Fixed-effects Model Analysis Research Articles

Empirical analysis of the relationship between the costs of corporate social responsibility policy implementation and Russian companies’ financial performance

Analysis of the current body of scientific knowledge on the problems of economic efficiency of corporate social responsibility (CSR) policy displays highly controversial results. The paper focuses on empirical analysis of the relationship between the level of social responsibility, as proxied by CSR policy implementation costs, and financial performance of Russian companies. The research methodology includes the conceptual framework of the instrumental approach to the corporate social responsibility theory. Accumulated knowledge and empirical results systematized in the article serve as the basis for statistical analysis of panel data. The authors employ random effects and fixed effects models. The sample comprises data covering the period of 2012–2018 for 22 Russian publicly traded companies. The value multiplier Market-to-Book Ratio (MBR) and the accounting indicator of profitability EBITDA margin are used as dependent variables. Estimates of the random effects model confirm a positive relationship between the value multiplier MBR and CSR policy implementation costs. However, the fixed effects model analysis failed to confirm any statistically significant relationship between the value multiplier MBR and CSR costs, which supports the conclusion that decisions on CSR policy implementation in Russia are mainly due to individual characteristics of companies related to unobservable effects. Both models did not reveal a statistically significant relationship between the chosen CSR proxy variable and the accounting indicator of financial performance. The empirical results generally confirm that socially responsible behavior can act as a driver of raising funds even in the context of imperfect market; however, managerial decisions in this field are largely determined by individual characteristics of companies.

FAKTOR YANG MEMPENGARUHI PERTUMBUHAN EKONOMI SUMATERA UTARA

The results from the fixed effects model analysis show that the natural resources,gross fixed capital formation, and technology have a significant and positive effectsimultaneously on economic growth in North Sumatra. While labor has a nonsignificant effect on economic growth in North Sumatra. Effect of natural resources, gross fixed capital formation, and technology on economic growth is inelastic and shows a diminishing return for the all the sources of growth. The largest source of economic growth that affects economic growth in North Sumatra is gross fixed capital formation by 0.497 and the largest increase in economic growth due to changes in the sources of economic growth is Pematangsiantar by 5,235 percent, while the smallest is Tanjungbalai City by 2,234 percent.

ANALISIS INSTRUMEN KEBIJAKAN FISKAL TERHADAP PERTUMBUHAN EKONOMI DI 35 KABUPATEN / KOTA PROVINSI JAWA TENGAH TAHUN 2013 - 2017

This study examines the role of fiscal policy in the economic growth in 35 Cities/Regency in Central Java Province in 2013 – 2017. This study using panel data with fixed effect model analysis to explain determinants of economic growth. The result of this study show that determinants of economic growth indicate that tax and personnel expenditure have a negative effect to economic growth. While indirect expenditure has a positive influence on economic growth. The results also suggest that goods and services expenditure have an unsignificant influence on economic growth 35 Cities in Province Central Java.

Prognostic and Clinicopathological Significance of SERTAD1 in Various Types of Cancer Risk: A Systematic Review and Retrospective Analysis

SERTAD/TRIP-Br genes are considered as a key nuclear transcriptional player in diverse mechanisms of cell including carcinogenesis. The Oncomine™-Online Platform was used for differential expression and biological insights. Kaplan-Meier survival estimated by KM-plotter/cBioPortal/PrognoScan with 95% CI. SERTAD1 was found significantly elevated levels in most of tumor samples. Kaplan-Meier Plotter results distinctly showed the SERTAD1 over-expression significantly reduced median overall-survival (OS) of patients in liver (n = 364/Logrank-test p = 0.0015), ovarian (n = 655/Logrank-test p = 0.00011) and gastric (n = 631/Logrank-test p = 0.1866). Increased level of SERTAD1 has a significantly higher survival rate in the initial time period, but after 100 months slightly reduced OS (n = 26/Logrank-test p = 0.34) and RFS in HER2 positive breast cancer patients. In meta-analysis, cancer patients with higher SERTAD1 mRNA fold resulted worse overall survival than those with lower SERTAD1 levels. Heterogeneity was observed in the fixed effect model analysis DFS [Tau2 = 0.0.073, Q (df = 4) = 15.536 (p = 0.004), I2 = 74.253], DSS [Tau2 = 1.015, Q (df = 2) = 33.214, (p = 0.000), I2 = 93.973], RFS [Tau2 = 0.492, Q (df = 7) = 71.133 (p = 0.000), I2 = 90.159] (Figure 5). OS [Tau2 = 0.480, Q (df = 17) = 222.344 (p = 0.000), I2 = 92.354]. Lastly, SERTAD1 involved in several signaling cascades through interaction and correlation with many candidate factors as well as miRNAs. This meta-analysis demonstrates a robust evidence of an association between higher or lower SERTAD1, alteration and without alteration of SERTAD1 in cancers in terms of survival and cancer invasiveness.

Effect of index-based livestock insurance on herd offtake: Evidence from the Borena zone of southern Ethiopia

When weather shocks strike in agrarian economies, households may often utilize offtake of their productive livestock as a major risk coping strategy. However, a distressful asset offtake could lead to difficulties in recovering after the shock; consequently, the macro economy of a subsistence agriculture-dependent country could remain slow for an extended period. In this paper, we analysed the effect of index-based livestock insurance on the herd offtake behaviour of herders in the Borena zone, which is the southernmost area of Ethiopia, using three rounds of panel data. Using fixed effect model analysis, our results shows that households that purchased index-based livestock insurance coverage are less likely to offtake their herds. Empirically, this finding appeared to have a positive and significant effect on reducing the herd offtake behaviour of the households. This finding suggests that the coverage can help in reducing the fear and worry of the herding households regarding the possible incidence of covariate herd loss. Consequently, distressful herd offtake can be reduced, thereby sustaining the household’s economic growth.

Associations among job demands and resources, work engagement, and psychological distress: fixed-effects model analysis in Japan.

Objectives: We examined the associations among job demands and resources, work engagement, and psychological distress, adjusted for time-invariant individual attributes. Methods: We used data from a Japanese occupational cohort survey, which included 18,702 observations of 7,843 individuals. We investigated how work engagement, measured by the Utrecht Work Engagement Scale, was associated with key aspects of job demands and resources, using fixed-effects regression models. We further estimated the fixed-effects models to assess how work engagement moderated the association between each job characteristic and psychological distress as measured by Kessler 6 scores. Results: The fixed-effects models showed that work engagement was positively associated with job resources, as did pooled cross-sectional and prospective cohort models. Specifically, the standardized regression coefficients (β) were 0.148 and 0.120 for extrinsic reward and decision latitude, respectively, compared to -0.159 and 0.020 for role ambiguity and workload and time pressure, respectively (p < 0.001 for all associations). Work engagement modestly moderated the associations of psychological distress with workload and time pressure and extrinsic reward; a one-standard deviation increase in work engagement moderated their associations by 19.2% (p < 0.001) and 11.3% (p = 0.034), respectively. Conclusions: Work engagement was associated with job demands and resources, which is in line with the theoretical prediction of the job demands-resources model, even after controlling for time-invariant individual attributes. Work engagement moderated the association between selected aspects of job demands and resources and psychological distress.

Traditional Chinese Medicine Injections in the Treatment of Diabetic Foot: A Systematic Review and Meta-Analysis.

Context The role of traditional Chinese medicine injections (TCMIs) in diabetic foot (DF) has not been well estimated. Objective To evaluate the clinical effective rate, safety, and the financial cost of TCMIs in treating DF and ulcer wound healing. Methods We searched PubMed, Embase, CENTRAL, China National Knowledge Infrastructure (CNKI), VIP database, and Wanfang database from inception to May 2018 to find all randomized control trials (RCTs) related to TCMIs in DF treatment. The search items were “Traditional Chinese Medicine Injection” AND “Diabetic foot or Diabetic foot ulcer” AND “random”. Study Selection and Synthesis Only RCTs of TCMIs combined conventional therapies versus conventional therapies and that can be quantitatively synthesized were included. Finally, 17 studies and 1294 participants were included after extraction. Two investigators independently extracted and analyzed the data using RevMan5.3 software. Results The overall clinical effective rate of TCMI groups is higher than that of control groups [RR=1.27, 95CI % (1.20, 1.34), P<0.00001] based on fixed effect model analysis. Regarding motor nerve conduction velocity of median nerve and peroneal nerve, TCMI group showed a significant improvement (MD=3.84[2.28, 5.41], P<0.00001; MD=2.89[0.63, 5.15], P=0.01). Regarding plasma viscosity TCMI group showed a statistically difference (MD=0.27[0.04, 0.49], P=0.02). In terms of blood viscosity at high shear rate, there was an improvement of TCMI group (MD=0.36[0.05, 0.67], P=0.02). However, sensory nerve conduction velocity of peroneal nerve and median nerve showed a contradiction to motor nerve conduction velocity, respectively (MD=2.59[-1.69, 6.87], p=0.24; MD=2.73[-0.96, 6.43], P=0.15). Conclusion The data of this study shows that TCMIs can bring benefits to patients with diabetic foot. However, due to low methodological quality of included RCTs, more rigorous designed RCTs with large sample size are recommended to provide more high-quality evidence.

Tax Revenue and Disparity: How to Improvement Income Inequality in Islamic Perspective

Tax revenue and income disparity Becomes attention and important study that need to be Analyzed, this is how tax revenues continue to increase it were an effect on income inequality in Indonesia. The magnitude of per capita income in Indonesia is the medium category with poor people have continued to rise in the last ten years. This research is to find out how the effect on the tax revenue with income disparity in Indonesia. Typically, the data that the data used is the panel that combines with a cross section of data and time series, starts from 2014 - 2016. Analysis that will uses in this research is double semi-log linear regression through Pooled Least Square with Fixed Effects Model (FEM) analysis, in conclusion the research finds that tax revenues has positive correlation with income disparity and will be reviewed restaurants by an Islamic perspective. Tax policy in the Islamic perspective gives important input to implement tax policy in Indonesia. In Islam's view, the tax for Muslims has been applied for reviews their own responsibilities and regulations, Islamic Also has been implement how the source and the collecting system, the system should have secured or make a guarantee that the rich people and the welfare people get bigger proportion (to pay tax) because welfare social order. The cost of the tax burden in society that will show equal and not too give strength if the cost that applied based on people's ability follows the tax system in Islam. Indeed, it can be a reason for decreasing inequality and poverty in each region.

GAB2 rs2373115 variant contributes to Alzheimer's disease risk specifically in European population

A genome-wide association study identified GAB2 rs2373115 to be associated with Alzheimer's disease (AD) risk in European population. However, inconsistent results are reported in East Asian population. Here, we performed an updated analysis using 65,704 samples including 20,982 AD cases and 44,722 controls. First, we investigated the GAB2 rs2373115 variant in Asian population using 3974 AD cases and 7568 controls. To further evaluate the effect of rs2373115 in different populations, we selected 17,008 AD cases and 37,154 controls in European population. We used three genetic models, and found no significant heterogeneity in Asian population. A fixed effect model analysis showed no significant association between rs2373115 and AD in Asian population. There was no significant heterogeneity in the pooled East Asian and European populations. The fixed effect model analysis again showed no significant association between rs2373115 and AD in these pooled populations. Taken together, these findings suggest that GAB2 rs2373115 may contribute to AD susceptibility only in European population but not in East Asian population.

Economic Growth Effects of Grants Based on Income Level: Evidence from the Major Recipient Countries of Korea

This paper analyzes empirically the economic growth effects of grants relative to income levelon grant-recipient countries of Korea. We conducted fixed effect model analysis of panel datafor 42 main development partners of Korea during the period from 1996 to 2013. Estimationresults of this analysis show that when policy condition is not considered, grants have apositive and significant effect on economic growth in the Least Developed Countries (LDCs),while grants do not have a significant effect on economic growth in the Middle IncomeCountries (MICs). When the expanded model is considered, grants have only a significantlypositive effect on economic growth in the Fragile Countries (Fragile-Cs). In particular, whenpolicy condition is considered, the positive economic growth effect of grants in the LDCs isrevealed to be conditional upon macroeconomic policy expressed in terms of inflation rate.However, there are no evidence of diminishing return to grants in all income level ofrecipient-countries.

Elasticity of Demand for Cellular Phone Network Access in Malaysia

This study analyzes the elasticity of demand for cellular phone network access and the network effects in Malaysia. It uses quarterly data from 2003Q1 to 2011Q4 with 7 difference variables in two separate equations. The dependent variable is the penetration rate of cellular phone. From the analysis, we found that the penetration rates of cellular phone are strongly related to the factors highlighted in the study and all the variables are strongly significant. The F-test also suggested that the entity Fixed Effects Model (FEM) is the appropriate model and more preferred for this study. From the entity FEM analysis, all independent variables are significant. The price elasticity of demand, crossprice elasticity and income elasticity are elastic. The result also shows that the fixed-line is complementary and luxury goods to the cellular phone network in Malaysia and the networks externalities are strongly significant when we used number of subscriber as a proxy.

Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA).

Endovascular aneurysm repair (EVAR) is an alternative treatment for ruptured abdominal aortic aneurysms (rAAA) in hemodynamically (hd) stable patients. Treatment for patients with hd-unstable rAAA remains controversial. The aim of this study was to compare the outcomes of EVAR and open surgery (OS) in hd-stable and hd-unstable rAAA patients using meta-analysis. The first part of this study included 48 articles that reported the treatment outcomes of rAAA managed with EVAR (n=9610) and OS (n=93867). The second part, which is the focus of this study, included 5 out of 48 articles, which further reported treatment results in hd-stable (n=198) and hd-unstable (n=185) patients. When heterogeneity among the groups was observed, a random-effects model was used to calculate the adjusted odds ratios (OR) or in cases of non-heterogeneity, a fixed-effects model analysis was employed. In the first part of this study, the in-hospital mortality rate was found to be lower in the EVAR group than in the OS group (29.9 vs 40.8%; OR 0.59; 95% CI 0.52-0.66; P<0.01). In the second part of this study, 383 patients from 5 articles were included: 152 patients were treated by EVAR, and 231 were treated by OS. The total mortality was 147/383 (38.4%), while the mortality of the EVAR group and the OS group was 25.7% (39/152) and 46.8% (108/231), respectively. In the hd-stable group, the in-hospital mortality after EVAR was significantly lower than that after OS [18.9% (18/95) vs 28.2% (29/103); OR 0.47; 95% CI 0.22-0.97; P=0.04]. For the hd-unstable rAAA patients, the in-hospital mortality after EVAR was significantly lower than that after OS [36.8% (21/57) vs 61.7% (79/128); OR 0.40; 95% CI 0.20-0.79; P<0.01]. This study indicated that compared with OS, EVAR in hd-unstable rAAA patients is associated with improved outcomes. Available publications are currently limited; thus, the best treatment strategy for this subgroup of patients remains unclear. Further clinical studies are needed to provide more detailed data, such as the shock index and long-term results.

Orthokeratology to control myopia progression: a meta-analysis.

ObjectiveTo evaluate the clinical treatment effects of orthokeratology to slow the progression of myopia.MethodsSeveral well-designed controlled studies have investigated the effects of orthokeratology in school-aged children. We conducted this meta-analysis to better evaluate the existing evidence. Relevant studies were identified in the Medline and Embase database without language limitations. The main outcomes included axial length and vitreous chamber depth reported as the mean ± standard deviation. The results were pooled and assessed with a fixed-effects model analysis. Subgroup analyses were performed according to geographical location and study design.ResultsOf the seven eligible studies, all reported axial length changes after 2 years, while two studies reported vitreous chamber depth changes. The pooled estimates indicated that change in axial length in the ortho-k group was 0.27 mm (95% confidence interval [CI]: 0.22, 0.32) less than the control group. Myopic progression was reduced by approximately 45%. The combined results revealed that the difference in vitreous chamber depth between the two groups was 0.22 mm (95% confidence interval [CI]: 0.14, 0.31). None of the studies reported severe adverse events.ConclusionThe overall findings suggest that ortho-k can slow myopia progression in school-aged children.

Retraction note: Meta-analysis on the efficacy of tourniquet on ankle trauma surgery.

In our study, we used meta-analysis to study the efficacy of the tourniquet on ankle trauma surgery. Postoperative infection rate, deep venous thrombosis incidence, hospital stay, and joint range of motion were studied to compare the tourniquet and non-tourniquet groups and provide certain references for clinical decision. We searched PubMed, MEDLINE, EMBASE, and the Cochrane controlled trials register for all publications about the efficacy of tourniquet published before November 2012. The quality of included studies was evaluated by two estimators. I2-test and Q-statistic were used for heterogeneity analysis. When there was heterogeneity between studies, the random effects model analysis was applied or else the fixed effects model analysis was used. Three studies were included with 166 patients suffering from ankle trauma surgery. There was no statistical difference (P >0.05) between the tourniquet and non-tourniquet groups on operation time (mean difference (MD) −5.45, 95% confidence intervals (CI): (−13.98, 3.09)), postoperative infection rate (relative risk (RR) 1.83, 95% CI: (0.65, 5.12)), and deep venous thrombosis incidence (RR 4.13, 95% CI: (0.47, 36.17)). But statistical significances were observed on hospital stays (MD 3.17, 95% CI: (1.39, 4.95)) and joint range of motion (MD − 5.25, 95% CI: (−9.61, −0.89)). In general, the efficacy of the tourniquet group is comparable to that of the non-tourniquet group. The non-tourniquet group achieved greater benefits for the joint range of motion and reduced the hospital stay. However, a larger number of primary studies is still required for future evaluation of tourniquet efficacy on ankle trauma surgery.

Association between the ERCC2 rs13181 polymorphism and the risk of glioma: a meta-analysis.

Several studies have focused on the association between the ERCC2 rs13181 polymorphism and glioma risk, but the results were inconclusive. We aimed to conduct a meta-analysis to investigate the role of ERCC2 rs13181 on the risk of glioma. We searched and collated the relevant studies in both Chinese and English through the PubMed, Web of Science, Cochrane Library, and EMBASE databases published through June 1, 2014. A total of 11 studies for ERCC2 rs13181 were selected; these included 3456 glioma cases and 4957 controls. Using fixed-effects model analysis, we found that no significant difference could be identified between the ERCC2 rs13181 polymorphism and the risk of glioma. Subgroup analysis showed that the ERCC2 rs13181 GT and TT genotypes were significantly associated with an increased risk of glioma in the Chinese population [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.17-1.85; and OR = 1.50, 95%CI = 1.02-2.22, respectively], but no significant increased risk of glioma was detected with these genotypes in the Caucasian populations. No publication bias was identified in this meta-analysis. Our meta-analysis strongly suggested that ERCC2 rs13181 was associated with a higher susceptibility to glioma in the Chinese population.

A genetic variant rs1801274 in FCGR2A as a potential risk marker for Kawasaki disease: a case-control study and meta-analysis.

ObjectivesRecent genome-wide association study found rs1801274, a functional single nucleotide polymorphism (SNP) in IgG receptor gene FCGR2A, was associated with increased risk of Kawasaki disease (KD). However, subsequent studies on the role of this SNP were limited and controversial.MethodsA case-control study was conducted in a Chinese Han population including 428 KD patients and 493 controls to examine the association between rs1801274 and KD susceptibility. A meta-analysis was performed in combination with the relevant published studies to further clarify such an association.ResultsOur case-control study found that rs1801274 was significantly associated with increased risk of KD in the Chinese Han population, with an odds ratio (OR) of 1.58 (95% CI = 0.96–2.62) for the GA genotype and 1.93 (95% CI = 1.16–3.19) for the AA genotype compared with the GG genotype. The result of meta-analysis further demonstrated that the A allele of rs1801274 was significantly correlated with KD risk under the allelic model (OR = 1.35, 95% CI = 1.27–1.44) without heterogeneity by fixed-effects model analysis (Q = 17.30, p = 0.139). Moreover, sensitivity analysis supported the robustness of this meta-analysis.ConclusionThese results further confirm that rs1801274 in the FCGR2A gene is significantly associated with increased risk of KD.

HMG-CoA enzyme inhibitors for prevention of contrast-induced nephropathy

To the Editor, We read with great interest the recent meta-analysis by Barbieri et al. [1] which showed that among patients undergoing coronary angiography/percutaneous intervention the use of short-term statins reduces the incidence of contrast-induced nephropathy (CIN). In light of increasing numbers of high-risk patients undergoing coronary interventions, the current results along with the findings of recent randomized studies have important implications. In particular, given the absence of other established pharamacological protective options, these results appear to suggest that unless otherwise contraindicated, statin therapy should be considered as a potentially viable intervention to prevent CIN in the ‘‘at-risk’’ population undergoing coronary angiography/interventions. Nevertheless, close inspection of the studies analyzed by the authors revealed some methodological issues that are worth mentioning and clarifying. Adopting the same search methodology as Barbieri et al., we have localized a relevant study by Quintavalle et al. [2] which has not been included in the meta-analysis. Additionally, the authors mention that they used the for fixed effect model analysis. We would like to point out here that the DerSimonian–Laird method is used for random-effects model analysis. In the absence of heterogeneity, pooled estimates of odd risks (ORs) with their 95 % confidence intervals (CIs) were calculated using the Mantel–Haenszel method. A DerSimonian–Laird randomeffects model for ORs estimation of all outcomes was used in the presence of heterogeneity. Moreover, the authors used a heterogeneity test cutoff P value of \0.1. Usually, statistically significant heterogeneity is defined as an X P value less than 0.05 or an I statistic greater than 75 %. We also noticed that the authors suggested there is no evidence of publication bias based on funnel plot methods. We would suggest that the small study effect, including publication bias, should be tested using the Egger’s test. If publication bias is found, the nonparametric trim and fill method of Duvall and Tweedie should be performed to add studies that appeared to be missing. Also, the Cochrane’s risk of bias tool [3] rather than the Jadad score should have been utilized in order to assess the individual risk of bias of each study. The subgroup analysis of studies into lowand highdose statin groups may not be the most appropriate way of approaching this topic. We believe that all studies used high-doses of statins. Finally, analysis of other available outcomes such as all-cause mortality and rates hemodialysis/hemofiltration would have been very helpful. Taking all the above into account provide a corrected estimation of the pooled odds ratio (Fig. 1). We believe that these remarks will contribute to further, more accurate elaboration and substantiation of the original results presented by Barbieri et al. [1].

Meta-analysis on the efficacy of tourniquet on ankle trauma surgery.

BackgroundIn our study, we used meta-analysis to study the efficacy of the tourniquet on ankle trauma surgery. Postoperative infection rate, deep venous thrombosis incidence, hospital stay, and joint range of motion were studied to compare the tourniquet and non-tourniquet groups and provide certain references for clinical decision.MethodsWe searched PubMed, MEDLINE, EMBASE, and the Cochrane controlled trials register for all publications about the efficacy of tourniquet published before November 2012. The quality of included studies was evaluated by two estimators. I2-test and Q-statistic were used for heterogeneity analysis. When there was heterogeneity between studies, the random effects model analysis was applied or else the fixed effects model analysis was used.ResultsThree studies were included with 166 patients suffering from ankle trauma surgery. There was no statistical difference (P >0.05) between the tourniquet and non-tourniquet groups on operation time (mean difference (MD) −5.45, 95% confidence intervals (CI): (−13.98, 3.09)), postoperative infection rate (relative risk (RR) 1.83, 95% CI: (0.65, 5.12)), and deep venous thrombosis incidence (RR 4.13, 95% CI: (0.47, 36.17)). But statistical significances were observed on hospital stays (MD 3.17, 95% CI: (1.39, 4.95)) and joint range of motion (MD − 5.25, 95% CI: (−9.61, −0.89)).ConclusionsIn general, the efficacy of the tourniquet group is comparable to that of the non-tourniquet group. The non-tourniquet group achieved greater benefits for the joint range of motion and reduced the hospital stay. However, a larger number of primary studies is still required for future evaluation of tourniquet efficacy on ankle trauma surgery.

A Simplified Pathway for Total Knee Arthroplasty Improves Outcomes

Care pathways for total knee arthroplasty (TKA) demonstrate improved quality and utilization outcomes. Standardizing these processes over large systems is difficult due to the variability of practice patterns and the complexity of multistep pathways. A simplified approach to this process focusing on early activity and avoidance of continuous urinary catheters was performed to overcome these perceived barriers for implementing a system-wide care pathway. Data were collected from a total of 6,154 consecutive patients during the time period of 1 year before and 1 year after implementation of a pathway focusing on two key drivers: early activity and continuous urinary catheter avoidance. Patients included were adults admitted for elective primary TKA. A composite score was calculated based on the successful completion of the two key drivers. Outcome measures were tracked before and after implementation. Following implementation of a simplified TKA care pathway, there was a significant increase in the composite score with increases attributable to both increased early activity (p < 0.0001) and continuous urinary catheter avoidance (p < 0.0001). This improvement in composite score was associated with a significant decrease in hospital length of stay (HLOS) (p < 0.0001), costs (p < 0.0001), complications (p < 0.0001), and 30-day readmissions (p < 0.0106). A fixed-effect model analysis demonstrated early activity was associated with improvements in HLOS (p < 0.0001), complications (p = 0.0240), and 30-day readmissions (p = 0.0046). Avoidance of a continuous urinary catheter was associated with improvements in HLOS (p = 0.0001), costs (p < 0.0001), complications (p = 0.0006), and 30-day readmissions (p = 0.0008). A simplified care pathway for TKA focusing on early activity and continuous urinary catheter avoidance is associated with improved complications, costs, HLOS, and 30-day readmissions.

Tiotropium HandiHaler Improves the Survival of Patients with COPD: A Systematic Review and Meta-Analysis

Tiotropium HandiHaler (TioH) has been shown to improve lung function, exacerbations, and quality of life when added to the pharmacotherapy of patients with stable chronic obstructive pulmonary disease (COPD). The purpose of this meta-analysis was to synthesize current evidence regarding the impact of TioH on the survival rate of these patients, which is still controversial. A systematic search in the electronic databases of the Cochrane Library, Medline, Scopus, EMBASE, PschINFO, CINAHL, and Web of Science was conducted by two independent authors (December 2012). Randomized clinical trials (RCTs) comparing inhaled TioH versus control (placebo or open control) were included. Data on total mortality were extracted, and missing data were obtained from authors. Relative risk (RR) for total mortality was calculated for each study and pooled. Heterogeneity, the risk of bias, and the publication bias were assessed in accordance with Cochrane's guidance. Twenty-eight RCTs, evaluating 33,538 patients, met the inclusion criteria. Data were nonheterogeneous, so fixed-effects model analysis was used. The effect of TioH versus placebo was assessed in 19 RCTs, with a total population of 19,826 patients (31,914 patient years), of whom 1,018 died during the study period. A statistically significant decrease in all-cause mortality was associated with the administration of TioH [RR 0.86, 95% confidence interval (CI) 0.76-0.98]. The number needed to treat to prevent one fatality was estimated to be 64 (95% CI 56-110). Comparisons of tiotropium against six more comparators were identified, but the insufficient sample size did not allow robust comparisons with respect to mortality. Our meta-analysis of RCTs showed that TioH prolongs the survival of COPD patients compared with placebo. Further RCTs are needed to confirm the potential superiority of prescriptions with versus without TioH in mortality reduction.