Effects Meta-analysis Research Articles

Systematic review and meta-analyses of putative human health effects of exposure to per- and polyfluoroalkyl substances in children and adults

Systematic review and meta-analyses of putative human health effects of exposure to per- and polyfluoroalkyl substances in children and adults

P4392A systematic review and meta-analysis of the cardiovascular effects of e-cigarette

Abstract Background Electronic cigarette (EC) is marketed as a safe alternative to tobacco smoking, but EC cardiovascular effects remains largely unknown. Purpose To systematically review and meta-analyse published literature to investigate the cardiovascular effects and associated risk from EC use. Methods We searched PubMed from January 2000 until November 2017 for published studies assessing the cardiovascular effects of EC. For each eligible study we used the mean difference (MD) with 95% confidence intervals (CIs) for SBP, DBP and HR. The pooled MDs for each outcome of interest were calculated by using a fixed effects model. The presence of heterogeneity among studies was evaluated by the I2 statistic. Results We report conflicting evidence on the effects of EC on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. In a meta-analysis of 14 studies (n=441 participants), that despite the negative effects of EC on heart rate (pooled MD=2.27, 95% CI: 1.64 to 2.89, p<0.001), diastolic (DBP, pooled MD=2.01mmHg, 95% CI: 0.62 to 3.39, p=0.004) and systolic blood pressure (SBP, pooled MD=2.02mmHg, 95% CI: 0.07 to 3.97, p=0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to EC (SBP pooled MD=−7.00, 95% CI: −9.63 to −4.37, p<0.001; DBP pooled MD=−3.65, 95% CI: −5.71 to −1.59, p=0.001). Evidence suggests that EC negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are derived from single study reports and have not been confirmed in additional studies. Conclusions We report adverse effects of EC use on heart rate and blood pressure. Unless supported by stronger evidence, EC should not be labelled as cardiovascular safe products. Future studies should delineate whether EC use is less hazardous to cardiovascular health than conventional cigarette smoking.

P668Aspirin for primary prevention of cardiovascular disease

Abstract Background Platelet inhibition by aspirin reduces ischemic events but increases the risk of bleeding events. Yet, the role of aspirin in primary prevention of cardiovascular disease remains unclear. Purpose To produce a clinically relevant benefit-risk assessment of aspirin for primary prevention of cardiovascular disease. Methods We performed a meta-analysis of aspirin effects in primary prevention of cardiovascular disease comprising 13 randomized-controlled trials in 164.225 patients comparing aspirin versus placebo/control during a mean follow-up period of 6.4 years. Using a random effect model, relative risks and 95% confidence intervals were calculated for each outcome. Results Aspirin reduced the relative risk of ischemic stroke by 10% (RR: 0.90; 95% CI: 0.82–0.99), myocardial infarction by 14% (RR: 0.86; 95% CI: 0.77–0.95) and the major adverse cardiovascular events by 9% (RR: 0.91; 95% CI: 0.86–0.95) but was associated with a 46% relative risk increase of major bleeding events (RR: 1.46; 95% CI: 1.30–1.64). Aspirin did not reduce the risk of cardiovascular mortality (RR: 0.99; 95% CI: 0.90–1.08), all-cause mortality (RR: 0.98; 95% CI: 0.93–1.02) or cancer (RR 1.05; 95% CI, 0.87–1.26). Aspirin use did not translate into a net clinical benefit adjusted for event-associated mortality risk (mean 0.034%; 95% CI: −0.18 to 0.25%). Forest plot of major outcomes. Conclusions Aspirin use in primary prevention is associated with a reduced risk of stroke and myocardial infarction, but at a cost of an increased risk of major bleeding. Acknowledgement/Funding None

치매노인 대상 미술치료의 효과성에 대한 메타분석

치매노인 대상 미술치료의 효과성에 대한 메타분석

메이커 교육의 효과에 대한 메타분석

메이커 교육의 효과에 대한 메타분석

PLISSIT Interventions and Sexual Functioning: Useful Tools for Social Work in Palliative Care?

Discussing sexual health with healthcare patients and their partners is difficult and often avoided. The PLISSIT model is a framework to effectively initiate the conversation about sexual concerns. This rapid review and small meta-analysis explores and clarifies knowledge about the effectiveness of PLISSIT in resolving sexual dysfunction and glean insight into its utility as a social work intervention in a palliative care setting. Evidence from 15 interventional studies was synthesized. Cohen’s d-index served as the meta-analytic effect size statistic for each individual study. Significant ds were converted to Cohen’s U3 statistic to aid in practical interpretations. Between-study heterogeneity was evaluated with Cochran’s Q statistic to examine possible relationships between effect sizes and moderator variables. Statistically and practically significant evidence revealed that PLISSIT is effective in treating sexual dysfunction (d = 1.00, U3 = 84%, 95% CI = 1.06, 1.08): 84% of participants who received PLISSIT interventions scored lower on sexual dysfunction measures than did the typical participant in the comparison condition. Study design and frequency of intervention delivery moderated the overall effect. The findings and inferences may be best thought of as developed hypotheses for future research testing.

Evaluation of Reproducible Research Practices in Oncology Systematic Reviews With Meta-analyses Referenced by National Comprehensive Cancer Network Guidelines

Reproducible research practices are essential to biomedical research because these practices promote trustworthy evidence. In systematic reviews and meta-analyses, reproducible research practices ensure that summary effects used to guide patient care are stable and trustworthy. To evaluate the reproducibility in theory of meta-analyses in oncology systematic reviews cited by the 49 National Comprehensive Cancer Network (NCCN) guidelines for the treatment of cancer by site and evaluate whether Cochrane reviews or systematic reviews that report adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines use more reproducible research practices. A cross-sectional investigation of all systematic reviews with at least 1 meta-analysis and at least 1 included randomized clinical trial (RCT) that are cited by NCCN guidelines for treatment of cancer by site. We scanned the reference list of all NCCN guidelines (n = 49) for potential systematic reviews and meta-analyses. All retrieved studies were screened, and data were extracted, independently and in duplicate. The analysis was carried out between May 6, 2018, and January 28, 2019. The frequency of reproducible research practices, defined as (1) effect estimate and measure of precision (eg, hazard ratio with 95% confidence interval); (2) clear list of studies included for each analysis; and (3) for subgroup and sensitivity analyses, it must be clear which studies were included in each group or level. We identified 1124 potential systematic reviews, and 154 meta-analyses comprising 3696 meta-analytic effect size estimates were included. Only 2375 of the 3696 meta-analytic estimates (64.3%), including subgroup and sensitivity analyses, were reproducible in theory. Forest plots appear to improve the reproducibility of meta-analyses. All meta-analytic estimates were reproducible in theory in 100 systematic reviews (64.9%), and in 15 systematic reviews (9.7%), no meta-analytic estimates could potentially be reproduced. Data were said to be imputed in 29 meta-analyses, but none specified which data. Only 1 meta-analysis included a link to an online data set. More reproducible research practices are needed in oncology meta-analyses, as suggested by those that are cited by the NCCN. Reporting meta-analyses in forest plots and requirements for full data sharing are recommended.

Interventions integrating health and academic education in schools to prevent substance misuse and violence: a systematic review

Background Schools struggle to timetable health education. Interventions integrating academic and health education to reduce substance use and violence offer promise. No current systematic reviews examine such interventions. Objectives To review evidence to explore the following questions: (1) what types of interventions integrating health and academic education in schools serving those aged 4–18 years have been evaluated? (2) What theories of change inform these interventions? (3) What factors facilitate or limit the successful implementation and receipt of such interventions, and what are the implications for the delivery of such implementations in the UK? (4) How effective are such interventions in reducing smoking and violence and the use of alcohol and drugs, and at increasing attainment? Does this vary by students’ sociodemographic characteristics? (5) What factors appear to influence the effectiveness of such interventions? Data sources In total, 19 databases were searched from 18 November to 22 December 2015, updating searches for outcome evaluations for violence on 28 February 2018 and for substance use on 14 May 2018. References were extracted from included studies and authors contacted. Review methods Included studies reported on theories of change, and process or outcome evaluations of interventions that integrated academic and health education to reduce substance use and/or violence. References were screened on the title/abstract and then on the full report. Data extraction and appraisal used Cochrane, Evidence for Policy and Practice Information Centre and other established tools. Theories of change and process data were qualitatively synthesised. Outcome evaluations were synthesised narratively and meta-analytically. Results In total, 78,451 unique references were originally identified and 62 reports included. Search updates on 28 February and 14 May 2018 retrieved a further 2355 and 1945 references, respectively, resulting in the inclusion of six additional reports. Thirty-nine reports described theories, 16 reports (15 studies) evaluated process and 41 reports (16 studies) evaluated outcomes. Multicomponent interventions are theorised to erode ‘boundaries’ (strengthen relationships) between academic and health education, teachers and students, behaviour in classrooms and in the wider school, and schools and families. Teachers, pro-social peers and parents are theorised to act as role models and reinforcers of healthy behaviours learnt in lessons. There was clear evidence that interventions are facilitated by supportive senior management and alignment with the schools’ ethos, collaborative and supportive teaching environments, and positive pre-existing student, teacher and parent attitudes towards interventions. The barriers were overburdened teachers who had little time to both learn and implement integrated curricula. The strongest evidence for effectiveness was found for the reduction of substance use in school key stages (KSs) 2 and 3. For example, a meta-analysis for substance use at KS3 reported a mean difference of –0.09 (95% confidence interval –0.17 to –0.01). A meta-analysis for effectiveness in reducing violence victimisation in KS2 found no effect. There was mixed evidence for effects on academic outcomes, with meta-analysis precluded by methodological heterogeneity. Limitations Study quality was variable. Integration was sometimes not emphasised in theories of change. Conclusions These interventions are undertheorised but involve multiple forms of boundary erosion. There is clear evidence of characteristics affecting implementation. Interventions are likely to have the greatest impact on substance use. These programmes may be effective in reducing substance use but do not appear to reduce violence and findings on educational impacts are mixed. Future work Future evaluations should assess interventions with clearer theories of change and examine academic outcomes alongside violence and substance use outcomes. Study registration This study is registered as PROSPERO CRD42015026464. Funding The National Institute for Health Research Public Health Research programme.

Meta-analysis of the intervention effects of early ambulation on acquired weakness in intensive care unit patients with mechanical ventilation

Objective To systematic analyze the intervention effects of early ambulation on ICU acquired weakness (ICU-AW) in ICU patients. Methods The Cochrane Library, PubMed, EMBASE, MEDLINE, CBM, CNKI and Wanfang database were searched via computer for randomized controlled trials on early ambulation to prevent ICU-AW in ICU patients from the data base establishment date to February 10th, 2019.After screening literature, extracting data and evaluating the quality of literature, Meta-analysis was carried out with RevMan 5.3 software. Results Finally, 11 randomized controlled trials were included. Meta-analysis results showed that the incidence of ICU-AW was RR=0.52, 95%CI was (0.41, 0.66) ; muscle strength (MRC-score) WMD=8.08, 95%CI was (6.27, 9.81) ; Barthel index WMD=18.24, 95%CI was (7.27, 29.2) ; mechanical ventilation time was WMD=-1.29, 95%CI was (-1.96, -0.61) ; ICU hospitalization time was MD=-1.81, 95%CI was (-2.78, -0.84) ; total hospitalization time WMD=-3.39, 95%CI (-5.91, -0.88) . Conclusions Based on the present evidence, early ambulation can reduce the incidence of ICU-AW, improve the activity of daily life ability of patients, shorten the duration of mechanical ventilation, length of stay in ICU and hospital, which is worthy of clinical application. Key words: Intensive care unit; Respiration, artificial; Early ambulation; Early exercise; ICU acquired weakness; ICU acquired muscle weakness

메타분석을 이용한 가족 탄력성 증진 프로그램의 효과

메타분석을 이용한 가족 탄력성 증진 프로그램의 효과

EHealth Interventions for Fruit and Vegetable Intake: A Meta-Analysis of Effectiveness.

Background. An adequate intake of fruits and vegetables (FVI) has shown benefits for reduced risk of manifesting chronic diseases. Thus, development of effective interventions to promote FVI is paramount. Aim. To assess the effectiveness of eHealth interventions for FVI targeted to healthy population, in comparison with control groups, and identify the moderators contributing to their effectiveness. Method. A database search was conducted in April 2016 and July 2018 using MEDLINE, PsycINFO, ERIC, Google Scholar, SciELO, and RISS, yielding 19 eligible studies. Risk of bias was assessed using Cochrane's Risk of Bias Tool. Random-effects model was used to calculate effect sizes (ES) by weighted standardized mean differences. Results. This meta-analysis includes 19 studies and 6,894 participants. The most common eHealth tool used was Internet-based interventions (n = 10). Most of studies were conducted in adults (n = 11), followed by children (n = 4), and adolescents (n = 4). The minimum number of behavior change techniques (BCTs) used was one, and the maximum seven. The overall ES was small (0.26, p < .001), favoring eHealth interventions. The between-studies heterogeneity was large (I2 = 62.77%, p < .001). Subgroup analyses showed that the components with larger ES were tailored interventions (0.27, p < .001), computer-based interventions (0.44, p < .001), and use of ≥7 BCTs (0.42, p < .001). Discussion. All studies showed a positive ES favoring interventions. Large heterogeneity could be explained in part by the number of BCTs and type of eHealth tool used. Nonetheless, more concrete evidence regarding other intervention components effectiveness was limited by small sample size. Conclusion. The use of eHealth tools for the improvement of FVI showed to be more effective compared with nonintervention and interventions not using these technologies. Nonetheless, more research is needed to determine the specific combination of intervention components that could translate into larger effectiveness.

Meta-analysis of clinical effects of abdominal aortic balloon occlusion in resection of pelvic and sacral tumors

Objective To systematically evaluate the clinical effects of abdominal aortic balloon occlusion in resection of pelvic and sacral tumors. Methods All the randomized controlled trials (RCT) and cohort studies about abdominal aortic balloon occlusion in resection of pelvic and sacral tumors were electronically collected by searching databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine disc (CBMdisc), PubMed, Embase, Cochrane Library Database. Search time interval period was from construction of databases to December 31, 2018. Cochrane bias risk assessment table was used to evaluate the quality of RCT, and New Castle-Ottawa Scale (NOS) was used to evaluate the quality of cohort studies. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, evaluated the quality of the included literatures and risk of bias, and extracted relevant research data. Meta-analysis of the clinical effects of abdominal aortic balloon occlusion for pelvic and sacral tumor resection was performed by RevMan5.3 software. Outcome observation indicators included intraoperative blood loss, intraoperative blood transfusion volume, operation duration time and incidences of postoperative complications. Results ① A total of 219 related literatures were screened out in this study. Six of them met the inclusion and exclusion criteria of literatures, which included 1 RCT and 5 retrospective cohort studies. A total of 609 patients with pelvic and sacral tumor resection were involved in these 6 literatures. Among them, 258 patients underwent abdominal aortic balloon occlusion, and 351 did not receive abdominal aortic balloon occlusion. ② Cochrane bias risk assessment results of 1 RCT were uncertain, and NOS scores of 5 retrospective cohort studies were 7 scores. According to the results of literature quality evaluation, 5 high-quality cohort studies were included in the Meta-analysis. ③ Meta-analysis of this study showed that the intraoperative blood loss, intraoperative blood transfusion volume, operation duration time (excluded clinical heterogeneity) of patients undergoing abdominal aortic balloon occlusion for pelvic and sacral tumors resection were significantly lower than those of patients without abdominal aortic balloon occlusion (SMD=-917.12, 95%CI: -1 239.61 to -594.62, P 0.05). Conclusions Abdominal aortic balloon occlusion can reduce the amount of bleeding and blood transfusion during pelvic and sacral tumor resection without increasing the incidence of complications, including nerve injury, wound infection, urethral injury and vaginal injury. Key words: Balloon occlusion; Aortic, abdominal; Sacrum; Pelvic tumor; Blood loss, surgical; Blood transfusion; Postoperative complications

유아 놀이의 발달적 효과에 대한 메타분석

본 연구는 유아 놀이에 대한 발달적 효과가 어떠한가를 메타분석을 통해 체계적으로 정리하는데 목적이 있다. 이를 위해 2005년부터 2016년까지 11년간 국내에서 발행된 연구논문을 수집하였으며, 학위논문 90편과 학술논문 20편 등 총 110편의 논문을 최종 분석하였다. 연구결과 첫째, 유아 놀이에 의한 유아발달 전체효과크기는 1.21로 통제집단에 비해서 실험집단의 효과크기가 38.7% 높게 나타났다. 하지만 삽입된 효과크기를 계산한 결과 .81로 나타나 결측 연구들을 포함할 때는 현재 효과 크기보다는 낮아질 수 있는 것으로 나타났다. 둘째, 유아발달 하위요인에서는 신체발달 1.28은 .95으로, 정서발달 1.42에서 .86로, 사회성 발달 1.13은 .85로, 인지발달 1.19는 1.07로, 언어발달 1.30은 1.30으로, 창의성 발달 1.00은 .69로 실제 효과크기는 대체적으로 낮아지는 경향을 보였으나 모든 발달영역에서 효과크기가 있는 것으로 나타났다. 셋째, 조절변인에 의한 효과크기를 살펴본 결과 측정방법, 연령, 훈련 총 횟수, 놀이유형에서 집단 간에 통계적으로 유의한 차이가 나타났다. 본 연구의 결과는 유아 놀이가 발달적 측면에 효과가 있다는 것을 밝힘으로써 놀이가 유아의 발달을 반영하고, 발달을 촉진하며 발달적 변화를 위한 도구로서의 기능을 한다는 것을 확인하였다는데 의의가 있다.

Meta analysis of the clinical effect of sulfasalazine combined with probiotics on the treatment of inflammatory bowel disease

Objective To evaluate the clinical efficacy of domestic sulfasalazine (SASP) combined with probiotics on the treatment of inflammatory bowel disease (IBD). Methods According to the search of Chinese periodical full-text database, PubMed and other Chinese databases as well as English databases, the cases of IBD treated with SASP combined with probiotics or metronidazole in China were collected and screened for randomized controlled trials (RCT). The results between combined group and control group were compared using odds ratio (OR) and 95% Confidence Interval (CI) indicates. The evaluation indicator was the remission rate. According to the inclusion and exclusion criteria, the literature was selected, and data was extracted. Quality assessment of the included methodologies was performed, and RevMan 5.3 software was used for meta-analysis. Results 26 studies including a total of 2 403 patients were adopted in the present study. Among them, 13 studies suggested that the remission rate of IBD in SASP combined with probiotics group was significantly improved compared with that in the SASP group alone (χ2=10.29, df=12, I2=0%, P<0.05, the effect model OR=3.70, 95% CI as 2.62-5.21), demonstrating that the combined treatment was superior to monotherapy in IBD. 10 studies suggested that the remission rate of ulcerative colitis (UC) in SASP combined with probiotics group was significantly improved compared with that in the SASP group alone (χ2=2.59, df=9, I2=0%, P<0.05, the effect model OR=3.84, 95% CI as 2.52-5.86), demonstrating that the combined treatment was superior in UC. The other 3 studies showed that the remission rate of UC with infection in SASP combined with probiotics group was significantly improved compared with that in SASP combined with metronidazole group (χ2=0.07, df=2, I2=0%, P<0.05, the effect model χ2=4.77, 95% CI as 2.27-10.02), demonstrating that treatment of SASP combined with probiotics was superior in UC with infection. Conclusions SASP combined with probiotics can improve the effective response rate in the treatment of IBD. Key words: Sulfasalazine; Probiotics; Inflammatory bowel diseases; Colitis, ulcerative; Meta-analysis

Intuition, Deliberation, and Cooperation: Further Meta-Analytic Evidence from 91 Experiments on Pure Cooperation

What is the role of intuitive versus deliberative cognitive processing in human cooperation? The Social Heuristics Hypothesis (SHH) stipulates that (i) intuition favors behaviors that are typically advantageous (i.e. long-run payoff-maximizing), and that for most people cooperation is typically advantageous due to mechanisms such as repetition, reputation, and institutions; whereas (ii) deliberation favors the behavior that is payoff-maximizing in the given decision setting. As a result, the SHH predicts that in the context of pure cooperation – where non-cooperation is strictly payoff – maximizing – promoting intuition will lead to more cooperation than promoting deliberation. In this paper, I present the largest empirical investigation of this prediction to date by meta-analyzing 91 experiments in which participants made non-hypothetical pure cooperation decisions, and reliance on intuition versus deliberation was experimentally manipulated. A random effects meta-analysis of the overall intent-to-treat effect found the predicted result, with cooperation being 3.1 percentage points higher (p < .001) in the more intuition conditions compared to the more deliberation conditions. Meta-regression revealed that the effect was significantly larger when using emotion-inductions compared to other manipulation types, but that there was no significant difference in effect sizes across the other manipulations (time pressure, cognitive load, recall-inductions, and depletion). Critically, the meta-analytic effect remained significantly positive when excluding emotion-induction experiments, with cooperation being 1.6 percentage points higher (p = .009) in the more intuition conditions compared to the more deliberation conditions. Thus, the current body of evidence supports this key prediction of the SHH. I conclude by recommending that future work in this area should focus on developing new paradigms that avoid the issues with non-compliance and non-comprehension that plague existing studies.

Goal adjustment capacities and quality of life: A meta-analytic review.

This meta-analysis quantified associations between goal disengagement and goal reengagement capacities with individuals' quality of life (i.e., well-being and health). Effect sizes (Fisher's Z'; N=421) from 31 samples were coded on several characteristics (e.g., goal adjustment capacity, quality of life type/subtype, age, and depression risk status) and analyzed using meta-analytic random effects models. Goal disengagement (r = 0.08, p < 0.01) and goal reengagement (r = 0.19, p < 0.01) were associated with greater quality of life. While goal disengagement more strongly predicted negative (r = -0.12, p < 0.01) versus positive (r = 0.02, p = 0.37) indicators of well-being, goal reengagement was similarly associated with both (positive: r = 0.24, p < 0.01; negative: r = -0.17, p < 0.01). Finally, the association between goal disengagement and lower depressive symptoms (r = -0.11, p < 0.01) was reversed in samples at-risk for depression (r = 0.08, p = 0.01), and goal disengagement more strongly predicted quality of life in older samples (B=0.003, p < 0.01). These findings support theory on the self-regulatory functions of individuals' capacities to adjust to unattainable goals, document their distinct benefits, and identify key moderating factors.

학교 부적응 중학생을 위한 학교적응력향상프로그램 효과 메타분석: 학교교사, 학교생활, 학교수업, 학교친구 효과크기를 중심으로

본 연구는 학교 부적응 중학생을 대상으로 한 학교적응력향상프로그램의 효과를 파악하기 위해 학교적응력과 관련된 논문 29편에 대한 메타분석을 실시했다. 메타분석을 통한 연구결과는 다음과 같다. 첫째, 학교적응력향상프로그램의 전체효과크기는 1.29로 매우 높은 효과크기를 나타냈다. 둘째, 학교적응의 4개 하위요인인 학교교사, 학교생활, 학교수업, 학교친구에 따른 효과크기 차이를 살펴 본 결과, 학교생활의 효과크기가 1.10으로 가장 높게 나타났다. 셋째, 처치유형에 따른 효과크기의 차이를 분석한 결과, 집단상담의 경우가 효과적인 것으로 확인되었다. 넷째, 처치소분류에 따른 효과크기 차이를 분석을 한 결과는 원예, 상담, 미술, 독서 등 분류에 따라 다양한 분포의 효과크기가 나타남을 확인하였다. 다섯째, 성별에 따른 효과크기 차이는 남성의 경우가 상대적으로 높은 효과크기를 보였다. 마지막으로 장기적인 프로그램의 실시가 필요한 것으로 나타났고 이에 대한 추후 연구가 지속되어야 한다. 본 연구는 중학생의 학교적응력향상프로그램 효과성에 대한 결과를 다각적으로 분석하여 프로그램 개발 및 효과적인 운영에 필요한 정보를 제공하는데 의의가 있다. 분석된 연구결과를 토대로 시사점과 추후 제안을 논의 하였다.

The Estimating effectiveness from efficacy taxonomy (EFFECT): A tool to estimate the real-world impact of health interventions

AimsTo develop and pilot test a taxonomy that empirically estimates health intervention effectiveness from efficacy data. MethodsWe developed a taxonomy to score health interventions across 11 items on a scale from 0–100. The taxonomy was pilot-tested in efficacy and effectiveness diabetes prevention studies identified in two separate systematic reviews; here, the face validity, inter-rater reliability and factor structure of the taxonomy were established. Random effects meta-analyses were used to obtain weight loss and diabetes incidence pooled effects across studies. These effects and taxonomy scores were used to down calibrate efficacy estimates to effectiveness estimates as follows: Efficacy effect*[Efficacy score/highest possible score]. ResultsWe scored 82 effectiveness lifestyle modification studies (mean score 49.2), 32 efficacy lifestyle modification studies (mean score 69.8) and 20 efficacy studies testing medications (mean score 77.4). The taxonomy had face validity and good inter-rater reliability (ICC = 0.9 [0.87, 0.93]). The between-groups down calibrated weight loss estimate was similar to that observed in the effectiveness meta-analysis (1.7 and 1.8 kg, respectively). The down calibrated diabetes relative risk reduction was also similar to that observed in the effectiveness meta-analysis (30.6% over 2.7 years and 29% over 2 years, respectively). ConclusionsThe taxonomy is a promising tool to estimate the real-world impact of health interventions.

Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk Cohort

Transcatheter aortic valve implantation (TAVI) has been used to treat high surgical risk cohorts but has been expanded to treat low-to-intermediate risk cohort as well. We performed a systematic review and meta-analysis to compare the outcomes between TAVI and surgical aortic valve replacement (SAVR) in low-to-intermediate risk cohort. We queried PUBMED, EMBASE, and ClinicalTrial.gov for relevant articles. Randomized controlled trials that compared at least one of the outcomes of interest between TAVI and SAVR were included. Risk ratio (RR) and 95% confidence interval (CI) were pooled with a random-effects model to compare the risk of the primary outcome between the 2 procedures. The primary outcome was a composite of all-cause mortality or disabling/major stroke at 1 year. Seven studies with a total of 7,143 patients (3,665 TAVI) were included. All-cause mortality or disabling/major stroke at 30 days (6 studies, RR 0.71, 95% CI 0.49 to 1.03) was similar between TAVI and SAVR but was significantly lower in TAVI at 1 year (5 studies, RR 0.81, 95% CI 0.67 to 0.98). All-cause mortality was similar at both 30 days (7 studies, RR 0.90, 95% CI 0.67 to 1.21) and 1 year (6 studies, RR 0.89, 95% CI 0.76 to 1.04). Disabling/major stroke was similar between the 2 procedures (6 studies, RR 0.69, 95% CI 0.42 to 1.12) at 30 days but was significantly lower in TAVI at 1 year (5 studies RR 0.71, 95% CI 0.51 to 0.98). Age, gender, diabetes, and surgical risk score did not modulate the primary outcome. TAVI had a significantly lower composite of all-cause mortality or disabling/major stroke at 1 year compared with SAVR in low-to-intermediate surgical risk cohort.

학업성취에 대한 피드백 효과의 메타분석

학업성취에 대한 피드백 효과의 메타분석