This represented 437 different combinations of components. Of the 33 reviews, confidence in review findings was high in four reviews and moderate in nine reviews, as measured by the AMSTAR 2 critical appraisal tool. The remaining 20 reviews were low or critically low due to one or more critical weaknesses, most commonly inadequate investigation or discussion (or both) of the impact of publication bias. Of note, the critical weaknesses identified did not affect the searching, screening, or data extraction elements of the review process, which have direct bearing on our CNMA. Of the included studies, 125/312 were at low risk of bias overall, 50 were at high risk of bias, and the remainder were at unclear risk. Analyses from the contributing reviews and from our CNMA showed behavioural interventions for smoking cessation can increase quit rates, but effectiveness varies on characteristics of the support provided. There was high-certainty evidence of benefit for the provision of counselling (odds ratio (OR) 1.44, 95% credibility interval (CrI) 1.22 to 1.70, 194 studies, n = 72,273) and guaranteed financial incentives (OR 1.46, 95% CrI 1.15 to 1.85, 19 studies, n = 8877). Evidence of benefit remained when removing studies at high risk of bias. These findings were consistent with pair-wise meta-analyses from contributing reviews. There was moderate-certainty evidence of benefit for interventions delivered via text message (downgraded due to unexplained statistical heterogeneity in pair-wise comparison), and for the following components where point estimates suggested benefit but CrIs incorporated no clinically significant difference: individual tailoring; intervention content including motivational components; intervention content focused on how to quit. The remaining intervention components had low-to very low-certainty evidence, with the main issues being imprecision and risk of bias. There was no evidence to suggest an increase in harms in groups receiving behavioural support for smoking cessation. Intervention effects were not changed by adjusting for population characteristics, but data were limited. Increasing intensity of behavioural support, as measured through the number of contacts, duration of each contact, and programme length, had point estimates associated with modestly increased chances of quitting, but CrIs included no difference. The effect of behavioural support for smoking cessation appeared slightly less pronounced when people were already receiving smoking cessation pharmacotherapies.
AUTHORS' CONCLUSIONS
Behavioural support for smoking cessation can increase quit rates at six months or longer, with no evidence that support increases harms. This is the case whether or not smoking cessation pharmacotherapy is also provided, but the effect is slightly more pronounced in the absence of pharmacotherapy. Evidence of benefit is strongest for the provision of any form of counselling, and guaranteed financial incentives. Evidence suggested possible benefit but the need of further studies to evaluate: individual tailoring; delivery via text message, email, and audio recording; delivery by lay health advisor; and intervention content with motivational components and a focus on how to quit. We identified 23 economic evaluations; evidence did not consistently suggest one type of behavioural intervention for smoking cessation was more cost-effective than another. Future reviews should fully consider publication bias. Tools to investigate publication bias and to evaluate certainty in CNMA are needed.
Topics: Adult; Bayes Theorem; Behavior Therapy; Bias; Counseling; Exercise; Female; Humans; Hypnosis; Male; Middle Aged; Network Meta-Analysis; Publication Bias; Randomized Controlled Trials as Topic; Self Care; Smoking Cessation; Systematic Reviews as Topic; Time Factors; Young Adult
PubMed: 33411338
DOI: 10.1002/14651858.CD013229.pub2 -
Research Synthesis Methods Mar 2017Although well developed to assess efficacy questions, meta-analyses and, more generally, systematic reviews, have received less attention in application to... (Review)
Review
Although well developed to assess efficacy questions, meta-analyses and, more generally, systematic reviews, have received less attention in application to safety-related questions. As a result, many open questions remain on how best to apply meta-analyses in the safety setting. This appraisal attempts to: (i) summarize the current guidelines for assessing individual studies, systematic reviews, and network meta-analyses; (ii) describe several publications on safety meta-analytic approaches; and (iii) present some of the questions and issues that arise with safety data. A number of gaps in the current quality guidelines are identified along with issues to consider when performing a safety meta-analysis. While some work is ongoing to provide guidance to improve the quality of safety meta-analyses, this review emphasizes the critical need for better reporting and increased transparency regarding safety data in the systematic review guidelines. Copyright © 2016 John Wiley & Sons, Ltd.
Topics: Bayes Theorem; Celecoxib; Clinical Trials as Topic; Cyclosporine; Data Interpretation, Statistical; Drug Design; Evidence-Based Medicine; Guidelines as Topic; Humans; Meta-Analysis as Topic; Network Meta-Analysis; Outcome Assessment, Health Care; Patient Safety; Pharmaceutical Preparations; Publication Bias; Publishing; Quality Control; Research Design; United States; United States Food and Drug Administration
PubMed: 27612447
DOI: 10.1002/jrsm.1219 -
BMC Cancer Mar 2018Systematic reviews, with or without meta-analysis, play an important role today in synthesizing cancer research and are frequently used to guide decision-making.... (Review)
Review
Systematic reviews, with or without meta-analysis, play an important role today in synthesizing cancer research and are frequently used to guide decision-making. However, there is now an increase in the number of systematic reviews on the same topic, thereby necessitating a systematic review of previous systematic reviews. With a focus on cancer, the purpose of this article is to provide a practical, stepwise approach for systematically reviewing the literature and publishing the results. This starts with the registration of a protocol for a systematic review of previous systematic reviews and ends with the publication of an original or updated systematic review, with or without meta-analysis, in a peer-reviewed journal. Future directions as well as potential limitations of the approach are also discussed. It is hoped that the stepwise approach presented in this article will be helpful to both producers and consumers of cancer-related systematic reviews and will contribute to the ultimate goal of preventing and treating cancer.
Topics: Biomedical Research; Evidence-Based Medicine; Humans; Meta-Analysis as Topic; Neoplasms; Peer Review, Research; Research Design
PubMed: 29499652
DOI: 10.1186/s12885-018-4163-6 -
Academic Medicine : Journal of the... Aug 2020Academic medical faculty members are assessed on their research productivity for hiring, promotion, grant, and award decisions. The current work systematically reviews,... (Meta-Analysis)
Meta-Analysis
PURPOSE
Academic medical faculty members are assessed on their research productivity for hiring, promotion, grant, and award decisions. The current work systematically reviews, synthesizes, and analyzes the available literature on publication productivity by academic rank across medical specialties.
METHOD
The authors searched PubMed for medical literature, including observational studies, published in English from 2005 to 2018, using the term "h-index," on July 1, 2018. Studies had to report on h-indices for faculty in academic medicine and, if available, other publication metrics, including number of citations, number of publications, and m-indices, stratified by academic rank. The DerSimonian and Laird method was used to perform meta-analyses for the primary (h-index) and secondary (m-index) outcome measures.
RESULTS
The systematic review included 21 studies. The meta-analysis included 19 studies and data on 14,567 academic physicians. Both h- and m-indices increased with academic rank. The weighted random effects summary effect sizes for mean h-indices were 5.22 (95% confidence interval [CI]: 4.21-6.23, n = 6,609) for assistant professors, 11.22 (95% CI: 9.65-12.78, n = 3,508) for associate professors, 20.77 (95% CI: 17.94-23.60, n = 3,626) for full professors, and 22.08 (95% CI: 17.73-26.44, n = 816) for department chairs. Mean m-indices were 0.53 (95% CI: 0.40-0.65, n = 1,653) for assistant professors, 0.72 (95% CI: 0.58-0.85, n = 883) for associate professors, 0.99 (95% CI: 0.75-1.22, n = 854) for full professors, and 1.16 (95% CI: 0.81-1.51, n = 195) for department chairs.
CONCLUSIONS
Both h- and m-indices increase with successive academic rank. There are unique distributions of these metrics among medical specialties. The h- and m-indices should be used in conjunction with other measures of academic success to evaluate faculty members for hiring, promotion, grant, and award decisions.
Topics: Bibliometrics; Canada; Career Mobility; Efficiency; Faculty, Medical; Humans; Periodicals as Topic; Publishing; United States
PubMed: 32028299
DOI: 10.1097/ACM.0000000000003185 -
European Spine Journal : Official... Nov 2023The number of articles retracted by peer-reviewed journals has increased in recent years. This study systematically reviews retracted publications in the spine surgery... (Review)
Review
PURPOSE
The number of articles retracted by peer-reviewed journals has increased in recent years. This study systematically reviews retracted publications in the spine surgery literature.
METHODS
A search of PubMed MEDLINE, Ovid EMBASE, Retraction Watch, and the independent websites of 15 spine surgery-related journals from inception to September of 2022 was performed without language restrictions. PRISMA guidelines were followed with title/abstract screening, and full-text screening was conducted independently and in duplicate by two reviewers. Study characteristics and bibliometric information for each publication was extracted.
RESULTS
Of 250 studies collected from the search, 65 met the inclusion criteria. The most common reason for retraction was data error (n = 15, 21.13%), followed by plagiarism (n = 14, 19.72%) and submission to another journal (n = 14, 19.72%). Most studies pertained to degenerative pathologies of the spine (n = 32, 80.00%). Most articles had no indication of retraction in their manuscript (n = 24, 36.92%), while others had a watermark or notice at the beginning of the article. The median number of citations per retracted publication was 10.0 (IQR 3-29), and the median 4-year impact factor of the journals was 5.05 (IQR 3.20-6.50). On multivariable linear regression, the difference in years from publication to retraction (p = 0.0343, β = 6.56, 95% CI 0.50-12.62) and the journal 4-year impact factor (p = 0.0029, β = 7.47, 95% CI 2.66-12.28) were positively associated with the total number of citations per retracted publication. Most articles originated from China (n = 30, 46.15%) followed by the United States (n = 12, 18.46%) and Germany (n = 3, 4.62%). The most common study design was retrospective cohort studies (n = 14, 21.54%).
CONCLUSIONS
The retraction of publications has increased in recent years in spine surgery. Researchers consulting this body of literature should remain vigilant. Institutions and journals should collaborate to increase publication transparency and scientific integrity.
Topics: Humans; Scientific Misconduct; Retrospective Studies; Plagiarism; Journal Impact Factor; Research Design; Biomedical Research
PubMed: 37725162
DOI: 10.1007/s00586-023-07927-7 -
PloS One 2023In this study, we aim to evaluate the efficacy and safety of acupuncture for vocal nodules, concerning qualitive overall efficacy and quantitative improvement on quality... (Meta-Analysis)
Meta-Analysis
In this study, we aim to evaluate the efficacy and safety of acupuncture for vocal nodules, concerning qualitive overall efficacy and quantitative improvement on quality of voice. Four English and four Chinese databases were searched up to December 10th, 2022. Risk of bias among the included trials were evaluated by the Cochrane ROB tool. Systematic reviews and meta-analyses were conducted based on the Cochrane systematic review method by using RevMan 5.4 Software, and trial sequential analyses were performed by TSA 0.9. Meta-influence analyses, subgroup-analyses, meta-regression, and evaluation of publication bias were performed for exploration of heterogeneity by Stata V.14. Quality of the results was accessed through the GRADE-pro GDT. Cluster analyses and correlation coefficient were performed by R 4.1.3. Finally, 15 trials involving 1,888 participants were included. Results showed that compared with western medicine alone or Chinese herbal medicine alone, acupuncture alone yielded significantly (p<0.05) higher clinical effective rate and more improvement on scores of voice analyses. However, reduction on scores of grade, roughness, and breathiness and voice handicap index during follow-ups, and results of clinical effective rate suggested that acupuncture was inferior to voice training. In addition, meta-regression and sub-group analyses firstly revealed advanced efficacies of acupuncture when performed with local and remote acupoints, compared with local acupoints only. Acupuncture specified adverse event was denied in six trials while it was not mentioned in other nine trials. Results of cluster analyses and correlation coefficient showed that Kai yin yi hao and He gu (LI-4) were the most frequently applied matching-acupoints in trials. In conclusion, compared with western medicine (level of evidence: low ⨁⨁◯◯, GRADE C) and Chinese herbal medicine (level of evidence: moderate ⨁⨁⨁◯, GRADE B), acupuncture is safe and of better efficacy for patients with vocal nodules, while there is also need for RCTs with improvements on designing and interventions in experimental and controls.
Topics: Male; Humans; Drugs, Chinese Herbal; Acupuncture Therapy; Treatment Outcome; Acupuncture Points; Publication Bias
PubMed: 37922255
DOI: 10.1371/journal.pone.0288252 -
Nature Communications Feb 2021The COVID-19 pandemic began in early 2020 with major health consequences. While a need to disseminate information to the medical community and general public was...
The COVID-19 pandemic began in early 2020 with major health consequences. While a need to disseminate information to the medical community and general public was paramount, concerns have been raised regarding the scientific rigor in published reports. We performed a systematic review to evaluate the methodological quality of currently available COVID-19 studies compared to historical controls. A total of 9895 titles and abstracts were screened and 686 COVID-19 articles were included in the final analysis. Comparative analysis of COVID-19 to historical articles reveals a shorter time to acceptance (13.0[IQR, 5.0-25.0] days vs. 110.0[IQR, 71.0-156.0] days in COVID-19 and control articles, respectively; p < 0.0001). Furthermore, methodological quality scores are lower in COVID-19 articles across all study designs. COVID-19 clinical studies have a shorter time to publication and have lower methodological quality scores than control studies in the same journal. These studies should be revisited with the emergence of stronger evidence.
Topics: Animals; COVID-19; Clinical Studies as Topic; Data Accuracy; Humans; Pandemics; Peer Review, Research; Periodicals as Topic; Research Design; Time Factors
PubMed: 33574258
DOI: 10.1038/s41467-021-21220-5 -
Eating Behaviors Aug 2023Dimensions of perfectionism are associated with the onset and maintenance of eating disorder pathology in both clinical and non-clinical samples. The aim of this study... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Dimensions of perfectionism are associated with the onset and maintenance of eating disorder pathology in both clinical and non-clinical samples. The aim of this study was to conduct a systematic review and meta-analysis of the association between perfectionism and eating disorders in adults.
METHOD
A literature search was conducted using the PsycINFO, Medline, Scopus, Embase, Web of Science and ProQuest databases. Ninety-five studies met the inclusion criteria and included a total sample of 32,840 participants (clinical eating disorder diagnosis N = 2414, non-clinical N = 30,428). Correlation coefficients (r) for the association between eating disorders and perfectionism were pooled. A meta-analysis to determine the association between two dimensions of perfectionism and eating disorder symptoms was conducted. Subgroup analyses were conducted with studies using clinical samples, and studies using the Eating Disorder Examination Questionnaire.
RESULTS
The pooled effect size for the association between perfectionistic concerns and eating disorder symptoms was r = 0.33 [0.30, 0.37]; and r = 0.20 [0.14, 0.25] for the association between perfectionistic strivings and eating disorder symptoms. In the clinical subgroup analyses the effect sizes were r = 0.40 [0.22, 0.58]; and r = 0.35 [0.26, 0.44] respectively. Medium to high heterogeneity was identified across all subgroup analyses and a significant level of publication bias was also identified.
DISCUSSION
The findings indicate both perfectionistic strivings and perfectionistic concerns have significant associations with eating disorders, and further support the argument that both dimensions of perfectionism are important factors in the prevention and treatment of eating disorders.
Topics: Adult; Female; Humans; Male; Feeding and Eating Disorders; Perfectionism; Publication Bias
PubMed: 37327637
DOI: 10.1016/j.eatbeh.2023.101769