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BMJ Open Dec 2023The review aims to conduct the first network meta-analysis to comprehensively evaluate the application of multiple acupuncture techniques in patients with postmenopausal...
INTRODUCTION
The review aims to conduct the first network meta-analysis to comprehensively evaluate the application of multiple acupuncture techniques in patients with postmenopausal osteoporosis, ranking the best acupuncture treatment and providing a reference for clinical treatment extensively.
METHODS AND ANALYSIS
Randomised controlled trials of different acupuncturerelated therapies for postmenopausal osteoporosis will be searched in the following databases from 1 January 2002 to 31 December 2022, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database and China Biomedical Literature Database. Overall, clinical efficacy rate, bone mineral density and a Visual Analogue Scale score are used as the primary outcome indicators. In addition, the secondary outcome indicator is adverse reactions. The entire screening process will be conducted by two independent investigators; meanwhile, Stata (V.14.0) and RevMan (V.5.4) will be used to conduct the network meta-analysis. If the data are permissible and feasible, we will also perform meta-regression and subgroup analyses to address the underlying causes of data inconsistency and heterogeneity in the statistical analyses. Besides, to improve the credibility of this network meta-analysis, we will evaluate the quality of evidence in this research according to the GRADE assessment.
ETHICS AND DISSEMINATION
Ethics approval is not required for network meta-analyses, which do not involve animals' or people's welfare. The results of this network meta-analysis will be submitted to a recognised journal for publication.
PROSPERO REGISTRATION NUMBER
CRD42023401003.
Topics: Female; Humans; Acupuncture Therapy; Bayes Theorem; Meta-Analysis as Topic; Network Meta-Analysis; Osteoporosis, Postmenopausal; Research Design; Systematic Reviews as Topic
PubMed: 38159952
DOI: 10.1136/bmjopen-2023-074740 -
PLoS Biology Jan 2016In growing recognition of the importance of how scientific research is designed, performed, communicated, and evaluated, PLOS Biology announces a broadening of its scope...
In growing recognition of the importance of how scientific research is designed, performed, communicated, and evaluated, PLOS Biology announces a broadening of its scope to cover meta-research articles.
Topics: Biology; Meta-Analysis as Topic
PubMed: 26727031
DOI: 10.1371/journal.pbio.1002334 -
BMJ Open Oct 2021Perinatal depression is common and can often lead to adverse health outcomes for mother and child. Multiple pharmacological and non-pharmacological treatments have been...
INTRODUCTION
Perinatal depression is common and can often lead to adverse health outcomes for mother and child. Multiple pharmacological and non-pharmacological treatments have been evaluated against usual care or placebo controls in meta-analyses for preventing and treating perinatal depression compared. It is not yet established which of these candidate treatments might be the optimal approach for prevention or treatment.
METHODS AND ANALYSIS
A systematic review and Bayesian network meta-analyses will be conducted. Eight electronic databases shall be searched for randomised controlled trials that have evaluated the effectiveness of treatments for prevention and/or treatment of perinatal depression. Screening of articles shall be conducted by two reviewers independently. One network meta-analysis shall evaluate the effectiveness of interventions in preventing depression during the perinatal period. A second network meta-analysis shall compare the effectiveness of treatments for depression symptoms in women with perinatal depression. Bayesian 95% credible intervals shall be used to estimate the pooled mean effect size of each treatment, and surface under cumulative ranking area will be used to rank the treatments' effectiveness.
ETHICS AND DISSEMINATION
We shall report our findings so that healthcare providers can make informed decisions on what might be the optimal approach for addressing perinatal depression to prevent cases and improve outcomes in those suffering from depression through knowledge exchange workshops, international conference presentations and journal article publications.
PROSPERO REGISTRATION NUMBER
CRD42020200081.
Topics: Bayes Theorem; Child; Depression; Depressive Disorder; Female; Humans; Meta-Analysis as Topic; Network Meta-Analysis; Pregnancy; Systematic Reviews as Topic; Treatment Outcome
PubMed: 34635517
DOI: 10.1136/bmjopen-2021-048764 -
Annals of Medicine 2023At present, there are some randomized controlled trials (RCTs) of oral small molecule drugs. The purpose of this study was to evaluate the efficacy and safety of oral... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
At present, there are some randomized controlled trials (RCTs) of oral small molecule drugs. The purpose of this study was to evaluate the efficacy and safety of oral small molecule drug treatment for COVID-19.
METHODS
RCTs were identified through systematic searches of PubMed, Embase, and Cochrane Central Register of Controlled Trials through 1 April 2023. A total of nine RCTs were included, including 30,970 COVID-19 patients comparing five treatments (azvudine, molnupiravir, paxlovid, VV116, and placebo). The Cochrane risk of bias tool for randomized trials (RoB) was used to assess the bias risk of the included studies. The direct and indirect evidence were combined using a Bayesian network meta-analysis (PROSPERO Code No: CRD42023397837).
RESULTS
Direct analysis showed that paxlovid was associated with a reduced risk of mortality (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.06-0.25) and hospitalization (OR = 0.04, 95% CI: 0.00-0.67) compared with placebo. Network meta-analysis showed that paxlovid had the highest probability of being the best management strategy in patients with COVID-19, reducing mortality (OR = 0.11, 95% CI: 0.01-1.99; surface under the cumulative ranking curve [SUCRA]: 0.77) and hospitalization (OR = 0.06, 95% CI: 0.00-1.03; SUCRA: 0.95). For prespecified safety outcomes, SUCRA values ranked VV116 (OR = 0.09, 95% CI: 0.00-2.07: SUCRA 0.86) as the most beneficial intervention for the prevention of serious adverse events.
CONCLUSIONS
When compared to other antiviral medications, paxlovid can reduce the mortality and hospitalization of COVID-19 patients.
Topics: Humans; COVID-19; Network Meta-Analysis
PubMed: 37967171
DOI: 10.1080/07853890.2023.2274511 -
BMJ (Clinical Research Ed.) Mar 2024To synthesise evidence of the effectiveness of community based complex interventions, grouped according to their intervention components, to sustain independence for... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To synthesise evidence of the effectiveness of community based complex interventions, grouped according to their intervention components, to sustain independence for older people.
DESIGN
Systematic review and network meta-analysis.
DATA SOURCES
Medline, Embase, CINAHL, PsycINFO, CENTRAL, clinicaltrials.gov, and International Clinical Trials Registry Platform from inception to 9 August 2021 and reference lists of included studies.
ELIGIBILITY CRITERIA
Randomised controlled trials or cluster randomised controlled trials with ≥24 weeks' follow-up studying community based complex interventions for sustaining independence in older people (mean age ≥65 years) living at home, with usual care, placebo, or another complex intervention as comparators.
MAIN OUTCOMES
Living at home, activities of daily living (personal/instrumental), care home placement, and service/economic outcomes at 12 months.
DATA SYNTHESIS
Interventions were grouped according to a specifically developed typology. Random effects network meta-analysis estimated comparative effects; Cochrane's revised tool (RoB 2) structured risk of bias assessment. Grading of recommendations assessment, development and evaluation (GRADE) network meta-analysis structured certainty assessment.
RESULTS
The review included 129 studies (74 946 participants). Nineteen intervention components, including "multifactorial action from individualised care planning" (a process of multidomain assessment and management leading to tailored actions), were identified in 63 combinations. For living at home, compared with no intervention/placebo, evidence favoured multifactorial action from individualised care planning including medication review and regular follow-ups (routine review) (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty); multifactorial action from individualised care planning including medication review without regular follow-ups (2.55, 0.61 to 10.60; low certainty); combined cognitive training, medication review, nutritional support, and exercise (1.93, 0.79 to 4.77; low certainty); and combined activities of daily living training, nutritional support, and exercise (1.79, 0.67 to 4.76; low certainty). Risk screening or the addition of education and self-management strategies to multifactorial action from individualised care planning and routine review with medication review may reduce odds of living at home. For instrumental activities of daily living, evidence favoured multifactorial action from individualised care planning and routine review with medication review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living: combined activities of daily living training, aids, and exercise; and combined activities of daily living training, aids, education, exercise, and multifactorial action from individualised care planning and routine review with medication review and self-management strategies. For personal activities of daily living, evidence favoured combined exercise, multifactorial action from individualised care planning, and routine review with medication review and self-management strategies (0.16, -0.51 to 0.82; low certainty). For homecare recipients, evidence favoured addition of multifactorial action from individualised care planning and routine review with medication review (0.60, 0.32 to 0.88; low certainty). High risk of bias and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty.
CONCLUSIONS
The intervention most likely to sustain independence is individualised care planning including medicines optimisation and regular follow-up reviews resulting in multifactorial action. Homecare recipients may particularly benefit from this intervention. Unexpectedly, some combinations may reduce independence. Further research is needed to investigate which combinations of interventions work best for different participants and contexts.
REGISTRATION
PROSPERO CRD42019162195.
Topics: Humans; Aged; Activities of Daily Living; Network Meta-Analysis
PubMed: 38514079
DOI: 10.1136/bmj-2023-077764 -
Addiction Biology Mar 2024A network meta-analysis (NMA) including randomized controlled trials (RCTs) was conducted to evaluate the effects of different interventions on smoking cessation.... (Meta-Analysis)
Meta-Analysis
A network meta-analysis (NMA) including randomized controlled trials (RCTs) was conducted to evaluate the effects of different interventions on smoking cessation. Studies were collected from online databases including PubMed, EMBASE, Cochrane Library, and Web of Science based on inclusion and exclusion criteria. Eligible studies were further examined in the NMA to compare the effect of 14 interventions on smoking cessation. Thirty-four studies were examined in the NMA, including a total of 14 interventions and 28 733 participants. The results showed that health education (HE; odds ratio ([OR] = 200.29, 95% CI [1.62, 24 794.61])), other interventions (OI; OR = 29.79, 95% CI [1.07, 882.17]) and multimodal interventions (MUIs; OR = 100.16, 95% CI [2.06, 4867.24]) were better than self-help material (SHM). HE (OR = 243.31, 95% CI [1.39, 42531.33]), MUI (OR = 121.67, 95% CI [1.64, 9004.86]) and financial incentive (FI; OR = 14.09, 95% CI [1.21, 164.31]) had positive effects on smoking cessation rate than smoking cessation or quitting APP (QA). Ranking results showed that HE (83.6%) and motivation interviewing (MI; 69.6%) had better short-term effects on smoking cessation. HE and MUI provided more smoking cessation benefits than SHM and QA. FI was more effective at quitting smoking than QA. Also, HE and MI were more likely to be optimal smoking cessation interventions.
Topics: Humans; Smoking Cessation; Network Meta-Analysis; Smoking; Tobacco Use Cessation Devices; Behavior Therapy
PubMed: 38488699
DOI: 10.1111/adb.13376 -
Psychological Medicine Oct 2023Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis.
METHODS
Randomized controlled trials of outcomes of TBIs face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis.
RESULTS
Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions ( = 0.16, ≤ 0.0001) and to specific outcomes, namely, neurocognition ( = 0.13, ≤ 0.0001), functioning ( = 0.25, = 0.006), and social cognition ( = 0.32, ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [ = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life ( = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology.
CONCLUSIONS
TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.
Topics: Humans; Network Meta-Analysis; Quality of Life; Psychotic Disorders
PubMed: 36472150
DOI: 10.1017/S0033291722003610 -
Psychotherapy and Psychosomatics 2023Many psychological interventions aim to prevent suicide, but there is limited information regarding their comparative effectiveness. (Meta-Analysis)
Meta-Analysis
Effectiveness of Psychotherapy on Prevention of Suicidal Re-Attempts in Psychiatric Emergencies: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
INTRODUCTION
Many psychological interventions aim to prevent suicide, but there is limited information regarding their comparative effectiveness.
OBJECTIVES
We conducted a systematic review and network meta-analysis to evaluate the relative effects of psychological interventions for preventing suicide re-attempts in psychiatric emergencies.
METHODS
We searched PubMed, Embase, Cochrane, and PsycINFO from inception to December 1, 2022. Selection and data extraction were conducted independently by two reviewers based on prespecified criteria. We evaluated the efficacy of interventions, potential effect moderators, and study quality both within individual studies and across studies. Global and local inconsistencies and publication bias were explored. The primary outcome was suicide re-attempt rate. The network meta-analysis was conducted using the "netmeta" package in R. The protocol was registered with PROSPERO (CRD42021291407).
RESULTS
There were 3,155 participants from 26 randomized controlled trials included in the network meta-analysis. Cognitive behavioral therapy (CBT) was the only intervention that was more effective than a common comparator for reducing suicide re-attempts among psychological interventions in both direct and indirect comparisons (odds ratio: [95% confidence interval], 0.46 [0.25-0.85] vs. 0.47 [0.27-0.83]). CBT had the highest score (p score = 0.8727) across the various psychological interventions. Neither global nor local inconsistencies were significant. There was no clear evidence of violations of the transitivity assumption when comparing characteristics of studies across interventions. Publication bias was not suspected for the primary outcome.
CONCLUSIONS
CBT may be regarded as a reasonable first-line psychological intervention to prevent re-attempts among people with previous suicide attempts. We observed a moderate quality of evidence supporting an 87% probability of CBT being the best treatment available for preventing suicide re-attempts.
Topics: Humans; Suicidal Ideation; Network Meta-Analysis; Emergencies; Randomized Controlled Trials as Topic; Psychotherapy
PubMed: 37015209
DOI: 10.1159/000529753 -
Efficacy of acupuncture therapies on pressure injury: A systematic review and network meta-analysis.Asian Journal of Surgery Nov 2023
Meta-Analysis
Topics: Humans; Acupuncture Therapy; Network Meta-Analysis; Pressure Ulcer
PubMed: 37537068
DOI: 10.1016/j.asjsur.2023.07.009 -
BMC Medical Research Methodology Jun 2023Network meta-analysis (NMA) allows estimating and ranking the effects of several interventions for a clinical condition. Component network meta-analysis (CNMA) is an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Network meta-analysis (NMA) allows estimating and ranking the effects of several interventions for a clinical condition. Component network meta-analysis (CNMA) is an extension of NMA which considers the individual components of multicomponent interventions. CNMA allows to "reconnect" a disconnected network with common components in subnetworks. An additive CNMA assumes that component effects are additive. This assumption can be relaxed by including interaction terms in the CNMA.
METHODS
We evaluate a forward model selection strategy for component network meta-analysis to relax the additivity assumption that can be used in connected or disconnected networks. In addition, we describe a procedure to create disconnected networks in order to evaluate the properties of the model selection in connected and disconnected networks. We apply the methods to simulated data and a Cochrane review on interventions for postoperative nausea and vomiting in adults after general anaesthesia. Model performance is compared using average mean squared errors and coverage probabilities.
RESULTS
CNMA models provide good performance for connected networks and can be an alternative to standard NMA if additivity holds. For disconnected networks, we recommend to use additive CNMA only if strong clinical arguments for additivity exist.
CONCLUSIONS
CNMA methods are feasible for connected networks but questionable for disconnected networks.
Topics: Adult; Humans; Network Meta-Analysis; Computer Simulation; Probability; Records
PubMed: 37316775
DOI: 10.1186/s12874-023-01959-9