-
International Journal of Radiation... May 2021Dose escalation improves localized prostate cancer disease control, and moderately hypofractionated external beam radiation is noninferior to conventional fractionation....
PURPOSE
Dose escalation improves localized prostate cancer disease control, and moderately hypofractionated external beam radiation is noninferior to conventional fractionation. The evolving treatment approach of ultrahypofractionation with stereotactic body radiation therapy (SBRT) allows possible further biological dose escalation (biologically equivalent dose [BED]) and shortened treatment time.
METHODS AND MATERIALS
The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiation Therapy/SBRT included a subgroup to study the prostate tumor control probability (TCP) with SBRT. We performed a systematic review of the available literature and created a dose-response TCP model for the endpoint of freedom from biochemical relapse. Results were stratified by prostate cancer risk group.
RESULTS
Twenty-five published cohorts were identified for inclusion, with a total of 4821 patients (2235 with low-risk, 1894 with intermediate-risk, and 446 with high-risk disease, when reported) treated with a variety of dose/fractionation schemes, permitting dose-response modeling. Five studies had a median follow-up of more than 5 years. Dosing regimens ranged from 32 to 50 Gy in 4 to 5 fractions, with total BED (α/β = 1.5 Gy) between 183.1 and 383.3 Gy. At 5 years, we found that in patients with low-intermediate risk disease, an equivalent doses of 2 Gy per fraction (EQD2) of 71 Gy (31.7 Gy in 5 fractions) achieved a TCP of 90% and an EQD2 of 90 Gy (36.1 Gy in 5 fractions) achieved a TCP of 95%. In patients with high-risk disease, an EQD2 of 97 Gy (37.6 Gy in 5 fractions) can achieve a TCP of 90% and an EQD2 of 102 Gy (38.7 Gy in 5 fractions) can achieve a TCP of 95%.
CONCLUSIONS
We found significant variation in the published literature on target delineation, margins used, dose/fractionation, and treatment schedule. Despite this variation, TCP was excellent. Most prescription doses range from 35 to 40 Gy, delivered in 4 to 5 fractions. The literature did not provide detailed dose-volume data, and our dosimetric analysis was constrained to prescription doses. There are many areas in need of continued research as SBRT continues to evolve as a treatment modality for prostate cancer, including the durability of local control with longer follow-up across risk groups, the efficacy and safety of SBRT as a boost to intensity modulated radiation therapy (IMRT), and the impact of incorporating novel imaging techniques into treatment planning.
Topics: Dose-Response Relationship, Radiation; Humans; Linear Models; Male; Models, Biological; Models, Theoretical; Probability; Prostatic Neoplasms; Radiation Dose Hypofractionation; Radiosurgery; Relative Biological Effectiveness; Risk; Time Factors; Treatment Outcome; Urethra
PubMed: 32900561
DOI: 10.1016/j.ijrobp.2020.08.014 -
The Australian and New Zealand Journal... Oct 2015Depression has been identified as a priority disorder among children and adolescents. While numerous reviews have examined the individual and family factors that... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Depression has been identified as a priority disorder among children and adolescents. While numerous reviews have examined the individual and family factors that contribute to child and adolescent depressive symptoms, less is known about community-level risk and protective factors. The aim of this study was to complete a systematic review to identify community risk and protective factors for depression in school-aged children (4-18 years).
METHOD
The review adopted the procedures recommended by the Cochrane Non-Randomised Studies Methods Working Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted to identify both observational and intervention study designs in both peer-reviewed and non-peer reviewed publications.
RESULTS
A total of 21 studies met the inclusion criteria. Seventeen of the 18 community association studies and 2 of the 3 intervention studies reported one or more significant effects. Results indicated that community safety and community minority ethnicity and discrimination act as risk factors for depressive symptoms in school-aged children. Community disadvantage failed to achieve significance in meta-analytic results but findings suggest that the role of disadvantage may be influenced by other factors. Community connectedness was also not directly associated with depressive symptoms.
CONCLUSION
There is evidence that a number of potentially modifiable community-level risk and protective factors influence child and adolescent depressive symptoms suggesting the importance of continuing research and intervention efforts at the community-level.
Topics: Adolescent; Child; Child, Preschool; Depression; Humans; Protective Factors; Residence Characteristics; Risk Factors
PubMed: 26416916
DOI: 10.1177/0004867415603129 -
European Review For Medical and... Feb 2021The drugs used in Europe to treat episodic cluster headache (eCH) are mainly verapamil and lithium carbonate, even though topiramate and pizotifen can be used....
OBJECTIVE
The drugs used in Europe to treat episodic cluster headache (eCH) are mainly verapamil and lithium carbonate, even though topiramate and pizotifen can be used. Galcanezumab, a humanized monoclonal antibody was approved by FDA recently for prophylaxis treatment of eCH. In order to evaluate the efficacy of galcanezumab compared to the drugs used for the preventive treatment of eCH, a systematic literature review (SLR) and network meta-analysis (NMA) of only randomized controlled trials (RCTs) was performed.
MATERIALS AND METHODS
A literature search in MEDLINE, Embase and Cochrane Library including RCTs and observational studies was conducted. The primary outcomes for the NMA included the main change from baseline in reducing ECH attacks while the percentage of responders was used to pairwise comparisons of the observational studies. The NMA was conducted using a fixed-effect model and a random-effects model with deviance information criterion (DIC) reported for both models. The surface under the cumulative ranking (SUCRA) was shown only for the model with the lower DIC.
RESULTS
Three RCTs and six observational studies were included in the SLR. The Bayesian NMA was performed on the two RCTs included in the SLR, specifically galcanezumab and verapamil studies. SUCRA indicated that galcanezumab had the highest probability of being the most effective treatment (probability = 66.33%) compared to verapamil (probability = 31.58%) and placebo (probability = 2.09%). Galcanezumab was also the treatment with the highest overall probability to be the second most effective (probability = 88.79%).
CONCLUSIONS
The results suggest that galcanezumab is more effective compared to verapamil as a prophylaxis treatment for reducing eCH attacks in adults. Further, head-to-head RCTs of galcanezumab vs. treatments using in clinical practice are needed to better assess its comparative efficacy and benefit-risk profile.
Topics: Bayes Theorem; Cluster Headache; Humans; Network Meta-Analysis
PubMed: 33629333
DOI: 10.26355/eurrev_202102_24874 -
BMJ (Clinical Research Ed.) Feb 2015To assess the effectiveness and safety of prostaglandins used for labour induction. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the effectiveness and safety of prostaglandins used for labour induction.
DESIGN
Systematic review with Bayesian network meta-analysis
DATA SOURCES
The Cochrane Pregnancy and Childbirth Group's Database of Trials (which incorporates the results of a broad generic search for all pregnancy and postpartum trials). Sources included are CENTRAL, Medline, Embase, NHS Economic Evaluation Database, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised clinical trials of prostaglandin or prostaglandin analogues used for third trimester cervical ripening or labour induction versus placebo or no treatment, alternative prostaglandin dose or administration, or a different type of prostaglandin. We included studies recruiting women with a viable fetus, but had no other restrictions relating to indication for labour induction or language of publication. Outcomes assessed were serious neonatal morbidity (trialist defined) or perinatal death; serious maternal morbidity (trialist defined) or death; vaginal delivery not achieved within 24 hours, caesarean section, and uterine hyperstimulation with fetal heart rate changes.
RESULTS
280 randomised clinical trials were included (48 068 women) in the review. Maternal and neonatal mortality and serious morbidity were rarely reported and are summarized narratively. Unresolved inconsistency was observed for the hyperstimulation outcome. Relative to placebo, the odds of failing to achieve a vaginal delivery were lowest for vaginal misoprostol (≥50 µg) (odds ratio 0.06 (95% credible interval 0.02 to 0.12)), with a 39% absolute probability of event (95% credible interval 1% to 94%). Compared with placebo, odds of caesarean section were lowest for titrated oral misoprostol solution (<50 µg) (odds ratio 0.65 (0.49 to 0.83)), with an absolute probability of event of 15% (3% to 40%).
CONCLUSIONS
Low dose(<50 µg) titrated oral misoprostol solution had the lowest probability of caesarean section, whereas vaginal misprostol (≥50 µg) had the highest probability of achieving a vaginal delivery within 24 hours. These findings have important implications for a series of current national and international guidelines for induction of labour and future research in this area.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO 2013:CRD42013005116.
Topics: Bayes Theorem; Dose-Response Relationship, Drug; Female; Humans; Infant, Newborn; Labor, Induced; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prostaglandins
PubMed: 25656228
DOI: 10.1136/bmj.h217 -
International Journal of Molecular... Jul 2016Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk... (Review)
Review
Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk and mortality. The aims of this systematic review are to (1) describe diet quality scores used in cohort or cross-sectional research examining cancer outcomes; and (2) describe associations between diet quality scores and cancer risk and mortality. The protocol was registered in Prospero, and a systematic search using six electronic databases was conducted through to December 2014. Records were assessed for inclusion by two independent reviewers, and quality was evaluated using a validated tool. Sixty-four studies met inclusion criteria from which 55 different diet quality scores were identified. Of the 35 studies investigating diet quality and cancer risk, 60% (n = 21) found a positive relationship. Results suggest no relationship between diet quality scores and overall cancer risk. Inverse associations were found for diet quality scores and risk of postmenopausal breast, colorectal, head, and neck cancer. No consistent relationships between diet quality scores and cancer mortality were found. Diet quality appears to be related to site-specific adult cancer risk. The relationship with cancer mortality is less conclusive, suggesting additional factors impact overall cancer survival. Development of a cancer-specific diet quality score for application in prospective epidemiology and in public health is warranted.
Topics: Databases, Factual; Diet; Epidemiologic Studies; Humans; Neoplasms; Odds Ratio; Proportional Hazards Models; Risk Factors
PubMed: 27399671
DOI: 10.3390/ijms17071052 -
Age and Ageing Jan 2018light-to-moderate alcohol consumption is protective against all-cause mortality and cardiovascular diseases. There is limited evidence in the literature on how alcohol... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
light-to-moderate alcohol consumption is protective against all-cause mortality and cardiovascular diseases. There is limited evidence in the literature on how alcohol consumption is related to frailty.
METHODS
five databases (Embase, Scopus, MEDLINE, CINAHL, PsycINFO) were systematically searched in July 2016 for prospective studies published between 2000 and 2016 examining baseline alcohol consumption and subsequent frailty risk among middle-aged or older community-dwelling population. Odds ratios (ORs) for incident frailty were pooled using a random-effects model. Heterogeneity, methodological quality and publication bias were assessed.
RESULTS
of 926 studies identified by the systematic search, four studies were included (total n = 44,051, ≥55 years, 66.2% alcohol users). OR of incident frailty for the highest (at least 24 g of alcohol/day for men, 12g of alcohol/day for women) or the most frequent (≥5 days of drinking/week) alcohol consumption compared with no drinking were used for a meta-analysis. Pooled OR among three studies measuring alcohol consumption quantitatively showed that the highest alcohol consumption was associated with lower frailty risk (3 studies:pooled OR = 0.44, 95%CI = 0.19-1.00, P = 0.05). Adding the other study measuring frequency of alcohol consumption made little change (4 studies:pooled OR = 0.61, 95%CI = 0.44-0.77, P < 0.001). Two of the included studies suggested a possible U-shaped association with lowest risks for moderate drinkers. Heterogeneity was moderate in both analyses (I2 = 52-67%). There was no evidence of publication bias.
CONCLUSIONS
this systematic review and meta-analysis study provides the first pooled evidence suggesting that heavier alcohol consumption is associated with lower incident frailty compared with no alcohol consumption among community-dwelling middle-aged and older people. However, this association may be due to unadjusted effect measures, residual confounding, 'sick quitter' effect or survival bias.
Topics: Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Chi-Square Distribution; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Incidence; Logistic Models; Male; Middle Aged; Odds Ratio; Prognosis; Prospective Studies; Protective Factors; Risk Assessment; Risk Factors; Time Factors
PubMed: 28541395
DOI: 10.1093/ageing/afx086 -
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 -
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 Aug 2021Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However,... (Meta-Analysis)
Meta-Analysis
CONTEXT
Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However, previous reviews mainly focused on general adult populations.
OBJECTIVE
The aim of this systematic review and meta-analysis was to explore the association between healthy dietary patterns and depression risk in older adults.
DATA SOURCES
Eight databases were searched up to September 2019. The inclusion criteria were older adults aged ≥ 65 years, healthy dietary patterns, depression assessed by a physician or by validated screening tools, and quantitative study design.
DATA EXTRACTION
Data were extracted independently by 2 researchers, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed.
DATA ANALYSIS
Meta-analysis was conducted by calculating the pooled odds ratio (OR) and 95% CIs. A total of 18 eligible studies were meta-analyzed. Results showed that a healthy dietary pattern is associated with a reduced risk of depression in older adults (OR, 0.85; 95%CI, 0.78-0.92; P < 0.001). There was high heterogeneity (I2 = 64.9%; P < 0.001) among the studies. Subgroup analyses indicated that sample size and depression screening tools were the main sources of study heterogeneity.
CONCLUSIONS
An inverse association between healthy dietary patterns and depression risk in older adults was found. However, the high heterogeneity among the studies should be considered.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration no. CRD 42020169195.
Topics: Aged; Depression; Diet; Humans; Odds Ratio; Risk Factors
PubMed: 33236111
DOI: 10.1093/nutrit/nuaa118 -
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