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BACKGROUND@#The effects of acupuncture have varied in different randomized controlled trials (RCTs), and there are many factors that influence treatment effect of acupuncture in different outcomes, with conflicting results.@*OBJECTIVE@#To identify factors and their impact on the treatment effect of acupuncture in different outcomes.@*METHODS@#Acupuncture RCTs were searched from 7 databases including Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc between January 1st, 2015 and December 31st, 2019. Eligible studies must compare acupuncture to no acupuncture, sham acupuncture, or waiting lists, and report at least 1 patient-important outcome. A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables, even those excluded from the multivariable model due to collinearities. We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences (SMDs), categorising them as small (<0.2), moderate (0.2-0.4), or large (>0.4) effects.@*RESULTS@#The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables. High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude, the difference of adjusted SMDs 0.46, 95% confidence interval (CI) 0.07 to 0.84; P=0.02]. The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables. Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture (0.30, 95% CI 0.06 to 0.53; P=0.01). The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables. Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects, compared to non-penetrating acupuncture and fixed regimen, respectively (0.40, 95% CI 0 to 0.80; P=0.05; 0.29, 95% CI 0.06 to 0.53; P=0.01).@*CONCLUSIONS@#High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms. Penetrating acupuncture demonstrated greater effect in relieving non-painful symptoms. Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes. Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.
Subject(s)
Humans , Randomized Controlled Trials as Topic , Acupuncture Therapy/methods , Pain , Pain Management , ChinaABSTRACT
Abstract Existing meta-analyses on the effect of online psychological interventions (OPIs) have found small to medium effect sizes for the treatment of anxiety and depression. On the other hand, third-generation trans-diagnostic OPIs are very rare and, due to the large variability among disorders, symptoms or target populations, it is difficult to assess their overall effect. Other systematic reviews and meta-analyses have overly broad inclusion criteria that make the understanding of the findings more difficult. The current study aims to analyze the empirical evidence for third-wave trans-diagnostic OPIs designed to decrease symptoms and promote psychological flexibility, including studies that compare a OPI to some control condition (e. g., waiting list, treatment as usual or other that should not have any effect) and include a general symptomatology scale as dependent variable. A search without filters or timeframe was performed on Scopus and 1 408 articles were found, among which 21 were reviewed in depth and 6 were included for meta-analysis. Risk of bias was assessed by a quality and heterogeneity assessment. Separate meta-analyses were performed for general distress and psychological flexibility at post-treatment and last follow-up. Risk of bias analysis suggest low risk of threats to validity and attribute heterogeneity to between-study attrition rates. Additionally, meta-regression models for duration, attrition rate, and mean age are proposed for each time point. The results show significantly large effect sizes for both variables at both time points. According to the meta-regression models attrition rates are a mediating variable for the effect on general distress both at completion and at the last follow-up. On the other hand, duration, age and attrition rate are all mediating variables for the effect on psychological flexibility at the end of treatment. The findings suggest that the high attrition rates observed on tele-psychology need to be mitigated; if this is not possible, intention-to-treat approaches should be adopted for data analysis.
Resumen Los metaanálisis existentes sobre el efecto de las intervenciones psicológicas en línea (OPIs, por sus siglas en inglés) han encontrado tamaños de efecto pequeños o medianos para el tratamiento de la ansiedad y la depresión. Por otra parte, las OPIs transdiagnósticas de tercera generación son muy escasas y, debido a la gran variabilidad entre los trastornos, los síntomas o las poblaciones objetivo, es difícil evaluar su efecto global. Otras revisiones sistemáticas y metaanálisis tienen criterios de inclusión demasiado amplios que dificultan la comprensión de los hallazgos. El presente estudio tiene como objetivo analizar la evidencia empírica actual para las OPIs transdiagnósticas de tercera generación diseñadas para disminuir los síntomas y promover la flexibilidad psicológica, incluyendo estudios que comparen una OPI con alguna condición de control (por ejemplo lista de espera, tratamiento habitual u otro que no debería tener efecto) y que incluyan una escala de sintomatología general como variable dependiente. Se excluyeron estudios basados en otras terapias y/o diseñados para prevenir o tratar una población, un trastorno o un conjunto de síntomas específicos. También se excluyeron los protocolos de estudio, los diseños pretest-postest y otros en los que era imposible calcular el tamaño del efecto. Se realizó una búsqueda sin filtros ni marco temporal en Scopus y se encontraron 1 408 artículos entre los cuales 21 fueron revisados en profundidad y 6 fueron incluidos en el presente estudio. El riesgo de sesgo se evaluó mediante una evaluación de calidad y heterogeneidad; no fue posible realizar análisis de sesgo de publicación. Se realizaron metaanálisis separados para el malestar general y la flexibilidad psicológica en postratamiento y último seguimiento. El análisis del riesgo de sesgo sugiere un bajo riesgo de amenazas a la validez y atribuye la heterogeneidad principalmente a las tasas de deserción entre los estudios. Además, se proponen modelos de metarregresión para la duración, la tasa de deserción y la edad promedio en cada punto temporal. Los resultados muestran tamaños de efecto significativamente grandes para ambas variables en ambos puntos temporales y se evalúa su heterogeneidad, que se atribuye en gran medida a las tasas de deserción de los estudios incluidos. Según los modelos de metarregresión, las tasas de deserción son una variable mediadora del efecto sobre el malestar general tanto en el momento de la finalización como en el último seguimiento. Por otra parte, la duración, la edad y la tasa de abandono son variables mediadoras del efecto sobre la flexibilidad psicológica al final del tratamiento. Los resultados sugieren que es necesario mitigar las altas tasas de deserción observadas en la telepsicología y, cuando no sea posible, adoptar enfoques de intención de tratar para el análisis de los datos.
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Abstract Background Our aim was to compare the efficacy of rituximab, tocilizumab, and abatacept in individuals with rheumatoid arthritis (RA) refractory to treatments with MTX or TNFi agents. Methods We searched 6 databases until January 2023 for phase 2-4 RCTs evaluating patients with RA refractory to MTX or TNFi therapy treated with rituximab, abatacept, and tocilizumab (intervention arm) compared to controls. Study data were independently assessed by two investigators. The primary outcome was considered as achieving ACR70 response. Results The meta-analysis included 19 RCTs, with 7,835 patients and a mean study duration of 1.2 years. Hazard ratios for achieving an ACR70 response at six months were not different among the bDMARDs, however, we found high heterogeneity. Three factors showing a critical imbalance among the bDMARD classes were identified: baseline HAQ score, study duration, and frequency of TNFi treatment in control arm. Multivariate meta-regression adjusted to these three factors were conducted for the relative risk (RR) for ACR70. Thus, heterogeneity was attenuated (I2 = 24%) and the explanatory power of the model increased (R2 = 85%). In this model, rituximab did not modify the chance of achieving an ACR70 response compared to abatacept (RR = 1.773, 95%CI 0.113-10.21, p = 0.765). In contrast, abatacept was associated with RR = 2.217 (95%CI 1.554-3.161, p < 0.001) for ACR70 compared to tocilizumab. Conclusion We found high heterogeneity among studies comparing rituximab, abatacept, and tocilizumab. On multivariate metaregressions, if the conditions of the RCTs were similar, we estimate that abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab. Key messages Abatacept could increase the chance of reaching an ACR70 response by 2.2-fold compared to tocilizumab.
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@#【Objective】To evaluate the efficacy of ziprasidone injection and the related influencing factors for treating agitation in schizophrenic patients based on published literature in English or Chinese. 【Methods】We searched PubMed， EMBASE， Web of Knowledge， Cochrane Library， Wanfang data， Chinese Journal Full- Text Database（CJFD），Chinese Biomedical Literature Database（CBMdisc）and VIP Chinese Technology Periodical Database（VIP）. The Consolidated Standards of Reporting Trials（CONSORT）statement was used as a criterion for screening and assessing the literature. Meta-analysis and meta-regression were conducted by using STATA. With the effect size as the dependent variable and sex，age，baseline PANSS scale total score and oral antipsychotics as the covariates ，the meta- regression model was analyzed. 【Results】The Grades of Recommendation ，Assessment ，Development and Evaluation（GRADE） approach was employed to rate the overall quality of evidence. A total of 14 studies（5 in English and 9 in Chinese）were included in meta analysis and meta regression. The samples were ，respectively，1 197 and 1 149 at baseline and after treatment. Random effect Meta analysis showed that ziprasidone injection had significant efficacy in the treatment of agitation symptoms［SMD=2.04，95%CI（1.47，2.61），P = 0.000］. Meta regression revealed that the efficacy was related to baseline PANSS scores（t = 5.57 ，P = 0.011）and oral antipsychotics（t = 4.07 ，P = 0.027），but irrelevant to age（t = 0.74，P = 0.539）and language published（t = -0.57，P = 0.625）. The efficacy was better in female patients than that in male patients （t = -2.95 ，P = 0.060）. 【Conclusion】 Ziprasidone injection has significant efficacy in schizophrenia patients with agitation symptoms and the efficacy may be enhanced in those patients with higher baseline PANSS score and added with oral antipsychotics.
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The objective of this study was to describe general approaches for intervention meta-analysis available for quantitative data synthesis using the R software. We conducted an intervention meta-analysis using two types of data, continuous and binary, characterized by mean difference and odds ratio, respectively. The package commands for the R software were “metacont”, “metabin”, and “metagen” for the overall effect size, “forest” for forest plot, “metareg” for meta-regression analysis, and “funnel” and “metabias” for the publication bias. The estimated overall effect sizes, test for heterogeneity and moderator effect, and the publication bias were reported using the R software. In particular, the authors indicated methods for calculating the effect sizes of the target studies in intervention meta-analysis. This study focused on the practical methods of intervention meta-analysis, rather than the theoretical concepts, for researchers with no major in statistics. Through this study, the authors hope that many researchers will use the R software to more readily perform the intervention meta-analysis and that this will in turn generate further related research.
Subject(s)
Forests , Hope , Odds Ratio , Population Characteristics , Publication BiasABSTRACT
The objective of this study was to describe general approaches for intervention meta-analysis available for quantitative data synthesis using the R software. We conducted an intervention meta-analysis using two types of data, continuous and binary, characterized by mean difference and odds ratio, respectively. The package commands for the R software were “metacont”, “metabin”, and “metagen” for the overall effect size, “forest” for forest plot, “metareg” for meta-regression analysis, and “funnel” and “metabias” for the publication bias. The estimated overall effect sizes, test for heterogeneity and moderator effect, and the publication bias were reported using the R software. In particular, the authors indicated methods for calculating the effect sizes of the target studies in intervention meta-analysis. This study focused on the practical methods of intervention meta-analysis, rather than the theoretical concepts, for researchers with no major in statistics. Through this study, the authors hope that many researchers will use the R software to more readily perform the intervention meta-analysis and that this will in turn generate further related research.
Subject(s)
Forests , Hope , Odds Ratio , Population Characteristics , Publication BiasABSTRACT
Background: Bangladesh has been struggling to reduce the prevalence of childhood undernutrition, which impedes physical and mental capability and accelerates morbidity and mortality. Objectives: The objective of the paper is to examine the changes over time in the association between potential covariates and nutritional status of Bangladeshi children. Methods: The study combined and analyzed data from six waves of Demographic and Health Surveys between 1997 and 2014. Multivariable binary logistic regression models have been fitted to data from individual waves. Overall association has been investigated using forest plots, and meta-regression has been utilized to assess the pace of change in the association over time. Results: Parental education and place of residence showed a consistent association with nutritional status of children. Children from parents with no little education were more likely to be undernourished than those from parents with secondary or higher level of education (odds ratio [OR] in 1997 = 3.34, 95% confidence interval [CI] = 2.65�22, OR in 2004 = 1.93, 95% CI = 1.58�37). On the other hand, gaps in the association of wealth and childhood nutrition have been widening consistently so that in 2014 children from households from the lowest 40% wealth category were 2.66 times (OR = 2.66, 95% CI = 2.13�33) as likely as to be undernourished than those from upper 20%. Conclusions: The findings have policy implications in terms of developing programs directed to mothers with a relatively poor socioeconomic background. A specific example would be providing nutritional education in relation to importance of childhood nutrition or cheaper nutritious food.
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This paper aims to conduct a literature meta-analysis of the results of existing empirical researches about the relationship between fiscal decentralization and supply of public health service in China.It was found that the different empirical results of the impact of China''s fiscal decentralization on the supply of public health services are subject to different research characteristics.The actual results of the impact, especially the significant effect, are influenced by the characteristics of the starting year, the year of termination, and the number of models, whether the model contains population density, transfer payments, degree of openness, and whether the independent variables include the fiscal expenditure decentralization.Through the funnel plot asymmetry test, it was found that there was publication bias in the sample literature.
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The effectiveness of phosphodiesterase type 5 inhibitors (PDE5-Is) for erectile dysfunction (ED) varies considerably among trials, but available studies investigating the factors that affect the effectiveness are few and findings are not consistent. A systematic search was performed in PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials comparing PDE5-Is with placebo for the treatment of ED. The methodological quality of included studies was assessed by the Cochrane Collaborations tool for assessing risk of bias. The associations between prespecified study-level factors and effectiveness were tested by a random effects meta-regression model. This study included 93 trials with 26 139 patients. When all PDE5-Is were grouped together, Caucasian ethnicity was associated with 15.636% (95% confidence interval [CI]: 0.858% to 32.579%) increase in risk ratio (RR) for Global Assessment Questionnaire question-1 (GAQ-1), and 1.473 (95% CI: 0.406 to 2.338) score increase in mean difference (MD) for posttreatment International Index of Erectile Function-Erectile Function domain score (IIEF-EF), compared to Asian ethnicity. A one-score increase in baseline IIEF-EF was associated with -5.635% (95% CI: -9.120% to -2.017%) reduction in RR for GAQ-1, and -0.229 (95% CI: -0.425 to -0.042) score decrease in MD for posttreatment IIEF-EF. In conclusion, PDE5-Is are more effective in Caucasians than Asians, and in patients with more severe ED.
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Resumen Para el desarrollo de políticas sanitarias y económicas en el sector salud, es necesario que la toma de decisiones esté basada en la evidencia. El desarrollo de nuevas tecnologías para el cuidado de la salud se ha incrementado en las últimas décadas permitiendo la aparición, cada vez más rápida, de múltiples alternativas farmacológicas para el manejo de una misma patología; dada la cantidad de intervenciones se hace indispensable comparar las relevantes, en especial, mediante la realización de ensayos clínicos controlados, con el fin de evaluar y determinar la mejor alternativa en términos de beneficios, menores efectos adversos y costos. Sin embargo, debido a la ausencia de este tipo de estudios dado su alto costo, las comparaciones indirectas de tratamientos como las redes de meta-análisis y las comparaciones mixtas de tratamientos, son una herramienta útil para la selección de la mejor opción. Esta revisión, proporciona una orientación sobre la interpretación de las comparaciones indirectas, los métodos, supuestos, validez, métodos de análisis, beneficios y limitaciones, con el fin de proporcionar herramientas suficientes para la adecuada toma de decisiones en salud.
Abstract For the development of health and economic policies in the health system, it is necessary for decision making is based on evidence. The development of new technologies for health care has increased in recent decades, allowing the appearance, fastest growing, multi-drug alternatives for handling the same pathology, given the number of interventions is essential to compare all relevant specially through controlled clinical trials, to evaluate and determine the best alternative in terms of benefits, fewer side effects and costs. However, due to the absence of this type of study due to its high cost, indirect comparisons of treatments such as networks of meta-analysis and mixed treatment comparisons provide a useful tool for selecting the best treatment option. This review provides guidance on the interpretation of indirect comparisons, methods, assumptions, validity, analysis methods, benefits and limitations in order to provide sufficient tools for proper decision-making in health.
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Humans , Rheumatology , ColombiaABSTRACT
Studies have shown links between household secondhand tobacco smoke (SHS) exposure and induction of childhood asthma. But the true nature of this link remains unclear in many studies. We conducted a meta-analysis of studies published from 1970 to 2005 to uncover consistent patterns of relative risk estimates (RRs), and found substantial heterogeneity within initial summary RRs of 1.48 [95 percent confidence interval (CI), 1.32-1.65], 1.25 (1.21-1.30), and 1.21 (1.08-1.36), for ever, current, and incident asthma, respectively. Lack of control for type of atopy history (familial or child) and child's own smoking status within studies and age category altered summary RRs in separate metaregressions. After adjustments, consistent patterns of association emerged between SHS exposure and childhood asthma induction. Our summary RR of 1.33 (95 percent CI, 1.14-1.56) from studies of incident asthma among older children (618 years old) is 1.27 times the estimate from studies of younger children and higher than estimates from earlier meta-analyses. This showns that exposure duration may be a more important factor than previously understood, and suggests that SHS could be a more fundamental cause of childhood asthma than some previous meta-analyses have indicated.
Diversos estudos demonstraram a ligação entre a exposição ao tabagismo passivo domiciliar (TPD) e a ocorrência de asma na infância. A verdadeira natureza desta ligação, no entanto, continua não esclarecida em muitos deles. Uma meta-análise de estudos publicados entre 1970 e 2005 conduzida a fim de revelar padrões consistentes de estimativas de risco relativas (RRs) revelou heterogeneidade substancial do RR sumário inicial de 1,48 [intervalo de confidência (IC) de 95 percent , 1,32-1,65], 1,25 (1,21-1,30), e 1,21 (1,08-1,36), e de 1,21 (1,08-1,36), para a asma intermitente e persistente, respectivamente. A falta de controles para tipos de história de atopia (familiar ou da criança) e sobre a condição de fumante da própria criança, assim como de faixas etárias, alterou os RRs em meta-regressões individuais. Após ajustes, emergiram padrões de associação consistentes entre exposição ao TPD e asma infantil. Nosso RR sumário de 1,33 (95 percent CI, 1,14-1,56) dos estudos de asma intermitente entre crianças maiores (entre 6 e 18 anos) é 1,27 vezes a estimativa de estudos feitos com crianças menores, além de ser maior do que as estimativas de meta-análises anteriores. Isto demonstra que a duração da exposição pode ser um fator mais importante do que se pensava, e sugere a exposição ao TPD como causa mais fundamental de asma na infância do que indicado em estudos anteriores.
Subject(s)
Humans , Child , Adolescent , Asthma , Inhalation Exposure , Tobacco Smoke Pollution/adverse effects , Tobacco Use Disorder/adverse effects , Risk Factors , Meta-AnalysisABSTRACT
To explore the role and application of Meta-regression and subgroup analyses to recognize and control the heterogeneity in Meta-analysis, Meta-regression models were established by secondary data to screen the factors resulting heterogeneity,and subgroup analyses were used to compare the change of heterogeneity before and after.The heterogeneity was found in the Meta-analysis(Q=44.71,df=27,P=0.017).Sample size and region were selected(P=0.012 and P=0.091,respectively)by Meta-regression from many possible factors such as sample size,year,region and case/contml ratio.The Q values were lowered from 44.71 to 32.11 after subgroup analyses.Thus,Metaregression method was convenient and reliable to screen the affected factors of heterogeneity,and subgroup analyses based on the hypothesis that could significantly lower the heterogeneity.It was recommended to a combined use when an obvious heterogeneity existed but was in need to get an overall result in Metaanalysis.We could correctly judge and lower the heterogeneity to increase the robustness and rationality of results from Meta-analysis.