Review Meta-analysis Research Articles

Nutritional interventions in patients with burn injury: an umbrella review of systematic reviews and meta-analyses of randomised clinical trials.

Multiple reviews have examined the impact of nutritional interventions in patients with burn injuries; however, discrepancies among results cast doubt about their validity. We implemented this review to assess the impact of various nutritional interventions in adult patients with burn injuries. We conducted a thorough search of PubMed, Scopus and Web of Science databases until 1 August 2024, to identify relevant meta-analyses of intervention trials, examining the impact of nutritional interventions on burn patients. We adopted the random-effect models to determine the pooled effect sizes while employing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to examine evidence certainty. Thirty-three original intervention trials from eleven meta-analyses were entered in our review. Early enteral nutrition could substantially reduce overall mortality (relative risk (RR): 0·36, 95 % CI: 0·19, 0·68, GRADE = moderate certainty), hospital stay (mean difference (MD): -15·3, 95 % CI: -20·4, -10·2, GRADE = moderate certainty) and sepsis risk (RR: 0·23, 95 % CI: 0·11, 0·45, GRADE = moderate certainty). Glutamine showed a notable decrease in the length of hospital stay (MD: -6·23, 95 % CI: -9·53, -2·94, GRADE = low certainty). However, other nutritional interventions, including combined immunonutrition, branched-chain amino acids, fish oil, ornithine α-ketoglutarate and trace elements, did not significantly affect the assessed clinical outcomes. Early enteral nutrition might impose a beneficial effect on mortality, hospital stay length and incidence of sepsis with moderate evidence. Lower length of hospital stay was also seen in burn patients supplemented with glutamine, although the evidence was weak.

An umbrella analysis assessing the risk of acute kidney injury in COVID-19 patients.

A number of research studies have indicated a potential association between COVID-19 and acute kidney injury (AKI). However, the methodologies employed and the risk estimates derived from these studies vary. Therefore, an umbrella review of systematic reviews and meta-analyses was conducted to determine the incidence of AKI in COVID-19 patients and AKI-associated mortality. A complete literature search was undertaken in PubMed, Embase, Scopus, and the Cochrane Library. The methodological rigor of the included papers was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR-2) instrument. The pooled risk ratio (RR) and odds ratio (OR) of the included studies were calculated to establish the strength of the association between AKI cases and COVID-19 infections. This umbrella review included 20 studies. Two of the 20 studies assessed adult COVID-19 patient risk factors for AKI, 1 examined survival rates and 7 examined the incidence of AKI. The remaining 10 investigations revealed that patients with coronavirus were susceptible to AKI. The umbrella analysis comprised reviews that contained a range of 6 to 54 papers. The AMSTAR-2 ratings yielded a total of 14 studies deemed to be of high quality, with 6 studies classified as intermediate quality. Statistical analysis of included reviews revealed a 1.50 RR for AKI incidence in COVID-19 patients (95% confidence interval (95% CI): 1.40-1.60, I2 69%, p < 0.0001) and a 2.02 RR (95% CI: 1.79-2.29, I2 56%, p < 0.0001) for AKI-associated death. This umbrella review revealed that individuals infected with the novel coronavirus often develop AKI. SARS-CoV-2 infections were associated with AKI due to advanced age, male gender, coronary artery disease, diabetes, and hypertension. However, AKI and a renal replacement therapy (RRT) requirement independently predicted unfavorable COVID-19 results.

Addressing epistemic violence and methodological nationalism through a meta-analytical review on intergroup contact and conflict studies in Turkey

This paper provides an examination of intergroup contact research in the context of the Turkish-Kurdish ‘conflict’ through a meta-analytical scoping review. By doing so, we discuss how dominant biases in the literature such as methodological nationalism and epistemic violence influence research practices and knowledge-production systems in conflict and contact studies conducted under colonial rule. Through a thematic investigation, we found four variables that were commonly tested in intergroup contact studies: i) attitudes towards outgroup, ii) support for minority rights or multiculturalism, iii) perception of discrimination against the minority group, and iv) ethnic identity. We conducted four meta-analyses using a pool of 28 studies conducted in Turkey to unpack the associations of intergroup contact with: i) outgroup attitudes (r = .42; n = 5,624), ii) support for minority rights and multiculturalism (r = -.06ns; n = 1,567), iii) perception of discrimination against Kurds (r = .22; n = 2,431), and iv) ethnic identity (r = -.13; n = 4,636). The results demonstrated a moderate to strong relationship between intergroup contact and positive outgroup attitudes, while the findings were less robust for support for minority rights, perception of discrimination against Kurds, and ethnic identity. Furthermore, the group status and sample characteristics of the studies moderate the relationships between variables. Based on the findings and a critical analysis of the current literature, we discuss the limitations of the existing research and critical points for future studies.

Effect of Antithyroid Drugs Treatment Duration on The Remission Rates of Graves' Disease in Children and Adolescents: A Single-Arm Meta-Analysis and Systematic Review.

Antithyroid drugs (ATDs) are the preferred treatment option for Graves' disease (GD), yet there is a lack of systematic evaluations studying the relationship between treatment duration and therapeutic outcomes. This study aims to assess the remission rate (RR) in children with GD under ATDs therapy and to conduct an analysis of associated factors. Systematically searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang database, with a search time limit from the establishment of the database to 23 November 2023. The primary outcome was the RR. The pooled RR was calculated and subgroup comparisons were performed. Meta-analysis was conducted using R Studio 2023.09.0 + 463 software. The study incorporated a total of 19 research projects, which collectively involved 3359 paediatric patients diagnosed with GD (comprising 2600 girls and 759 boys). The overall RR for paediatric GD treated with ATDs was 25.4% (95% Confidence Interval [CI]: 20.7%, 30.1%). The pooled RR following treatment durations of < 2 years, 2-5 years, and > 5 years were respectively 15.5%, 24.1% and 33.0%. Meta-regression results indicated that the duration of treatment and follow-up duration were significant sources of high heterogeneity among the studies. Specifically, for every additional year of ATDs treatment, there was an increase in the RR by 3.8% (Coefficient = 3.8%, 95% CI: 0.6%, 7.0%, p < 0.01). The overall RR for the treatment of paediatric GD with ATDs is 25.4%, and prolonging the treatment course can indeed lead to an increased RR.

A meta-analysis and systematic review on adipokines as potential biomarker for proliferative diabetic retinopathy

A meta-analysis and systematic review on adipokines as potential biomarker for proliferative diabetic retinopathy

A Meta-Analytic Review of Transformational Leadership Research in Public Administration

Despite the increasing research attention devoted to transformational leadership in public administration, there is still concern over whether it is appropriate and effective in the public context. To answer the important question of whether and when transformational leadership is effective, this study meta-analytically reviewed transformational leadership research based on 70 primary studies that include 151 independent effect sizes from 718,601 participants. It was found that transformational leadership was significantly related to outcomes at both individual (motivations, attitudes, and behaviors) and organizational (performance and innovation) levels, and positively related to transactional leadership and leader-member exchange. Moderation analyses revealed that national cultural values and public/semipublic affiliation of the studied samples, as well as measurement scales of transformational leadership explained some of the transformational leadership-outcome relationship variations. Theoretical and practical implications are discussed.

Day Care Attendance and Risk of Type 1 Diabetes: A Meta-Analysis and Systematic Review.

A meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published. To investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024. Data from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes. Studies that reported a measure of association between day care attendance and risk of type 1 diabetes were included. Details, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks. The principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes. Seventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37). These results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.

Reporting bias, not external focus: A robust Bayesian meta-analysis and systematic review of the external focus of attention literature.

Evidence has ostensibly been accumulating over the past 2 decades suggesting that an external focus on the intended movement effect (e.g., on the golf club during a swing) is superior to an internal focus on body movements (e.g., on your arms during a swing) for skill acquisition. Seven previous meta-studies have all reported evidence of external focus superiority. The most comprehensive of these concluded that an external focus enhances motor skill retention, transfer, and performance and leads to reduced eletromyographic activity during performance and that more distal external foci are superior to proximal external foci for performance. Here, we reanalyzed these data using robust Bayesian meta-analyses that included several plausible models of publication bias. We found moderate to strong evidence of publication bias for all analyses. After correcting for publication bias, estimated mean effects were negligible: g = 0.01 (performance), g = 0.15 (retention), g = 0.09 (transfer), g = 0.06 (electromyography), and g = -0.01 (distance effect). Bayes factors indicated data favored the null for each analysis, ranging from BF01 = 1.3 (retention) to 5.75 (performance). We found clear evidence of heterogeneity in each analysis, suggesting the impact of attentional focus depends on yet unknown contextual factors. Our results contradict the existing consensus that an external focus is always more effective than an internal focus. Instead, focus of attention appears to have a variety of effects that we cannot account for, and, on average, those effects are small to nil. These results parallel previous metascience suggesting publication bias has obfuscated the motor learning literature. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Who am I? A second-order meta-analytic review of correlates of the self in childhood and adolescence.

People's subjective beliefs about themselves affect what people think and, consequently, what they do. Positive self-beliefs are important for many life outcomes, from academic success to well-being, especially during K-12 education as a crucial developmental period. Many empirical studies and meta-analyses have examined correlates of self-beliefs. The present second-order meta-analytic review integrates this large and diverse body of research, addressing two research aims: First, we examined the comparative strength of different variables related to self-beliefs. Second, we provide a methodological review of meta-analyses in this area, thereby facilitating readers' ability to assess the risk of bias when interpreting the results. We summarized 105 first-order meta-analyses published before July 2023 that investigated variables associated with self-beliefs during K-12 education, comprising 493 first-order effect sizes based on more than 8,500 primary studies and more than 16 million children and adolescents. We computed second-order standardized mean differences (SMD) using two-level meta-analyses with robust variance estimation. Personal characteristics (SMD = 0.50) showed stronger relations with self-beliefs than interventions (SMD = 0.27). Achievement (SMD = 0.66) and noncognitive variables (SMD = 0.67) were the personal characteristics most strongly related to self-beliefs compared to cognitive abilities (SMD = 0.30) and background variables (SMD = 0.21). Interventions targeting individual characteristics (SMD = 0.35) and especially self-beliefs (SMD = 0.52) showed larger effect sizes than interventions that focused on improving teaching and classroom structure (SMD = 0.20). Few meta-analyses investigated situational aspects, such as the geographical origin of the sample, in association with children's and adolescents' self-beliefs. Overall, this second-order meta-analytic review provides a comprehensive map of correlates of the self, highlighting pathways for future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Fenestrating Versus Reconstituting Subtotal Cholecystectomy: Systematic Review and Meta-Analysis on Bile Leak, Bile Duct Injury, and Outcomes.

Symptoms of gallstone disease are the most common reason for cholecystectomy. Fenestration reduces the likelihood of severe inflammation or scarring after normal treatments are used, and it also enhances control over bile outflow. The goal of reconstituted cholecystectomy is to lessen symptoms like pain and jaundice without undergoing the high-risk procedures associated with more invasive procedures. The reconstituted and fenestrated procedures were assessed by a meta-analysis and systematic review. Of the five studies, 189 (34.2%) had a reconstituted subtotal cholecystectomy, and 363 (65.8%) had a fenestrated subtotal cholecystectomy, which had populations from the United States of America, the United Kingdom, Japan, and Turkey. Two individuals from three trials had bile duct injury, according to three studies. Whereas the fenestrated group reported no bile injury from 236 individuals (0%), the reconstituted group reported two bile duct injuries from 100 patients (2%). The incidence was found to be lower in the fenestrated group (OR 10.81; CI 95% 1.03-113.65; p = 0.39; I2 = 0%) than in the reconstituted group. Four studies revealed 92 cases of bile leaks: 19 out of 155 cases (12.3%) were reconstituted, and 73 out of 351 cases (20.8%) were fenestrated. Between the two groups, there was a significant difference in bile leakage (OR 0.72; CI 95% 0.23-2.32; p = 0.03; I2 = 66%). Two studies reported the establishment of fistulas following surgery in 58 patients in the reconstituted group (5.2%) and 120 patients in the fenestrated group (2.5%) (p = 0.56, I2 = 0%, and OR 0.65; CI 95% 0.12-3.38); however, there was no statistically significant difference between the groups. Following a fenestrated partial cholecystectomy, postoperative bile leakage, fistula development, wound infection, and retained stones are more prevalent. Additionally, we saw that the fenestrated method was being used more frequently for post-operative endoscopic retrogradecholangiopancreatography (ERCP). The subtotal cholecystectomy technique used should be chosen according to the surgeon's comfort level and experience with the various techniques and intraoperative findings, even if the reconstituted procedure could be preferred when feasible. To completely understand the role of each method in the general surgeon's toolkit for treating complex gallbladder (GB) patients, longer-term follow-up studies are still necessary.

Early Surgery and High Dose Steroids in Treating Patients with Indirect Traumatic Optic Neuropathy: A Meta-Analysis and Systematic Review

Introduction: Optic nerve injury is a devastating cause of permanent visual loss after blunt or penetrating injury occurring in up to 7% of head trauma cases. No single treatment strategy and timing of intervention has proved optimal. Timely and appropriate management is key to improving visual outcomes. We compared whether immediate surgical decompression or steroids would lead to improvement of visual outcomes in individuals with indirect traumatic optic neuropathy. Methods: We searched from several online databases and included studies of patients with direct Optic nerve injury, those who received combined treatment with surgery and steroids, and those with delayed initiation of treatment were excluded. Results: The final search yielded eleven eligible studies. Both interventions showed similar results in improvement of visual function (RR 2.35, 95% CI 0.87 to 6.34, p=0.09, I2 0%). Both early and late intervention also showed similar results in improvement of visual function (RR 1.72, 95% CI 0.89 to 3.35, p=0.11, I2 61%). Among patients who underwent early surgical decompression, the rate of visual acuity improvement was 73% with those who underwent transcranial surgery and 69% with those who underwent endoscopic surgery. Conclusion: This study shows that immediate surgical decompression and early high dose steroid administration are equally effective in improving visual function. Patients with no light perception (NLP) and light perception (LP) pre treatment resulted to better visual improvement with steroids while those with counting fingers (CF) and more than CF pre treatment, resulted to better visual improvement with surgical decompression.

Effectiveness of exercise intervention in improving physical and mental status of patients with alcohol use disorders: A systematic review and meta-analysis.

This meta-analysis and systematic review examined the effects of an exercise intervention on alcohol dependence and physical and mental states in patients with alcohol use disorder (AUD). PubMed, Web of Science, Cochrane Library, EBSCO, and Embase. Randomized controlled trials published in English from the inception of the database until June 30, 2024, were included. All forms of exercise intervention (aerobic, resistance, yoga, mixed exercise, etc.) were included in the study, using an exercise intervention for patients with AUD and a non-exercise control group. Studies that excluded acute exercise or did not describe a specific intervention program; duplicate publications; review articles, conference articles, etc.; and studies that did not report appropriate outcome metrics. This protocol was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol standard. The risk of bias was assessed via the Cochrane risk-of-bias tool as described by the Cochrane Handbook for Systematic Reviews and Interventions. Alcohol dependence (number of drinks per day, number of drinks per week, AUDIT), physical and mental status [maximal oxygen uptake (VO2 max), resting heart rate, anxiety state, depression state, stress level]. Seventeen RCTs with a total of 1,905 patients with alcohol use disorders were included as subjects, and the results revealed that the exercise intervention had a significant effect on alcohol dependence, the number of drinks per day and the AUDIT score, the exercise intervention also had a significant effect on physical and mental status, VO2max, the resting heart rate, the anxiety state, the depression state, and the stress level. High heterogeneity in the number of drinks per day, anxiety, depression and stress outcomes (I2 > 50%), but Egger's test showed no publication bias for all outcome indicators (p > 0.05). Exercise intervention can effectively reduce alcohol dependence and significantly improve the physical and mental states of AUD patients, and exercise intervention as an adjunct to the treatment of AUD patients is significantly effective.

A Meta-Analytic Review of Personality and Teacher-Student Relationships.

This meta-analysis provides the first comprehensive synthesis of associations between student and teacher personality traits and the quality of teacher-student relationships. Fifty-five studies met the eligibility criteria, contributing a total of 238 effect sizes. We used multivariate meta-analysis with robust variance estimation (RVE) to model the dependency of effect sizes. Student prosocial behavior (ρ = 0.59) and proactive personality (ρ = 0.48) were the strongest predictors of positive teacher-student relationship quality. All Big Five traits of students, except neuroticism, showed significant positive associations, with all correlations exceeding 0.4 when holding constant with all other moderators. Teacher agreeableness (ρ = 0.31) and conscientiousness (ρ = 0.29) yielded modest associations. Students with less emotional stability or aggressive behaviors were more likely to experience negative teacher-student relationships, such as conflict and dependency. Our findings highlight the critical role of student personality in explaining the quality of teacher-student interactions. Multiple traits appear equally important, as indicated by comparable effect sizes. The literature is relatively limited when it comes to teacher personality. We were unable to examine teacher traits in relation to teacher-student conflict and dependency, but, overall, agreeable and conscientious teacher behaviors appeared to be important for favorable interactions, whereas teacher neuroticism may undermine the quality of such interactions.

Challenges and possibilities in adolescent loneliness interventions

Abstract Researchers typically associate the high prevalence of loneliness during adolescence with evolving dynamics and changes in relationships, both familial and peer-related. Consequently, transient feelings of loneliness are anticipated and considered part of the normative developmental process. While many adolescents naturally navigate through periods of loneliness by reconnecting with peers, a subset experiences prolonged feelings of loneliness. This group faces an increased risk of additional mental health issues and potential adverse health consequences. Such findings underscore the importance of effective and scalable interventions. This presentation draws upon a comprehensive meta-analytical review of loneliness interventions and a dedicated chapter in the upcoming Cambridge Handbook of Loneliness. focusing on interventions for adolescents. It will offer a brief overview of contemporary loneliness interventions and intervention strategies. Furthermore, it will discuss the unique considerations required when addressing loneliness in adolescents compared to other age groups. This includes the critical importance of loneliness prevention for adolescents, particularly within the school environment. Furthermore, the presentation will discuss the potential of community-based interventions aimed at tackling adolescent loneliness, showcasing the ongoing Danish community-based intervention ‘More Together.’ ‘More Together’ is a large-scale, complex, multi-component and multi-level intervention for community change that aims to reduce loneliness among young and elderly people. The intervention is rooted in an extensive cross-sector partnership. The presentation will highlight potentials and pitfalls encountered when addressing adolescent loneliness within a community setting.

The Long-Term Consequences of Family Violence Victimization: An Umbrella Review of Longitudinal Meta-Analyses on Child Maltreatment and Intimate Partner Violence

The Long-Term Consequences of Family Violence Victimization: An Umbrella Review of Longitudinal Meta-Analyses on Child Maltreatment and Intimate Partner Violence

Indicators of Cultural Ecosystem Services for Peri-Urban Agricultural and Natural Areas at an Intermediate Scale: A Case Study of Arequipa, Peru

The evaluation of management in peri-urban agricultural and natural areas (PANAs) constitutes a complex topic, particularly when considering its scale in cities where landscape planning is a priority. Therefore, indicators are required to assess the non-material well-being, biodiversity, and quality of life of society, which are criteria of cultural ecosystem services (CESs). This research develops identification and subclassification CESs and tangible and intangible indicators that facilitate the management of the PANA landscape, using the city of Arequipa as a case study—a dynamic cultural city with a declared cultural heritage, in turn located in an artificial oasis in the Atacama Desert. Therefore, the results will enable the selection of indicators that are practically applicable to planning instruments, serving as support systems for decision-making regarding interventions in PANAs. The methodology began with a systematic and meta-analytic (PRISMA) review, identifying 25 articles containing 230 indicators across 19 subclassifications. Using the Multiscale Indicators Framework (MSIF), the literature was integrated with a participatory workshop to validate these findings. The level of impact was assessed for 115 indicators across 13 subclassifications, applying criteria such as diversity, sustainable management, quality of life, and scalability—factors necessary to comply with urban sustainability policies.

Association of cataract surgery with risk of dementia: a meta-analysis and systematic review of cohort studies with 720,075 participants

Association of cataract surgery with risk of dementia: a meta-analysis and systematic review of cohort studies with 720,075 participants

Prevalence of spin reporting bias in hip labrum reconstruction: a qualitative assessment of systematic reviews and meta-analyses

Hip labral reconstruction is an evolving technique to treat labral pathology. Spin is a recent concept that is defined as a reporting bias that misrepresents research. The purpose of this study is to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding acetabular labral reconstruction. Electronic libraries were queried for meta-analyses and systematic reviews regarding hip labrum reconstruction. The nine most severe types of spin found in abstracts were used as an evaluation tool. Two reviewers each performed a blinded assessment of each article for spin. A third reviewer was used to address any discrepancies between the original reviewers. Other variables evaluated include number of citations, journal impact factor, reported conflicts of interest (COI), adherence to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodologic quality according to a measurement tool to assess systematic reviews (AMSTAR-2). The electronic database search resulted in 1,148 articles, of which 10 met inclusion criteria. Of these 10 articles, 70% (7/10) were found to have at least one form of spin present, 20% (2/10) contained 3 different types of spin, 30% (3/10) contained 2 different types of spin, and 20% (2/10) contained 1 type of spin. The most common type of spin found was type 5, “conclusion claims the beneficial effect of the experimental treatment despite high risk of bias in the primary studies,” which was found in 60% (6/10) of the articles. When assessing AMSTAR-2 score, 90% (9/10) of the articles were found to be ‘low quality’ or ‘critically low quality.’ Spin was present in 70% of the abstracts of meta-analyses and systematic reviews pertaining to hip labrum reconstruction. Recognition of spin is crucial for orthopaedic surgeons. Improved guidelines should be considered to reduce the prevalence of spin in orthopaedic literature.

Infraclavicular versus supraclavicular nerve block for upper limb surgeries: A meta-analysis.

The impact of infraclavicular versus supraclavicular nerve block on the analgesia for upper limb surgeries is unclear. This meta-analysis and systematic review aims to study the analgesic efficacy of infraclavicular versus supraclavicular nerve block for upper limb surgeries. We searched several databases including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases from inception to December 2023, and randomized controlled trials (RCTs) assessing the effect of infraclavicular versus supraclavicular nerve block for upper limb surgeries were included. We excluded studies reporting other nerve block approaches. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes. This meta-analysis was conducted by the fixed-effect model or random-effect model based on the heterogeneity. Eight RCTs and 725 patients were included in this meta-analysis. Compared with supraclavicular nerve block for upper limb surgeries, infraclavicular nerve block was able to significantly increase duration of motor block (SMD = 0.34; 95% CI = 0.12 to 0.56) and decrease readiness for surgery (SMD = -0.43; 95% CI = -0.77 to -0.10), but showed similar duration of sensory block (SMD = 0.17; 95% CI = -0.05 to 0.39), block performance time (SMD = -0.14; 95% CI = -0.51 to 0.22), onset of sensory blockade (SMD = -0.13; 95% CI = -0.59 to 0.33) and onset of motor blockade (SMD = -0.17; 95% CI = -0.26 to 0.12). No high heterogeneity was seen among the included studies. Infraclavicular nerve block may be superior to control the analgesia for upper limb surgeries than supraclavicular nerve block.

Impact of Extent of Resection on Overall Survival in Glioblastomas: An Umbrella Review of Meta-Analyses

(1) Background: Glioblastoma (GBM) is the most common malignant brain tumor in adults. Due to a lack of level 1 evidence, there is no clear consensus on the optimal extent of resection to improve overall survival. This umbrella review aggregates existing meta-analyses (MAs) to assess overall survival in patients undergoing subtotal resection (STR) versus gross total resection (GTR). (2) Methods: A systematic search of PubMed, Scopus, and Web of Science identified 441 studies, with four MAs meeting inclusion criteria. Data were analyzed using the metaumbrella R package, focusing on overall survival. Quality was assessed using AMSTAR2, with scores ranging from 0 to 11. The Ioannidis criteria were applied to evaluate the credibility of the evidence. (3) Results: The quality assessment rated all four studies highly, with a mean AMSTAR2 score of 10.25. The pooled analysis revealed a significant survival advantage for GTR over STR. However, the Ioannidis classification graded the evidence as Class III, indicating weak credibility. (4) Conclusions: GTR offers a slight survival benefit over STR in GBM patients, but the credibility of the evidence is weak, highlighting the need for further research.