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BMC Pulmonary Medicine Sep 2023Glucocorticoids and Beta-2 receptor agonists are commonly used for the treatment of asthma in clinical practice, while these agents are accompanied by adverse reactions... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Glucocorticoids and Beta-2 receptor agonists are commonly used for the treatment of asthma in clinical practice, while these agents are accompanied by adverse reactions of different kinds. Studies have shown that acupuncture is effective in treating bronchial asthma. However, different acupuncture modalities have different costs and skill requirements, and there remains a lack of comparisons between different acupuncture modalities. This study aims to assess the efficacy of various acupuncture modalities in the treatment of asthma.
METHODS
The following databases were searched for randomized controlled trials (RCTs) on acupuncture for the treatment of bronchial asthma from database inception to August 26, 2022: PubMed, Embase, The Cochrane Library, Web of Science, Chinese Journal Full-text Database (CNKI), Wanfang Database (Wanfang Date), VIP Database (VIP), China Biology Medicine disc (CBM). Stata 15.1 software was used to conduct network meta-analysis. The risk of bias in the included studies was evaluated using the Cochrane Risk of Bias Assessment Tool 2 (RoB2).
RESULTS
A total of 8,693 relevant studies were found, and 30 RCTs were included, involving 2,722 patients with bronchial asthma and eight acupuncture modalities: manual acupuncture, moxibustion, electroacupuncture, ignipuncture, flying needle acupuncture, acupoint catgut embedding, acupoint application, and warm-needle moxibustion. The other 29 studies had certain risks, with the quality graded as "moderate". Among the pair-wise comparisons of statistical significance (p < 0.05), acupoint application was the most effective in improving pulmonary function (FEV1: Traditional medicine therapy-acupoint application [-7.29 (-12.11,-2.47)]; acupoint application-moxibustion [7.20 (0.28,14.11)]; FVC: acupoint application-Traditional medicine therapy [8.02 (2.54,13.50)]). Acupoint catgut embedding was the most effective in improving the ACT score of the patients (Traditional medicine therapy-acupoint catgut embedding [-4.29 (-7.94, -0.65)]; acupoint catgut embedding-moxibustion [5.52 (1.05,9.99)]).
CONCLUSION
Acupoint application has evident merits in improving the clinical response rate and pulmonary function, while acupoint catgut embedding can improve other secondary indicators. For the clinical treatment of asthma, acupoint application can be selected as a complementary and alternative therapy, while the other acupuncture therapies can also be considered according to the examination results of the patients.
Topics: Humans; Acupuncture Therapy; Asthma; Network Meta-Analysis; Randomized Controlled Trials as Topic
PubMed: 37740212
DOI: 10.1186/s12890-023-02645-8 -
Supermicrosurgical treatment for lymphedema: a systematic review and network meta-analysis protocol.Systematic Reviews Feb 2022Lymphedema is a condition that affects up to 130 million subjects worldwide. Since it is related to several complications and a significant reduction in terms of quality...
BACKGROUND
Lymphedema is a condition that affects up to 130 million subjects worldwide. Since it is related to several complications and a significant reduction in terms of quality of life, it is a heavy burden not only to the patients but also for the healthcare system worldwide. Despite the development of supermicrosurgery, such as vascularized lymph node transfer (VLNT) and lymphovenous anastomosis LVA, the indications and outcomes of these complex groups of interventions remain a controversial topic in the field of reconstructive plastic surgery.
METHODS
This systematic review and network meta-analysis aims to assess the evidence of outcomes of LVA and VLNT in patients with lymphedema. Secondary aims of the project are to determine if for any outcomes, LVA or VLNT is superior to conservative therapy alone, and whether the available evidence favors any kind of supermicrosurgical interventions for lymphedema patients. This study will include original studies of patients with lymphedema on the extremities indexed in PubMed, EMBASE, CENTRAL, PASCAL, FRANCIS, ISTEX, LILACS, CNKI, and IndMED that reported microsurgery (supermicrosurgery) of all techniques aiming the re-functionalization of the lymphatic system. As comparators, mere observation, conservative treatment of any kind, and the other subgroups of supermicrosurgery are planned. The primary outcome of this systematic review and network meta-analysis is the difference of the limb volume, while the secondary outcomes of interest will be erysipelas rates, major and minor complications, postoperative necessity of continuous compression garments, and patient satisfaction, measured by already published and validated scores for quality of life.
DISCUSSION
We will provide an overview and evidence grade analysis of the scientific literature available on the effectiveness of the subcategories of supermicrosurgical interventions for lymphedema.
Topics: Anastomosis, Surgical; Humans; Lymphatic Vessels; Lymphedema; Meta-Analysis as Topic; Network Meta-Analysis; Quality of Life; Systematic Reviews as Topic
PubMed: 35105375
DOI: 10.1186/s13643-022-01885-9 -
Journal of B.U.ON. : Official Journal... 2017Meta-analyses are considered to provide level I-II evidence. Based on this premise, several statements have been developed to standardize guidelines and optimize... (Meta-Analysis)
Meta-Analysis
PURPOSE
Meta-analyses are considered to provide level I-II evidence. Based on this premise, several statements have been developed to standardize guidelines and optimize results. The purpose of this study was to investigate the quality of the information delivered by meta-analyses.
METHODS
Meta-analyses published in Annals of Surgery during an 11-year period were reviewed whereas individual publications of each meta-analysis were assessed. An Excel database encompassing 29 parameters was constructed based on the Quality of Reporting of Meta-analyses (QUOROM) statement.
RESULTS
The present study included 31 consecutive meta- analyses. The number of meta-analyses conforming with each of the parameters considered was as follows: information obtained from more than 2 databases 23/31; language of publication exclusively English 25/31; defined population, intervention, and principal outcomes 31/31; study design encompassing review of randomised controlled trials (RCTs) 10/31; quality assessment of contributing publications 10/31; handling of missing data 10/31; assessment of statistical heterogeneity 30/31; subgroup analysis 23/31; assessment of publication bias 26/31; agreement on selection and validity assessment 22/31; simple summary results 28/31; data available to calculate effect size and confidence interval 27/31; key findings summarized 30/31; clinical inferences based on internal and external validity 24/31; description of potential biases in the review process 23/31; future research agenda suggested 18/31.
CONCLUSIONS
Evidence derived from meta-analyses must be interpreted with caution. Although QUOROM guidelines were observed, quality assessments showed considerable variability.
Topics: Databases, Factual; Humans; Meta-Analysis as Topic; Publication Bias; Randomized Controlled Trials as Topic
PubMed: 28534382
DOI: No ID Found -
Animal : An International Journal of... Aug 2020In animal sciences, the number of published meta-analyses is increasing at a rate of 15% per year. This current review focuses on the good practices and the potential...
In animal sciences, the number of published meta-analyses is increasing at a rate of 15% per year. This current review focuses on the good practices and the potential pitfalls in the conduct of meta-analyses in animal sciences, nutrition in particular. Once the study objectives have been defined, several key phases must be considered when doing a meta-analysis. First, as a principle of traceability, criteria used to select or discard publications should be clearly stated in a way that one could reproduce the final selection of data. Then, the coding phase, aiming to isolate specific experimental factors for an accurate graphical and statistical interpretation of the database, is discussed. Following this step, the study of the levels of independence of factors and of the degree of data balance of the meta-design represents an essential phase to ensure the validity of statistical processing. The consideration of the study effect as fixed or random must next be considered. It appears based on several examples that this choice does not generally have any influence on the conclusions of a meta-analysis when the number of experiments is sufficient.
Topics: Animals; Databases, Factual; Meta-Analysis as Topic
PubMed: 32662377
DOI: 10.1017/S1751731120001688 -
The Journal of Thoracic and... Jul 2021
Topics: Humans; Meta-Analysis as Topic
PubMed: 32807558
DOI: 10.1016/j.jtcvs.2020.07.067 -
BMJ Open Aug 2023Suicide is an important public health problem. Providing evidence-based psychosocial interventions to individuals presenting with self-harm is recognised as an important...
INTRODUCTION
Suicide is an important public health problem. Providing evidence-based psychosocial interventions to individuals presenting with self-harm is recognised as an important suicide prevention strategy. Therefore, it is crucial to understand which intervention is most effective in preventing self-harm repetition. We will evaluate the comparative efficacy of psychosocial interventions for the prevention of self-harm in adults.
METHODS AND ANALYSIS
We will perform a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) testing psychosocial interventions for the prevention of self-harm repetition. We will include RCTs in adults (mean age: 18 years or more) who presented with self-harm in the 6 months preceding enrolment in the trial. Interventions will be categorised according to their similarities and underpinning theoretical approaches (eg, cognitive behavioural therapy, case management). A health sciences librarian will update and adapt the search strategy from the most recent Cochrane pairwise systematic review on this topic. The searches will be performed in MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), Cochrane Central (Wiley), Cochrane Protocols (Wiley), LILACS and PSYNDEX from 1 July 2020 (Cochrane review last search date) to 1 September 2023. The primary efficacy outcome will be self-harm repetition. Secondary outcomes will include suicide mortality, suicidal ideation and depressive symptoms. Retention in treatment (ie, drop-outs rates) will be analysed as the main acceptability outcome. Two reviewers will independently assess the study eligibility and risk of bias (using RoB-2). An NMA will be performed to synthesise all direct and indirect comparisons. Ranked forest plots and Vitruvian plots will be used to represent graphically the results of the NMA. Credibility of network estimates will be evaluated using Confidence in NMA (CINeMA).
ETHICS AND DISSEMINATION
As this is the protocol for an aggregate-data level NMA, ethical approval will not be required. Results will be disseminated at national/international conferences and in peer-review journals.
TRIAL REGISTRATION NUMBER
CRD42021273057.
Topics: Adult; Humans; Adolescent; Network Meta-Analysis; Psychosocial Intervention; Self-Injurious Behavior; Suicide; Public Health; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 37620269
DOI: 10.1136/bmjopen-2023-072289 -
Journal of Pain and Symptom Management Mar 2018
Topics: Constipation; Humans; Network Meta-Analysis
PubMed: 29329690
DOI: 10.1016/j.jpainsymman.2017.12.494 -
BMC Medical Informatics and Decision... May 2021Network meta-analysis (NMA) has been widely used in the field of medicine and health, but the research topics and development trends are still unclear. This study aimed... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Network meta-analysis (NMA) has been widely used in the field of medicine and health, but the research topics and development trends are still unclear. This study aimed to identify the cooperation of countries and institutes and explore the hot topics and future prospects in the field of NMA.
METHODS
Data of publications were downloaded from the Web of Science Core Collection. We used CiteSpace V, HistCite 2.1, and Excel 2016 to analyze literature information, including years, journals, countries, institutes, authors, keywords, and co-cited references.
RESULTS
NMA research developed gradually before 2010 and rapidly in the following years. 2846 NMA studies were published in 771 journals in six languages. The PLoS One (110, 3.9%) was the most productive journal, and N Engl J Med (5904 co-citations) was the most co-cited journal. The most productive country was the United States (889, 31%) and the most productive institute was the University of Bristol (113, 4.0%). The active collaborations were observed between developed countries and between productive institutes. Of the top 10 authors, four were from the UK, and among the top 10 co-cited authors, six were from the UK. Randomized evidence, oral anti-diabetic drugs, coronary artery bypass, certolizumab pegol, non-valvular atrial fibrillation, and second-line antihyperglycemic therapy were the hot topics in this field.
CONCLUSIONS
NMA studies have significantly increased over the past decade, especially from 2015 to 2017. Compared with developing countries, developed countries have contributed more to these publications and have closer cooperation, indicating that cooperation between developed and developing countries should be further strengthened. The treatment of diabetes, cardiovascular diseases, and immune rheumatism are the main hot topics.
Topics: Bibliometrics; Network Meta-Analysis; Publications; United States
PubMed: 33941172
DOI: 10.1186/s12911-021-01470-5 -
Journal of Comparative Effectiveness... Jul 2020To illustrate that bias associated with indirect treatment comparison and network meta-analyses can be reduced by adjusting for outcomes on common reference arms.... (Review)
Review
To illustrate that bias associated with indirect treatment comparison and network meta-analyses can be reduced by adjusting for outcomes on common reference arms. Approaches to adjusting for reference-arm effects are presented within a causal inference framework. Bayesian and Frequentist approaches are applied to three real data examples. Reference-arm adjustment can significantly impact estimated treatment differences, improve model fit and align indirectly estimated treatment effects with those observed in randomized trials. Reference-arm adjustment can possibly reverse the direction of estimated treatment effects. Accumulating theoretical and empirical evidence underscores the importance of adjusting for reference-arm outcomes in indirect treatment comparison and network meta-analyses to make full use of data and reduce the risk of bias in estimated treatments effects.
Topics: Bayes Theorem; Bias; Delivery of Health Care; Humans; Meta-Analysis as Topic; Models, Theoretical; Network Meta-Analysis; Research Design; Treatment Outcome
PubMed: 32490682
DOI: 10.2217/cer-2020-0042 -
Clinical Trials (London, England) Oct 2022Adaptive platform trials allow randomized controlled comparisons of multiple treatments using a common infrastructure and the flexibility to adapt key design features... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Adaptive platform trials allow randomized controlled comparisons of multiple treatments using a common infrastructure and the flexibility to adapt key design features during the study. Nonetheless, they have been criticized due to the potential for time trends in the underlying risk level of the population. Such time trends lead to confounding between design features and risk level, which may introduce bias favoring one or more treatments. This is particularly true when experimental treatments are not all randomized during the same time period as the control, leading to the potential for bias from non-concurrent controls.
METHODS
Two analysis methods addressing this bias are stratification and adjustment. Stratification uses only comparisons between treatment cohorts randomized during identical time periods and does not use non-concurrent randomizations. Adjustment uses a modeled analysis including time period adjustment, allowing all data to be used, even from periods without concurrent randomization. We show that these competing approaches may be embedded in a common framework using network meta-analysis principles. We interpret the stages between adaptations in a platform trial as separate fixed design trials. This allows platform trials to be viewed as networks of direct randomized comparisons and indirect non-randomized comparisons. Network meta-analysis methodology can be re-purposed to aggregate the total information from a platform trial and to transparently decompose this total information into direct randomized evidence and indirect non-randomized evidence. This allows sensitivity to indirect information to be assessed and the two analysis methods to be clearly compared.
RESULTS
Simulations of platform trials were analyzed using a network approach implemented in the netmeta package in R. The results demonstrated bias of unadjusted methods in the presence of time trends in risk level. Adjustment and stratification were both unbiased when direct evidence and indirect evidence were consistent. Network tests of inconsistency may be used to diagnose inconsistency when it exists. In an illustrative network analysis of one of the treatment comparisons from the STAMPEDE platform trial in metastatic prostate cancer, indirect comparisons using non-concurrent controls were inconsistent with the information from direct randomized comparisons. This supports the primary analysis approach of STAMPEDE, which used only direct randomized comparisons.
CONCLUSION
Network meta-analysis provides a natural methodology for analyzing the network of direct and indirect treatment comparisons from a platform trial. Such analyses provide transparent separation of direct and indirect evidence, allowing assessment of the impact of non-concurrent controls. We recommend time-stratified analysis of concurrently controlled comparisons for primary analyses, with time-adjusted analyses incorporating non-concurrent controls reserved for secondary analyses. However, regardless of which methodology is used, a network analysis provides a useful supplement to the primary analysis.
Topics: Bias; Humans; Male; Network Meta-Analysis; Randomized Controlled Trials as Topic; Research Design
PubMed: 35993542
DOI: 10.1177/17407745221112001