Meta-analysis For Comparison Research Articles

Telemedicine-Enabled Otoscopes as Catalysts for Accessible and Preventive Ear Health Care: Systematic Review and Meta-analysis

Background: Maintaining optimal hearing health and preventing ear infections is crucial across all life stages, spanning from before birth and infancy to middle age and beyond. The primary aim of the research was to evaluate and compare the effectiveness of the telemedicine-enabled otoscope (TEO) in diagnosing ear diseases with that of the conventional otoscope. Materials and Methods: The databases PubMed, Cochrane, and Embase were thoroughly searched to find original studies on TEO at the community as well as hospital levels along with meta-analysis for comparison with standard diagnostic methods using traditional otoscopes. Results: The telemedicine-equipped otoscope displays a sensitivity of 82% (confidence interval 0.78–0.95) and a specificity of 95% (confidence interval 0.93–0.96). When employed by physicians, the combined sensitivity and specificity become 84% (confidence interval 0.79–0.88) and 91% (confidence interval 0.87–0.94), respectively. Community Health Workers (CHWs) using telemedicine-enabled otoscopes exhibit a collective sensitivity of 80% (confidence interval 0.72–0.87) and a collective specificity of 97% (confidence interval 0.95–0.98). Snapping multiple photographs and removal of cerumen where necessary in increasing the quality of the photographs for diagnosis. Conclusions: The TEO holds the promise of substantially enhancing the accessibility of audiology services, encompassing evaluation, public outreach, and fundamental care. Its implementation has the potential to fortify primary health care environments, contributing to the prevention of ear diseases and assisting in mitigating the shortage of skilled ear care professionals.

Meta-Analysis for Comparison between Antireflux Surgery With or Without Endoscopic Management of Barrett's Esophagus

Abstract Background: In patients with BE, anti-reflux surgery aims to sustainable control reflux symptoms and heal reflux induced esophageal mucosal inflammation and prevent progression of BE to adenocarcinoma. Endoscopic resection of visible lesions if any, followed by ablation of the rest of the BE epithelium is the current standard of care for management of BE with confirmed dysplasia. Although the current literature describes multiple endoscopic and anti-reflux techniques for the management of BE, there is no published evidence on the efficacy of anti-reflux surgery followed by endoscopic man-agement on the outcomes of BE. Aim of Study: The objective of this study was to compare between anti-reflux surgery with or without endoscopic man-agement of BE. Patients and Methods: In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. The search retrieved 2089 unique records. We then retained 57 potentially eligible records for full-texts screening. Finally, 6 studies were included. Results: In the present systematic review and meta-analysis, five studies reported the rates of recurrence. The overall effect estimates showed the rate of recurrence was 5.7% (95% CI 1.2-10.2%). In the present systematic review and meta-analysis, five studies reported the overall complica-tions rate. The overall effect estimates showed the overall complications rate was 7.3% (95% CI 4.1-10.6%), mainly stricture and perforation. Conclusion: Endoscopic procedures after anti-reflux surgery is a safe modality, with high rate of success in complete eradication of BE in symptomatic GERD patients, especially those with severe anatomical impairment in distal esophageal segment. As a concurrent procedure, endoscopic procedures may be beneficial in the terms of reducing the early recurrence rates, which seems to be important issue during the manage-ment of BE. By doing synchronous endoscopic procedures and fundoplication, one might observe a true anatomy of esophagogastric junction in its entirety and might be able to truly observe the distal extent of columnar esophagus.

Comparison of systemic therapy efficacy in advanced hepatocellular carcinoma: Systematic review and frequentist network meta-analysis of randomized controlled trials.

293 Background: Several systemic agents are approved for use in the first line and second line treatment settings for advanced hepatocellular carcinoma (aHCC). However, choosing among available options in both first and second line settings remain difficult due to the paucity of head-to-head comparative trials. Therefore, we have conducted a systematic review and network meta-analysis for the indirect comparison of the systemic agents in the first line and second line settings. Methods: Published clinical trials that have evaluated systemic agents in the first line and second line settings in advanced HCC from inception to April 2020 were identified by searching PubMed, EMBASE, and Cochrane Databases and abstracts presented in the main annual ASCO and ESMO conferences from 2017 to 2020. Studies published in English providing clinical outcomes data including overall survival (OS), progression free survival (PFS) and objective response rate (ORR) were included in the analysis. The primary outcomes of interest were pooled hazard ratios (HR) of OS and OR of ORR in first line studies and HR of PFS and OR of ORR for second line studies. OS for second line agents were synthesized in a qualitative analysis. Results: Overall, 8,335 patients (13 studies) and 4,612 patients (11 studies) were analyzed in phase II/III trials for first line and second line settings respectively. In the first line setting, atezolizumab plus bevacizumab and lenvatinib were ranked highest as the regimens associated with the greatest OS (A+B, HR 0.58, 95% CI, 0.42-0.80; P-score 0.993) and ORR (lenva, OR 3.34, 95% CI, 2.17-5.14; P-score 0.080) respectively. In the second line setting, cabozantinib showed the highest probability of greatest PFS benefit (HR 0.44, 95% CI, 0.29-0.66; P-score 0.854) as well as the highest probability of greatest ORR benefit (cabo, OR 9.40, 95% CI, 1.25-70.83, P-score, 0.266). Conclusions: In the first line setting, atezolizumab plus bevacizumab may be the superior regimen whereas lenvatinib may be considered as the initial option when robust tumor responses are preferred. In the second line setting, cabozantinib may be the preferred option including in cases when robust tumor responses are favored.

Tu1063 SEDATION IN DIGESTIVE ENDOSCOPY - PROPOFOL VERSUS TRADITIONAL SEDATIVE AGENTS: SYSTEMATIC REVIEW WITH META-ANALYSIS

Sedation schemes for gastrointestinal endoscopic procedures using propofol have been increasingly employed. This drug is superior to traditional sedation regimens (benzodiazepines and opioids) in relation to the onset of action and post-procedure recovery profile of patients. However, there may be some disadvantages: need for administration by trained physicians, narrow therapeutic window, absence of antidote, increased risk of cardiorespiratory events. To perform a systematic review and meta-analysis for comparison between sedation schemes containing propofol alone and / or associated with traditional sedatives in endoscopic procedures of the TGI Search in MEDLINE databases, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, randomized clinical trials comparing propofol versus traditional sedatives associated or not with propofol, published until October 2017, addressing the following outcomes: adverse effects, patient satisfaction with sedation received, endoscopist satisfaction with sedation administered, dose of propofol used, recovery time after the procedure. Meta analysis performed using Revman5 software version 5.39. From the 6532 articles, resulting from the initial search, 23 clinical trials were included, comprising 3854 patients. There was a high heterogeneity among the studies included during the meta-analysis of all outcomes, despite the performance of sensitivity and bias analysis. There were no statistically significant differences between the sedation schemes compared to the outcomes analyzed. There was no difference between using propofol alone or in combination with traditional sedative agents in endoscopic gastrointestinal tract procedures.

A model-based metaanalysis for dose-response comparison of psoriasis treatments

A model-based metaanalysis for dose-response comparison of psoriasis treatments

Use of Meta-analysis for the Comparison and Transfer of Economic Base Multipliers

This paper demonstrates the potential of meta-analysis as a comparative research tool in rural and regional economics. Meta-analysis is applied to the results of economic base modelling (400 study areas) designed for the estimation of multiplier effects in small regional economies. The meta-models constructed from these results were analysed using two methods: econometrics (multiple regression); and rough set analysis. The hypotheses and potentialities inherent in each method are in fact complementary: uniformity of relations between variables for econometrics; existence of relations among the group of variables for the Rough Set Data Analysis (RSDA). Cet article montre les potentialités de la méta - analyse comme outil de recherche comparative en économie régionale. La méta - analyse est appliquée aux résultats d'études utilisant le modèle de la base pour estimer les effets multiplicateurs des activités économiques motrices dans de petites régions (400 zones d'études). Les méta - modèles élaborés à partir de ces résultats ont été construits et analysés en utilisant deux méthodes : l'économétrie (régressions linéaires multiples), et l'analyse des ensembles approximatifs ou Rough Set Data Analysis (RSDA). Les hypothèses et potentialités inhérentes àchaque méthode sont complémentaires : uniformitédes relations entre le multiplicateur et ses variables explicatives pour l'économétrie, non linéaritéde ces relations pour l'analyse des ensembles approximatifs. Dieser Artikel zeigt das Potential der Metaanalyse als Mittel der vergleichenden Forschung in der regionalen Wirtschaft. Die Metaanalyse wird auf Studienergebnisse angewandt, die auf dem Grundmodell ausgeführt wurden, um die Multiplikationseffekte von antreibenden wirtschaftlichen Tätigkeiten in kleinen Regionen (400 Studienzonen) einzuschätzen. Die auf der Grundlage dieser Ergebnisse ausgearbeiteten Metamodelle wurden unter Einbeziehung von zwei Methoden aufgebaut und analysiert: Ökonometrie (multiple lineare Regressionen) und Überschlaganalyse oder Rough Set Data Analysis (RSDA). Die jeder Methode innewohnenden Hypothesen und Möglichkeiten ergänzen sich: einheitliche Beziehungen zwischen dem Multiplikator und seinen erläuternden Größen bei der Ökonometrie, Nicht-Linearität dieser Beziehungen bei der Überschlaganalyse.

CV2: INDIRECT COMPARISONS OF DRUGS USING META-ANALYSIS: VALIDATION OF RESULTS

OBJECTIVES: Health care decision-makers need more head-to-head drug comparison trials. Industry rarely sponsors such studies, preferring placebo comparators. We present an example of using meta-analysis for an indirect comparison of 2 drugs, with the results subsequently validated in a direct comparison trial. METHODS: The drugs for comparison were abciximab and tirofiban, both GPIIb/IIIa inhibitors used in patients with acute coronary syndromes undergoing percutaneous coronary interventions (PCI). A class effect has been assumed for these agents, although they differ in molecular structure and duration of action. We identified all placebo-controlled trials of each drug in PCI patients, and meta-analysed the odds ratios (OR) for death or MI (D/MI) at 30 days for each set of studies. These ORs were then compared using a general linear model. RESULTS: For D/MI at 30 days, the results of the meta-analysis of the 6 abciximab studies [OR = 0.52 (0.43, 0.63)] appeared superior to the results of the 3 tirofiban studies [OR = 0.73 (0.55, 0.96)], although the differences did not reach significance. In the model, a non-significant (p = 0.10) abciximab advantage was observed. The ratio of the ORs of tirofiban/placebo and abciximab/placebo meta-analyses was 1.4, suggesting a higher risk of D/MI at 30 days for tirofiban relative to abciximab. After completion of these analyses, the results of a randomized comparison trial of tirofiban vs. abciximab in PCI patients were announced (for D/MI at 30days OR = 1.26, p = 0.04). The results demonstrated an advantage for abciximab, in keeping with our meta-analysis result. The magnitude of the efficacy difference was similar to that we had predicted. CONCLUSIONS: This is the first time an indirect comparison of drugs using meta-analytic techniques has been validated with a contemporaneous RCT. This method should be used to predict results of direct comparisons of drugs anytime such a trial is contemplated.