Comparison of Metacognitive Therapy Versus Cognitive Behavioral Therapy for Generalized Anxiety Disorder: A Meta-Analysis of Randomized Control Trials.

The aim of this meta-analysis is to compare the efficacy of meta-cognitive therapy (MCT) and cognitive behavioral therapy (CBT) in patients with generalized anxiety disorder (GAD). This study is reported according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic electronic literature search was conducted on April 20, 2023, to find studies reporting on the efficacy of MCT for GAD. The search keywords included "Generalized anxiety disorders," "meta-cognitive therapy," "cognitive behavior therapy," and "randomized control trials.: The following databases were searched to find relevant articles: PubMed, PsychInfo, CINAHL, and SCOPUS. Outcomes assessed in the present meta-analysis included the change in the Penn State Worry Questionnaire (PSWQ) from baseline to completion of treatment and after two years of follow-up. The PSWQ measures the trait of worry in adults. Worry is regarded as a dominant feature of GAD. Secondary outcomes assessed in this meta-analysis included symptom severity using the Beck anxiety inventory (BAI). Change in BAI was scored from baseline to completion of treatment and after two years of follow-up. A total of three studies were included in this meta-analysis. The results show that patients treated with MCT had greater reductions in PSWQ and BAI scores post-treatment and after two years of treatment, as well as higher rates of recovery compared to those treated with CBT. These findings suggest that MCT is a promising approach for treating GAD and may have advantages over traditional CBT approaches.

Factors Associated With Non-adherence to Anti-depressant Medication in Adults: A Systematic Review and Meta-Analysis.

The present meta-analysis has been conducted to review currently available literature to examine the factors associated with adherence to anti-depressant medications in adults. This meta-analysis and systematic review followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. According to this analysis, the three most important electronic resources for research were CINAHL, EMBASE, and Medline. Google Scholar was used to supplementing the articles already available for review. Keywords used to find relevant articles included "predictors," "non-adherence," "anti-depressants," and "adults." Medical subject headings (MeSH) terms and Boolean operators ("AND" and "OR") were used in the search strategy to refine the search further. Studies included in this meta-analysis had information on factors associated with non-adherence to anti-depressant medication. The study evaluated samples of adult participants over 18 years with a diagnosis of depression and who had been prescribed anti-depressants. In conclusion, this meta-analysis examined the relationship between demographic factors and non-adherence to anti-depressant medications. The findings revealed that gender, educational status, income level, marital status, and area of residence did not significantly predict non-adherence to anti-depressants. However, older age and polypharmacy were significant predictors of adherence to anti-depressants. The study also found that individuals living in urban areas were more likely to adhere to anti-depressants, but the difference was not statistically significant.

Pharmacologic Management of Intensive Care Unit Delirium and the Impact on the Duration of Delirium, Length of Intensive Care Unit Stay and 30-Day Mortality: A Network Meta-Analysis of Randomized-Control Trials.

The present network meta-analysis was conducted to compare typical and atypical antipsychotics for the management of intensive care unit (ICU) delirium. The present meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two investigators systematically searched electronic databases, including PubMed, EMBASE, and the Cochrane Library, for relevant studies in English from inception to February 15, 2023. The key terms used to search for relevant articles included "antipsychotic," "delirium," "randomized-controlled trials," and "efficacy." We used the term "randomized controlled trials (RCTs)" to limit the search to RCTs. The primary outcome was the duration of delirium in days. There were three predefined secondary outcomes included: mortality in 30 days, duration of mechanical ventilation in days, and length of ICU stay in days. A total of seven studies were included in the present meta-analysis. No significant difference was found between typical anti-psychotic, atypical anti-psychotic, and placebo in terms of duration of delirium, rate of mortality, duration of ICU stay, and duration of mechanical ventilation. In conclusion, this network meta-analysis comparing typical antipsychotic, atypical antipsychotic medications, and placebo on delirium in patients in the ICU did not find evidence that either typical or atypical antipsychotic medications led to a shorter duration of delirium. Patients who received treatment with typical or atypical antipsychotics and those who received a placebo had similar clinical outcomes, including mortality, length of stay in the ICU, and duration of ventilation.

Comparison of Effectiveness and Safety of Low-Dose Versus Standard-Dose Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke: A Meta-Analysis.

The aim of the present meta-analysis is to compare the efficacy and safety of low-dose and standard-dose recombinant tissue plasminogen activators (r-tPA) in patients with acute ischemic stroke. The present meta-analysis was conducted according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted a systematic search in PubMed, Embase, and the Cochrane Library to identify studies published between January 1, 2010, and January 31, 2023, using the following terms: "stroke," "alteplase," "doses," "efficacy," "tissue plasminogen activator," "r-tPA," and "safety." Primary efficacy outcomes included favorable outcomes (Modified Rankin Scale scores of 0-2), while secondary efficacy outcome was all-cause mortality at 90 days. Safety outcomes included asymptomatic intracerebral hemorrhage (ICH) and symptomatic ICH assessed using the National Institute of Neurological Disorders and Stroke (NINDS) study and the Safe Implementation of Thrombolysis in Stroke-Monitoring (SITS-MOST) study. We also compared parenchymal hematomas as safety outcome between the two groups defined by the authors themselves in their research. A total of 16 studies were included in the present meta-analysis. The meta-analysis did not report any significant difference between low-dose and standard-dose r-tPA in terms of mortality, symptomatic intracranial hemorrhage (SICH), asymptomatic ICH, and parenchymal hematomas. However, the favorable outcome was significantly greater in patients receiving a standard dose of r-tPA.