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Banyard H, Edward K, Garvey L, Stephenson J, Azevedo L, Benson AC. The Effects of Aerobic and Resistance Exercise on Depression and Anxiety: Systematic Review With Meta-Analysis. Int J Ment Health Nurs 2025; 34:e70054. [PMID: 40432290 PMCID: PMC12117297 DOI: 10.1111/inm.70054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 03/20/2025] [Accepted: 04/03/2025] [Indexed: 05/29/2025]
Abstract
Exercise can reduce physiological and psychological symptoms associated with depression and anxiety. However, it is unknown which mode of exercise, if any, is more beneficial. To determine whether aerobic, resistance, or aerobic and resistance exercise improves depressive and/or anxiety symptoms in individuals diagnosed with depression or anxiety. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Five electronic databases were searched, until February 24, 2024. Studies were included for analysis based on satisfying quality appraisal standards and the established inclusion criteria associated with aerobic or resistance exercise in adults with a diagnosis of depression or anxiety. Random effects meta-analysis was performed where possible. Thirty-two randomised controlled trial studies (n = 3243 participants) met the inclusion criteria for this systematic review, and 26 studies (n = 2681 participants) were included in the meta-analyses. For the 25 studies assessing the effect of exercise on depressive symptoms, the pooled standardised mean difference (SMD) favoured exercise as a beneficial treatment of depression (-0.97, 95% confidence interval [CI] -1.28 to -0.66), with a large magnitude of effect. For the 11 studies reporting the effect of exercise on anxiety symptoms, the pooled SMD results revealed that exercise had a significant, moderate magnitude of effect favouring exercise treatment (-0.66, 95% CI -1.09 to -0.23). No studies excessively influenced the outcomes of depression and anxiety. Aerobic, resistance, or a mixture of aerobic and resistance exercise is beneficial for improving symptoms of depression and anxiety. Protocol Registration: PROSPERO registration number: CRD42019119341 (date of registration: 5/2/2019).
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Affiliation(s)
- Harry Banyard
- Department of Biomedical, Health, and Exercise SciencesSchool of Health Sciences, Swinburne University of TechnologyMelbourneAustralia
| | - Karen‐Leigh Edward
- Nursing and MidwiferyCollege of Sport, Health and Engineering, Victoria UniversityMelbourneAustralia
| | - Loretta Garvey
- Federation University AustraliaMelbourneAustralia
- Centre for Behavioural ScienceSwinburne University of TechnologyMelbourneAustralia
| | - John Stephenson
- School of Human and Health Sciences, University of HuddersfieldHuddersfieldUK
| | - Liane Azevedo
- School of Human and Health Sciences, University of HuddersfieldHuddersfieldUK
- School of Sport and Physical Activity, Sheffield Hallam UniversitySheffieldUK
| | - Amanda Clare Benson
- Department of Biomedical, Health, and Exercise SciencesSchool of Health Sciences, Swinburne University of TechnologyMelbourneAustralia
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Goeddel LA, Grant MC, Bandeen-Roche K, Vetter TR. Fortifying the Evidence Pyramid in Anesthesiology and Perioperative Medicine: From Cornerstone to Capstone. Anesth Analg 2025; 140:366-372. [PMID: 39008424 DOI: 10.1213/ane.0000000000007032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Affiliation(s)
- Lee A Goeddel
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael C Grant
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas
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3
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Benitz WE, Polin RA. Recommitting to Rules of Evidence and Laws of Inference. J Pediatr 2024; 275:114199. [PMID: 39032771 DOI: 10.1016/j.jpeds.2024.114199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Affiliation(s)
- William E Benitz
- Division of Neonatal and Development Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Richard A Polin
- Division of Neonatology, Columbia University College of Physicians and Surgeons, New York, NY
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Warlo LS, El Bardai S, de Vries A, van Veelen ML, Moors S, Rings EH, Legerstee JS, Dierckx B. Game-Based eHealth Interventions for the Reduction of Fatigue in People With Chronic Diseases: Systematic Review and Meta-Analysis. JMIR Serious Games 2024; 12:e55034. [PMID: 39419502 PMCID: PMC11528177 DOI: 10.2196/55034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/11/2024] [Accepted: 05/31/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Fatigue is a common and debilitating side effect of chronic diseases, significantly impacting patients' quality of life. While physical exercise and psychological treatments have been shown to reduce fatigue, patients often struggle with adherence to these interventions in clinical practice. Game-based eHealth interventions are believed to address adherence issues by making the intervention more accessible and engaging. OBJECTIVE This study aims to compile empirical evidence on game-based eHealth interventions for fatigue in individuals with chronic diseases and to evaluate their effectiveness in alleviating fatigue. METHODS A comprehensive literature search was performed across Embase, MEDLINE ALL, PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in August 2021. Study characteristics and outcomes from the included studies were extracted, and a random-effects meta-analysis was conducted. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity. RESULTS Of 1742 studies identified, 17 were included in the meta-analysis. These studies covered 5 different chronic diseases: multiple sclerosis (n=10), cancer (n=3), renal disease (n=2), stroke (n=1), and Parkinson disease (n=1). All but 1 study used exergaming interventions. The meta-analysis revealed a significant moderate effect size in reducing fatigue favoring the experimental interventions (standardized mean difference [SMD] -0.65, 95% CI -1.09 to -0.21, P=.003) compared with control conditions consisting of conventional care and no care. However, heterogeneity was high (I2=85.87%). Subgroup analyses were conducted for the 2 most prevalent diseases. The effect size for the multiple sclerosis subgroup showed a trend in favor of eHealth interventions (SMD -0.47, 95% CI -0.95 to 0.01, P=.05, I2=63.10%), but was not significant for the cancer group (SMD 0.61, 95% CI -0.36 to 1.58, P=.22). Balance exercises appeared particularly effective in reducing fatigue (SMD -1.19, 95% CI -1.95 to -0.42, P=.002). CONCLUSIONS Game-based eHealth interventions appear effective in reducing fatigue in individuals with chronic diseases. Further research is needed to reinforce these findings and explore their impact on specific diseases. Additionally, there is a lack of investigation into interventions beyond exergaming within the field of game-based learning.
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Affiliation(s)
- Leonie S Warlo
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Souraya El Bardai
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Andrica de Vries
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Marie-Lise van Veelen
- Department of Neurosurgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Suzan Moors
- Department of Physiotherapy, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Edmond Hhm Rings
- Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
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Kastrati L, Raeisi-Dehkordi H, Llanaj E, Quezada-Pinedo HG, Khatami F, Ahanchi NS, Llane A, Meçani R, Muka T, Ioannidis JPA. Agreement Between Mega-Trials and Smaller Trials: A Systematic Review and Meta-Research Analysis. JAMA Netw Open 2024; 7:e2432296. [PMID: 39240561 PMCID: PMC11380108 DOI: 10.1001/jamanetworkopen.2024.32296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 07/12/2024] [Indexed: 09/07/2024] Open
Abstract
Importance Mega-trials can provide large-scale evidence on important questions. Objective To explore how the results of mega-trials compare with the meta-analysis results of trials with smaller sample sizes. Data Sources ClinicalTrials.gov was searched for mega-trials until January 2023. PubMed was searched until June 2023 for meta-analyses incorporating the results of the eligible mega-trials. Study Selection Mega-trials were eligible if they were noncluster nonvaccine randomized clinical trials, had a sample size over 10 000, and had a peer-reviewed meta-analysis publication presenting results for the primary outcome of the mega-trials and/or all-cause mortality. Data Extraction and Synthesis For each selected meta-analysis, we extracted results of smaller trials and mega-trials included in the summary effect estimate and combined them separately using random effects. These estimates were used to calculate the ratio of odds ratios (ROR) between mega-trials and smaller trials in each meta-analysis. Next, the RORs were combined using random effects. Risk of bias was extracted for each trial included in our analyses (or when not available, assessed only for mega-trials). Data analysis was conducted from January to June 2024. Main Outcomes and Measures The main outcomes were the summary ROR for the primary outcome and all-cause mortality between mega-trials and smaller trials. Sensitivity analyses were performed with respect to the year of publication, masking, weight, type of intervention, and specialty. Results Of 120 mega-trials identified, 41 showed a significant result for the primary outcome and 22 showed a significant result for all-cause mortality. In 35 comparisons of primary outcomes (including 85 point estimates from 69 unique mega-trials and 272 point estimates from smaller trials) and 26 comparisons of all-cause mortality (including 70 point estimates from 65 unique mega-trials and 267 point estimates from smaller trials), no difference existed between the outcomes of the mega-trials and smaller trials for primary outcome (ROR, 1.00; 95% CI, 0.97-1.04) nor for all-cause mortality (ROR, 1.00; 95% CI, 0.97-1.04). For the primary outcomes, smaller trials published before the mega-trials had more favorable results than the mega-trials (ROR, 1.05; 95% CI, 1.01-1.10) and subsequent smaller trials published after the mega-trials (ROR, 1.10; 95% CI, 1.04-1.18). Conclusions and Relevance In this meta-research analysis, meta-analyses of smaller studies showed overall comparable results with mega-trials, but smaller trials published before the mega-trials gave more favorable results than mega-trials. These findings suggest that mega-trials need to be performed more often given the relative low number of mega-trials found, their low significant rates, and the fact that smaller trials published prior to mega-trial report more beneficial results than mega-trials and subsequent smaller trials.
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Affiliation(s)
- Lum Kastrati
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Hamidreza Raeisi-Dehkordi
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Erand Llanaj
- Epistudia, Bern, Switzerland
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Hugo G. Quezada-Pinedo
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Sadat Ahanchi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Internal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Renald Meçani
- Epistudia, Bern, Switzerland
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Taulant Muka
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
- Epistudia, Bern, Switzerland
| | - John P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California
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Pujol-Lopez M, Tung R. Large-scale aggregate data for left bundle branch area pacing as first line for CRT: climbing the pyramid of evidence. J Interv Card Electrophysiol 2024; 67:1293-1296. [PMID: 38848007 DOI: 10.1007/s10840-024-01827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Margarida Pujol-Lopez
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
| | - Roderick Tung
- Division of Cardiology, The University of Arizona College of Medicine - Phoenix, Banner - University Medical Center, 755 E McDowell Road, Phoenix, AZ, 85006, USA.
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Deng Y, Zeng X, Tang C, Hou X, Zhang Y, Shi L. The effect of exercise training on heart rate variability in patients with hypertension: A systematic review and meta-analysis. J Sports Sci 2024; 42:1272-1287. [PMID: 39115012 DOI: 10.1080/02640414.2024.2388984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/30/2024] [Indexed: 09/01/2024]
Abstract
We aimed to assess the effect of exercise training on heart rate variability (HRV) in hypertensive patients and to provide practical recommendations. We systematically searched seven databases for randomized controlled trials (RCTs) comparing the efficacy of exercise interventions vs. non-exercise control for HRV in adults with hypertension. HRV parameters, blood pressure (BP), and heart rate (HR) from the experimental and control groups were extracted to carry out meta-analysis. To explore the heterogeneity, we performed sensitivity analysis, sub-analysis, and meta-regression. Twelve RCTs were included, and the main results demonstrated exercise produced improvement in root mean square of successive RR-intervals differences (RMSSD) and high frequency (HF), and reductions in LF/HF, resting systolic blood pressure (SBP), and HR. The sub-analysis and meta-regression showed that AE improved more HRV indices and was effective in reducing BP compared with RE. Follow-up duration was also an important factor. Data suggests exercise training has ameliorating effects on HRV parameters, resting SBP, and HR in hypertensive patients, showing enhanced autonomic nervous system function and vagal activity. This effect may be better realized with exercise interventions of 4 weeks or more. Considering our results and the hypertension practice guidelines, we tend to recommend patients choose supervised AE.
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Affiliation(s)
- Yuxiao Deng
- Department of Exercise Physiology, Beijing Sport University, Beijing, P. R. China
| | - Xianxiang Zeng
- Department of Exercise Physiology, Beijing Sport University, Beijing, P. R. China
| | - Chunxue Tang
- Department of Exercise Physiology, Beijing Sport University, Beijing, P. R. China
| | - Xiao Hou
- Laboratory of Sports Stress and Adaptation of General Administration of Sport, Beijing Sport University, Beijing, China
| | - Yanyan Zhang
- Department of Exercise Physiology, Beijing Sport University, Beijing, P. R. China
- Laboratory of Sports Stress and Adaptation of General Administration of Sport, Beijing Sport University, Beijing, China
| | - Lijun Shi
- Department of Exercise Physiology, Beijing Sport University, Beijing, P. R. China
- Laboratory of Sports Stress and Adaptation of General Administration of Sport, Beijing Sport University, Beijing, China
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8
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Goel H, Raheja D, Nadar SK. Evidence-based medicine or statistically manipulated medicine? Are we slaves to the P-value? Postgrad Med J 2024; 100:451-460. [PMID: 38330498 DOI: 10.1093/postmj/qgae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024]
Abstract
First popularized almost a century ago in epidemiologic research by Ronald Fisher and Jerzy Neyman, the P-value has become perhaps the most misunderstood and even misused statistical value or descriptor. Indeed, modern clinical research has now come to be centered around and guided by an arbitrary P-value of <0.05 as a magical threshold for significance, so much so that experimental design, reporting of experimental findings, and interpretation and adoption of such findings have become largely dependent on this "significant" P-value. This has given rise to multiple biases in the overall body of biomedical literature that threatens the very validity of clinical research. Ultimately, a drive toward reporting a "significant" P-value (by various statistical manipulations) risks creating a falsely positive body of science, leading to (i) wasted resources in pursuing fruitless research and (ii) futile or even harmful policies/therapeutic recommendations. This article reviews the history of the P-value, the conceptual basis of P-value in the context of hypothesis testing and challenges in critically appraising clinical evidence vis-à-vis the P-value. This review is aimed at raising awareness of the pitfalls of this rigid observation of the threshold of statistical significance when evaluating clinical trials and to generate discussion regarding whether the scientific body needs a rethink about how we decide clinical significance.
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Affiliation(s)
- Harsh Goel
- Department of Medicine, St. Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, United States
- Lewis Katz School of Medicine, Temple University, 1801 N Broad St, Philadelphia, PA 19122, United States
| | - Divisha Raheja
- Lewis Katz School of Medicine, Temple University, 1801 N Broad St, Philadelphia, PA 19122, United States
- Department of Neurology, St. Luke's University Hospital, 801 Ostrum St. Bethlehem, PA 18015, United States
| | - Sunil K Nadar
- Department of Cardiology, Dudley Group of Hospitals NHS Trust, Pensnett Road, Dudley, DY1 2HQ United Kingdom
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Chiang JK, Chiang PC, Kao HH, You WC, Kao YH. Exercise Effects on Autonomic Nervous System Activity in Type 2 Diabetes Mellitus Patients over Time: A Meta-Regression Study. Healthcare (Basel) 2024; 12:1236. [PMID: 38921350 PMCID: PMC11487405 DOI: 10.3390/healthcare12121236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Diabetic autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), especially in patients with long-term, poorly controlled diabetes. This study investigates the effects of exercise on autonomic nervous system activity in T2DM patients over time. METHODS A literature review using MEDLINE, Embase, Cochrane Library, Scopus, and PubMed identified studies assessed via heart rate variability. Papers were categorized into three groups: immediate effects (within 60 min), short-term effects (2-3 months), and long-term effects (over 4 months). RESULTS Nine articles with 161 T2DM patients were included in the meta-analysis. RMSSD changes after exercise were -4.3 (p = 0.227), 8.14 (p < 0.001), and 4.17 (p = 0.002) for the immediate, short-term, and long-term groups, respectively. LF/HF ratio changes were 0.21 (p = 0.264), -3.04 (p = 0.102), and -0.05 (p = 0.006) for the respective groups. Meta-regression indicated age, male gender, and exercise duration were associated with increased RMSSD, with coefficients of 2.36 (p = 0.001), 13.76 (p = 0.008), and 1.50 (p = 0.007), respectively. Age positively correlated with the LF/HF ratio, with a coefficient of 0.049 (p = 0.048). CONCLUSIONS Regular exercise (≥3 times per week) for over 2 months increases parasympathetic activity in T2DM patients, while sympathetic activity decreases significantly after 4 months. Further study is needed to validate these findings.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi 622, Taiwan;
| | - Po-Chen Chiang
- Department of Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
| | - Hsueh-Hsin Kao
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Weir-Chiang You
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung-Te Road, Tainan 701, Taiwan
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Hersh AR, Carroli G, Hofmeyr GJ, Garg B, Gülmezoglu M, Lumbiganon P, De Mucio B, Saleem S, Festin MPR, Mittal S, Rubio-Romero JA, Chipato T, Valencia C, Tolosa JE. Third stage of labor: evidence-based practice for prevention of adverse maternal and neonatal outcomes. Am J Obstet Gynecol 2024; 230:S1046-S1060.e1. [PMID: 38462248 DOI: 10.1016/j.ajog.2022.11.1298] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 03/12/2024]
Abstract
The third stage of labor is defined as the time period between delivery of the fetus through delivery of the placenta. During a normal third stage, uterine contractions lead to separation and expulsion of the placenta from the uterus. Postpartum hemorrhage is a relatively common complication of the third stage of labor. Strategies have been studied to mitigate the risk of postpartum hemorrhage, leading to the widespread implementation of active management of the third stage of labor. Initially, active management of the third stage of labor consisted of a bundle of interventions including administration of a uterotonic agent, early cord clamping, controlled cord traction, and external uterine massage. However, the effectiveness of these interventions as a bundle has been questioned, leading to abandonment of some components in recent years. Despite this, upon review of selected international guidelines, we found that the term "active management of the third stage of labor" was still used, but recommendations for and against individual interventions were variable and not necessarily supported by current evidence. In this review, we: (1) examine the physiology of the third stage of labor, (2) present evidence related to interventions that prevent postpartum hemorrhage and promote maternal and neonatal health, (3) review current global guidelines and recommendations for practice, and (4) propose future areas of investigation. The interventions in this review include pharmacologic agents to prevent postpartum hemorrhage, cord clamping, cord milking, cord traction, cord drainage, early skin-to-skin contact, and nipple stimulation. Treatment of complications of the third stage of labor is outside of the scope of this review. We conclude that current evidence supports the use of effective pharmacologic postpartum hemorrhage prophylaxis, delayed cord clamping, early skin-to-skin contact, and controlled cord traction at delivery when feasible. The most effective uterotonic regimens for preventing postpartum hemorrhage after vaginal delivery include oxytocin plus ergometrine; oxytocin plus misoprostol; or carbetocin. After cesarean delivery, carbetocin or oxytocin as a bolus are the most effective regimens. There is inconsistent evidence regarding the use of tranexamic acid in addition to a uterotonic compared with a uterotonic alone for postpartum hemorrhage prevention after all deliveries. Because of differences in patient comorbidities, costs, and availability of resources and staff, decisions to use specific prevention strategies are dependent on patient- and system-level factors. We recommend that the term "active management of the third stage of labor" as a combined intervention no longer be used. Instead, we recommend that "third stage care" be adopted, which promotes the implementation of evidence-based interventions that incorporate practices that are safe and beneficial for both the woman and neonate.
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Affiliation(s)
- Alyssa R Hersh
- Oregon Health & Science University, Portland, OR; FUNDARED-MATERNA, Bogotá, Colombia.
| | | | - G Justus Hofmeyr
- University of Botswana, Gaborone, Botswana; University of the Witwatersrand, Johannesburg, Johannesburg, South Africa; Walter Sisulu University, Mthatha, South Africa
| | - Bharti Garg
- Oregon Health & Science University, Portland, OR
| | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bremen De Mucio
- Latin American Center for Perinatology, Women and Reproductive Health, Montevideo, Uruguay
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mario Philip R Festin
- Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines, Manila, Philippines
| | | | | | - Tsungai Chipato
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
| | - Catalina Valencia
- FUNDARED-MATERNA, Bogotá, Colombia; Medicina Fetal SAS, Medellin, Colombia
| | - Jorge E Tolosa
- Oregon Health & Science University, Portland, OR; FUNDARED-MATERNA, Bogotá, Colombia; St. Luke's University Health Network, Bethlehem, PA
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11
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Turner RD, Smith JA, Birring SS. Gefapixant for Chronic Cough. JAMA 2024; 331:529. [PMID: 38349378 DOI: 10.1001/jama.2023.26032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Richard D Turner
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, England
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, King's College London, London, England
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12
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Xu J, Li X, Lv L, Dong Q, Du X, Li G, Hou L. The role of Shenqi Fuzheng injection as adjuvant therapy for breast cancer: an overview of systematic reviews and meta-analyses. BMC Complement Med Ther 2024; 24:33. [PMID: 38212731 PMCID: PMC10782532 DOI: 10.1186/s12906-023-04274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the most frequent malignancy in the world. Chemotherapy (CT) is a common treatment for BC but is accompanied by toxicity and side effects. Shenqi Fuzheng Injection (SFI) is an adjuvant therapy with promising results in improving efficacy and reducing toxicity in clinical studies. This overview of systematic reviews and meta-analysis (SRs/MAs) aimed to summarize the benefits and evaluate the quality of evidence supporting SFI adjuvant as CT for BC. METHODS A systematic search for SRs/MAs of randomized controlled trials (RCTs) on SFI treatment for BC was performed by searching PubMed, Web of Science, EMbase, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases from inception to October 1, 2022. The quality of SRs/MAs was evaluated using AMSTAR-2, PRISMA 2020, ROBIS, and GRADE by two reviewers. The corrected covered area (CCA) was used to quantify the degree of duplication of the original SRs/MAs. Finally, quantitative analysis of RCTs was conducted using RevMan 5.4 software. This study was registered with PROSPERO, CRD42022377290. RESULTS Six SRs/MAs including 61 RCTs with 5593 patients were included in this study. Studies were published between 2015 and 2019, the original RCTs ranged from 7-49, with sample sizes ranging from 336-1989. The quantitative meta-analysis found that adjuvant CT of SFI improved the clinical response rate (RR=1.37, 95% CI=1.28, 1.46; P<0.00001) and the KPS score (RR=1.66, 95% CI 1.54, 1.79, P<0.00001) of patients with BC. In terms of immune function, CD3+ (SMD=1.51, 95% CI 0.91, 2.10; P<0.00001), CD4+ (SMD=1.87, 95% CI 1.18, 2.56; P<0.00001), CD4+/CD8+ (SMD=0.86, 95% CI 0.48, 1.23; P<0.00001), and NK cell levels (SMD=0.94, 95% CI 0.63, 1.24; P<0.00001) in the adjuvant CT group SFI were better than those with CT alone. Adverse reactions following SFI adjuvant CT showed reduced incidence of leukopenia (RR=0.53, 95% CI 0.46, 0.62; P<0.00001) and gastrointestinal reactions (RR=0.48, 95% CI 0.39, 0.58; P<0.00001). However, the GRADE results showed 'very low' to 'moderate' evidence for the 42 outcomes, without high-quality evidence supporting them, limited mainly by deficiencies in the design of RCTs (42/42, 100.00%), inconsistency (19/42, 45.24%), publication bias (41/42, 97.62%), and inaccuracy (3/42, 7.14%). The unsatisfactory results of AMSTAR-2, PRISMA 2020, and ROBIS were limited to lack of registration of study protocols, explanation of inclusion basis of RCTs, description of funding sources for the included studies, incomplete search strategy and screening process, addressing heterogeneity and sensitivity, and reporting potential conflicts of interest. CONCLUSION Adjuvant CT with SFI for BC had better benefits and a lower risk of adverse events. The methodology and quality of the evidence are generally low, highlighting a need of greater attention during study implementation. More objective and high-quality studies are needed to verify the efficacy of adjuvant CT with SFI in clinical decision-making for BC.
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Affiliation(s)
- Jing Xu
- Department of Hematology and oncology, Dongzhimen Hospital Affiliated with, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Li
- Department of Hematology and oncology, Dongzhimen Hospital Affiliated with, Beijing University of Chinese Medicine, Beijing, China
| | - Liyuan Lv
- Department of Hematology and oncology, Dongzhimen Hospital Affiliated with, Beijing University of Chinese Medicine, Beijing, China
| | - Qing Dong
- Department of Hematology and oncology, Dongzhimen Hospital Affiliated with, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaofeng Du
- Department of Hematology and oncology, Dongzhimen Hospital Affiliated with, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Guangda Li
- Department of Hematology and oncology, Dongzhimen Hospital Affiliated with, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Li Hou
- Department of Hematology and oncology, Dongzhimen Hospital Affiliated with, Beijing University of Chinese Medicine, Beijing, China.
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Gale RP, Zhang MJ, Lazarus HM. The role of randomized controlled trials, registries, observational databases in evaluating new interventions. Best Pract Res Clin Haematol 2023; 36:101523. [PMID: 38092482 DOI: 10.1016/j.beha.2023.101523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/17/2023] [Indexed: 12/18/2023]
Abstract
Approaches to comparing safety and efficacy of interventions include analyzing data from randomized controlled trials (RCTs), registries and observational databases (ODBs). RCTs are regarded as the gold standard but data from such trials are sometimes unavailable because a disease is uncommon, because the intervention is uncommon, because of structural limitations or because randomization cannot be done for practical or (seemingly) ethical reasons. There are many examples of an unproved intervention being so widely-believed to be effective that clinical trialists and potential subjects decline randomization. Often, when a RCT is finally done the intervention is proved ineffective or even harmful. These situations are termed medical reversals and are not uncommon [1,2]. There is also the dilemma of when seemingly similar RCTs report discordant conclisions Data from high-quality registries, especially ODBs can be used when data from RCTs are unavailable but also have limitations. Biases and confounding co-variates may be unknown, difficult or impossible to identify and/or difficult to adjust for adequately. However, ODBs sometimes have large numbers of diverse subjects and often give answers more useful to clinicians than RCTs. Side-by-side comparisons suggest analyses from high-quality ODBs often give similar conclusions from high quality RCTs. Meta-analyses combining data from RCTs, registries and ODBs are sometimes appropriate. We suggest increased use of registries and ODBs to compare efficacy of interventions.
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Affiliation(s)
- Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London, UK.
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
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Noma H, Hamura Y, Gosho M, Furukawa TA. Kenward-Roger-type corrections for inference methods of network meta-analysis and meta-regression. Res Synth Methods 2023; 14:731-741. [PMID: 37399845 DOI: 10.1002/jrsm.1652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
Network meta-analysis has been an essential methodology of systematic reviews for comparative effectiveness research. The restricted maximum likelihood (REML) method is one of the current standard inference methods for multivariate, contrast-based meta-analysis models, but recent studies have revealed the resultant confidence intervals of average treatment effect parameters in random-effects models can seriously underestimate statistical errors; that is, the actual coverage probability of a true parameter cannot retain the nominal level (e.g., 95%). In this article, we provided improved inference methods for the network meta-analysis and meta-regression models using higher-order asymptotic approximations based on the approach of Kenward and Roger (Biometrics 1997;53:983-997). We provided two corrected covariance matrix estimators for the REML estimator and improved approximations for its sample distribution using a t-distribution with adequate degrees of freedom. All of the proposed procedures can be implemented using only simple matrix calculations. In simulation studies under various settings, the REML-based Wald-type confidence intervals seriously underestimated the statistical errors, especially in cases of small numbers of trials meta-analyzed. By contrast, the proposed Kenward-Roger-type inference methods consistently showed accurate coverage properties under all the settings considered in our experiments. We also illustrated the effectiveness of the proposed methods through applications to two real network meta-analysis datasets.
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Affiliation(s)
- Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Yasuyuki Hamura
- Graduate School of Economics, Kyoto University, Kyoto, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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15
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Lam Hoai XL, Simonart T. Comparing Meta-Analyses with ChatGPT in the Evaluation of the Effectiveness and Tolerance of Systemic Therapies in Moderate-to-Severe Plaque Psoriasis. J Clin Med 2023; 12:5410. [PMID: 37629452 PMCID: PMC10455399 DOI: 10.3390/jcm12165410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Meta-analyses (MAs) and network meta-analyses (NMAs) are high-quality studies for assessing drug efficacy, but they are time-consuming and may be affected by biases. The capacity of artificial intelligence to aggregate huge amounts of information is emerging as particularly interesting for processing the volume of information needed to generate MAs. In this study, we analyzed whether the chatbot ChatGPT is able to summarize information in a useful fashion for providers and patients in a way that matches up with the results of MAs/NMAs. METHODS We included 16 studies (13 NMAs and 3 MAs) that evaluate biologics (n = 6) and both biologic and systemic treatment (n = 10) for moderate-to-severe psoriasis, published between January 2021 and May 2023. RESULTS The conclusions of the MAs/NMAs were compared to ChatGPT's answers to queries about the molecules evaluated in the selected MAs/NMAs. The reproducibility between the results of ChatGPT and the MAs/NMAs was random regarding drug safety. Regarding efficacy, ChatGPT reached the same conclusion as 5 out of the 16 studies (four out of four studies when three molecules were compared), gave acceptable answers in 7 out of 16 studies, and was inconclusive in 4 out of 16 studies. CONCLUSIONS ChatGPT can generate conclusions that are similar to MAs when the efficacy of fewer drugs is compared but is still unable to summarize information in a way that matches up to the results of MAs/NMAs when more than three molecules are compared.
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Affiliation(s)
- Xuân-Lan Lam Hoai
- Department of Dermatology, St Pierre—Brugmann—HUDERF University Hospitals, Université Libre de Bruxelles, 1050 Brussels, Belgium;
| | - Thierry Simonart
- Department of Dermatology, Delta Hospital, CHIREC, Université Libre de Bruxelles, 1050 Brussels, Belgium
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16
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Alam MK, Alqahtani AA, Zaman MU, Kanwal B, Robaian A, Alqahtani F. Clinical and radiographic outcomes of adjunctive photodynamic therapy for treating peri-implantitis among diabetics and cigarette smokers: a systematic review of randomized controlled trials. Lasers Med Sci 2023; 38:142. [PMID: 37335369 DOI: 10.1007/s10103-023-03807-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Abstract
Photodynamic therapy (PDT) has been suggested as an adjunctive therapeutic approach for peri-implantitis. This systematic review aimed to assess the clinical and radiographic outcomes of adjunctive PDT (aPDT) for the treatment of peri-implantitis among diabetics and cigarette smokers. Randomized controlled trials (RCTs), which assessed the clinical and radiographic outcomes of aPDT versus other intervention(s) and/or MD alone among diabetics and smokers with peri-implantitis, were considered eligible for the review. Meta-analysis was performed for calculating the standard mean difference (SMD) with a 95% confidence interval (CI). The methodological quality of the included studies was evaluated using the modified Jadad quality scale. The meta-analysis revealed no significant differences between the influence of aPDT and other intervention/MD alone on the peri-implant PI among diabetics at the final follow-up. However, statistically significant improvements in the peri-implant PD, BOP, and CBL were observed after the application of aPDT among diabetics. Similarly, no significant differences were found between the influence of aPDT and other interventions/MD alone on the peri-implant PD among smokers with peri-implant diseases at the final follow-up. However, statistically significant improvements in the peri-implant PI, BOP, and CBL were observed after the application of aPDT among smokers. Significant improvements in the peri-implant PD, BOP, and CBL among diabetics and the peri-implant PI, BOP, and CBL among smokers after the application of aPDT at the final follow-up. However, large-scale, well-designed, and long-term RCTs are recommended in this domain.
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Affiliation(s)
- Mohammad Khursheed Alam
- Orthodontics, Department of Preventive Dental Science, College of Dentistry, Jouf University, Sakaka, Saudi Arabia.
| | - Abdullah Ali Alqahtani
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mahmud Uz Zaman
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdullaziz University, Al-Kharj, Saudi Arabia
| | | | - Ali Robaian
- Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Haslam A, Tuia J, Prasad V. Scoping Review of Published Oncology Meta-analyses in High-Impact Oncology Journals. JAMA Netw Open 2023; 6:e2318877. [PMID: 37358855 PMCID: PMC10293908 DOI: 10.1001/jamanetworkopen.2023.18877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/29/2023] [Indexed: 06/27/2023] Open
Abstract
Importance Many meta-analyses have been conducted on a wide array of topics, and many of these have focused on treatment efficacy of drugs or bias in interventional studies on a specific topic. Objective To examine the factors associated with having a positive study conclusion in meta-analyses in the field of oncology. Evidence Review All meta-analyses published between January 1, 2018, and December 31, 2021, on 5 oncology journal websites were identified and study characteristics, study results, and information on study authors were abstracted. The meta-analysis authors' conclusions were coded as positive, negative, or equivocal, and each article subject matter was coded as one that could affect profits and marketing of a company. Whether an association existed between study characteristics and authors' conclusions was also examined. Findings Database searches resulted in 3947 potential articles, of which 93 meta-analyses were included in this study. Of the 21 studies with author funding from industry, 17 studies (81.0%) reported favorable conclusions. Of the 9 studies that received industry funding, 7 (77.8%) reported favorable conclusions, and of the 63 studies that did not have author or study funding from industry, 30 (47.6%) reported favorable conclusions. Studies that were funded through nonindustry sources and authors who had no relevant conflict of interest had the lowest percentage of positive conclusions and the highest percentage of negative and equivocal conclusions compared with studies with other sources of potential conflict of interest. Conclusions and Relevance In this cross-sectional study of meta-analyses published in oncology journals, multiple factors were associated with having a positive study conclusion, which suggests that future research should be performed to elucidate reasons for more favorable conclusions among studies with study or author industry funding.
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Affiliation(s)
- Alyson Haslam
- School of Medicine, University of California, San Francisco
| | - Jordan Tuia
- School of Medicine, University of California, San Francisco
| | - Vinay Prasad
- School of Medicine, University of California, San Francisco
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18
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Naillon PL, Flaudias V, Brousse G, Laporte C, Baker JS, Brusseau V, Comptour A, Zak M, Bouillon-Minois JB, Dutheil F. Cannabis Use in Physicians: A Systematic Review and Meta-Analysis. MEDICINES (BASEL, SWITZERLAND) 2023; 10:medicines10050029. [PMID: 37233605 DOI: 10.3390/medicines10050029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
Background: Cannabis use by physicians can be detrimental for them and their patients. We conducted a systematic review and meta-analysis on the prevalence of cannabis use by medical doctors (MDs)/students. Method: PubMed, Cochrane, Embase, PsycInfo and ScienceDirect were searched for studies reporting cannabis use in MDs/students. For each frequency of use (lifetime/past year/past month/daily), we stratified a random effect meta-analysis depending on specialties, education level, continents, and periods of time, which were further compared using meta-regressions. Results: We included 54 studies with a total of 42,936 MDs/students: 20,267 MDs, 20,063 medical students, and 1976 residents. Overall, 37% had used cannabis at least once over their lifetime, 14% over the past year, 8% over the past month and 1.1 per thousand (‱) had a daily use. Medical students had a greater cannabis use than MDs over their lifetime (38% vs. 35%, p < 0.001), the past year (24% vs. 5%, p < 0.001), and the past month (10% vs. 2%, p < 0.05), without significance for daily use (0.5% vs. 0.05%, NS). Insufficient data precluded comparisons among medical specialties. MDs/students from Asian countries seemed to have the lowest cannabis use: 16% over their lifetime, 10% in the past year, 1% in the past month, and 0.4% daily. Regarding periods of time, cannabis use seems to follow a U-shape, with a high use before 1990, followed by a decrease between 1990 and 2005, and a rebound after 2005. Younger and male MDs/students had the highest cannabis use. Conclusions: If more than a third of MDs tried cannabis at least once in their lifetime, this means its daily use is low but not uncommon (1.1‱). Medical students are the biggest cannabis users. Despite being common worldwide, cannabis use is predominant in the West, with a rebound since 2005 making salient those public health interventions during the early stage of medical studies.
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Affiliation(s)
- Pierre-Louis Naillon
- Université Clermont Auvergne, CNRS, LaPSCo, CHU Clermont-Ferrand, WittyFit, F-63000 Clermont-Ferrand, France
| | - Valentin Flaudias
- Université de Nantes, Laboratoire de Psychologie des Pays de la Loire, LPPL, F-44000 Nantes, France
| | - Georges Brousse
- Université Clermont Auvergne, NPsy-Sydo, CHU Clermont-Ferrand, Addiction, F-63000 Clermont-Ferrand, France
| | - Catherine Laporte
- Université Clermont Auvergne, Clermont Auvergne INP, CNRS, Institut Pascal, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Julien S Baker
- Sport and Physical Education, Hong Kong Baptist University, Kowloon CN-99230, Hong Kong
| | - Valentin Brusseau
- Université Clermont Auvergne, CHU Clermont-Ferrand, Endocrinology Diabetology and Metabolic Diseases, F-63000 Clermont-Ferrand, France
| | - Aurélie Comptour
- INSERM, CIC 1405 CRECHE Unit, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Marek Zak
- Institute of Health Sciences, The Jan Kochanowski University of Kielce, P-25-002 Kielce, Poland
| | | | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, CHU Clermont-Ferrand, WittyFit, F-63000 Clermont-Ferrand, France
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19
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Alqahtani JS, Aldhahir AM, Alghamdi SM, Al Ghamdi SS, AlDraiwiesh IA, Alsulayyim AS, Alqahtani AS, Alobaidi NY, Al Saikhan L, AlRabeeah SM, Alzahrani EM, Heubel AD, Mendes RG, Alqarni AA, Alanazi AM, Oyelade T. A systematic review and meta-analysis of heart rate variability in COPD. Front Cardiovasc Med 2023; 10:1070327. [PMID: 36873414 PMCID: PMC9981678 DOI: 10.3389/fcvm.2023.1070327] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with disruption in autonomic nervous control of the heart rhythm. We present here quantitative evidence of the reduction in HRV measures as well as the challenges to clinical application of HRV in COPD clinics. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we search in June 2022 Medline and Embase databases for studies reporting HRV in COPD patients using relevant medical subject headings (MeSH) terms. The quality of included studies was assessed using the modified version of the Newcastle-Ottawa Scale (NOS). Descriptive data were extracted, while standardized mean difference was computed for changes in HRV due to COPD. Leave-one-out sensitivity test was performed to assess exaggerated effect size and funnel plots to assess publication bias. RESULTS The databases search yielded 512 studies, of which we included 27 that met the inclusion criteria. The majority of the studies (73%) had a low risk of bias and included a total of 839 COPD patients. Although there were high between-studies heterogeneity, HRV time and frequency domains were significantly reduced in COPD patients compared with controls. Sensitivity test showed no exaggerated effect sizes and the funnel plot showed general low publication bias. CONCLUSION COPD is associated with autonomic nervous dysfunction as measured by HRV. Both sympathetic and parasympathetic cardiac modulation were decreased, but there is still a predominance of sympathetic activity. There is high variability in the HRV measurement methodology, which affects clinical applicability.
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Affiliation(s)
- Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Saeed M. Alghamdi
- Respiratory Care Program, Clinical Technology Department, College of Applied Health Science, Umm Al Qura University, Makkah, Saudi Arabia
| | - Shouq S. Al Ghamdi
- Anesthesia Technology Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ibrahim A. AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah S. Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Abdullah S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Nowaf Y. Alobaidi
- Respiratory Therapy Department, King Saud bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia
| | - Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad M. AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Eidan M. Alzahrani
- Physical Therapy Department, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Alessandro D. Heubel
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Renata G. Mendes
- Cardiopulmonary Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Abdullah A. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah M. Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tope Oyelade
- UCL Institute for Liver and Digestive Health, London, United Kingdom
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20
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Todorovic N, Fernández-Landa J, Santibañez A, Kura B, Stajer V, Korovljev D, Ostojic SM. The Effects of Hydrogen-Rich Water on Blood Lipid Profiles in Clinical Populations: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2023; 16:142. [PMID: 37259294 PMCID: PMC9967957 DOI: 10.3390/ph16020142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 12/24/2023] Open
Abstract
Over the last two decades, a plethora of disease models and human studies have confirmed the beneficial effects of molecular hydrogen (H2), a simple biotherapeutic gas. Recent small-scale studies evaluating the effects of hydrogen-rich water (HRW) on various metabolic conditions pointed to advantageous effects of HRW in regulating blood lipid profiles. However, to the best of the authors' knowledge, no systematic review and/or meta-analysis (SRMA) were published considering HRW consumption and lipid/lipoprotein status. Therefore, the aim of this SRMA was to assess the effects of HRW consumption on blood lipid panel in clinical populations. The search strategy was designed using PRISMA guidelines, and the databases PubMed/Medline, Web of Science, and Scopus were explored from inception until 4 October 2022. A total of seven studies satisfied all the eligibility criteria and were included in SRMA. The results for the pooled meta-analysis showed a significant reduction in total cholesterol, low-density lipoprotein, and triglycerides after HRW intake (p = 0.01), with small to moderate effects (pooled SMD = -0.23 (from -0.40 to 0.05); pooled SMD = -0.22 (from -0.39 to 0.04); pooled SMD = -0.38 (from -0.59 to 0.18), respectively). Our findings indicate that drinking HRW can significantly improve lipid status in the clinical populations. Additional studies are warranted to further validate this connection.
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Affiliation(s)
- Nikola Todorovic
- Applied Bioenergetics Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Julen Fernández-Landa
- Physical Education and Sports Department, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria, Spain
| | - Asier Santibañez
- Physical Education and Sports Department, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria, Spain
| | - Branislav Kura
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia
| | - Valdemar Stajer
- Applied Bioenergetics Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Darinka Korovljev
- Applied Bioenergetics Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Sergej M. Ostojic
- Applied Bioenergetics Lab, Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
- Department of Nutrition and Public Health, University of Agder, Universitetsveien 25, 4604 Kristiansand, Norway
- Faculty of Health Sciences, University of Pecs, 7601 Pecs, Hungary
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Synthesizing genome regulation data with vote-counting. Trends Genet 2022; 38:1208-1216. [PMID: 35817619 DOI: 10.1016/j.tig.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 01/24/2023]
Abstract
The increasing availability of high-throughput datasets allows amalgamating research information across a large body of genome regulation studies. Given the recent success of meta-analyses on transcriptional regulators, epigenetic marks, and enhancer:gene associations, we expect that such surveys will continue to provide novel and reproducible insights. However, meta-analyses are severely hampered by the diversity of available data, concurring protocols, an eclectic amount of bioinformatics tools, and myriads of conceivable parameter combinations. Such factors can easily bar life scientists from synthesizing omics data and substantially curb their interpretability. Despite statistical challenges of the method, we would like to emphasize the advantages of joining data from different sources through vote-counting and showcase examples that achieve a simple but highly intuitive data integration.
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22
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Boeykens M, Keller EX, Bosio A, Wiseman OJ, Contreras P, Ventimiglia E, Talso M, Pietropaolo A, Tailly T, De Coninck V. Impact of Ureteral Stent Material on Stent-related Symptoms: A Systematic Review of the Literature. EUR UROL SUPPL 2022; 45:108-117. [PMID: 36281431 PMCID: PMC9587365 DOI: 10.1016/j.euros.2022.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
Context Ureteral stents are essential implants that are used on a daily basis. Since their invention, advances in stent design have been directed towards alleviating stent-related symptoms. It remains unclear how the material composition of the stent affects stent-related symptoms. Objective To review the literature and define the clinical impact of ureteral stent material on stent-related symptoms. Evidence acquisition A literature search of the Embase, MEDLINE (PubMed), and Web of Science databases was conducted on December 17, 2021 to collect articles comparing stent composition materials regarding stent-related symptoms. Thirteen publications met the inclusion criteria, of which only one met the high-quality requirements of the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. Evidence synthesis Most trials, including the highest quality trial, seem to support that silicone double-J (DJ) stents reduce stent-related symptoms compared to nonsilicone DJ stents. Regarding physical properties, it seems that "soft" or "flexible" DJ stents reduce stent-related symptoms. However, since there was only one high-quality study with a low risk of bias, it is impossible to draw a definitive conclusion owing to the lack of quality data. Conclusions Silicone DJ stents, and by extension "soft" DJ stents, appear to reduce stent-related symptoms compared to nonsilicone polymers and "hard" DJ stents. No definitive conclusion can be drawn owing to a lack of quality evidence. Creating a standard for measuring and reporting physical stent properties should be the first step for further research. Patient summary A ureteral stent is a small hollow tube placed inside the ureter to help urine drain from the kidney. We reviewed the literature on the impact of stent material on stent-related symptoms. We found that silicone may reduce stent-related symptoms, but no definitive conclusion can be drawn and further studies are needed.
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Affiliation(s)
- Matthias Boeykens
- Department of Urology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Etienne X. Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Young Academic Urologists Urolithiasis and Endourology Working Group, European Association of Urology, Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions, Paris, France
| | - Andrea Bosio
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Oliver J. Wiseman
- Urology Department, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pablo Contreras
- Servicio de Urología, Hospital Alemán, Buenos Aires, Argentina
| | - Eugenio Ventimiglia
- Young Academic Urologists Urolithiasis and Endourology Working Group, European Association of Urology, Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions, Paris, France
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michele Talso
- Young Academic Urologists Urolithiasis and Endourology Working Group, European Association of Urology, Arnhem, The Netherlands
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Amelia Pietropaolo
- Young Academic Urologists Urolithiasis and Endourology Working Group, European Association of Urology, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Thomas Tailly
- Young Academic Urologists Urolithiasis and Endourology Working Group, European Association of Urology, Arnhem, The Netherlands
- Academic Department of Urology, University Hospital Ghent, University of Ghent, Ghent, Belgium
| | - Vincent De Coninck
- Young Academic Urologists Urolithiasis and Endourology Working Group, European Association of Urology, Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions, Paris, France
- Department of Urology, AZ Klina, Brasschaat, Belgium
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23
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Chen W, Chen J, Wang Y, Yan J, Yan X, Wang D, Liu Y. The role of Qishen Yiqi dripping pills in treating chronic heart failure: An overview of systematic reviews and meta-analyses. Front Cardiovasc Med 2022; 9:1001072. [PMID: 36352851 PMCID: PMC9637556 DOI: 10.3389/fcvm.2022.1001072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/03/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives Evidence from systematic reviews/meta-analyses about the efficacy and safety of Qishen Yiqi (QSYQ) dripping pills in chronic heart failure (CHF) remains unclear. This study comprehensively reviewed available systematic reviews on latest evidence to provide reliable information for the clinical use of QSYQ in CHF. Methods The systematic review was performed on studies retrieved from six major medical databases. Eligible studies were evaluated in terms of methodological quality and quality of evidence using the Assessment of Multiple Systematic review 2 (AMSTAR-2) tool, the Risk of Bias in Systematic Reviews (ROBIS) was used to assess the risk of bias, and the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) 2020 was utilized for assessing reporting quality. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine primary outcome indicators' evidence quality. Results A total of 14 systematic reviews were included in this study, based on which it could be concluded that QSYQ combined with conventional medicine (CM) treatment tended to be superior to CM treatment alone in terms of improving cardiac function-related indices (e.g., increasing the left ventricular ejection fraction [LVEF] and reducing the left ventricular end-diastolic dimension [LVEDD] and left ventricular end-systolic internal diameter [LVESD]), improving the total effective rate and 6-min walking distance (6MWD), and reducing N-terminal pro-brain natriuretic peptide (NT-proBNP). Overall, no serious QSYQ-related adverse events were observed. However, the GRADE results showed "very low" to "moderate" evidence for these outcomes, with no high-quality evidence supporting them. Unsatisfactory results were obtained in terms of methodological quality, risk of bias and reporting quality after assessment using the AMSTAR-2, ROBIS, and PRISMA 2020, limited mainly by deficiencies in the following areas: registration of study protocols, explanation of the inclusion of randomized controlled trials (RCTs), complete and detailed search strategy, list of excluded literature, description of funding sources for inclusion in RCTs, investigation of the impact of risk of bias on the results of meta-analysis, and reporting of potential conflicts of interest. Conclusion The efficacy and safety of QSYQ adjuvant therapy in CHF remain to be further clarified due to the lack of high-quality evidence provided by current systematic reviews.
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Affiliation(s)
- Wensheng Chen
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiezhen Chen
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanping Wang
- Shunde Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiaqi Yan
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xia Yan
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dawei Wang
- Shunde Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
- The First Clinical Medical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Yuntao Liu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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Comparison of the anaesthetic effects of 4% articaine hydrochloride and 2% lidocaine hydrochloride for maxillary molar extraction: A randomized double blind crossover study. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Savage WM, Harel NY. Reaching a Tipping Point for Neurorehabilitation Research: Obstacles and Opportunities in Trial Design, Description, and Pooled Analysis. Neurorehabil Neural Repair 2022; 36:659-665. [DOI: 10.1177/15459683221124112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The record-breaking pace of COVID-19 vaccine development and implementation depended heavily on collaboration among academic, government, and commercial stakeholders, especially through data-sharing and robust multicenter trials. Collaborative efforts have not been as fruitful in fields such as neurorehabilitation, where non-pharmacological interventions play a much larger role. Barriers to translating scientific advancements into clinical practice in neurorehabilitation include pervasively small study sizes, exacerbated by limited funding for non-pharmacological multicenter clinical trials; difficulty standardizing—and adequately describing—non-pharmacological interventions; and a lack of incentives for individual patient-level data-sharing. These barriers prevent reliable meta-analysis of non-pharmacological clinical studies in neurorehabilitation. This point-of-view will highlight these challenges as well as suggest practical steps that may be taken to improve the neurorehabilitation pipeline between evidence and implementation.
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Affiliation(s)
- William M. Savage
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Noam Y. Harel
- Department of Neurology and Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, James J. Peters Veterans Affairs Medical Center, New York, NY, USA
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26
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Effect of Hyperthyroidism Treatments on Heart Rate Variability: A Systematic Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10081982. [PMID: 36009529 PMCID: PMC9405700 DOI: 10.3390/biomedicines10081982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The reversibility of HRV abnormalities in hyperthyroidism remains contradictory. The design of this study involves conducting a systematic review and meta-analysis on the effect of antithyroid treatments on HRV in hyperthyroidism. PubMed, Cochrane, Embase, and Google Scholar were searched until 4 April 2022. Multiple reviewers selected articles reporting HRV parameters in treated and untreated hyperthyroidism. Independent data extraction by multiple observers was stratified by degree of hyperthyroidism for each HRV parameter: RR intervals, SDNN (standard deviation of RR intervals), RMSSD (square root of the mean difference of successive RR intervals), pNN50 (percentage of RR intervals with >50 ms of variation), total power (TP), LFnu (low-frequency normalized unit) and HFnu (high-frequency), VLF (very low-frequency), and LF/HF ratio. We included 11 studies for a total of 471 treated hyperthyroid patients, 495 untreated hyperthyroid patients, and 781 healthy controls. After treatment, there was an increase in RR, SDNN, RMSSD, pNN50, TP, HFnu, and VLF and a decrease in LFnu and LF/HF ratio (p < 0.01). Overt hyperthyroidism showed similar results, in contrast to subclinical hyperthyroidism. Compared with controls, some HRV parameter abnormalities persist in treated hyperthyroid patients (p < 0.05) with lower SDNN, LFnu, and higher HFnu, without significant difference in other parameters. We showed a partial reversibility of HRV abnormalities following treatment of overt hyperthyroidism. The improvement in HRV may translate the clinical cardiovascular benefits of treatments in hyperthyroidism and may help to follow the evolution of the cardiovascular morbidity.
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27
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Buttet M, Bagheri R, Ugbolue UC, Laporte C, Trousselard M, Benson A, Bouillon-Minois JB, Dutheil F. Effect of a lifestyle intervention on telomere length: A systematic review and meta-analysis. Mech Ageing Dev 2022; 206:111694. [PMID: 35760212 DOI: 10.1016/j.mad.2022.111694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to assess the effects of lifestyle intervention on telomere length (TL). METHOD Four databases were searched for studies reporting TL in leukocytes, before and after a lifestyle intervention. We computed random-effects meta-analysis on TL within intervention and control group after versus before intervention, and on changes in TL between groups. Sensitivity analyses and Meta-regression were conducted. RESULTS We included 20 studies in the systematic review (2995 participants, mean 50.3 years old, 77% women, 2045 following an intervention and 950 controls) and 19 in the meta-analysis. TL were similar at baseline between intervention and control groups. The physical activity ± diet group had an increase in TL (Effect size 0.17, 95%CI 0.03-0.31, p = 0.020) using changes within the intervention group, whereas TL shortened in the control group (-0.32, -0.61 to -0.02, p = 0.037). TL was longer in the physical activity ± diet intervention group (0.24, 0.08-0.40, p = 0.004) compared to controls after the intervention. Sensitivity analysis gave similar results. Meta-regressions demonstrated that combining strength and endurance exercise increased TL more than endurance alone or strength alone. CONCLUSION A lifestyle intervention with physical activity ± diet can increase telomere length, independently of population characteristics or baseline TL.
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Affiliation(s)
- Marjorie Buttet
- Université Clermont Auvergne, General medicine, F-63000 Clermont-Ferrand, France
| | - Reza Bagheri
- University of Isfahan, Exercise physiology department, Isfahan, Iran
| | - Ukadike C Ugbolue
- University of the West of Scotland, Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of Strathclyde, Glasgow, Scotland, UK
| | - Catherine Laporte
- Université Clermont Auvergne, EA 7280 NPsy-Sydo, General medicine, F-63000 Clermont-Ferrand, France
| | - Marion Trousselard
- French Armed Forces, Biomedical Research Institute, IRBA, Neurophysiology of Stress, Neuroscience and Operational Constraint Department, Brétigny-sur-Orge, France; APEMAC/EPSAM, EA 4360, Ile du Saulcy, 57000 Metz, France
| | - Amanda Benson
- Swinburne University of Technology, Sport Innovation Research Group, Department of Health and Biostatistics, Melbourne, VIC 3122, Australia
| | - Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Emergency medicine, F-63000 Clermont-Ferrand, France.
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Occupational and Environmental Medicine, WittyFit, F-63000 Clermont-Ferrand, France
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28
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Heart rate variability in hypothyroid patients: A systematic review and meta-analysis. PLoS One 2022; 17:e0269277. [PMID: 35657799 PMCID: PMC9165841 DOI: 10.1371/journal.pone.0269277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Hypothyroidism may be associated with changes in the autonomic regulation of the cardiovascular system, which may have clinical implications.
Objective
To conduct a systematic review and meta-analysis on the impact of hypothyroidism on HRV.
Materials and methods
PubMed, Cochrane, Embase and Google Scholar were searched until 20 August 2021 for articles reporting HRV parameters in untreated hypothyroidism and healthy controls. Random-effects meta-analysis were stratified by degree of hypothyroidism for each HRV parameters: RR intervals (or normal to normal-NN intervals), SDNN (standard deviation of RR intervals), RMSSD (square root of the mean difference of successive RR intervals), pNN50 (percentage of RR intervals with >50ms variation), total power (TP), LFnu (low-frequency normalized unit), HFnu (high-frequency), VLF (very low frequency), and LF/HF ratio.
Results
We included 17 studies with 11438 patients: 1163 hypothyroid patients and 10275 healthy controls. There was a decrease in SDNN (effect size = -1.27, 95% CI -1.72 to -0.83), RMSSD (-1.66, -2.32 to -1.00), pNN50 (-1.41, -1.98 to -0.84), TP (-1.55, -2.1 to -1.00), HFnu (-1.21, -1.78 to -0.63) with an increase in LFnu (1.14, 0.63 to 1.66) and LF/HF ratio (1.26, 0.71 to 1.81) (p <0.001). HRV alteration increased with severity of hypothyroidism.
Conclusions
Hypothyroidism is associated with a decreased HRV, that may be explained by molecular mechanisms involving catecholamines and by the effect of TSH on HRV. The increased sympathetic and decreased parasympathetic activity may have clinical implications.
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Lu M, Liu S, Yuan Y. Why there are so many contradicted or exaggerated findings in highly cited clinical research? Contemp Clin Trials 2022; 118:106782. [PMID: 35525531 DOI: 10.1016/j.cct.2022.106782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/09/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
It is not uncommon that clinical studies of the same intervention contradicted with each other, e.g., one study produced positive results, while the other produced negative results. Ioanndis (2005a) found that among 49 highly-cited original clinical research studies, published in New England Journal of Medicine, Journal of the American Medical Association, Lancet or in a high-impact medical specialty journal, 32% of them were contradicted in subsequent large-scale studies, or were shown to have potentially overestimated the efficacy of the experimental intervention. This finding is disturbing and of serious concern given the widespread impact of these highly-cited studies and the rigorous standards used to design and conduct the studies. We perform Bayesian analysis of these highly-cited clinical studies based on Bayesian factor. We identified one cause of the issue: p values strongly overstated the experimental evidence. For the highly-cited studies, when the p value was 0.05, there was a 74.4% percentage chance that the null hypothesis was true. The use of a p value of 0.05 as the criterion for significance caused many researchers to mistakenly draw conclusions of positive findings, which were then contradicted by subsequent large-scale studies.
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Affiliation(s)
- Mengyi Lu
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Suyu Liu
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Amin-Hanjani S, Riina HA, Barker FG. Editorial. Delphi studies in neurosurgery. J Neurosurg 2022; 136:1217-1218. [PMID: 34598163 DOI: 10.3171/2021.4.jns21622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Howard A Riina
- 2Departments of Neurosurgery and Radiology, New York University School of Medicine, New York, New York; and
| | - Fred G Barker
- 3Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Nuñez NA, Joseph B, Pahwa M, Kumar R, Resendez MG, Prokop LJ, Veldic M, Seshadri A, Biernacka JM, Frye MA, Wang Z, Singh B. Augmentation strategies for treatment resistant major depression: A systematic review and network meta-analysis. J Affect Disord 2022; 302:385-400. [PMID: 34986373 PMCID: PMC9328668 DOI: 10.1016/j.jad.2021.12.134] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare the efficacy and discontinuation of augmentation agents in adult patients with treatment-resistant depression (TRD). We conducted a systematic review and network meta-analyses (NMA) to combine direct and indirect comparisons of augmentation agents. METHODS We included randomized controlled trials comparing one active drug with another or with placebo following a treatment course up to 24 weeks. Nineteen agents were included: stimulants, atypical antipsychotics, thyroid hormones, antidepressants, and mood stabilizers. Data for response/remission and all-cause discontinuation rates were analyzed. We estimated effect-size by relative risk using pairwise and NMA with random-effects model. RESULTS A total of 65 studies (N = 12,415) with 19 augmentation agents were included in the NMA. Our findings from the NMA for response rates, compared to placebo, were significant for: liothyronine, nortriptyline, aripiprazole, brexpiprazole, quetiapine, lithium, modafinil, olanzapine (fluoxetine), cariprazine, and lisdexamfetamine. For remission rates, compared to placebo, were significant for: thyroid hormone(T4), aripiprazole, brexpiprazole, risperidone, quetiapine, and olanzapine (fluoxetine). Compared to placebo, ziprasidone, mirtazapine, and cariprazine had statistically significant higher discontinuation rates. Overall, 24% studies were rated as having low risk of bias (RoB), 63% had moderate RoB and 13% had high RoB. LIMITATIONS Heterogeneity in TRD definitions, variable trial duration and methodological clinical design of older studies and small number of trials per comparisons. CONCLUSIONS This NMA suggests a superiority of the regulatory approved adjunctive atypical antipsychotics, thyroid hormones, dopamine compounds (modafinil and lisdexamfetamine) and lithium. Acceptability was lower with ziprasidone, mirtazapine, and cariprazine. Further research and head-to-head studies should be considered to strengthen the best available options for TRD.
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Affiliation(s)
- Nicolas A Nuñez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Boney Joseph
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mehak Pahwa
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Rakesh Kumar
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Manuel Gardea Resendez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Larry J Prokop
- Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Marin Veldic
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Ashok Seshadri
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States; Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, MN, United States
| | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States
| | - Zhen Wang
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States; Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, United States
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States.
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Heart Rate Variability in Hyperthyroidism: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063606. [PMID: 35329294 PMCID: PMC8949365 DOI: 10.3390/ijerph19063606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022]
Abstract
Objective: Cardiovascular effects of thyroid hormones may be measured through heart rate variability (HRV). We sought to determine the impact of hyperthyroidism on HRV. Design: A systematic review and meta-analysis on the impact of hyperthyroidism on HRV. Methods: PubMed, Cochrane, Embase and Google Scholar were searched until 20 August 2021 for articles reporting HRV parameters in untreated hyperthyroidism and healthy controls. Random-effects meta-analysis was stratified by degree of hyperthyroidism for each HRV parameter: RR intervals (or Normal-to-Normal intervals—NN), SDNN (standard deviation of RR intervals), RMSSD (square root of the mean difference of successive RR intervals), pNN50 (percentage of RR intervals with >50 ms of variation), total power (TP), LFnu (low-frequency normalized unit) and HFnu (high-frequency), VLF (very low-frequency), and LF/HF ratio. Results: We included 22 studies with 10,811 patients: 1002 with hyperthyroidism and 9809 healthy controls. There was a decrease in RR (effect size = −4.63, 95% CI −5.7 to −3.56), SDNN (−6.07, −7.42 to −4.71), RMSSD (−1.52, −2.18 to −0.87), pNN50 (−1.36, −1.83 to −0.88), TP (−2.05, −2.87 to −1.24), HFnu (−3.51, −4.76 to −2.26), and VLF power (−2.65, −3.74 to −1.55), and an increase in LFnu (2.66, 1.55 to 3.78) and LF/HF ratio (1.75, 1.02 to 2.48) (p < 0.01). Most parameters had ES that was twice as high in overt compared to subclinical hyperthyroidism. Increased peripheral thyroid hormones and decreased TSH levels were associated with lower RR intervals. Conclusions: Hyperthyroidism is associated with a decreased HRV, which may be explained by the deleterious effect of thyroid hormones and TSH. The increased sympathetic and decreased parasympathetic activity may have clinical implications.
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Jayaraj D, Rajendran SP. Rise and Fall of Therapeutic Hypothermia in Low-Resource Settings: Lessons from the HELIX Trial: Correspondence. Indian J Pediatr 2022; 89:305. [PMID: 34609652 DOI: 10.1007/s12098-021-03962-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Srijithesh P Rajendran
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Gras D, Lanhers C, Bagheri R, Ugbolue UC, Coudeyre E, Pereira B, Zak M, Bouillon-Minois JB, Dutheil F. Creatine supplementation and VO 2max: a systematic review and meta-analysis. Crit Rev Food Sci Nutr 2021:1-12. [PMID: 34859731 DOI: 10.1080/10408398.2021.2008864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although creatine supplementation is well-known to increase exercise performance in acute high-intensity exercises, its role in aerobic performance based on VO2max is more controversial. Thus, we performed a systematic review and meta-analysis on the effects of creatine supplementation on VO2max. PubMed, Cochrane, Embase, and ScienceDirect were searched for randomized controlled trials (RCTs) reporting VO2max in creatine supplementation and placebo groups before and after supplementation. We computed a random-effects meta-analysis on VO2max at baseline, within groups following supplementation, on changes on VO2max between groups, and after supplementation between groups. Sensitivity analyses and meta-regression were conducted. We included 19 RCTs for a total of 424 individuals (mean age 30 years old, 82% men). VO2max did not differ at baseline between groups (creatine and placebo). Participants in both groups were engaged in exercise interventions in most studies (80%). Using changes in VO2max, VO2max increased in both groups but increased less after creatine supplementation than placebo (effect size [ES] = -0.32, 95%CI = -0.51 to -0.12, p = 0.002). Comparisons after creatine supplementation confirmed a lower VO2max in the creatine group compared to the placebo group (ES= -0.20, 95%CI = -0.39 to -0.001, p = 0.049). Meta-analysis after exclusion from meta-funnel resulted in similar outcomes in a subgroup of young and healthy participants. Meta-regressions on characteristics of supplementation, physical training, or sociodemographic were not statistically significant. Creatine supplementation has a negative effect on VO2max, regardless of the characteristics of training, supplementation, or population characteristics.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2008864 .
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Affiliation(s)
- Damien Gras
- CHU Clermont-Ferrand, Physical and Rehabilitation Medicine, Université Clermont Auvergne, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Charlotte Lanhers
- CHU Clermont-Ferrand, Physical and Rehabilitation Medicine, Université Clermont Auvergne, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Ukadike Chris Ugbolue
- University of the West of Scotland, School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, South Lanarkshire, Scotland, UK
| | - Emmanuel Coudeyre
- INRAE, Human Nutrition Unit (UNH), Université Clermont Auvergne, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Physical and Rehabilitation Medicine, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Marek Zak
- Faculty of Medicine and Health Sciences, Institute of Physiotherapy, The Jan Kochanowski University, Kielce, Poland
| | - Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Occupational and Environmental Medicine, WittyFit, Clermont-Ferrand, France
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Sun CH, Jiang WL, Cai DB, Wang ZM, Sim K, Ungvari GS, Huang X, Zheng W, Xiang YT. Adjunctive multi-session transcranial direct current stimulation for neurocognitive dysfunction in schizophrenia: A meta-analysis. Asian J Psychiatr 2021; 66:102887. [PMID: 34740126 DOI: 10.1016/j.ajp.2021.102887] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/21/2021] [Accepted: 10/14/2021] [Indexed: 01/13/2023]
Abstract
Findings of multi-session transcranial direct current stimulation (tDCS) as an adjunctive treatment of neurocognitive dysfunction in schizophrenia have been inconsistent. This meta-analysis of randomized controlled trials (RCTs) investigated the neurocognitive effects of adjunctive multi-session tDCS for schizophrenia. Twelve RCTs covering 418 schizophrenia patients were included and analyzed in this meta-analysis. The RevMan software (Version 5.3) was used to calculate risk ratios (RRs) and standardized mean differences (SMDs) with their 95% confidence intervals (CIs). Adjunctive tDCS outperformed the comparator in improving working memory deficits (SMD = 0.34, 95% CI: 0.03, 0.65; I2 = 52%; p = 0.03), but no significant effects were found in other cognitive domains. No group differences were found with regard to total psychopathology measured by the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale (SMD =-0.29, 95%CI: -0.61, 0.03; I2 = 50%, p = 0.07) and discontinuation due to any reason (RR=0.80, 95%CI: 0.39, 1.66; I2 = 9%, p = 0.56). Adjunctive tDCS appears to have a significant therapeutic effect improving the working memory deficits in schizophrenia.
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Affiliation(s)
- Chen-Hui Sun
- Qingdao Mental Health Center, Qingdao University, Shandong, China
| | | | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhi-Min Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Kang Sim
- West Region, Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Xiong Huang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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Sheridan SL. Translating Evidence Updates to International Standards: Is More Certainty Needed for International Standards on Decision Aids? Med Decis Making 2021; 42:3-7. [PMID: 34845947 DOI: 10.1177/0272989x211063429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Agarwal A, Rochwerg B, Sevransky JE. 21st Century Evidence: Randomized Controlled Trials Versus Systematic Reviews and Meta-Analyses. Crit Care Med 2021; 49:2001-2002. [PMID: 34582418 PMCID: PMC8654119 DOI: 10.1097/ccm.0000000000005343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ankita Agarwal
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathan E Sevransky
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Emory Critical Care Center, Atlanta, GA
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Ramirez A, Sanabria A. Prophylactic central neck dissection for well-differentiated thyroid carcinoma: results and methodological assessment of systematic reviews. JBI Evid Synth 2021; 20:980-1003. [PMID: 34860180 DOI: 10.11124/jbies-21-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim was to assess the methodological quality of systematic reviews evaluating the effectivness of prophylactic central neck dissection plus thyroidectomy to decrease locoregional recurrence in patients with thyroid carcinoma. INTRODUCTION Many systematic reviews have been published concerning prophylactic central neck dissection in well-differentiated thyroid carcinoma, finding inconsistent results regarding the risk of locoregional recurrence. Because systematic reviews are considered the best source on which to base clinical decisions, the assessment of methodological quality is important. INCLUSION CRITERIA This paper included studies that mentioned that a systematic review was performed in adult patients with confirmed diagnosis of well-differentiated thyroid carcinoma without evidence of nodal metastatic disease who underwent total thyroidectomy. Reviews evaluated prophylactic central neck dissection compared with no neck diessection for decreasing locoregional recurrence. METHODS A systematic search was performed using MEDLINE, Embase, the Cochrane Database of Systematic Reviews, LILACS, Web of Science, CNKI, and Google Scholar. PROSPERO was searched for unpublished studies and gray literature. Data regarding the study characteristics, patient types, numbers of patients, and locoregional recurrence by group were extracted. Methodological characteristics, type of statistical analysis and summary estimator, heterogeneity, and publication bias were recorded. The methodological quality was measured using the AMSTAR 2 tool. RESULTS The search identified 12 systematic reviews. Only four systematic reviews reported adherence to methodological guidelines. The AMSTAR 2 critical criteria classified all the studies as critically low quality. The pooled risk difference for locoregional recurrence varied among studies from -5% to 0%. Most of the studies were published in high-impact journals. CONCLUSIONS The published systematic reviews that assessed prophylactic central neck dissection as an intervention to decrease the rate of locoregional recurrence have a critically low methodological quality. The results and recommendations based on these studies should be used with caution. The evaluation of methodological quality by peer reviewers must be improved.
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Affiliation(s)
- Adonis Ramirez
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellin, Colombia SURCAC, Centro Surcolombiano de Cirugia de Cabeza y Cuello, Neiva, Colombia CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
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The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials. Transl Psychiatry 2021; 11:531. [PMID: 34657142 PMCID: PMC8520525 DOI: 10.1038/s41398-021-01638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/13/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
Several care models have been developed to improve treatment for depression, all of which provide "enhanced" evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13-1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11-1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of -0.42 (95%CI: -0.61-(-0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94-1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668.
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Ahn E, Kang H. Concepts and emerging issues of network meta-analysis. Korean J Anesthesiol 2021; 74:371-382. [PMID: 34551467 PMCID: PMC8497908 DOI: 10.4097/kja.21358] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
Most diseases have more than two interventions or treatment methods, and the application of network meta-analysis (NMA) studies to compare and evaluate the superiority of each intervention or treatment method is increasing. Understanding the concepts and processes of systematic reviews and meta-analyses is essential to understanding NMA. As with systematic reviews and meta-analyses, NMA involves specifying the topic, searching for and selecting all related studies, and extracting data from the selected studies. To evaluate the effects of each treatment, NMA compares and analyzes three or more interventions or treatment methods using both direct and indirect evidence. There is a possibility of several biases when performing NMA. Therefore, key assumptions like similarity, transitivity, and consistency should be satisfied when performing NMA. Among these key assumptions, consistency can be evaluated and quantified by statistical tests. This review aims to introduce the concepts of NMA, analysis methods, and interpretation and presentation of the results of NMA. It also briefly introduces the emerging issues in NMA, including methods for evaluation of consistency.
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Affiliation(s)
- EunJin Ahn
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Guniganti R, Giordan E, Chen CJ, Abecassis IJ, Levitt MR, Durnford A, Smith J, Samaniego EA, Derdeyn CP, Kwasnicki A, Alaraj A, Potgieser ARE, Sur S, Chen SH, Tada Y, Winkler E, Phelps RRL, Lai PMR, Du R, Abla A, Satomi J, Starke RM, van Dijk JMC, Amin-Hanjani S, Hayakawa M, Gross BA, Fox WC, Bulters D, Kim LJ, Sheehan J, Lanzino G, Piccirillo JF, Kansagra AP, Zipfel GJ. Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort. J Neurosurg 2021; 136:951-961. [PMID: 34507282 DOI: 10.3171/2021.1.jns202790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranial dural arteriovenous fistulas (dAVFs) are rare lesions, hampering efforts to understand them and improve their care. To address this challenge, investigators with an established record of dAVF investigation formed an international, multicenter consortium aimed at better elucidating dAVF pathophysiology, imaging characteristics, natural history, and patient outcomes. This report describes the design of the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) and includes characterization of the 1077-patient cohort. METHODS Potential collaborators with established interest in the field were identified via systematic review of the literature. To ensure uniformity of data collection, a quality control process was instituted. Data were retrospectively obtained. RESULTS CONDOR comprises 14 centers in the United States, the United Kingdom, the Netherlands, and Japan that have pooled their data from 1077 dAVF patients seen between 1990 and 2017. The cohort includes 359 patients (33%) with Borden type I dAVFs, 175 (16%) with Borden type II fistulas, and 529 (49%) with Borden type III fistulas. Overall, 852 patients (79%) presented with fistula-related symptoms: 427 (40%) presented with nonaggressive symptoms such as tinnitus or orbital phenomena, 258 (24%) presented with intracranial hemorrhage, and 167 (16%) presented with nonhemorrhagic neurological deficits. A smaller proportion (224 patients, 21%), whose dAVFs were discovered incidentally, were asymptomatic. Many patients (85%, 911/1077) underwent treatment via endovascular embolization (55%, 587/1077), surgery (10%, 103/1077), radiosurgery (3%, 36/1077), or multimodal therapy (17%, 184/1077). The overall angiographic cure rate was 83% (758/911 treated), and treatment-related permanent neurological morbidity was 2% (27/1467 total procedures). The median time from diagnosis to follow-up was 380 days (IQR 120-1038.5 days). CONCLUSIONS With more than 1000 patients, the CONDOR registry represents the largest registry of cranial dAVF patient data in the world. These unique, well-annotated data will enable multiple future analyses to be performed to better understand dAVFs and their management.
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Affiliation(s)
| | - Enrico Giordan
- Departments of4Neurological Surgery and.,5Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ching-Jen Chen
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - Michael R Levitt
- 7Department of Neurological Surgery and.,8Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Andrew Durnford
- 9Department of Neurosurgery, University of Southampton, University Hospital Southampton, United Kingdom
| | - Jessica Smith
- 10Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Edgar A Samaniego
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Colin P Derdeyn
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amanda Kwasnicki
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Ali Alaraj
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Adriaan R E Potgieser
- 15Department of Neurological Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Samir Sur
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - Stephanie H Chen
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - Yoshiteru Tada
- 17Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ethan Winkler
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Ryan R L Phelps
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Pui Man Rosalind Lai
- 19Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rose Du
- 19Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adib Abla
- 18Weill Institute for Neurosciences, Department of Neurosurgery, University of California, San Francisco, California
| | - Junichiro Satomi
- 17Department of Neurosurgery, Institute of Biomedical Biosciences, Tokushima University Graduate School, Tokushima, Japan
| | - Robert M Starke
- 16Department of Neurological Surgery and Radiology, University of Miami, Florida
| | - J Marc C van Dijk
- 15Department of Neurological Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sepideh Amin-Hanjani
- 14Department of Neurological Surgery, University of Illinois at Chicago, Illinois
| | - Minako Hayakawa
- Departments of12Neurology and.,13Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bradley A Gross
- 11Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - W Christopher Fox
- 10Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Diederik Bulters
- 9Department of Neurosurgery, University of Southampton, University Hospital Southampton, United Kingdom
| | - Louis J Kim
- 7Department of Neurological Surgery and.,8Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Jason Sheehan
- 6Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Giuseppe Lanzino
- Departments of4Neurological Surgery and.,5Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jay F Piccirillo
- 3Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri
| | - Akash P Kansagra
- 1Department of Neurological Surgery.,2Mallinckrodt Institute of Radiology, and
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Buisson M, Navel V, Labbé A, Watson SL, Baker JS, Murtagh P, Chiambaretta F, Dutheil F. Deep learning versus ophthalmologists for screening for glaucoma on fundus examination: A systematic review and meta-analysis. Clin Exp Ophthalmol 2021; 49:1027-1038. [PMID: 34506041 DOI: 10.1111/ceo.14000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to compare deep learning versus ophthalmologists in glaucoma diagnosis on fundus examinations. METHOD PubMed, Cochrane, Embase, ClinicalTrials.gov and ScienceDirect databases were searched for studies reporting a comparison between the glaucoma diagnosis performance of deep learning and ophthalmologists on fundus examinations on the same datasets, until 10 December 2020. Studies had to report an area under the receiver operating characteristics (AUC) with SD or enough data to generate one. RESULTS We included six studies in our meta-analysis. There was no difference in AUC between ophthalmologists (AUC = 82.0, 95% confidence intervals [CI] 65.4-98.6) and deep learning (97.0, 89.4-104.5). There was also no difference using several pessimistic and optimistic variants of our meta-analysis: the best (82.2, 60.0-104.3) or worst (77.7, 53.1-102.3) ophthalmologists versus the best (97.1, 89.5-104.7) or worst (97.1, 88.5-105.6) deep learning of each study. We did not retrieve any factors influencing those results. CONCLUSION Deep learning had similar performance compared to ophthalmologists in glaucoma diagnosis from fundus examinations. Further studies should evaluate deep learning in clinical situations.
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Affiliation(s)
- Mathieu Buisson
- CHU Clermont-Ferrand, Ophthalmology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Valentin Navel
- CHU Clermont-Ferrand, Ophthalmology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,CNRS UMR 6293, INSERM U1103, Genetic Reproduction and Development Laboratory (GReD), Translational Approach to Epithelial Injury and Repair Team, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Antoine Labbé
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, APHP, Université de Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Julien S Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Patrick Murtagh
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Frédéric Chiambaretta
- CHU Clermont-Ferrand, Ophthalmology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,CNRS UMR 6293, INSERM U1103, Genetic Reproduction and Development Laboratory (GReD), Translational Approach to Epithelial Injury and Repair Team, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Witty Fit, Clermont-Ferrand, France
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Parums DV. Editorial: Review Articles, Systematic Reviews, Meta-Analysis, and the Updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Guidelines. Med Sci Monit 2021; 27:e934475. [PMID: 34421116 PMCID: PMC8394590 DOI: 10.12659/msm.934475] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Subjective narrative review articles have an educational and informative role in medical and scientific journals. Systematic review of the literature requires an objective and complete review of all available publications on an identified topic. Systematic review that undergoes meta-analysis aims to provide a complete and objective evaluation of all the published data. Data from systematic review and meta-analysis publications support evidence-based medical practice and are prepared as original research articles. These studies require a clear aim and detailed planning with registration and approval of the study protocol before the study commences. Systematic review and meta-analysis studies are designed, conducted, and reported according to mandatory guidelines. The number of these publications has continued to rise during the past decade. However, concerns with the quality of the studies have resulted in more stringent study guidelines. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, guidelines, reporting checklist, and study flow diagram from 2009 were updated and published in March 2021 as PRISMA 2020. The Editorial aims to present the roles and requirements of subjective narrative review articles, systematic review of the literature, and systematic review and meta-analysis, and introduces the revisions and aims of the PRISMA 2020 guidelines.
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Affiliation(s)
- Dinah V Parums
- Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA
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Dutheil F, Méchin G, Vorilhon P, Benson AC, Bottet A, Clinchamps M, Barasinski C, Navel V. Breastfeeding after Returning to Work: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168631. [PMID: 34444380 PMCID: PMC8393856 DOI: 10.3390/ijerph18168631] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The benefits of breastfeeding are widely known; however, continuation after returning to work (RTW) is not. We aimed to conduct a systematic review and meta-analysis to assess the prevalence of breastfeeding after RTW. The secondary objectives were to compare the economic statuses between continents. METHOD PubMed, Cochrane Library, Base, and Embase were searched until 1 September 2020, and two independent reviewers selected the studies and collated the data. To be included, articles needed to describe our primary outcome, i.e., prevalence of breastfeeding after RTW. RESULTS We included 14 studies, analyzing 42,820 women. The overall prevalence of breastfeeding after RTW was 25% (95% CI, 21% to 29%), with an important heterogeneity (I2 = 98.6%)-prevalence ranging from 2% to 61%. Stratification by continents and by GDP per capita also showed huge heterogeneity. The Middle East had the weakest total prevalence with 10% (6% to 14%), and Oceania the strongest with 35% (21% to 50%). Despite the prevalence of breastfeeding in general increasing with GDP per capita (<US$5000: 19%, US$5000-30,000: 22%; US$30,000 to 50,000: 25%, >US$50,000 42%), the prevalence of non-exclusive breastfeeding follows more of a U-curve with the lowest and highest GDP per capita having the highest percentages of breastfeeding (<US$5000: 47% and >US$50,000: 50%, versus <28% for all other categories). CONCLUSION Breastfeeding after RTW is widely heterogeneous across the world. Despite economic status playing a role in breastfeeding after RTW, cultural aspects seem influential. The lack of data regarding breastfeeding after RTW in most countries demonstrates the strong need of data to inform effective preventive strategies.
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Affiliation(s)
- Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Occupational and Environmental Medicine, Université Clermont Auvergne, WittyFit, F-63000 Clermont-Ferrand, France;
- Correspondence: ; Tel.: +33-6-88-22-48-48; Fax: +33-4-73-27-46-49
| | - Grégory Méchin
- Department of General Practice, UFR Medicine, 28 Place Henri-Dunant, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
| | - Philippe Vorilhon
- Department of General Practice, UFR Medicine, Research Unit ACCePPT Self-Medication, Multi-Professional Support for Patients, Université Clermont Auvergne, 28 Place Henri-Dunant, F-63000 Clermont-Ferrand, France; (P.V.); (A.B.)
| | - Amanda C. Benson
- Swinburne University of Technology, Health and Biostatistics, Hawthorn, Victoria, VIC 3122, Australia;
| | - Anne Bottet
- Department of General Practice, UFR Medicine, Research Unit ACCePPT Self-Medication, Multi-Professional Support for Patients, Université Clermont Auvergne, 28 Place Henri-Dunant, F-63000 Clermont-Ferrand, France; (P.V.); (A.B.)
| | - Maëlys Clinchamps
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Occupational and Environmental Medicine, Université Clermont Auvergne, WittyFit, F-63000 Clermont-Ferrand, France;
| | - Chloé Barasinski
- CNRS, SIGMA Clermont, Institut Pascal, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Université Clermont Auvergne Perinatality, F-63000 Clermont-Ferrand, France;
| | - Valentin Navel
- CNRS, INSERM, GReD, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
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Seehra J, Stonehouse-Smith D, Pandis N. Assessment of early exaggerated treatment effects in orthodontic interventions using cumulative meta-analysis. Eur J Orthod 2021; 43:601-605. [PMID: 34184029 PMCID: PMC8633600 DOI: 10.1093/ejo/cjab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background The reported initial strong treatment effects reported in early trials that are refuted in subsequent future studies assessing the same interventions have been attributed to novelty bias. The aim of this study was to determine whether there is any evidence of novelty bias in the reported treatment effects of orthodontics interventions. Materials and methods Relevant orthodontic systematic review (SRs) topics containing at least one meta-analysis on either binary or continuous outcomes with a minimum of three trials considered important areas in the field of orthodontic practice were identified. SR, meta-analysis, and primary study-level characteristics were extracted. Descriptive statistics were calculated at the SRs, meta-analysis, and at the individual study level. All SR and trial-level data were imported into the statistical software and all meta-analyses were replicated using the cumulative random-effects meta-analysis approach. Changes in the size and direction of the estimates between the first trial and the cumulative effect over time were recorded. Results Forty-seven meta-analyses were included. The total number of primary studies included within these meta-analyses was 408 (N = 408). Overall, the final effect size estimate decreased in 29 (61.7%, N = 29/47) cumulative meta-analyses whilst it increased in the remaining 18 (38.3%, N = 18/47). No association between the level of risk of bias and the cumulative absolute effect size was evident (OR 1.00; 95% CI: 0.98, 1.03; P = 0.717) after adjusting for year of the primary study (P = 0.22). Conclusions Clinicians should be wary of the results of trials reporting the effectiveness of new interventions as there is a possibility that the reported effect size will be often exaggerated.
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Affiliation(s)
- Jadbinder Seehra
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, UK
| | - Daniel Stonehouse-Smith
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, UK
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Switzerland
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Picard M, Tauveron I, Magdasy S, Benichou T, Bagheri R, Ugbolue UC, Navel V, Dutheil F. Effect of exercise training on heart rate variability in type 2 diabetes mellitus patients: A systematic review and meta-analysis. PLoS One 2021; 16:e0251863. [PMID: 33999947 PMCID: PMC8128270 DOI: 10.1371/journal.pone.0251863] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), that can be measured through heart rate variability (HRV)–known to be decreased in T2DM. Physical exercise can improve HRV in healthy population, however results are under debate in T2DM. We conducted a systemic review and meta-analysis to assess the effects of physical exercise on HRV in T2DM patients. Method PubMed, Cochrane, Embase, and ScienceDirect databases were searched for all studies reporting HRV parameters in T2DM patients before and after exercise training, until September 20th 2020, without limitation to specific years. We conducted random-effects meta-analysis stratified by type of exercise for each of the HRV parameters: RR–intervals (or Normal to Normal intervals–NN), standard deviation of RR intervals (SDNN), percentage of adjacent NN intervals varying by more than 50 milliseconds (pNN50), root mean square of successive RR-intervals differences (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio. Sensitivity analyses were computed on studies with the highest quality. Results We included 21 studies (9 were randomized) for a total of 523 T2DM patients: 472 had an exercise training and 151 were controls (no exercise). Intervention was endurance (14 studies), resistance (2 studies), endurance combined with resistance (4 studies), and high intensity interval training (HIIT) (4 studies). After exercise training, all HRV parameters improved i.e. an increase in SDNN (effect size = 0.59, 95%CI 0.26 to 0.93), RMSSD (0.62, 0.28 to 0.95), pNN50 (0.62, 0.23 to 1.00), HF (0.58, -0.16 to 0.99), and a decrease in LF (-0.37, -0.69 to -0.05) and LF/HF (-0.52, -0.79 to -0.24). There were no changes in controls. Stratification by type of exercise showed an improvement in most HRV parameters (SDNN, RMSSD, pNN50, LF, HF, LF/HF) after endurance training, whereas mostly LF/HF was improved after both resistance training and HIIT. Supervised training improved most HRV parameters. Duration and frequency of training did not influence the benefits on HRV. Conclusion Exercise training improved HRV parameters in T2DM patients which may reflect an improvement in the activity of the autonomic nervous system. The level of proof is the highest for endurance training. Supervised training seemed beneficial.
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Affiliation(s)
- Mathilde Picard
- Endocrinology Diabetology and Metabolic Diseases, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont-Ferrand, France
| | - Igor Tauveron
- Endocrinology Diabetology and Metabolic Diseases, Université Clermont Auvergne, GReD, CNRS, INSERM, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont–Ferrand, France
| | - Salwan Magdasy
- Endocrinology Diabetology and Metabolic Diseases, Université Clermont Auvergne, GReD, CNRS, INSERM, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont–Ferrand, France
| | - Thomas Benichou
- Endocrinology Diabetology and Metabolic Diseases, CHU Clermont–Ferrand, University Hospital of Clermont–Ferrand, Clermont-Ferrand, France
| | - Reza Bagheri
- Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Ukadike C. Ugbolue
- Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Valentin Navel
- Translational Approach to Epithelial Injury and Repair, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, INSERM, GReD, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Occupational and Environmental Medicine, WittyFit, Clermont–Ferrand, France
- * E-mail:
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Ranganathan P, Aggarwal R. Study designs: Part 9 - Meta-analysis (II). Perspect Clin Res 2021; 12:53-57. [PMID: 33816210 PMCID: PMC8011520 DOI: 10.4103/picr.picr_369_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
The previous two articles in this series gave an overview of the methodology of systematic reviews and meta-analysis. In this third and concluding article, we look at the different types of biases that can confound the results of a meta-analysis and briefly describe some special types of meta-analysis.
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Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rakesh Aggarwal
- Director, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Garg R. Alteplase for Acute Ischemic Stroke Beyond 3 hours: Enthusiasm Outpaces Evidence. West J Emerg Med 2021; 22:687-689. [PMID: 34125047 PMCID: PMC8203024 DOI: 10.5811/westjem.2021.1.50764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/19/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ravi Garg
- Stritch School of Medicine at Loyola University, Department of Neurology, Division of Neurocritical Care, Maywood, Illinois
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Chén OY, Roberts B. Personalized Health Care and Public Health in the Digital Age. Front Digit Health 2021; 3:595704. [PMID: 34713084 PMCID: PMC8521939 DOI: 10.3389/fdgth.2021.595704] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Oliver Y. Chén
- Department of Engineering, University of Oxford, Oxford, United Kingdom
- Division of Biosciences, University College London, London, United Kingdom
| | - Bryn Roberts
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
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Saithna A, Helito CP, Carrozzo A, Kim JG, Sonnery-Cottet B. Regarding "The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis". Arthroscopy 2021; 37:787-789. [PMID: 33673961 DOI: 10.1016/j.arthro.2020.12.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/15/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Adnan Saithna
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, U.S.A
| | - Camilo P Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Jin Goo Kim
- Konkuk University Medical Center, Seoul, Republic of Korea
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