Cumulative Meta-analysis Research Articles

Thoracic irrigation for traumatic hemothorax: A systematic review and meta-analysis

BACKGROUND Traumatic hemothoraces (HTXs) are common, and tube thoracostomy (TT) insertion is generally the initial management. However, a retained HTX can develop into a fibrothorax or empyema requiring secondary intervention. We hypothesized that irrigation of the thoracic cavity at the time of TT may prevent retained HTX. METHODS Pubmed, EMBASE, and Scopus were searched from inception to May 2024. Studies with adult trauma patients with traumatic HTX who received a TT and had patients who underwent thoracic irrigation were included. The primary outcome was failure rate, defined as retained HTX requiring a second intervention. Cumulative analysis was performed with χ2 for dichotomous variables and unpaired t test for continuous variables. A fixed-effects model was applied for meta-analysis. RESULTS Six studies were included in the analysis; two retrospective and four prospective observational studies. These studies included 1,319 patients (513 irrigated TT, 837 nonirrigated TT). The mean age of patients was 45 years, 81% were male, mean Injury Severity Score was 21, and 42% had penetrating trauma. Failure rate was significantly lower in the irrigation group on cumulative analysis (10.7% vs. 18.2%, p < 0.001) and meta-analysis (effect size, 0.704; 95% confidence interval, 0.218–1.190; I 2 = 0.4; p < 0.001]. In addition, on meta-analysis, the irrigation group had a shorter TT duration and hospital and ICU length of stay (all p < 0.05). There were no differences in overall infectious complications, readmission, or mortality; however, all the models favored the irrigation group. CONCLUSION Patients who undergo simultaneous TT and thoracic irrigation have a lower rate of retained HTX and require fewer secondary interventions. Thoracic irrigation for traumatic HTX should be considered; however, randomized studies are needed prior to development of guidelines. LEVEL OF EVIDENCE Systematic Review/Meta-analysis; Level III.

Effectiveness of gait analysis in management of osteoarthritis knee at primary care settings in Asia: a systematic review and meta-analysis protocol

Background: This systematic review will focus on the effectiveness of gait analysis on osteoarthritis knee management. The objectives of this systematic review and meta-analysis are to synthesize the clinical effectiveness and to compare the effectiveness of gait analysis in the osteoarthritis knee management in Asian population. Methods: This review will be conducted and reported according to PRISMA guidelines. To discover relevant papers, the search technique will use MeSH terms such as osteoarthritis knee, gait analysis, osteoarthritis knee management, primary healthcare, effectiveness, and Asia. Other synonymous words will be searched using the Boolean operator "and"/"or" on PubMed, Embase, Scopus, and Cochrane. Randomized controlled trials assessing the efficacy of gait analysis in the therapy of osteoarthritis knee patients in primary care settings in Asia will be considered. A random effects meta-analysis will be carried out using the REVMAN software version 5.3.5. The STATA software version SE16 will be used for both cumulative and comparative meta-analysis. Conclusions: This review and meta-analysis will be among the first to give an extensive purview on the effectiveness of gait analysis in osteoarthritis knee management at primary care settings in Asian population. This study will also acknowledge the effects of different gait analysis strategies with an attempt to compare the same. Trial Registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42024540444).

Using of virtual reality and artificial intelligence in education: literature review

Many individuals believe that new technology has been a transformative force in the field of education. Various technologies have been integrated into educational process in order to identify its capacity of enhancing student-learning experience. According to the newest studies, some recently developed technologies such as artificial intelligence (AI) and virtual reality (VR) have the potential to significantly improve teaching and learning processes. The article considers the relevance of using virtual reality and artificial intelligence resources in education. With the help of systematic literature review, this article provides a cumulative meta-analysis of works of a number of scholars who examined the influence of application of VR and AI on student learning experience. The authors found that the advantages of integrating these technologies into educational process are based on the increase in students’ interests in the subject, the effectiveness in explaining complex topics, and the formation of a culture of openness to new technologies. The conclusions of the article contribute to the expansion of local academic understanding of this topic and are also useful for decision-makers in the field of secondary education and higher educational institutions which integrate educational technologies

Outcomes of Single Anastomosis Sleeve Ileal (SASI) Bypass as an Alternative Procedure in Treating Obesity: An Updated Systematic Review and Meta-Analysis.

The Single Anastomosis Sleeve Ileal (SASI) bypass is a novel bariatric procedure that simplifies Santoro's procedure, balancing functional restriction and neuroendocrine modulation while preserving anatomy. We aim to conduct a single-arm meta-analysis of the SASI bypass to explore its moderate-term efficacy, as this might expand the available choices for surgeons to choose the best bariatric surgery that suits the patient's condition. We conducted a comprehensive search on PubMed, Scopus, EMBASE, and Cochrane to identify studies for the SASI bypass surgery focusing on outcomes such as %EWL, %TWL, remission rate of comorbidities, and complications. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. Our findings illuminate SASI's potency by undertaking a single-arm meta-analysis involving 1873 patients across 26 studies. At 12months, we report a noteworthy % Excess Weight Loss (%EWL) (Mean 84.13; 95% CI 78.41-89.85; I2 = 95%), and % Total Weight Loss (%TWL) (Mean 35.17; 95% CI 32.30-38.04; I2 = 97%), highlighting SASI's efficacy on weight loss. Cumulative meta-analyses supported these findings. More weight loss was observed with a 250cm common limb and a greater than 3cm anastomosis. An 88.28% remission rate in type 2 diabetes mellitus (95% CI 79.74-95.03; I2 = 84%) at 12months was observed. Beyond weight outcomes, SASI impacts comorbidities with a good safety profile. Our study positions the SASI bypass as a good alternative option. However, long-term efficacy is yet to be explored in the future.

The Worldwide Prevalence of Internet Addiction among Medical Students: A Systematic Review and Meta-Analysis.

The internet helps us obtain necessary information, facilitates social communication, and provides access to entertainment content. The internet can also lead to the behavioral addictive condition termed internet addiction (IA) if used excessively. As active internet users, medical students are susceptible to IA, which is known to lead to depression and improper medical care delivery, poor academic performance, worse sleep quality, and undesirable financial issues. This systematic review and meta-analysis aimed to assess medical students' pooled IA prevalence. The analysis included thirteen cross-sectional studies involving 4787 medical students. Cumulative, subgroup, and meta-regression meta-analyses were applied, using the random-effects model and the restricted maximum likelihood method. The cumulative meta-analysis revealed a rise in the proportion of IA from 0.08 to 0.29, with minor fluctuations between 2015 and 2022. The IA prevalence in lower-middle-income countries was approximately three times higher than in high-income ones. Age and gender were not associated with IA among medical students. The worldwide prevalence of IA was 0.29, with a 95% CI between 0.19 and 0.41. Considering negative IA implications for medical students' well-being, policymakers and all stakeholders should pay special attention to addressing IA within the medical student community.

Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia.

In this randomized controlled trial (RCT) comparing current acupuncture with carbamazepine for trigeminal neuralgia, meta- and sequential analyses were utilized. To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine. The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database, Wanfang Data, VIP Database, as well as international databases such as Excerpt Medica Database, Cochrane Library, PubMed, and Web of Science, along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform, ChiCTR, and Clinical Trials up to 1 April 2020. Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool, primary outcome measures (pain reduction) were analyzed using STATA meta-analysis, outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis, GRADE was used to assess the evidence, and adverse reactions were documented. This study analyzed 16 RCTs with a total of 1231 participants. The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine [standardized mean difference (SMD) = 1.47; 95% confidence interval (CI): 0.99-1.95], although the quality of evidence was deemed to be of extremely low quality. Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time [SMD = 1.84; 95%CI: 0.22-3.47]. Additionally, the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine. Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine; however, firm conclusions still require a high-quality, multicenter, large-sample RCT to confirm these findings.

Comparing the safety and effectiveness of minimally invasive surgery and open inguinal lymph node dissection in penile cancer: A systematic review and meta-analysis

ObjectiveTo compare the safety and effectiveness of minimally invasive surgery (MIS) with open inguinal lymph node dissection (O-ILND) in penile cancer. MethodsWe performed a systematic reviews and cumulative meta-analyses of primary results of interest according to PRISMA criteria, and quality assessment followed AMSTAR. The system searched five databases, including Zhiwang, Embase, PubMed, Cochrane Library and Web of Science. The search period ranged was from database creation until September 2023. The statistical analysis software used Stata16. ResultsA total of 16 studies, including 898 patients. Compared to O-ILND, MIS is superior in length of stay (WMD = −2.96, 95%CI [-4.38, −1.54], P < 0.05), drainage time (WMD = −3.24, 95%CI [-4.70, −1.78], P < 0.05) and estimated blood loss (WMD = −35.70, 95%CI [-46.27, −25.14], P < 0.05), while operation time, recurrence rate and 5-year overall survival rate are the same. The number of lymph nodes dissection between the two groups are not statistically significant. Subgroup analyses found that there are more lymph nodes dissection in robotic-assisted inguinal lymph nodes dissection (WMD = 0.50, 95%CI [0.20, 0.80], P < 0.05). The overall complication rate of MIS was lower (OR = 0.26, 95%CI [0.09, 0.70], P < 0.05). ConclusionMinimally invasive inguinal lymph nodes dissection appears to be a better option for penile cancer cases. But more large samples and multicenter studies are needed to further confirm.

Comparative evaluation of reproductive organ-preserving versus standard radical cystectomy in female: a meta-analysis and systematic review of perioperative, oncological, and functional outcomes.

To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer. A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522). The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD -45.69, 95% CI -78.91 ~ -12.47, p = 0.007, and MD -0.69, 95% CI -1.25 ~ -0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival. ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.

The Outcomes of Surgical Pulmonary Embolectomy for Pulmonary Embolism: A Meta-Analysis.

Objectives: The purpose of this study is to assess the efficacy, short- and long-term cardiovascular and non-cardiovascular mortalities and postoperative morbidities of surgical pulmonary embolectomy (SPE) for patients with massive or submassive pulmonary embolism. Methods: A comprehensive literature review was performed to identify articles reporting SPE for pulmonary embolism. The outcomes included in-hospital and long-term mortality in addition to postoperative morbidities. The random effect inverse variance method was used. Cumulative meta-analysis, leave-one-out sensitivity analysis, subgroup analysis and meta-regression were performed. Results: Among the 1949 searched studies in our systematic literature search, 78 studies met our inclusion criteria, including 6859 cases. The mean age ranged from 42 to 65 years. The percentage of males ranged from 25.6% to 86.7%. The median rate of preoperative cardiac arrest was 27.6%. The percentage of contraindications to preoperative systemic thrombolysis was 30.4%. The preoperative systemic thrombolysis use was 11.5%. The in-hospital mortality was estimated to be 21.96% (95% CI: 19.21-24.98); in-hospital mortality from direct cardiovascular causes was estimated to be 16.05% (95% CI: 12.95-19.73). With a weighted median follow-up of 3.05 years, the late cardiovascular and non-cardiovascular mortality incidence rates were 0.39 and 0.90 per person-year, respectively. The incidence of pulmonary bleeding, gastrointestinal bleeding, surgical site bleeding, non-surgical site bleeding and wound complications was 0.62%, 4.70%, 4.84%, 5.80% and 7.2%, respectively. Cumulative meta-analysis showed a decline in hospital mortality for SPE from 42.86% in 1965 to 20.56% in 2024. Meta-regression revealed that the publication year and male sex were associated with lower in-hospital mortality, while preoperative cardiac arrest, the need for inotropes or vasopressors and preoperative mechanical ventilation were associated with higher in-hospital mortality. Conclusions: This study demonstrates acceptable perioperative mortality rates and late cardiovascular and non-cardiovascular mortality in patients who undergo SPE for massive or submassive pulmonary embolism.

Tobacco Cessation Interventions in Non-Respiratory Cancers: A Systematic Review With Meta-analysis of Randomized Controlled Trials.

Considering the high rates of persistent tobacco use, effective cessation interventions are needed for cancer patients and caregivers. Despite the need, there is a significant lack of research on tobacco cessation, especially for non-respiratory cancers (breast, prostate, colorectal, cervical, and bladder cancer). The objective was to evaluate tobacco use and tobacco cessation interventions among patients and caregivers for non-respiratory cancers. Randomized controlled trials assessing tobacco cessation interventions were identified. Five electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through July 2023. Studies exclusive to lung, oral, thoracic, and head and neck cancers were excluded. Effect sizes were estimated; risk of bias was assessed. Of 3,304 studies, 17 were included. Interventions included behavioral (n = 6), pharmacotherapy (n = 2), and a combination (n = 9) treatment. Eight studies included a health behavior model; mean behavioral change techniques were 5.57. Pooled magnitude of the odds of cessation was positive and significant (odds ratio = 1.24, 95% confidence interval [Lower Limit 1.02, Upper Limit 1.51]) relative to usual care/placebo. Cumulative meta-analysis examined the accumulation of results over-time and demonstrated that studies have been significant since 2020. Two studies included caregivers' who were involved in the provision of social support. Current interventions have the potential to reduce tobacco use in non-respiratory cancers. Results may be beneficial for promoting tobacco cessation among non-respiratory cancers. There is a considerable lack of dyadic interventions for cancer survivors and caregivers; researchers are encouraged to explore dyadic approaches.

Correlation between hepatitis B virus infection and adverse pregnancy outcomes-a systematic review and meta-analysis

Objective: To systematically evaluate the effect of hepatitis B virus (HBV) infection on the risk of adverse pregnancy outcomes. Methods: We searched PubMed, Embase, Web of Science, and Cochrane databases. Two researchers independently screened the literature, extracted data, and evaluated the quality. Meta-analysis and cumulative meta-analysis were performed using R4.4.1 software. Fixed/random effects models were used to analyze heterogeneous and non-heterogeneous results. Heterogeneous modifiers were identified by subgroup analysis. Funnel plots and Peters' test were used to analyze potential publication bias. Results: A total of 48 studies involving 92 836 HBsAg-positive pregnant women and 7 123 292 HBsAg-negative pregnant women were included. In terms of adverse pregnancy outcomes, HBV infection was significantly correlated with the occurrence of gestational diabetes mellitus [odds ratio (OR)=1.34, 95% confidence interval (CI): 1.17-1.53] and intrahepatic cholestasis (OR=2.48, 95%CI: 1.88-3.29), with statistically significant differences. In terms of adverse neonatal outcomes, HBV infection was significantly correlated with the occurrence of neonatal asphyxia (OR=1.49, 95%CI: 1.20-1.86) and preterm birth (OR=1.22, 95%CI: 1.12-1.33), with statistically significant differences. In addition, the cumulative meta-analysis demonstrated that the risk of gestational diabetes mellitus and preterm birth both tended to be stable in pregnant women with HBV infection following 2009 and 2010, respectively. The supplementary questions answered for repeated studies had limited significance. Conclusion: Intrahepatic cholestasis, gestational diabetes mellitus, neonatal asphyxia, and preterm birth occurrence risk can be raised with HBV infection in pregnant women.

Making Drug Approval Decisions in the Face of Uncertainty: Cumulative Evidence versus Value of Information.

The COVID-19 pandemic underscored the criticality and complexity of decision making for novel treatment approval and further research. Our study aims to assess potential decision-making methodologies, an evaluation vital for refining future public health crisis responses. We compared 4 decision-making approaches to drug approval and research: the Food and Drug Administration's policy decisions, cumulative meta-analysis, a prospective value-of-information (VOI) approach (using information available at the time of decision), and a reference standard (retrospective VOI analysis using information available in hindsight). Possible decisions were to reject, accept, provide emergency use authorization, or allow access to new therapies only in research settings. We used monoclonal antibodies provided to hospitalized COVID-19 patients as a case study, examining the evidence from September 2020 to December 2021 and focusing on each method's capacity to optimize health outcomes and resource allocation. Our findings indicate a notable discrepancy between policy decisions and the reference standard retrospective VOI approach with expected losses up to $269 billion USD, suggesting suboptimal resource use during the wait for emergency use authorization. Relying solely on cumulative meta-analysis for decision making results in the largest expected loss, while the policy approach showed a loss up to $16 billion and the prospective VOI approach presented the least loss (up to $2 billion). Our research suggests that incorporating VOI analysis may be particularly useful for research prioritization and treatment implementation decisions during pandemics. While the prospective VOI approach was favored in this case study, further studies should validate the ideal decision-making method across various contexts. This study's findings not only enhance our understanding of decision-making strategies during a health crisis but also provide a potential framework for future pandemic responses. This study reviews discrepancies between a reference standard (retrospective VOI, using hindsight information) and 3 conceivable real-time approaches to research-treatment decisions during a pandemic, suggesting suboptimal use of resources.Of all prospective decision-making approaches considered, VOI closely mirrored the reference standard, yielding the least expected value loss across our study timeline.This study illustrates the possible benefit of VOI results and the need for evidence accumulation accompanied by modeling in health technology assessment for emerging therapies.

Effect and safety of PCSK9 inhibitor in-hospital use on blood lipid level in the ACS patients: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): none Aims To evaluate the effect and safety of in-hospital use of the proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor on blood lipid levels in the acute coronary syndrome (ACS) patients. Methods We searched the PubMed, MEDLINE, Web of Science, Ovid and Cochrane Library electronic databases through July 2023 to identify randomized controlled trials (RCTs) and cohort studies using PCSK9 inhibitors during ACS hospitalization. Then we compared the PCSK9 inhibitor group with a placebo or a blank control group with the same background of lipid-lowering therapy. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias for the included studies. A software was used to analyze the changes in overall lipids from baseline and the adverse event rates. Results A total of 15 studies enrolling 3891 patients with ACS were eligible, including 10 RCTs (n = 1406) and 5 cohort studies (n = 2485). Treatment with PCSK9 inhibitors showed a greater reduction in low-density lipoprotein cholesterol (LDLC) (SMD=1.46, 95% CI: 1.16-1.76, P&amp;lt;0.01). The cumulative meta-analysis of follow-up time showed that the degree of LDLC reduction stabilized after 12 weeks (SMD=1.42 at 12 weeks, 95% CI: 1.06-1.79, P&amp;lt;0.01), and thus, PCSK9 inhibitors dramatically decreased LDLC levels in comparison to controls at both ≤12 weeks and 12–72 weeks. The LDLC levels with PCSK9 inhibitors that reached the recommended standards of AHA/ACC (≤1.8mmol/l) and ESC (≤1.4mmol/l) were 95% and 80% respectively, which were significantly higher than those of the control group (58% and 22%). PCSK9 inhibitors can also reduce the total cholesterol, triglycerides, apolipoprotein B, and lipoprotein (a), while increasing the high-density lipoprotein cholesterol, but they have no statistical significance in reducing apolipoprotein A1. Compared with placebo or blank control, the addition of PCSK9 inhibitor did not increase the occurrence of adverse events (RR =-0.01,95% CI:-0.19-0.18, P = 0.95) and serious adverse events (RR =-0.03, 95% CI:-0.48-0.43, P=0.91). Conclusion In-hospital use of PCSK9 inhibitors can significantly improve the blood lipid levels of ACS patients and increase the target LDLC attainment rate, with satisfactory safety and good tolerance.

Stage 2 Registered Report: Anomalous perception in a Ganzfeld condition - A meta-analysis of more than 40 years investigation

This meta-analysis is an investigation into anomalous perception (i.e., conscious identification of information without any conventional sensorial means). The technique used for eliciting an effect is the Ganzfeld condition (a form of sensory homogenization that eliminates distracting peripheral noise). The database consists of studies published between January 1974 and December 2020 inclusive. The overall effect size estimated both with a frequentist and a Bayesian random-effect model, were in close agreement yielding an effect size of approximately .08 (.04 -.12). This result passed four publication bias tests and seems not contaminated by questionable research practices. Trend analysis carried out with a cumulative meta-analysis and a meta-regression model with year of publication as a covariate, did not indicate sign of decline of this effect size. The moderators’ analyses show that the selected participants’ effect size was almost three-times that obtained by non-selected participants and that tasks that simulate telepathic communication show a two-fold effect size for tasks requiring the participants to guess a target. The Stage 1 Registered Report can be accessed here: https://doi.org/10.12688/f1000research.24868.3

Rhythm vs Rate Control Strategy for Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials

BackgroundRhythm control, either with antiarrhythmic drugs or catheter ablation, and rate control strategies are the cornerstones of atrial fibrillation (AF) management. Despite the increasing role of rhythm control over the past few years, it remains inconclusive which strategy is superior in improving clinical outcomes. ObjectivesThis study summarizes the total and time-varying evidence regarding the efficacy of rhythm- vs rate-control strategies in the management of AF. MethodsWe systematically perused the MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials), and Web of Science databases for randomized controlled trials from inception to November 2023. We included studies that compared the efficacy of rhythm control (ie, antiarrhythmic drugs classes Ia, Ic, or III, AF catheter ablation, and electrical cardioversion) and rate control (ie, beta-blocker, digitalis, or calcium antagonist) strategies among patients with nonvalvular AF. The primary outcome was cardiovascular (CV) death, whereas secondary outcomes included all-cause death, stroke, hospitalization for heart failure (HF), sinus rhythm at the end of the follow-up, and rhythm control–related adverse events. A cumulative meta-analysis to assess temporal trends and a meta-regression analysis using the percentage of ablation use was performed. ResultsWe identified 18 studies with a total of 17,536 patients (mean age: 68.6 ± 9.7 years, 37.9% females) and a mean follow-up of 28.5 months. Of those, 31.9% had paroxysmal AF. A rhythm control strategy reduced CV death (HR: 0.78; 95% CI: 0.62-0.96), stroke (HR: 0.801; 95% CI: 0.643-0.998), and hospitalization for HF (HR: 0.80; 95% CI: 0.69-0.94) but not all-cause death (HR: 0.86; 95% CI: 0.73-1.02) compared with a rate control strategy. This benefit was driven by contemporary studies, whereas more ablation use within the rhythm control arm was associated with improved outcomes, except stroke. ConclusionsIn patients with AF, a contemporary rhythm control strategy leads to reduced CV mortality, HF events, and stroke compared with a rate control strategy.

An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996-2023.

Diabetes mellitus (DM) poses a significant threat to public health, and the anticipated surge of over 100% in the age-standardized prevalence of type 2 diabetes in Iran between 2021 and 2050 underscores the pressing need for focused attention. The rationale for estimating the prevalence of type 2 diabetes in Iran becomes even more compelling when considering the potential cascading effects on the healthcare system, quality of life, and economic burden. The aim of this study was to estimate the prevalence and trends of DM from 1996 to 2023 in the Islamic Republic of Iran. Up to July 2023, without deadlines, the search for appropriate articles in Persian and English. Iranian sources including SID, Magiran, and Element were included in the databases, along with foreign ones like PubMed/MEDLINE, Web of Science, Science Direct, Embase, Scopus, ProQuest, and Google Scholar. Using the JBI quality checklist, the study's level of quality was evaluated. Version 14 of STATA was used to carry out the statistical analysis. The Dersimonian and Liard random-effects models were used because of heterogeneity. To investigate the causes of heterogeneity, subgroup analysis and univariate meta-regression were utilized. Sensitivity analysis was then carried out to see how each study's findings affected the final findings. The prevalence pattern over time was also followed using cumulative meta-analysis. There were 53 studies in all, with a combined sample size of 1,244,896 people. Men were predicted to have a type 2 diabetes prevalence of 10.80% (95% CI: 9.1-12.4), while women were assessed to have a prevalence of 13.4% (95% CI: 11.6-15.3). Additionally, the prevalence of diabetes was much higher in the 55-64 age group, coming in at 21.7% (95% CI: 17.5-25.0). The anticipated prevalence of diabetes was 7.08% for 1988 to 2002, 9.05% for 2003 to 2007, 9.14% for 2008 to 2012, 15.0% for 2013 to 2017, and 13.40% for 2018 to 2023, among other time periods. Geographically, type 2 diabetes was most prevalent in Khuzestan (15.3%), followed by Razavi Khorasan (14.4%), Qazvin (14.3%), and Yazd (12.6%). The prevalence of type 2 diabetes was estimated at 10.8%, highlighting variations across gender, age groups, and geographic regions that underscore the necessity for specific interventions. These findings advocate for proactive measures, including tailored screening and lifestyle modification programs. The notable temporal increase from 2013 to 2017 signals the need for policymakers and healthcare practitioners to develop effective strategies, anticipating and addressing the potential future burden on the healthcare system. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437506, identifier: CRD42023437506.

Which indices of heart rate variability are the best predictors of mortality after acute myocardial infarction? Meta-analysis of observational studies

BackgroundCardiovascular disease is the first cause of death globally with myocardial infarction as the main event. Heart rate variability (HRV) has been associated with an increased risk of mortality post-myocardial infarction. However, which indices of heart rate variability are the best predictors for total and cardiac mortality post-myocardial infarction remains unclear. We performed a systematic review to evaluate this association. Methods and resultsPubMed, Google Scholar, Embase and Cochrane databases were searched for studies with HRV as a predictive mortality marker. Two authors independently selected papers and extracted data and disagreements were solved with a third author. HRV indices included were SDNN, SDANN, HRV index, Total power, RMSSD, LF, HF, ULF, VLF, and LF/HF. For these clinical and statistical heterogeneity was assessed, forest and funnel plot graphs were made and sensitivity analysis, cumulative and regression meta-analysis were performed. Stata 16 was used for statistical analysis.Out of 19.960 articles found, 332 were initially selected for abstract screening and 27 finally fulfilled the criteria and allowed the extraction of data. After a sensitivity analysis, low values of SDNN, HRV index, ULF, VLF, Total Power, LF, LF/HF ratio and HF showed a statistically significant association with cardiac mortality, but SDNN index had the highest association (RR 4.19, CI95% 3.36–5.22, I2 39.7%). For total mortality, HRV index, VLF, ULF, LF, Total power, SDNNN, LF/HF ratio, HF were significantly associated, but HRV index was the index with highest association, (RR 3.60, CI95% 2.30–5.64, I2 27.5%). ConclusionsBased on a sensitivity analysis, the best index associated with cardiac mortality post-myocardial infarction is low values of SDNN and for total mortality is low values of HRV index.

Determining the conclusiveness of a meta-analysis.

The pursuit of conclusive evidence related to an unanswered foreground (decision-making) question has been the driving factor behind multiple ongoing and planned randomized controlled trials as well as meta-analyses. However, a fundamental challenge lies in establishing robust methods for ascertaining whether a collection of synthesized trials has yielded a definitive answer to that foreground question through the process of meta-analysis. This article explores the evolution of methods that attempt to address this challenge. These methods have primarily focused on defining and measuring the sufficiency and stability of evidence within a meta-analytic context. Cumulative meta-analysis and trial sequential analysis are the tools currently used, but they both come with limitations and challenges. We further discuss methods aimed at evaluating the evolution of effects over time more directly, such as the recursive cumulative meta-analysis. The latter method can be considered a better alternative, as it serves to demonstrate whether there is a true underlying treatment effect to which the meta-analysis is converging. However, recursive cumulative meta-analysis falls short of a specific indicator that establishes whether convergence has been reached. We coin the term exit for a meta-analysis where convergence can be demonstrated. Developing methods to determine the exit status of a meta-analysis is the next priority in research synthesis methods, as it will indicate that the research journey has concluded on a particular foreground question with no expectation of a different result with the addition of future trials.

The association between prenatal cannabis use and congenital birth defects in offspring: A cumulative meta-analysis

ObjectiveTo examine the association between prenatal cannabis use and structural birth defects in exposed offspring. MethodsIn line with the preregistered protocol (PROSPERO: CRD42022368623), we systematically searched PubMed/Medline, CINHAL, EMBASE, Web of Science, ProQuest, Psych-Info, and Google Scholar for published articles until 25 January 2024. The methodological quality of the included studies was appraised by the Newcastle-Ottawa Quality Assessment Scale (NOS). A meta-analysis was carried out to report the pooled effect estimates from the included studies. We further performed subgroup, leave-one-out sensitivity, and meta-regression analyses, which increased the robustness of our findings. ResultsIn this cumulative meta-analysis, thirty-six observational studies, consisting of 18 case-control and 18 cohort studies, with 230, 816 cases of birth defects and 18,049,013 controls (healthy babies) were included in the final analysis. We found that offspring exposed to maternal prenatal cannabis are at greater risks of a wide range of structural birth defects: cardiovascular/heart [OR = 2.35: 95 % CI 1.63 – 3.39], gastrointestinal [OR = 2.42: 95 % CI 1.61 – 3.64], central nervous system [OR = 2.87: 95 % CI 1.51 – 5.46], genitourinary [OR = 2.39: 95 % CI 1.11 – 5.17], and any (unclassified) birth defects [OR = 1.25: 95 % CI 1.12 – 1.41]. ConclusionThe findings from the current study suggest that maternal prenatal cannabis exposure is associated with a higher risk of different forms of structural birth defects in offspring. The findings underscore the significance of implementing preventive strategies, including enhanced preconception counselling, to address cannabis use during pregnancy and mitigate the risk of birth defects in offspring.

Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis

BackgroundEffective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient’s pain perception during various medical procedures by conducting a systematic review and meta-analysis.MethodsWe searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I2 and explored it using subgroup and meta-regression analyses.ResultsIn total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD − 0.78, 95% CI − 1.00 to − 0.57, I2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD − 0.86, 95% CI − 1.23 to − 0.49, I2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD − 0.77, 95% CI − 1.01 to − 0.52, I2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD − 0.91, 95% CI − 1.26 to − 0.56, I2 = 87%, p = < 0.01) vs adults (n = 40, SMD − 0.66, 95% CI − 0.94 to − 0.39, I2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD − 0.99, 95% CI − 1.52 to − 0.46, I2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD − 0.99, 95% CI − 1.59 to − 0.38, I2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD − 0.51, 95% CI − 0.79 to − 0.23, I2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD − 0.8, 95% CI − 1.16 to − 0.45, I2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018.ConclusionsImmersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.