Mean Effect Size Estimate Research Articles

The Fragility of Statistical Significance in the Use of Aspirin in Prevention of Venous Thromboembolism Events Following Total Joint Arthroplasty: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: Comparative studies often use the p value to convey statistical significance, but fragility indices (FI) and fragility quotients (FQ) may better signify statistical strength. The use of aspirin as venous thromboembolism (VTE) chemoprophylaxis following elective arthroplasty has been debated between the orthopedic and cardiac fields. The purpose of this study was to apply both the FI and FQ to evaluate the degree of statistical fragility in the total joint arthroplasty (TJA) literature regarding aspirin (ASA) use for VTE prevention. Methods: We performed a systematic search for TJA clinical trials from 2004 to 2023 reporting comparisons between ASA and other chemoprophylaxis methods for VTE. The FI of each outcome was calculated through reversal of a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by study sample size and interquartile range (IQR) was calculated. SPSS Meta-analysis function was used to calculate the Mean Effect Size Estimate and 95% Confidence Intervals for each outcome. Results: Of 245 articles screened, 39 met search criteria, with 10 RCTs included for analysis (n = 11,481 patients). There were 38 outcome events reported, with three significant (p < 0.05) outcomes and 35 non-significant (p > 0.05) outcomes identified. The overall FI and FQ for all 38 outcomes were 6 (IQR: 5-7) and 0.059 (IQR: 0.044-0.064), respectively. Seven studies (70%) reported a loss-to-follow-up (LTF) greater than the overall FI. There was no increased risk of DVT, PE, or mortality with use of ASA (all p > 0.2). Conclusions: Despite showing non-inferiority in preventing venous thromboembolic events in TJA overall, the highest-level peer-reviewed literature concerning aspirin use following total joint arthroplasty is considered statistically fragile due to high loss-to-follow-up. In addition to the reporting of the p value, the fragility index and quotient can further provide insight into the strength and trustworthiness of outcome measures.

Assessing the Gender-Neutral Claim of Self-Control and Offending: A Meta-Analysis

While low self-control is one of the strongest predictors of offending, scholars do not agree whether the theory is gendered or gender neutral. This study used hierarchal meta-analytic methods to take stock of the self-control literature, focusing specifically on all-male and all-female samples. The analysis included 1,282 effect size estimates (ESEs) nested in 244 individual studies which used 169 unique datasets. Moderator analyses examined potential differences depending on sample and offense characteristics, measurement of self-control, and included controls in multivariate models. While mean ESEs did not differ significantly for males and females, suggesting that the effect between self-control and offending is similar, once moderator analyses were conducted, differences emerged in female offense type and measurement. This suggests that while self-control can explain both male and female offending, there may be important gendered risk factors that are also influential.

Associations of Circulating Biomarkers with Disease Risks: A Two-Sample Mendelian Randomization Study.

Circulating biomarkers play a pivotal role in personalized medicine, offering potential for disease screening, prevention, and treatment. Despite established associations between numerous biomarkers and diseases, elucidating their causal relationships is challenging. Mendelian Randomization (MR) can address this issue by employing genetic instruments to discern causal links. Additionally, using multiple MR methods with overlapping results enhances the reliability of discovered relationships. Here, we report an MR study using multiple methods, including inverse variance weighted, simple mode, weighted mode, weighted median, and MR-Egger. We use the MR-base resource (v0.5.6) from Hemani et al. 2018 to evaluate causal relationships between 212 circulating biomarkers (curated from UK Biobank analyses by Neale lab and from Shin et al. 2014, Roederer et al. 2015, and Kettunen et al. 2016 and 99 complex diseases (curated from several consortia by MRC IEU and Biobank Japan). We report novel causal relationships found by four or more MR methods between glucose and bipolar disorder (Mean Effect Size estimate across methods: 0.39) and between cystatin C and bipolar disorder (Mean Effect Size: -0.31). Based on agreement in four or more methods, we also identify previously known links between urate with gout and creatine with chronic kidney disease, as well as biomarkers that may be causal of cardiovascular conditions: apolipoprotein B, cholesterol, LDL, lipoprotein A, and triglycerides in coronary heart disease, as well as lipoprotein A, LDL, cholesterol, and apolipoprotein B in myocardial infarction. This Mendelian Randomization study not only corroborates known causal relationships between circulating biomarkers and diseases but also uncovers two novel biomarkers associated with bipolar disorder that warrant further investigation. Our findings provide insight into understanding how biological processes reflecting circulating biomarkers and their associated effects may contribute to disease etiology, which can eventually help improve precision diagnostics and intervention.

Associations of Circulating Biomarkers with Disease Risks: a Two-Sample Mendelian Randomization Study.

Circulating biomarkers play a pivotal role in personalized medicine, offering potential for disease screening, prevention, and treatment. Despite established associations between numerous biomarkers and diseases, elucidating their causal relationships is challenging. Mendelian Randomization (MR) can address this issue by employing genetic instruments to discern causal links. Additionally, using multiple MR methods with overlapping results enhances the reliability of discovered relationships. Here we report an MR study using multiple methods, including inverse variance weighted, simple mode, weighted mode, weighted median, and MR Egger. We use the MR-base resource (v0.5.6)1 to evaluate causal relationships between 212 circulating biomarkers (curated from UK Biobank analyses by Neale lab and from Shin et al. 2014, Roederer et al. 2015, and Kettunen et al. 2016)2-4 and 99 complex diseases (curated from several consortia by MRC IEU and Biobank Japan). We report novel causal relationships found by 4 or more MR methods between glucose and bipolar disorder (Mean Effect Size estimate across methods: 0.39) and between cystatin C and bipolar disorder (Mean Effect Size: -0.31). Based on agreement in 4 or more methods, we also identify previously known links between urate with gout and creatine with chronic kidney disease, as well as biomarkers that may be causal of cardiovascular conditions: apolipoprotein B, cholesterol, LDL, lipoprotein A, and triglycerides in coronary heart disease, as well as lipoprotein A, LDL, cholesterol, and apolipoprotein B in myocardial infarction. This Mendelian Randomization study not only corroborates known causal relationships between circulating biomarkers and diseases but also uncovers two novel biomarkers associated with bipolar disorder that warrant further investigation. Our findings provide insight into understanding how biological processes reflecting circulating biomarkers and their associated effects may contribute to disease etiology, which can eventually help improve precision diagnostics and intervention.

Change in Cognitive Function over the Course of Major Depressive Disorder: A Systematic Review and Meta-analysis.

Major depressive disorder (MDD) is associated with significant cognitive deficits during the acute and remitted stages. The aim of this systematic review and meta-analysis was to examine the course of cognitive function whilst considering demographic, treatment, or clinical features of MDD that could moderate the extent of cognitive change. Databases were searched to identify studies that reported on cognitive function in MDD with a ≥12-week test-retest interval. Relevant studies were pooled using random effects modelling to generate an inverse-variance, weighted, mean effect size estimate (Hedges' g) of cognitive change for each cognitive variable and for an overall composite cognitive domain. Of 6898 records, 99 eligible studies were identified from which 69 were meta-analysed, consisting of 4639 MDD patients (agemean = 40.25years, female% = 64.62%) across 44 cognitive variables. In over 95% of cognitive variables, improvements were either of non-significant, negligible, or of a small magnitude, and when compared to matched healthy controls, the possibility of practice effects could not be precluded. Depressive symptom improvement and the number of previous depressive episodes moderated the extent of cognitive change, demonstrating state- and scar-like features for one-quarter of the cognitive domains. Further longitudinal studies are required to elucidate the MDD cognitive trajectory from initial onset. Findings nonetheless suggest that following pharmacological and non-pharmacological treatment, cognitive change in MDD is typically small, but the capacity for change may be less with episode recurrence. Targeting cognition early in the course of illness may facilitate better prognosis and support a more complete functional recovery.

Partial Pressure of Arterial Oxygen in Healthy Adults at High Altitudes

With increasing altitude, the partial pressure of inspired oxygen decreases and, consequently, the Pao2 decreases. Even though this phenomenon is well known, the extent of the reduction as a function of altitude remains unknown. To calculate an effect size estimate for the decrease in Pao2 with each kilometer of vertical gain among healthy unacclimatized adults and to identify factors associated with Pao2 at high altitude (HA). A systematic search of PubMed and Embase was performed from database inception to April 11, 2023. Search terms included arterial blood gases and altitude. A total of 53 peer-reviewed prospective studies in healthy adults providing results of arterial blood gas analysis at low altitude (<1500 m) and within the first 3 days at the target altitude (≥1500 m) were analyzed. Primary and secondary outcomes as well as study characteristics were extracted from the included studies, and individual participant data (IPD) were requested. Estimates were pooled using a random-effects DerSimonian-Laird model for the meta-analysis. Mean effect size estimates and 95% CIs for reduction in Pao2 at HA and factors associated with Pao2 at HA in healthy adults. All of the 53 studies involving 777 adults (mean [SD] age, 36.2 [10.5] years; 510 men [65.6%]) reporting 115 group ascents to altitudes between 1524 m and 8730 m were included in the aggregated data analysis; 13 of those studies involving 305 individuals (mean [SD] age, 39.8 [13.6] years; 185 men [60.7%]) reporting 29 ascents were included in the IPD analysis. The estimated effect size of Pao2 was -1.60 kPa (95% CI, -1.73 to -1.47 kPa) for each 1000 m of altitude gain (τ2 = 0.14; I2 = 86%). The Pao2 estimation model based on IPD data revealed that target altitude (-1.53 kPa per 1000 m; 95% CI, -1.63 to -1.42 kPa per 1000 m), age (-0.01 kPa per year; 95% CI, -0.02 to -0.003 kPa per year), and time spent at an altitude of 1500 m or higher (0.16 kPa per day; 95% CI, 0.11-0.21 kPa per day) were significantly associated with Pao2. In this systematic review and meta-analysis, the mean decrease in Pao2 was 1.60 kPa per 1000 m of vertical ascent. This effect size estimate may improve the understanding of physiological mechanisms, assist in the clinical interpretation of acute altitude illness in healthy individuals, and serve as a reference for physicians counseling patients with cardiorespiratory disease who are traveling to HA regions.

Association of rs9939609 in FTO with BMI among Polynesian peoples living in Aotearoa New Zealand and other Pacific nations.

The fat mass and obesity associated (FTO) locus consistently associates with higher body mass index (BMI) across diverse ancestral groups. However, previous small studies of people of Polynesian ancestries have failed to replicate the association. In this study, we used Bayesian meta-analysis to test rs9939609, the most replicated FTO variant, for association with BMI with a large sample (n = 6095) of Aotearoa New Zealanders of Polynesian (Māori and Pacific) ancestry and of Samoan people living in the Independent State of Samoa and in American Samoa. We did not observe statistically significant association within each separate Polynesian subgroup. Bayesian meta-analysis of the Aotearoa New Zealand Polynesian and Samoan samples resulted in a posterior mean effect size estimate of +0.21 kg/m2, with a 95% credible interval [+0.03 kg/m2, +0.39 kg/m2]. While the Bayes Factor (BF) of 0.77 weakly favors the null, the BF = 1.4 Bayesian support interval is [+0.04, +0.20]. These results suggest that rs9939609 in FTO may have a similar effect on mean BMI in people of Polynesian ancestries as previously observed in other ancestral groups.

Detecting symptom exaggeration and minimization using translated versions of the MMPI-2 and MMPI-2-RF: A systematic review and preliminary meta-analysis.

This systematic review and preliminary meta-analysis examined the effectiveness of translated versions of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the MMPI-2 Restructured Form (MMPI-2-RF) in detecting response distortion (i.e., symptom exaggeration and minimization), a central concern in forensic assessment. We hypothesized that translated versions of the MMPI-2 and MMPI-2-RF would generate significantly weaker effect sizes in detecting response distortion than those observed with English-language studies. We identified 26 studies, representing seven language translations of the MMPI-2 (k = 20) and two of the MMPI-2-RF (k = 6). We calculated effect sizes (Cohen's ds) based on the mean score difference between honest and nongenuine responders for each study on each symptom exaggeration (e.g., F/F-r, Fp/Fp-r) and minimization (e.g., L/L-r, K/K-r) scale examined, along with mean effect size estimates (Hedges' g) for the Spanish and Italian translations (no other translation had more than two published studies). Spanish-language studies generally produced large (d ≥ 1.25) to very large (d ≥ 1.75) effect sizes when detecting both symptom exaggeration and minimization. Italian-language studies generally produced small to moderate effect sizes when detecting symptom exaggeration and predominately moderate (d ≤ 1.25) effect sizes when detecting minimization. Significant variability within and across scales was observed in both Spanish-language and Italian-language studies. Most studies utilizing a translated version of the MMPI-2 other than Spanish or Italian produced very large (d ≥ 1.75) effect sizes when detecting symptom exaggeration and weaker (d ≤ 1.00) effect sizes when detecting minimization. This systematic review and preliminary meta-analysis demonstrated effect sizes that overlapped with those observed in English-language studies. Although clearly preliminary, given the limited published research to date, these data suggest that the MMPI instruments retain some utility in detecting response distortion when translated. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Contingency Management for Patients Receiving Medication for Opioid Use Disorder

Medication treatment for opioid use disorder (MOUD) is efficacious, but comorbid stimulant use and other behavioral health problems often undermine efficacy. To examine the association of contingency management, a behavioral intervention wherein patients receive material incentives contingent on objectively verified behavior change, with end-of-treatment outcomes for these comorbid behavioral problems. A systematic search of PubMed, Cochrane CENTRAL, Web of Science, and reference sections of articles from inception through May 5, 2020. The following search terms were used: vouchers OR contingency management OR financial incentives. Prospective experimental studies of monetary-based contingency management among participants receiving MOUD. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline, 3 independent investigators extracted data from included studies for a random-effects meta-analysis. Primary outcome was the association of contingency management at end-of-treatment assessments with 6 clinical problems: stimulant use, polysubstance use, illicit opioid use, cigarette smoking, therapy attendance, and medication adherence. Random-effects meta-analysis models were used to compute weighted mean effect size estimates (Cohen d) and corresponding 95% CIs separately for each clinical problem and collapsing across the 3 categories assessing abstinence and the 2 assessing treatment adherence outcomes. The search identified 1443 reports of which 74 reports involving 10 444 unique adult participants met inclusion criteria for narrative review and 60 for inclusion in meta-analyses. Contingency management was associated with end-of-treatment outcomes for all 6 problems examined separately, with mean effect sizes for 4 of 6 in the medium-large range (stimulants, Cohen d = 0.70 [95% CI, 0.49-0.92]; cigarette use, Cohen d = 0.78 [95% CI, 0.43-1.14]; illicit opioid use, Cohen d = 0.58 [95% CI, 0.30-0.86]; medication adherence, Cohen d = 0.75 [95% CI, 0.30-1.21]), and 2 in the small-medium range (polysubstance use, Cohen d = 0.46 [95% CI, 0.30-0.62]; therapy attendance, d = 0.43 [95% CI, 0.22-0.65]). Collapsing across abstinence and adherence categories, contingency management was associated with medium effect sizes for abstinence (Cohen d = 0.58; 95% CI, 0.47-0.69) and treatment adherence (Cohen d = 0.62; 95% CI, 0.40-0.84) compared with controls. These results provide evidence supporting the use of contingency management in addressing key clinical problems among patients receiving MOUD, including the ongoing epidemic of comorbid psychomotor stimulant misuse. Policies facilitating integration of contingency management into community MOUD services are sorely needed.

Efficacy of new-generation antidepressants assessed with the Montgomery-Asberg Depression Rating Scale, the gold standard clinician rating scale: A meta-analysis of randomised placebo-controlled trials.

BackgroundIt has been claimed that efficacy estimates based on the Hamilton Depression Rating-Scale (HDRS) underestimate antidepressants true treatment effects due to the instrument’s poor psychometric properties. The aim of this study is to compare efficacy estimates based on the HDRS with the gold standard procedure, the Montgomery-Asberg Depression Rating-Scale (MADRS).Methods and findingsWe conducted a meta-analysis based on the comprehensive dataset of acute antidepressant trials provided by Cipriani et al. We included all placebo-controlled trials that reported continuous outcomes based on either the HDRS 17-item version or the MADRS. We computed standardised mean difference effect size estimates and raw score drug-placebo differences to evaluate thresholds for clinician-rated minimal improvements (clinical significance). We selected 109 trials (n = 32,399) that assessed the HDRS-17 and 28 trials (n = 11,705) that assessed the MADRS. The summary estimate (effect size) for the HDRS-17 was 0.27 (0.23 to 0.30) compared to 0.30 (0.22 to 0.38) for the MADRS. The effect size difference between HDRS-17 and MADRS was thus only 0.03 and not statistically significant according to both subgroup analysis (p = 0.47) and meta-regression (p = 0.44). Drug-placebo raw score difference was 2.07 (1.76 to 2.37) points on the HDRS-17 (threshold for minimal improvement: 7 points according to clinician-rating and 4 points according to patient-rating) and 2.99 (2.24 to 3.74) points on the MADRS (threshold for minimal improvement: 8 points according to clinician-rating and 5 points according to patient-rating).ConclusionsOverall there was no meaningful difference between the HDRS-17 and the MADRS. These findings suggest that previous meta-analyses that were mostly based on the HDRS did not underestimate the drugs’ true treatment effect as assessed with MADRS, the preferred outcome rating scale. Moreover, the drug-placebo differences in raw scores suggest that treatment effects are indeed marginally small and with questionable importance for the average patient.

Revisiting the Empirical Status of Social Learning Theory on Substance Use: A Systematic Review and Meta-Analysis

Background: Despite ample empirical research testing components of Akers’ Social Learning Theory (SLT) on substance use, no research to date has attempted to synthesize the empirical evidence. Objectives: The purpose of this article is to synthesize prior research that has examined the utility of SLT for predicting specific types of substance use, both legal and illegal. Methods: Using a systematic review and meta-analysis, the current study estimated the effect size results from 83 primary studies published between 1974 and 2018 that had empirically tested concepts of Akers’ SLT regarding substance use. In addition, moderator analyses examined variations in effect sizes across measurement constructs and among specific types of substance use. Results: Results indicated medium-sized weighted mean effect size estimates for SLT in relation to substance use. Regarding conceptualization of SLT, measures of Differential Association produced the strongest effect size estimates. Moderator analyses also revealed that mean effect size estimates were largest for soft drugs, for studies conducted in the context of the United States, and for adult samples. Conclusions: The authors conclude that SLT constructs may be better suited for explaining soft drug use than hard drug use. Given the relatively sparse primary research that has controlled for temporal ordering, collected data from multiple differential associates, or considered opportunity effects, caution in the interpretation of synthesis results is warranted.

Meta-analysis of pro-environmental behaviour spillover

When people engage in a first pro-environmental behaviour (PEB1; for example, conserving energy at home), are they more or less likely (positive and negative spillover, respectively) to engage in other pro-environmental behaviours (‘PEB2’; for example, conserving water at home)? We examined evidence for spillover using a meta-analysis of interventions. We coded 22 studies and unpublished data that fulfilled the following criteria: used experimental or quasi-experimental design, showed change in a PEB1 and measured at least one PEB2. Analysis of the 77 effect sizes found in these studies showed that the overall spillover from a PEB1 was positive, though small, on the intention to perform a PEB2 (pooled mean effect size estimate d+ = 0.17). However, the spillover effect was negative and small for actual behaviour (d+ = −0.03) and policy support (d+ = −0.01) for PEB2. Positive spillover was most likely when interventions targeted intrinsic motivation and when PEB1 and PEB2 were similar. Future research in the area should target and measure spillover processes, collect larger samples and statistically test for spillover in more consistent ways. An environmentally friendly behaviour is more likely to motivate a second such behaviour when both actions are similar and when the first behaviour is intrinsically motivated, according to a review of the literature.

Quality of life of parents of mentally-ill children: a systematic review and meta-analysis.

To examine the quality of life (QOL) of parents of children with a specific mental disorder (any age). Relevant articles were searched using different databases. Articles were included that compared the QOL of parents with mentally-ill children to parents of healthy controls or norm values or provided the required data for this comparison. A meta-analysis was conducted to obtain an overall mean effect size estimate. Additional analyses were performed to assess publication bias and moderation. Twenty-six out of 10 548 articles met the pre-defined inclusion criteria. Most of these studies focused on attention-deficit/hyperactivity disorder or autism spectrum disorder, used clinical samples that mainly included males and young children and studied the QOL of mothers. The meta-analysis revealed that parents of mentally-ill children are experiencing a clinically relevant reduction in their QOL relative to parents of healthy children and norm values (g = -0.66). The compromised QOL of parents of mentally-ill children needs to be considered and addressed by health professionals who are in contact with them. The paper provides insights into existing research gaps and suggests improvements for subsequent work.

Current Evidence on the Effects of Intensive Early Reading Interventions

Many students at risk for or identified with reading disabilities need intensive reading interventions. This meta-analysis provides an update to the Wanzek and Vaughn synthesis on intensive early reading interventions. Effects from 25 reading intervention studies are analyzed to examine the overall effect of intensive early reading interventions as well as relationships between intervention and student characteristics related to outcomes. The weighted mean effect size (ES) estimate (ES = 0.39), with a mean effect size adjusted for publication bias (ES = 0.28), both significantly different from zero, suggested intensive early reading interventions resulted in positive outcomes for early struggling readers in kindergarten through third grades. There was no statistically significant or meaningful heterogeneity in the study-wise effect sizes. Exploratory examination of time in intervention, instructional group size, initial reading achievement, and date of publication are provided.

Effectiveness of dexmedetomidine versus propofol on extubation times, length of stay and mortality rates in adult cardiac surgery patients: a systematic review and meta-analysis.

To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine. Prolonged mechanical ventilation is associated with complications, such as pneumonia and lung injury, and increases the risk of morbidity and mortality. Major risk factors that contribute to lung injury are due to high tidal volumes and barotrauma. Cardiac surgery patients remain on the ventilator postoperatively due to the high dose opioid-based anesthesia and the initial vulnerable hemodynamic state. An important component of postoperative management following cardiac surgery is the use of sedation to reduce the stress response, facilitate assisted ventilation, and provide anxiolysis. Propofol and dexmedetomidine are two common sedative agents with differing pharmacological profiles used to provide comfort and minimize hemodynamic disturbances during this recovery phase. Choice of drug may have an impact on length of mechanical ventilation, length of stay and mortality. Participants included were ≥18 years, of any gender or ethnicity, undergoing valvular surgery, coronary artery bypass graft (CABG) surgery, or valvular surgery and CABG. Studies were excluded if participants received both dexmedetomidine and propofol concurrently as a primary sedative. Interventions were propofol compared to dexmedetomidine as continuous infusions for sedation after cardiac surgery. All variations of dosages and duration of both sedative agents were included. Outcomes of interest were: total time (hours) of mechanical ventilation after cardiac surgery, specifically from end of surgery to extubation; total length of stay (LOS) in the ICU (hours) following cardiac surgery, specifically from ICU admission to transfer to medical ward; total hospital LOS (hours) following cardiac surgery, from date of admission to date of discharge; and in-hospital mortality rates, from date of admission to date of discharge. Randomized controlled trials (RCTs), controlled trials, and prospective and retrospective cohort studies were considered for inclusion. A search was conducted in MEDLINE via PubMed, Embase, Trip Database, ProQuest Nursing and Allied Health Source Database, Web of Science, ProQuest Dissertations and Theses Global, and MedNar to locate both published and unpublished studies between January 1, 1999 and November 23, 2017. Two reviewers assessed the methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Quantitative data were extracted using the standardized data extraction tool from JBI SUMARI. Data were pooled using Comprehensive Meta-Analysis Software Version 3 (Biostat, NJ, USA). Mean differences (95% confidence interval [CI]) and effect size estimates were calculated for continuous outcomes. Meta-analysis using a random-effects model was performed for length of mechanical ventilation, ICU LOS, and hospital LOS. Results have been presented in narrative form when findings could not be pooled using meta-analysis. Standard GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) evidence assessment of outcomes has been reported. A total of four studies were included in the review. Meta-analysis of three cohort studies revealed dexmedetomidine to be superior to propofol with an average reduction of 4.18 hours (95% CI -6.69 to -1.67, p = 0.001) on the extubation times, an average 9.89 hour (95% CI -18.6 to -1.19, p = 0.03) reduction in ICU LOS, and an average 37.9 hour (95% CI, -60.41 to -15.46, p = 0.00) reduction in overall hospital LOS. A RCT was excluded from pooling for meta-analysis, but its results were congruent with meta-analysis results. There was lack of sufficient data to perform meta-analysis on in-hospital mortality rates. In postoperative cardiac surgery patients, dexmedetomidine is associated with a shorter time to extubation, shorter ICU LOS, and shorter hospital LOS in postoperative cardiac surgery patients compared to propofol. The quality of evidence for these findings however is low and no recommendations can be made to change current practice. There was insufficient evidence to determine significant differences in-hospital mortality rates. Sedation protocols still need to be formulated.There are significant gaps in the literature. Areas of further research include additional well-designed and appropriately powered RCTs with wide inclusion criteria to reflect this surgical population; quantitative, transparent, and standardized sedation, weaning, and extubation protocols; precise and standardized methods and measurements for interventions and outcomes, and short- and long-term morbidity and mortality follow-up.

The effect of team-based learning on content knowledge: A meta-analysis

This article reports a synthesis and meta-analysis of intervention studies investigating the effects of team-based learning on content knowledge outcomes. Team-based learning is a particular set of instructional components most often used in higher education classrooms. Authors of team-based learning reviews report that team-based learning improves students’ end of course grades, test performance, and classroom engagement. Students report that team-based learning is interesting, allows for deeper understanding of content, and prepares them more effectively for assessment and course performance. A total of 30 studies were located and synthesized. In total, 17 studies met criteria for a meta-analysis, yielding a mean effect size estimate of 0.55, p &lt; 0.001 across all measures. Moderator analysis indicated that group size moderated the magnitude of effect to a statistically significant degree, with smaller group sizes contributing to additional effects. The meta-analysis is followed by a confirmatory synthesis of the remaining 13 studies. Implications for instruction incorporating the use of team-based learning are described.

Violent video game effects remain a societal concern: Reply to Hilgard, Engelhardt, and Rouder (2017).

A large meta-analysis by Anderson et al. (2010) found that violent video games increased aggressive thoughts, angry feelings, physiological arousal, and aggressive behavior and decreased empathic feelings and helping behavior. Hilgard, Engelhardt, and Rouder (2017) reanalyzed the data of Anderson et al. (2010) using newer publication bias methods (i.e., precision-effect test, precision-effect estimate with standard error, p-uniform, p-curve). Based on their reanalysis, Hilgard, Engelhardt, and Rouder concluded that experimental studies examining the effect of violent video games on aggressive affect and aggressive behavior may be contaminated by publication bias, and these effects are very small when corrected for publication bias. However, the newer methods Hilgard, Engelhardt, and Rouder used may not be the most appropriate. Because publication bias is a potential a problem in any scientific domain, we used a comprehensive sensitivity analysis battery to examine the influence of publication bias and outliers on the experimental effects reported by Anderson et al. We used best meta-analytic practices and the triangulation approach to locate the likely position of the true mean effect size estimates. Using this methodological approach, we found that the combined adverse effects of outliers and publication bias was less severe than what Hilgard, Engelhardt, and Rouder found for publication bias alone. Moreover, the obtained mean effects using recommended methods and practices were not very small in size. The results of the methods used by Hilgard, Engelhardt, and Rouder tended to not converge well with the results of the methods we used, indicating potentially poor performance. We therefore conclude that violent video game effects should remain a societal concern. (PsycINFO Database Record

Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review.

People with end-stage kidney disease (ESKD) develop impaired excretion of phosphate. Hyperphosphatemia develops in ESKD as a result of the kidney's reduced ability to excrete ingested phosphate load and is characterized by high bone turnover and increased musculoskeletal morbidity including bone pain and muscle weakness. Increased serum phosphate levels are also associated with cardiovascular disease and associated mortality. These effects are significant considering that cardiovascular disease is the leading cause of death in ESKD, making phosphate control a crucial treatment goal. To determine the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with ESKD receiving hemodialysis (HD). Adults aged over 18 years with ESKD undergoing HD, attending dialysis facilities regardless of frequency and duration of treatment sessions per week. Studies with participants receiving hemodiafiltration were excluded. All types of educational and behavioral interventions aimed at improving adherence to dietary phosphate restriction, phosphate binder medication and HD. Randomized controlled trials (RCTs), non-RCTs, before and after and cohort studies. Outcome measures included serum phosphate levels, patient knowledge and adherence to phosphate control methods, chronic kidney disease (CKD) self-management behavior and perceived self-efficacy for CKD related to phosphate control. A search was conducted in CINAHL, MEDLINE, The Cochrane Library, Embase, Web of Science, PsycINFO and ProQuest Dissertations and Theses Global to find published studies between January 2005 and December 2015. Risk of bias was assessed by three reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted using the standardized data extraction tool from JBI-MAStARI. Data were pooled using JBI software. Mean differences (95% confidence interval [CI]) and effect size estimates were calculated for continuous outcomes. Meta-analysis using a random-effects model was performed for serum phosphate levels, and where the findings could not be pooled using meta-analysis, results have been presented in a narrative form. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes has been reported. A total of 18 studies were included in the review: seven studies focused on dietary phosphate, four studies focused on medications (phosphate binders) and six studies focused on dietary phosphate and medications. Only one study taught patients about diet, medications and HD to control phosphate. Sixteen studies showed significant improvements in phosphate levels. Meta-analysis of eight RCTs favored educational or behavioral interventions over standard care for serum phosphate control, with a weighted mean reduction of -0.23 mmol/l (95% CI -0.37, -0.08) in treatment groups. Overall, educational or behavioral interventions increase adherence to phosphate control. Studies in this systematic review revealed improved outcomes on serum phosphate levels, patient knowledge and adherence to phosphate control methods, CKD self-management behavior and perceived self-efficacy for CKD related to phosphate control. However, there is a lack of sufficient data on how some of the studies implemented their interventions, suggesting that further research is required. Successful strategies that improve and optimize long-term adherence to phosphate control still need to be formulated.

A meta-analysis update on the effectiveness of early self-control improvement programs to improve self-control and reduce delinquency

To update Piquero et al.’s (Justice Quarterly 27:803–834, 2010) meta-analysis on early self-control improvement programs. Screening of eligible studies was carried out for the period between January 2010 and September 2015. An additional seven studies were identified, which were added to the original database of 34 studies, totaling an overall sample of 41 eligible studies. A random effects model was used to obtain an overall mean effect size estimate. Additional analyses were performed to assess publication bias and moderation. Overall average, positive, and significant effect sizes were observed for improving self-control (0.32) and reducing delinquency (0.27). There was evidence of publication bias for the self-control improvement outcomes, as well as some evidence of moderation for both self-control improvement and delinquency outcomes. Early self-control improvement programs are an effective evidence-based strategy for improving self-control and reducing delinquency.

Rheumatoid arthritis affects left ventricular mass: Systematic review and meta-analysis

BackgroundCardiovascular disease represents one of the most important extra-articular causes of morbidity and mortality in patients with rheumatoid arthritis (RA). Evidences showed that several cardiac structures can be affected during the course of the disease as well as abnormalities of left ventricular diastolic filling. Contrasting data are available about left ventricular mass (LVM) involvement in patients asymptomatic for cardiovascular disease.The purpose of this systematic review and meta-analysis is to summarize the effects of RA on LVM in rheumatoid arthritis patients without cardiovascular disease. MethodsA systematic research of the current case–control studies was conducted in Medline on November 20th, 2013. Studies were included if data of measurements of LVM were reported. The pooled mean effect size estimate was calculated according to methods described by Hedges and Olkin. ResultsSixteen eligible studies were included in this meta-analysis. RA determines an increase of absolute and indexed LVM compared with control patients [standardized mean difference (95% CI): 0.41(0.15–0.66) and 0.47(0.32–0.62), respectively]. On the contrary, posterior wall thickness did not show a significant RA effect. Finally, a significant positive effect of RA on interventricular wall thickness was found [standardized mean difference (95% CI): 0.39 (0.07–0.71)]. ConclusionsResults of this meta-analysis suggest that increased absolute and indexed LVM seem to be characteristic of RA patients with a fundamental clinical significance since they are related to an increased risk of cardiovascular morbidity and mortality. Our data suggest the use of LVM as surrogate end-point for clinical trials involving RA patients.