Meta-analysis Of Randomized Controlled Trials Research Articles

Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal Fractures.

Background:Management of displaced intraarticular calcaneus fractures can be operative or nonoperative. Several randomized and case-controlled trials have been recently conducted in order to reach a consensus. The purpose of this analysis is to provide recommendations for the management of these injuries based on the best available clinical evidence.Methods:An up-to-date search was conducted using predefined eligibility criteria. The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) was followed. Randomized and prospective clinical trials were only included after agreement among all authors. Relevant literature was appraised for methodologic quality using the Cochrane collaboration tool for the randomized controlled trials (RCTs) and Newcastle Ottawa Score for the prospective trials. Outcome measures included American Orthopaedic Foot & Ankle Society ankle-hindfoot score, visual analog scale score, return to activity, complications, residual pain, and development of arthritis. RevMan, version 5.3.5 software, was used for data analysis. A P value of <.05 was considered statistically significant, and CIs were set at 95%.Results:A total of 13 studies and 1251 patients were included in our analysis. This involved 10 RCTs and 3 prospective clinical trials. Shoe fitting problems and failure to return to activity favored the operative group. No other studied variables showed clear superiority of a specific treatment approach.Conclusion:The best evidence available at this time favors an advantage to operative treatment. Patients should be informed that the clear differences are centered on comfort of shoe wear and return to desired activity level.Level of Evidence: Level II, meta-analysis of RCT and Prospective Cohort studies.

The efficacy and safety of tranexamic acid in lumbar surgery: A meta-analysis of randomized-controlled trials.

Objectives This meta-analysis aims to assess tranexamic acid (TXA) effectiveness and safety in lumbar surgery.Patients and methods Renewals of randomized-controlled trials (RCTs) were conducted utilizing databases of medical literature such as PubMed, China Science and Technology Journal Database, Cochrane Library, China National Knowledge Infrastructure (CNKI), and EMBASE to compare principal and safety endpoints. The risk ratio (RR), standard mean difference (SMD), and 95% confidence intervals (CIs) were calculated. For the evaluation of the quality of the included studies, the Cochrane risk of bias criteria were utilized by two authors.Results In total, 49 articles were enrolled that included 4,822 patients. Of the patients, 2,653 were administered TXA and 2,169 were in the control group. The findings indicated that TXA was capable of significantly lowering postoperative blood loss (PBL), transfusion rate, transfusion volume, total blood loss (TBL), intraoperative blood loss (IBL), and drainage compared to the control group. Besides, hemoglobin (Hb) and hematocrit (Hct) values were higher in the TXA group compared to the control group. As the safety endpoints, TXA significantly reduced D-dimer levels compared to the control group; however, both TXA and control groups had no significant variations in deep venous thrombosis (DVT). Subgroup analysis was administrated according to the administration method of TXA and the operation type and intravenous and topical TXA were combined in the meta-analysis.Conclusion This meta-analysis showed that TXA had the potential to significantly lower PBL, transfusion rate, transfusion volume, TBL, IBL, and drainage compared to the control group. Besides, Hb and Hct values were higher in the TXA group compared to the control group. Its hemostatic potential after lumbar spine surgery is trustworthy. It is still controversial in safety endpoints that TXA can significantly reduce D-dimer compared to the control group, without no significant variations in DVT in both the TXA and control groups.

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs.

Objective To assess if the addition of fentanyl to brachial plexus block has an impact on anesthetic outcomes and complication rates in patients undergoing upper extremity surgeries. Methods We explore the PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases for all randomized controlled trials (RCTs) comparing adjuvant fentanyl with placebo/no drug for patients undergoing upper extremity surgery under brachial plexus block. Outcomes assessed were onset, duration of sensory and motor anesthesia, complications, and postoperative analgesia scores. Meta-analysis was conducted utilizing a random-effects model. The risk of bias was assessed using the Cochrane Collaboration's risk of bias assessment tool 2. Certainty of evidence was assessed using GRADE. Subgroup analysis was conducted depending upon the approach of brachial plexus block and type of local anesthetic. Results Twelve RCTs with 660 patients were included. Addition of fentanyl had no effect on onset of sensory anesthesia (11 studies; MD: 0.48; 95% CI: −1.81, 0.85; I2 = 96%; p=0.48) but significantly shortened onset of motor anesthesia (8 studies; MD: −2.36; 95% CI: −3.99, −0.74; I2 = 96%; p=0.48). Duration of sensory anesthesia (9 studies; MD: 82.81; 95% CI: 41.81, 123.81; I2 = 99%; p < 0.0001) and motor anesthesia (7 studies; MD: 93.41; 95% CI: 42.35, 144.46; I2 = 99%; p=0.0003) was significantly increased with addition of fentanyl. The certainty of evidence-based on GRADE was deemed to be moderate for both onset and duration of anesthesia. The incidence of overall complications (nausea/vomiting and pruritis) was significantly higher in the fentanyl group (7 studies; OR: 2.14; 95% CI: 1.04, 4.40; I2 = 8%; p=0.04) but with low certainty of evidence. Conclusions Adjuvant fentanyl with brachial plexus block improves the onset of motor anesthesia but not sensory anesthesia. The duration of both sensory and motor anesthesia is significantly prolonged with fentanyl by around 83–93 minutes. However, clinicians should be aware that complications such as nausea/vomiting and pruritis are increased twofold with the addition of the drug. Current evidence is limited risk of bias in the RCTs and high heterogeneity in the meta-analyses.

A Consistency Model for Identifying the Effects of n-3 and n-6 Fatty Acids on Lipoproteins in Dialysis Patients.

Numerous randomized controlled trials (RCTs) and meta-analyses have assessed the effects of supplemental dietary polyunsaturated fatty acids (PUFAs) on levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) and the LDL/HDL ratio in patients receiving renal replacement therapy (RRT). However, results are ambiguous due to mixed reports of various nutrients used in the intervention group. We performed a network meta-analysis of RCTs to assess the effects of PUFAs on lipid profiles in patients undergoing RRT. RCTs performed before November 2021 were gathered from three databases. The means, standard deviations and the number of cases for each arm were independently extracted by two authors to form a network meta-analysis of LDL and HDL levels and the LDL/HDL ratio in a random effects model. Twenty-eight RCTs (n = 2017 subjects) were included in this study. The pooled results revealed that the combination of omega-3 fatty acids (n-3) and omega-6 fatty acids (n-6) produced significantly lower LDL (standardized mean difference (SMD) = −1.43, 95% confidence interval: −2.28 to −0.57) than the placebo. Both n-3 fatty acids (SMD = 0.78) and the combination of n-3 + n-6 (SMD = 1.09) benefited HDL significantly compared with placebo. Moreover, n-3 alone also exhibited a significantly lower LDL/HDL ratio than placebo. Collectively, PUFAs seem to be adequate nutrients for controlling lipoproteins in patients undergoing RRT. Specifically, n-3 + n-6 supplementation improved LDL levels, while n-3 improved HDL levels and the LDL/HDL ratio. However, our data provide limited information on specific dosages of PUFAs to form a concrete recommendation.

Hypnosis and music interventions for anxiety, pain, sleep and well-being in palliative care: systematic review and meta-analysis

BackgroundMaintaining quality of life is a primary goal of palliative care (PC). Complementary interventions can help meet the needs of patients at the end of life.ObjectivesThis meta-analysis aims to (1)...

Additional capecitabine use in early-stage triple negative breast cancer patients receiving standard chemotherapy: a new era? A meta-analysis of randomized controlled trials

BackgroundThe efficiency of capecitabine has been proven in early-stage triple negative breast cancer (eTNBC) with residue invasive tumor (non-pCR) after standard neoadjuvant chemotherapy (NACT). However, for those unselected eTNBC patients without screening from NACT (i.e., newly diagnosed eTNBC patients undergoing breast surgery followed by adjuvant systemic therapy), the value of capecitabine has still remains unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate whether additional capecitabine in eTNBC patients could improve clinical outcomes.MethodsSeven RCTs (USO 01062, FinXX, GEICAM/2003, CREATE-X, CIBOMA/2004, CBCSG-010 and SYSUCC-001) were identified in online databases until December 2020 and included in the meta-analysis. We extracted the survival data including disease/relapse-free survival (DFS/RFS) and overall survival (OS), and utilized the STATA software to calculate the summarized hazard ratios (HRs) and 95% confidence intervals (95%CIs).ResultsA total of 3329 eTNBC patients were enrolled in this meta-analysis, with 1640 receiving standard neo−/adjuvant chemo-regimes alone, and the other 1689 receiving an additional capecitabine use, respectively. Both DFS and OS were significantly improved with the addition of capecitabine, and the benefits remained consistent in those unselected eTNBC patients without screening from NACT. Subgroup analysis further proved that this improvement in DFS was significant in both nodal negative and positive patients. Similar benefits are also found across menopausal status (both pre- and post-menopause). Regarding toxicity, the hand-foot syndrome and neutropenia are the most common capecitabine related adverse events, and are mostly tolerable.ConclusionsThe present meta-analysis of RCTs demonstrates for the first time that adding capecitabine to standard chemo-regimens could improve both DFS and OS in unselected eTNBC patients, and this benefit remains consistent regardless of nodal status and menopausal status, which may lead eTNBC therapy into a new era.

Effects of pharmacist interventions on cardiovascular risk factors and outcomes: An umbrella review of meta-analysis of randomized controlled trials.

To grade the evidence from published meta-analyses of randomized controlled trials (RCTs) that assessed effects of pharmacist intervention on cardiovascular risk factors and cardiovascular outcomes. MEDLINE, Embase, and the Cochrane Library were searched from database inception to July 2021. Meta-analyses of RCTs were eligible. Quality of evidence were assessed by GRADE approach. From 9308 publications, 149 full-text articles were evaluated for eligibility, and 24 studies with 85 unique meta-analyses that assessed effects of pharmacist intervention on cardiovascular risk factors and cardiovascular outcomes were selected. Overall, 71.7% (61/85) of unique meta-analyses showed significant impacts of pharmacist intervention. For the quality of evidence, 63.4% of meta-analyses had large heterogeneity (I2 > 50%) while 1.2, 16.5, 32.9 and 49.4% of meta-analyses were graded as high, moderate, low and very low quality based on GRADE approach, respectively. Among meta-analyses with moderate quality, pharmacist interventions significantly mitigated risk factors (including 6/3mmHg reduction of blood pressure, increased the rate of lipid control, glucose control and smoking cessation (pooled odds ratio, [95% confidence interval] 1.91 [1.55, 2.35], 3.11 [2.3, 4.3] and 2.3 [1.33, 3.97], respectively) and improved medication adherence (1.67 [1.38, 2.02]). Furthermore, pharmacist interventions significantly reduced all-cause mortality (0.72 [0.58, 0.89]) and improved quality of life in patients suffering from chronic heart failure. This umbrella review found convincing evidence that pharmacist intervention can provide a wide range of benefits in cardiovascular disease management, ranging from risk factor control, improvement in medication adherence and, in some settings, reduction in morbidity and mortality.

Effectiveness and safety of extracorporeal shock wave treatment for low back pain：a systematic review and meta-analysis of RCTs

This meta-analysis was designed to assess the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for patients with low back pain (LBP). Pubmed, Embase, Cochrane's library, PEDro (Physiotherapy Evidence Database), China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences (MD) were calculated for continuous outcomes, while odd ratios (OR) were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P ＜0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4–6 weeks, the pooled mean difference in ODI scores was −14.10 (P ＜0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. The use of ESWT is effective in alleviating pain and improving the general functional state for patients with LBP. However, more evidence was needed to verify its safety.

Effects of different doses of canagliflozin on blood pressure and lipids in patients with type 2 diabetes: a meta-analysis.

Canagliflozin is a sodium glucose-cotransporter-2 receptor inhibitor approved for the treatment of type 2 diabetes mellitus (T2DM). However, it is less prescribed due to increased LDL cholesterol (LDL-C), high incidence of urinary tract infection (UTI), high cost. Data on the effect of canagliflozin on blood pressure (BP) are also limited. We conducted a meta-analysis of randomized controlled trials (RCTs) to review dosedependent effects of canagliflozin on BP and lipids in patients with T2DM. A meta-analysis of RCTs in patients with T2DM was conducted. MEDLINE, the Cochrane Library of Trials and Clinicaltrials.gov were searched for relevant studies from January 2008 to May 2021. Compared with placebo, canagliflozin 100 mg reduced SBP by 3.43 mmHg and DBP by 1.05 mmHg. Canagliflozin 100 mg increased LDL-C by 0.10mmol/l and HDL cholesterol (HDL-C) by 0.05 mmol/l. Compared with placebo, canagliflozin 300 mg reduced SBP by 4.75 mmHg and DBP by 1.69 mmHg. Canagliflozin 300 mg increased LDL-C by 0.16 mmol/l and HDL-C by 0.06 mmol/l. Compared with canagliflozin 100 mg, canagliflozin 300 mg further reduced SBP by 1.21 mmHg and DBP by 0.64 mmHg, and further increased LDL-C by 0.06 mmol/l and HDL-C by 0.02 mmol/l. Compared with placebo and canagliflozin 100 mg, canagliflozin 300 mg increased the risk of UTI. The current meta-analysis provides new evidence on different doses of canagliflozin as an antihypertensive agent in T2DM complicated by hypertension; however, LDL-C and the risk of UTI should be monitored.

Efficacy of Vitamin D Supplements in Prevention of Acute Respiratory Infection: A Meta-Analysis for Randomized Controlled Trials.

Background: Previous systematic reviews and meta-analyses of randomized controlled trials (RCTs) have reported inconsistent results regarding the efficacy of vitamin D supplements in the prevention of acute respiratory infections (ARIs). Methods: We investigated these efficacy results by using a meta-analysis of RCTs. We searched PubMed, EMBASE, and the Cochrane Library in June 2021. Results: Out of 390 trials searched from the database, a total of 30 RCTs involving 30,263 participants were included in the final analysis. In the meta-analysis of all the trials, vitamin D supplementation showed no significant effect in the prevention of ARIs (relative risk (RR) 0.96, 95% confidence interval (CI) 0.91–1.01, I2 = 59.0%, n = 30). In the subgroup meta-analysis, vitamin D supplementation was effective in daily supplementation (RR 0.83, 95% CI, 0.73–0.95, I2 = 69.1%, n = 15) and short-term supplementation (RR 0.83, 95% CI, 0.71–0.97, I2 = 66.8%, n = 13). However, such beneficial effects disappeared in the subgroup meta-analysis of high-quality studies (RR 0.89, 95% CI, 0.78–1.02, I2 = 67.0%, n = 10 assessed by the Jadad scale; RR 0.87, 95% CI, 0.66–1.15, I2 = 51.0%, n = 4 assessed by the Cochrane’s risk of bias tool). Additionally, publication bias was observed. Conclusions: The current meta-analysis found that vitamin D supplementation has no clinical effect in the prevention of ARIs.

Efficacy of laughter-inducing interventions in patients with somatic or mental health problems: A systematic review and meta-analysis of randomized-controlled trials

Background and purposeLaughter-inducing interventions hold promise as affordable and easy to implement treatments for a range of ailments. The aim of this study was to build on meta-analytic evidence for the efficacy of such interventions in treating somatic or mental health patients. MethodsStudies eligible for the meta-analysis were identified by a comprehensive literature search in MEDLINE, CENTRAL, Web of Science, and PsycINFO and by a manual search (date of last search 22/06/2021). All randomized controlled trials comparing spontaneous laughter or simulated laughter to treatment as usual, no treatment/waitlist, or attention control groups were included. There were no language or date restrictions. Separate random-effects meta-analyses were conducted for mental health, physiological, and physical health outcomes. Hedges’ g is reported as the standardized mean difference estimate. The study was registered on PROSPERO (#CRD42019139299). ResultsForty-five studies comprising 2,547 randomized participants were included. Laughter-inducing interventions showed significant positive effects on mental health (31 studies, 1,543 patients, g = 0.74, 95% CI [0.48; 1.00], I2 = 81%), physiological (14 studies, 761 patients, g = 0.61 [0.20; 1.03], I2 = 86%), and physical health outcomes (21 studies, 1,105 patients, g = 0.59 [0.30; 0.88], I2 = 80%). Only one study reported adverse events, which were mild in nature. ConclusionLaughter-inducing interventions can have beneficial effects on a variety of health-related outcomes including mental health, physical health, and physiological parameters. Future research should focus on examining differential intervention effects and mechanisms of action.

Influenza vaccination in patients with heart failure: A protocol for meta-analysis of randomized controlled trials.

Background:Heart failure is a major public health problem. Although there have been significant advances in the management of heart failure, the mortality and morbidity in heart failure patients remain high. Heart failure patients are susceptible to influenza-related complications including acute heart failure exacerbations and secondary infections such as pneumonia, both of which lead to significant morbidity and mortality. An earlier meta-analysis of observational cohort studies reported that influenza vaccination was associated with reduced risk of mortality in heart failure patients. Although there are no published randomized controlled trials (RCTs) on the effect of influenza vaccination on clinical outcomes in heart failure patients, there are several on-going RCTs examining the effect in these patients. We aim to conduct a meta-analysis of RCTs to assess the efficacy and safety of influenza vaccination in heart failure patients.Methods:This meta-analysis will include RCTs examining the effect of influenza vaccination in heart failure patients. Information of studies will be collected from electronic databases. The primary outcome of interest will be cardiovascular death. The secondary outcomes of interest will be all-cause death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and hospitalization for any cause.Discussion:This meta-analysis will evaluate the efficacy and safety of influenza vaccination in heart failure patients, providing evidence to the use of influenza vaccine in these patients.Systematic review registration:INPLASY202210115.

Attrition Within Digital Health Interventions for People With Multiple Sclerosis: Systematic Review and Meta-analysis.

BackgroundDigital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition.ObjectiveThis study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS—digital health interventions that were intended to support a program of engagement over a defined period—and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs).MethodsWe conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators.ResultsThere were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively.ConclusionsThis paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type.

Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials.

ObjectiveThis study aimed to determine which bariatric procedure allows patients to obtain the best weight‐loss outcomes and a remission of type 2 diabetes.MethodsDatabases were searched for randomized‐controlled trials comparing Roux‐en‐Y gastric bypass (RYGB) with sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB). The mean difference (MD) or the relative risk was determined.ResultsTwenty‐five randomized‐controlled trials were analyzed. Excess weight loss (EWL, percentage) was greater for RYGB patients at 3 years (MD: 11.93, p < 0.00001) and 5 years (MD: 13.11, p = 0.0004). Higher excess BMI loss (percentage) was found in RYGB at 1 year (MD: 11.66, p = 0.01). Total weight loss (percentage) was greater for RYGB patients after 3 months (MD: 2.41, p = 0.02), 6 months (MD: 3.83, p < 0.00001), 1 year (MD: 6.35, p < 0.00001), and 5 years (MD: 3.90, p = 0.005). No difference in terms of remission of type 2 diabetes was seen between RYGB and SG. EWL was significantly more important after OAGB than after RYGB after 1 year (MD: −10.82, p = 0.003).ConclusionsRYGB is more efficient than SG in the midterm. OAGB offers greater EWL than RYGB after 1 year, but further evidence is needed to confirm this result.

Tocilizumab for COVID-19: A systematic review and meta-analysis of randomized controlled trials.

The effective treatment modalities for severe coronavirus disease 2019 (COVID-19) are needed. As the primary cause of mortality is a hyperinflammatory state, the interleukin-6 antagonist tocilizumab has been used in multiple clinical studies. We conducted this systematic review and meta-analysis to estimate the effectiveness of tocilizumab in reduction of mortality due to COVID-19.A systematic search of the Pubmed and Embase databases was performed to extract randomized controlled trials (RCTs) regarding the use of tocilizumab therapy for COVID-19. An overall pooled mortality analysis was performed, and odds ratios were reported. Cochrane risk of bias assessment tool was used to assess the risk of bias. Heterogeneity was assessed using the I2 statistic. Nine RCTs, including 6489 patients, were selected for meta-analysis. Seven trials reported 28-day mortality, and one trial each reported 21-day and 30-day mortality. There were 846 deaths among 3358 participants in the steroid group while 943 deaths among 3131 patients randomized to the control group (random-effects odds ratio 0.87, 95% confidence interval 0.73-1.03, p=0.11). There was some heterogeneity among the trials as the I2 value was 15%, with a p-value of 0.31. There was a reduction in the need for ICU admission in the tocilizumab group. A higher risk of secondary infections was noted in the tocilizumab group (fixed-effects odds ratio 0.72, 95% confidence interval 0.55-0.95, p=0.02). This meta-analysis of RCTs demonstrated that the use of tocilizumab was not associated with a reduction in all-cause mortality in patients with COVID-19 and had higher odds of secondary infections.

The Role of Hyaluronic Acid for Soft Tissue Indications: A Systematic Review and Meta-Analysis.

Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is increasing evidence examining the use of hyaluronic acid (HA) for the management of soft tissue injuries. To evaluate the treatment effect and role of HA for available soft tissue indications. A search of PubMed, MEDLINE, EMBASE, and CENTRAL from the inception date of each database through February 24, 2021, was conducted for all randomized controlled trials (RCTs) involving the use of HA for soft tissue indications. Two reviewers independently screened articles for eligibility and extracted data from included studies for analysis. We assessed risk of bias for all included studies and pooled outcomes using a fixed-effects model. Outcomes (ie, function and pain relief) were categorized to short-term (<6 weeks, 6-12 weeks) and mid-term (>12 weeks) data. We present effect estimates as mean differences (MDs) and standardized mean differences (SMDs) and present the estimate of effect of HA for available indications in relation to available comparators. Meta-analysis of RCTs. Level 1. Of the 6930 articles screened, 19 RCTs (n = 1629 patients) were eligible and included in this review. HA was evaluated across a variety of soft tissue indications including rotator cuff disease, elbow pain, ankle sprains, Achilles tendinopathy, patellar tendinopathy, and trigger finger. Of the 19 RCTs, 11 were placebo-controlled and 9 used active comparators (PRP, cortisone, prolotherapy, or extracorporeal shockwave therapy). The pooled treatment effect of HA across most soft indications against placebo and active comparators demonstrated benefit in short-term pain <6 weeks (MD visual analogue scale [VAS] 2.48, 95% CI 2.31-2.65) and 6 to 12 weeks (MD VAS 2.03, 95% CI 1.86-2.20). Mid-term pain relief also favored HA over comparators across indications >12 weeks from administration (MD VAS 3.57, 95% CI 3.35-3.78). High heterogeneity was present with rotator cuff (10 trials, I2 = 94%), and elbow tendinopathy (2 trials, I2 = 99%). We identified uncertain benefit for trigger finger (2 trials, I2 = 67%). Heterogeneity for ankle sprains, patellar tendinopathy and Achilles tendinopathy could not be assessed as they only had 1 trial each. This systematic review and meta-analysis support HA's efficacy in the treatment of a variety of soft tissue indications. Understanding the relative effects of HA to other injectable modalities requires additional, large trials.

Effect of horticultural therapy on mental health: A meta-analysis of randomized controlled trials.

WHAT IS KNOWN ON THE SUBJECT?: Mental health assessment is a common topic in horticultural therapy (HT). Some study findings were contrary to positive findings, although several studies have explored the effect of HT on mental health and reported positive results. There is weak evidence in the benefits of HT based on evidence-based medicine. Stronger evidence of the link between HT and mental health will help in policy making by health policy makers and governments. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The purpose of this meta-analysis of randomized controlled trials (RCTs) was to explore the effect of HT on mental health. This study is the first meta-analysis of RCTs to provide critical evidence that HT has a positive effect on mental health. The effect size of HT on mental health was medium (0.55). The included studies had no negative effects on mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: HT should be considered a useful therapy to be integrated in healthcare settings by horticultural therapists to improve mental health. In the HT program, indoor and outdoor plant activities, plant-related arts, crafts and other activities were common interventions to improve specific mental health problems through at least eight sessions. ABSTRACT: Introduction HT has been widely used to promote mental health. However, heterogeneity and sample size issues of randomized controlled trials made it challenging to illustrate effect sizes across the evidence. Aim The purpose of this meta-analysis was to explore the effect of HT on mental health. Methods We used the PRISMA framework. A keyword search of Web of Science, PubMed, ProQuest and Cochrane was performed. The inclusion criteria were HT with RCTs and mental health assessments. A random-effects model was used to perform the meta-analysis. Results A total of 1,056 records were searched, and 18 eligible studies were extracted. The included RCTs had no statistical heterogeneity and publication bias. The meta-analysis showed that the HT experimental groups had a significant and positive impact on mental health compared with the control groups (effect size=0.55). Discussion HT should be considered for enhancing mental health. The included studies had no negative outcomes and the most common HT intervention was at least eight sessions. Therefore, HT should be considered to enhance mental health. However, the concealed allocation and blinding processes should be improved in future studies. Implications for Practice: This study recommends that HT should be integrated into healthcare settings to improve mental health.

Efficacy of combination triple therapy with vasopressin, steroid, and epinephrine in cardiac arrest: a systematic review and meta-analysis of randomized-controlled trials

BackgroundThis study investigated whether combination therapy with vasopressin, steroid, and epinephrine (VSE) improves in-hospital survival and return of spontaneous circulation (ROSC) during and after resuscitation in-hospital cardiac arrest (CA).Materials and methodsVarious databases were explored from inception until October 2021 for relevant published clinical trials and cohort studies.ResultsThree clinical trials were included. Pooled analysis suggested that VSE was significantly associated with increased ROSC in patients with in-hospital CA (IHCA) (odds ratio (OR): 2.281, 95% confidence interval (CI): 1.304–3.989, P value = 0.004). Meta-analysis of two studies (368 patients) demonstrated a significant difference in the reduction of mean arterial pressure (MAP) during and 15–20 min after cardiopulmonary resuscitation (standardized mean difference (SMD): 1.069, 95% CI: 0.851–1.288, P value < 0.001), renal failure free days (SMD = 0.590; 95% CI: 0.312–0.869 days; P value < 0.001), and coagulation failure free days (SMD = 0.403; 95% CI: 0.128–0.679, P value = 0.004). However, no significant difference was observed for survival-to-discharge ratio (OR: 2.082, 95% CI: 0.638–6.796, P value = 0.225) and ventilator free days (SMD = 0.201, 95% CI: − 0.677, 1.079 days; P value = 0.838).ConclusionsVSE combination therapy during and after IHCA may have beneficial effects in terms of the ROSC, renal and circulatory failure free days, and MAP.Prospero registration: CRD42020178297 (05/07/2020).

Effect of curcumin on body mass index and glycemic indices in females with PCOS: a systematic review and meta-analysis of randomized controlled trial

PurposeThis paper aims to assess the impact of curcumin supplementation body mass index and glycemic indices in women with polycystic ovary syndrome (PCOS).Design/methodology/approachA systematic search of the literature was conducted in PubMed, Scopus and ISI web of science to identify all randomized controlled trials (RCTs) published from the earliest record up to February 2021. The authors used a random-effects model to estimate pooled effect sizes.FindingsA total of four potentially related clinical trials met the inclusion criteria which included a total of 198 participants. Random-effects meta-analysis showed significant effects of curcumin on fasting blood sugar (FBS) (−3.62 mg/dl, 95% CI [−5.65, −1.58], p-value < 0.001, I2 = 0.0%), insulin level (−1.67 µU/mL, 95% CI [−3.06, −0.28], p-value = 0.018, I2 = 0.0%) and homeostasis model of assessment insulin resistance (HOMA-IR) (−0.42, 95% CI [−0.76, −0.09], p-value < 0.01, I2 = 0.0%). No evidence of publication bias was discovered in the meta-analyses.Originality/valuePresent systematic review and meta-analysis of RCTs showed beneficial effects of curcumin consumption on FBS, insulin level and HOMA-IR in patients with PCOS. However, further large-scale studies are needed to confirm these results.

Effectiveness of repetitive transcranial magnetic stimulation on poststroke dysphagia: a meta-analysis of randomized-controlled trials.

Dysphagia is a common functional impairment after stroke, resulting in aspiration of liquids, ingested foods, or oral secretions and influencing the quality of life. Noninvasive repetitive transcranial magnetic stimulation has been widely used for rehabilitation of dysphagia. The purpose of this meta-analysis was to investigate the efficacy of repetitive transcranial magnetic stimulation on poststroke swallowing impairment. Four databases were systematically searched for eligible studies from their inception to 31 September 2021. Review Manager 5.4 software was used for this meta-analysis. The bias of included randomized controlled trials was assessed using the version 2 of the Cochrane risk-of-bias tool for randomized trials. Nine randomized controlled trials involving 393 patients were included according to the selection criteria. The results revealed significant benefit of repetitive transcranial magnetic stimulation as a treatment of dysphagia following the onset of stroke, when compared with intervention without repetitive transcranial magnetic stimulation. Applying repetitive transcranial magnetic stimulation on different stimulation sites effectively improved the dysphagia of poststroke patients, and no significant difference was observed among the different stimulation sites subgroups. Our findings support repetitive transcranial magnetic stimulation as an effectively treatment of the poststroke dysphagia, especially in unilateral hemispheric stroke patients.