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European Journal of Radiology Jan 2024In children with ileocolic intussusception, sedatives such as midazolam, ketamine and propofol may facilitate radiologic enema reduction, but studies on their separate... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In children with ileocolic intussusception, sedatives such as midazolam, ketamine and propofol may facilitate radiologic enema reduction, but studies on their separate and joint effects remain controversial.
OBJECTIVES
We aimed to systematically analyze studies for the effects of sedatives on the radiologic reduction of ileocolic intussusception in children.
METHODS
We searched PubMed, EMBASE, CINAHL, Scopus and Web of Science from database inception through March 2023 for articles that enrolled children with ileocolic intussusception who underwent non-operative pneumatic or hydrostatic enema reduction under ultrasound or fluoroscopic guidance with or without the use of sedatives. The primary and secondary outcomes were success rate in radiologic reduction of ileocolic intussusception and risk of perforation, respectively. Effect estimates from the individual studies were extracted and combined using the Hartung-Knapp-Sidik-Jonkman log-odds random-effects model. Heterogeneity between studies was checked using Cochran's Q test and the I statistic.
RESULTS
A total of 17 studies with 2094 participants were included in the final review, of which 15 were included in the meta-analysis. Nine studies reported on the success rate of radiologic reduction performed under sedation in all participants, while six studies compared the success rate in two patient groups undergoing the procedure with or without sedation. The pooled success rate of non-operative reduction under sedation was 87 % (95 % CI: 80-95 %), P = 0.000 with considerable heterogeneity (I = 85 %). A higher success rate of 94 % (95 % CI: 88-99 %) and homogeneity (I = 12 %) were found in studies with pneumatic enema reduction. Among comparative studies, the odds of success of non-operative reduction were increased when the procedure was performed under sedation, with a pooled odds ratio of 2.41 (95 % CI: 1.27-4.57), P = 0.010 and moderate heterogeneity (I = 60 %). In a sensitivity analysis, homogeneity was found between analyzed studies when two outliers were excluded (I = 0.73 %). The risk of perforation was not significantly different (OR 1.52, 95 % CI: 0.09-23.34), P = 0.764 indicating small study effects. No publication, bias was detected on visual inspection of the funnel plots or the Begg's and Egger's bias tests. Most studies were categorized as having a low risk of bias using Joanna Briggs Institute checklists.
CONCLUSIONS
In selected patient groups, sedation can increase the success rate of radiologic enema reduction in children with ileocolic intussusception without evidence of increased risk of perforation. Systematic review protocol registration: PROSPERO CRD42023404887.
Topics: Child; Humans; Infant; Enema; Hypnotics and Sedatives; Ileal Diseases; Intussusception; Propofol; Retrospective Studies
PubMed: 38039783
DOI: 10.1016/j.ejrad.2023.111237 -
Biological Psychiatry Global Open... Jan 2024Inner retinal atrophy has been demonstrated in schizophrenia spectrum disorder (SSD) using optical coherence tomography (OCT). This systematic review and meta-analysis...
BACKGROUND
Inner retinal atrophy has been demonstrated in schizophrenia spectrum disorder (SSD) using optical coherence tomography (OCT). This systematic review and meta-analysis investigated the role of contemporary Fourier domain OCT devices in SSD.
METHODS
MEDLINE, PubMed, Scopus, Embase, PsycInfo, PYSNDEX, World Health Organization, and Cochrane databases were searched from inception until May 2022. All peer-reviewed adult SSD case-control studies using Fourier domain OCT were included. Ocular pathologies known to affect retinal OCT scans were excluded. Search, data appraisal, and summary data extraction were independently performed by 2 authors.
RESULTS
The review criteria was met by k = 36 studies, with k = 24 studies (1074 cases, 854 controls) suitable for meta-analysis. The SSD group exhibited a thinner global peripapillary retinal nerve fiber layer (-3.26 μm, 95% CI, -5.07 to -1.45, = 64%, k = 21), thinner average macular layer (-7.88 μm, 95% CI, -12.73 to -3.04, = 65%, k = 11), and thinner macular ganglion cell-inner plexiform sublayer (-2.44 μm, 95% CI, -4.13 to -0.76, = 30%, k = 8) compared with the control group. Retinal nerve fiber layer findings remained significant after exclusion of metabolic disease, low quality, outlier, and influential studies. Studies involving eye examinations to exclude eye disease were associated with greater atrophy in SSD. Except for cardiometabolic disease, most studies did not report clinically significant covariate data known to influence retinal thickness.
CONCLUSIONS
Individuals with SSD generally exhibited retinal atrophy, possibly paralleling reduced brain volumes documented in clinical imaging. Prospective longitudinal studies that collect clinical data, including various illness phases, and control for confounders will be necessary to evaluate retinal atrophy as a biomarker in SSD.
PubMed: 38021252
DOI: 10.1016/j.bpsgos.2023.08.013 -
JAMA Psychiatry Jan 2024Variables such as severe symptoms, comorbidity, and sociodemographic characteristics (eg, low educational attainment or unemployment) are associated with a poorer... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Variables such as severe symptoms, comorbidity, and sociodemographic characteristics (eg, low educational attainment or unemployment) are associated with a poorer prognosis in adults treated for depressive symptoms. The exclusion of patients with a poor prognosis from RCTs is negatively associated with the generalizability of research findings.
OBJECTIVE
To compare the prognostic risk factors (PRFs) in patient samples of RCTs of face-to-face therapy (FTF) and internet-based therapy (IBT) for depression.
DATA SOURCES
PsycINFO, Cochrane CENTRAL, and reference lists of published meta-analyses were searched from January 1, 2000, to December 31, 2021.
STUDY SELECTION
RCTs that compared FTF (individual or group therapy) and IBT (guided or self-guided interventions) against a control (waitlist or treatment as usual) in adults with symptoms of depression were included.
DATA EXTRACTION AND SYNTHESIS
Data were extracted by 2 independent observers. The Cochrane revised risk-of-bias tool was used to assess the risk of bias. The study was preregistered with OSF Registries and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
The primary outcome was the standardized mean difference (Hedges g effect size) in depressive symptoms at treatment termination (assessed with standard patient self-report questionnaires), with a positive standardized mean difference indicating larger improvements in the intervention compared with those in the control group. Meta-regression analyses were adjusted for the type of control group. Three preregistered and 2 exploratory sensitivity analyses were conducted. A prognostic risk index (PROG) was created that calculated the sum of 12 predefined individual indicators, with scores ranging from 0 to 12 and higher scores indicating that a sample comprised patients with poorer prognoses.
RESULTS
This systematic review and meta-regression analysis identified 105 eligible RCTs that comprised 18 363 patients. In total, 48 studies (46%) examined FTF, and 57 studies (54%) examined IBT. The PROG was significantly higher in the RCTs of FTF than in the RCTs of IBT (FTF: mean [SD], 3.55 [1.75]; median [IQR], 3.5 [2.0-4.5]; IBT: mean [SD], 2.27 [1.66]; median [IQR], 2.0 [1.0-3.5]; z = -3.68, P < .001; Hedges g = 0.75; 95% CI, 0.36-1.15). A random-effects meta-regression analysis found no association of the PROG with the effect size. Sensitivity analyses with outliers excluded and accounting for risk of bias or small-study effects yielded mixed results on the association between the PROG and effect size.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review and meta-regression analysis suggest that samples of RCTs of FTF vs IBT differ with regard to PRFs. These findings have implications for the generalizability of the current evidence on IBT for depression. More RCTs of internet-based interventions with clinically representative samples are needed, and the reporting of PRFs must be improved.
Topics: Adult; Humans; Depression; Internet; Prognosis; Psychotherapy; Randomized Controlled Trials as Topic; Regression Analysis; Risk Factors
PubMed: 37819635
DOI: 10.1001/jamapsychiatry.2023.3861 -
Laryngoscope Investigative... Aug 2023What are the electrogustometer's (EGM) validity, reliability, and diagnostic accuracy in assessing taste sensation in adults compared to other taste tests? (Review)
Review
OBJECTIVE
What are the electrogustometer's (EGM) validity, reliability, and diagnostic accuracy in assessing taste sensation in adults compared to other taste tests?
DATA SOURCES
PubMed Medline, Elseviers's Embase, and the six databases of Cochrane Library.
METHODS
We conducted a systematic search on December 20, 2022, consisting of synonyms for EGM. We considered randomized controlled trials and observational studies with original data for inclusion if they included adults who underwent electrogustometry. Articles were excluded if no analysis regarding validity, reliability, or diagnostic accuracy had been performed or if these analyses could not be performed with the published data.
RESULTS
Nineteen articles discussing 18 studies were included for data extraction. The included studies carry a high risk of bias. Overall, the association between a variety of reference taste tests and EGM was moderate or weak with correlation coefficients ranging from -0.51 to 0.40 with one outlier of -0.74 found in one study correlating EGM and taste solutions. Test-retest reliability was good with reported correlation coefficients between 0.78 and 1.0. The sensitivity, specificity, PPV, and NPV of EGM in identifying abnormal taste function varied widely between the four studies on diagnostic accuracy.
CONCLUSION
The included studies in this review lack the required standards regarding study design to draw firm conclusions about the validity, reliability, and diagnostic accuracy of the EGM. Future research is needed to assess these measurement properties. Based on the reported results, we would not recommend using the EGM as a screening test for taste disturbance in clinical practice.
LEVEL OF EVIDENCE
NA.
PubMed: 37621297
DOI: 10.1002/lio2.1108 -
F1000Research 2023To estimate the prevalence of carpal tunnel syndrome (CTS) among dental surgeons and the effect of possible moderators on it. A systematic literature search (Medline... (Meta-Analysis)
Meta-Analysis
To estimate the prevalence of carpal tunnel syndrome (CTS) among dental surgeons and the effect of possible moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. Only observational studies that examined specifically the prevalence rates of CTS among dentists were included. Quality assessment was performed. The pooled prevalence with 95% confidence intervals (CI) was estimated. Outlier and influential analysis were conducted. Moderator analysis was performed in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, ten eligible studies (3,547 participants) were finally included in this meta-analysis. Two of them were estimated as high quality (low risk of bias) and the remaining ones as moderate quality (moderate risk of bias). The overall prevalence of CTS among dental surgeons was estimated as 9.87% (95%CI 6.84%-14.03%) with significant heterogeneity between studies. No study was identified as influential. Potential sources of heterogeneity were not identified through meta-regression analysis. In the subgroup analysis the prevalence was 12.47% (95%CI 6.38%-22.95%) for the group identified as having CTS through medical history and at least clinical examination or electrodiagnostic testing and 8.56% (95%CI 5.53%-13.01%) among those who identified solely through questionnaire. Our findings are important to provide the pooled prevalence of CTS among dentists. Our results were based on highly heterogeneous studies. Our study reports a considerable prevalence, consequently, significance of awareness among dental surgeons regarding the etiology of this issue is more than necessary. More studies need to be conducted that could guide researchers in order this issue to be fully investigated.
Topics: Humans; Carpal Tunnel Syndrome; Databases, Factual; Dentists; MEDLINE; Prevalence
PubMed: 37614565
DOI: 10.12688/f1000research.131173.3 -
Global Pediatric Health 2023Neonatal death is still alarming in low-income countries including Ethiopia, accounts 30 death per 1000 alive births. Birth trauma is the second most common...
Neonatal death is still alarming in low-income countries including Ethiopia, accounts 30 death per 1000 alive births. Birth trauma is the second most common contributing factors for the death. Nevertheless, there is no aggregate evidence on the prevalence and patterns of neonatal birth trauma in Ethiopia. Therefore, this study aimed to assess the pooled prevalence and patterns of neonatal birth trauma in Ethiopia. Searching databases including PubMed, MEDLINE, Popline, SCOPUS, Web of Science, EMBASE, CINHAL (EBSCO), Google, Google Scholar, and lists of references were used to search literatures in Ethiopia. STATA version 14 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for and -values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias. A total of 6 studies with a sample size of 3663 were included in this study. The overall prevalence of neonatal birth trauma was 15% (95% CI: 13-16). Subgaleal hemorrhage (39%), cephalohematoma (27%), and caput succedaneum (24%) were the most common neonatal birth trauma in Ethiopia. Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios, and the funnel plots did not show publication bias. This systematic review and meta-analysis revealed a high prevalence of neonatal birth trauma in Ethiopia. Moreover, most of the neonatal birth injuries were severe and life-threatening that need medical attention to safe the neonates and its life long complications.
PubMed: 37602141
DOI: 10.1177/2333794X231191982 -
International Journal of Health Policy... 2023The European Union Medical Device Regulation (MDR) requires manufacturers to undertake post-market clinical follow-up (PMCF) to assess the safety and performance of...
Quality and Utility of European Cardiovascular and Orthopaedic Registries for the Regulatory Evaluation of Medical Device Safety and Performance Across the Implant Lifecycle: A Systematic Review.
BACKGROUND
The European Union Medical Device Regulation (MDR) requires manufacturers to undertake post-market clinical follow-up (PMCF) to assess the safety and performance of their devices following approval and Conformité Européenne (CE) marking. The quality and reliability of device registries for this Regulation have not been reported. As part of the Coordinating Research and Evidence for Medical Devices (CORE-MD) project, we identified and reviewed European cardiovascular and orthopaedic registries to assess their structures, methods, and suitability as data sources for regulatory purposes.
METHODS
Regional, national and multi-country European cardiovascular (coronary stents and valve repair/replacement) and orthopaedic (hip/knee prostheses) registries were identified using a systematic literature search. Annual reports, peer-reviewed publications, and websites were reviewed to extract publicly available information for 33 items related to structure and methodology in six domains and also for reported outcomes.
RESULTS
Of the 20 cardiovascular and 26 orthopaedic registries fulfilling eligibility criteria, a median of 33% (IQR: 14%-71%) items for cardiovascular and 60% (IQR: 28%-100%) items for orthopaedic registries were reported, with large variation across domains. For instance, no cardiovascular and 16 (62%) orthopaedic registries reported patient/ procedure-level completeness. No cardiovascular and 5 (19%) orthopaedic registries reported outlier performances of devices, but each with a different outlier definition. There was large heterogeneity in reporting on items, outcomes, definitions of outcomes, and follow-up durations.
CONCLUSION
European cardiovascular and orthopaedic device registries could improve their potential as data sources for regulatory purposes by reaching consensus on standardised reporting of structural and methodological characteristics to judge the quality of the evidence as well as outcomes.
Topics: Humans; Orthopedics; Equipment Safety; Reproducibility of Results; Registries
PubMed: 37579359
DOI: 10.34172/ijhpm.2023.7648 -
Global Health Action Dec 2023Undernutrition remains a major public health issue in low- and middle-income countries. Objective Our aim for this study was to identify the factors contributing to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Undernutrition remains a major public health issue in low- and middle-income countries. Objective Our aim for this study was to identify the factors contributing to undernutrition in children under five years old in North Africa.
METHODS
We searched five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest, and CINAHL) for eligible observational studies published after 2006. STATA version 17 software was used to calculate the odds ratios between associated factors and indicators of undernutrition, with 95% confidence intervals. For each factor, the overall odds were pooled using a forest plot. Due to the significant heterogeneity among the studies (I2 > 50%), a random-effects model was used, and sensitivity analysis was conducted to examine the effect of outliers.
RESULTS
Out of 1093 initially identified studies, 14 met the selection criteria. Our meta-analysis revealed that uneducated mothers were the most common factor associated with undernutrition in North African children. Children aged 0-23 months were significantly associated with stunting (odds ratios (OR) = 1.27; 95% CI: 1.18; 1.37) and wasting (OR = 1.68; 95% CI: 1.42; 1.99). Children living in rural areas were also at higher odds of being stunted (OR = 1.74; 95% CI: 1.64; 1.84) and underweight (OR = 1.59; 95% CI: 1.35; 1.88). These analyses also indicated that a lower wealth index, mothers' nutritional health, uneducated fathers, and low birth weight were other factors significantly associated with stunting.
CONCLUSION
Addressing undernutrition in Northern Africa requires a multidisciplinary approach prioritising mothers and young children, especially families in underprivileged areas.
Topics: Female; Humans; Child; Infant; Child, Preschool; Wasting Syndrome; Malnutrition; Mothers; Thinness; Growth Disorders; Prevalence; Africa, Northern
PubMed: 37497693
DOI: 10.1080/16549716.2023.2240158 -
Frontiers in Cellular and Infection... 2023Human monkeypox (mpox) disease is a multicountry outbreak driven by human-human transmission which has resulted in an international public health emergency. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Human monkeypox (mpox) disease is a multicountry outbreak driven by human-human transmission which has resulted in an international public health emergency. However, there is limited evidence on the positivity rate of skin lesions for mpox viral DNA. We aim to fill this gap by estimating the pooled positivity rate of skin samples with mpox viral DNA from mpox patients globally.
METHODS
In this systematic review and meta-analysis, seven databases and several preprint servers have been extensively searched until 17 January 2023 according to a prospectively registered protocol (PROSPERO: CRD42023392505). Articles including the positivity rate of skin samples with mpox viral DNA in mpox-confirmed patients were considered eligible. After a quality assessment, a random-effect meta-analysis was used for pooled prevalence. To explore and resolve heterogeneity, we used statistical methods for outlier detection, influence analysis, and sensitivity analysis.
FINDINGS
Among the 331 articles retrieved after deduplication, 14 studies were finally included. The pooled positivity rate of the skin samples was 98.77% (95% CI: 94.74%-99.72%). After the removal of an influential outlier, for heterogeneity dropped from 92.5% to 10.8%. Meta-regression did not reveal any significant moderator.
CONCLUSION/INTERPRETATION
The present findings reinforce that skin lesions act as a reservoir of mpox viral DNA and contribute to a high infectivity risk. This may be a prevailing basis of prompt transmission during the current multicountry outbreak and also needs further investigation. The present imperative outcome may benefit in producing valuable preventive and management procedures in an appropriate health strategy.
Topics: Humans; DNA, Viral; Mpox (monkeypox); Prevalence; Databases, Factual; Disease Outbreaks
PubMed: 37457957
DOI: 10.3389/fcimb.2023.1179885 -
BMJ Open Jul 2023Benchmarking is common in clinical registries to support the improvement of health outcomes by identifying underperforming clinician or health service providers. Despite...
OBJECTIVES
Benchmarking is common in clinical registries to support the improvement of health outcomes by identifying underperforming clinician or health service providers. Despite the rise in clinical registries and interest in publicly reporting benchmarking results, appropriate methods for benchmarking and outlier detection within clinical registries are not well established, and the current application of methods is inconsistent. The aim of this review was to determine the current statistical methods of outlier detection that have been evaluated in the context of clinical registry benchmarking.
DESIGN
A systematic search for studies evaluating the performance of methods to detect outliers when benchmarking in clinical registries was conducted in five databases: EMBASE, ProQuest, Scopus, Web of Science and Google Scholar. A modified healthcare modelling evaluation tool was used to assess quality; data extracted from each study were summarised and presented in a narrative synthesis.
RESULTS
Nineteen studies evaluating a variety of statistical methods in 20 clinical registries were included. The majority of studies conducted application studies comparing outliers without statistical performance assessment (79%), while only few studies used simulations to conduct more rigorous evaluations (21%). A common comparison was between random effects and fixed effects regression, which provided mixed results. Registry population coverage, provider case volume minimum and missing data handling were all poorly reported.
CONCLUSIONS
The optimal methods for detecting outliers when benchmarking clinical registry data remains unclear, and the use of different models may provide vastly different results. Further research is needed to address the unresolved methodological considerations and evaluate methods across a range of registry conditions.
PROSPERO REGISTRATION NUMBER
CRD42022296520.
Topics: Humans; Benchmarking; Registries
PubMed: 37451708
DOI: 10.1136/bmjopen-2022-069130