Presence Of Statistical Heterogeneity Research Articles

Level of HIV serodiscordance and associated factors among heterosexual couples in Ethiopia: A systematic review and meta-analysis.

HIV-related causes accounted for approximately 770,000 deaths globally in 2018. Globally, there were 1.7 million new infections, and approximately 37.9 million people were living with HIV by the end of 2018. According to the WHO 2018 study, the African Region was the most affected, with 25.7 million people living with HIV in 2018. In Africa, married and cohabiting couples have a high prevalence of HIV discordance, ranging from 3% to 20% in the general population. Therefore, it is crucial to understand the level of HIV serodiscordance among married couples in Ethiopia and the contributing factors. Studies were systematically searched, utilizing international databases such as PubMed, Google Scholar, Cochrane Library, and Embase. The level of quality of the included articles, which employed cross-sectional and cohort study designs, was evaluated using the New Castle Ottawa scale. The systematic review employed a random-effects approach, and statistical analysis was conducted using STATA version 17 software. The presence of statistical heterogeneity within the included studies was assessed using the I-squared statistic. The random-effects meta-analysis model was used to estimate the pooled level of HIV serodiscordance. The results were reported following the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guideline. A total of ten (10) observational studies were included in this review. The pooled level of HIV serodiscordance among married heterosexual couples in Ethiopia was found to be 11.4% (95% CI = 7% -15.7%). The results from the meta-analysis indicated a significant positive association between HIV serodiscordance and the variables studied. Specifically, consistently using condoms (OR = 1.82; 95% CI: 1.08-2.56), having a CD4 count of >200 cells/mm3 (OR = 1.45; 95% CI: 1.12-1.77), and having a premarital sexual relationship (OR = 1.93; 95% CI: 1.28-2.57) were strongly linked to couples' serodiscordance. To protect a seronegative partner in a serodiscordant relationship from acquiring HIV infection, it is crucial to implement preventive measures. These measures include providing comprehensive health education on the correct and consistent use of condoms, ensuring regular monitoring and care at an antiretroviral therapy (ART) clinic, and offering voluntary counseling and testing (VCT) services to both sexual partners.

Longdan Xiegan formula as adjuvant therapy for acute herpes zoster: A meta-analysis of randomized controlled trials.

Longdan Xiegan (LDXG) decoction, an ancient Chinese herbal formula, has been widely used in treating herpes zoster. This meta-analysis aimed to evaluate whether LDXG formula as adjuvant therapy had additional benefits in acute herpes zoster patients. Two authors independently searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wanfang database from their inception to July 31, 2021. Relevant randomized controlled trials (RCTs) that investigated the add-on effects of LDXG formula (decoction, capsule, or pill) in the management of acute herpes zoster were included. Nine RCTs with 821 patients were identified. A random effect model meta-analyses showed that LDXG formula plus conventional therapy significantly reduced the time to blister resolution (weighted mean difference [WMD] -1.31 days; 95% confidence intervals [CI] -1.56 to -1.06), time to crust formation (WMD -1.91 days; 95% CI -2.31 to -1.50), time to pain resolution (WMD -2.13 days; 95% CI -2.65 to -1.60), pain intensity assessed by visual analogue scale (WMD -1.13; 95% CI -2.03 to -0.24), and incidence of persistent pain (risk ratio [RR] 0.28; 95% CI 0.15-0.50) compared with the conventional therapy alone. However, the overall certainty of evidence was very low to moderate. LDXG formula as adjuvant therapy may achieve additional benefits in terms of accelerating skin healing process, relieving pain symptoms, and preventing persistent pain in acute herpes zoster patients. However, interpretation of these findings should be considered the presence of statistical heterogeneity and/or unclear risk of bias.

Factors Associated with Implanon Discontinuation among Women of Reproductive Age in Ethiopia: A Systematic Review and Meta-Analysis.

Background Implanon is a long-acting contraceptive method that is extremely effective in preventing pregnancy with a clinical failure rate of less than 1%. Despite these, the rate of Implanon discontinuation is a common problem in various societies and exposes women to unwanted conception and its consequences. Objective The current study sought to find and consolidate relevant literature on Implanon discontinuation and associated factors in Ethiopia. Methods Medline, PubMed, Cochrane Library, EMBASE, and Google Scholar databases were systematically searched for studies published in English before December 2021. The included studies were critically appraised using the JBI instrument for observational studies. STATA version 16 was used for analysis. The presence of statistical heterogeneity was checked using Cochran's Q test, and its level was quantified using I2 statistics. A pooled estimate of the proportion of outcome variables was calculated. To measure the effect size, pooled odds ratios with 95% CI were computed. Results The pooled prevalence of Implanon discontinuation in Ethiopia was 32.89%, 95% CI: 24.11%, 41.66%. Experiencing side effects (OR = 2.52, 95% CI 1.75, 3.65), having no children (OR = 1.69, 95% CI 1.15, 2.47), not having received preinsertion counselling (OR = 1.65, 95% CI 1.36, 2.00), having no postinsertion appointment (OR = 2.97, 95% CI 2.10, 4.21), and not satisfied with the service (OR = 2.72, 95% CI 2.47, 5.59) were significantly associated with Implanon discontinuation. Conclusion The pooled prevalence of Implanon discontinuation in Ethiopia was high. Experiencing side effects, having no child, not receiving preinsertion counselling, having no follow-up appointment, and not being satisfied with the service were significantly associated with Implanon discontinuation. Therefore, healthcare providers should offer preinsertion counselling in accordance with national family planning guidelines, emphasizing the method's advantages and side effects.

Association between previous abortion history and risk of autism spectrum disorders among offspring: a meta-analysis.

Previous studies have been showed an association between previous abortion history and risk of Autism spectrum disorders (ASD). However, there is still controversy about true effect estimate of the association. This meta-analysis aimed to evaluate the association between previous abortion history and the risk of ASD. A systematic search was performed using PubMed, Scopus, and Web of Sciences databases to identify potential studies published until December 2021. The presence of statistical heterogeneity was determined using the I2 value. In the case of substantial heterogeneity, the random-effects model meta-analysis was used to estimate the pooled relative risks. The publication bias was assessed using the Egger and Begg tests. Thirteen studies with a total of 331,779 children remained in the present meta-analysis. The estimated odds ratio of the risk of ASD associated with previous abortion history was 1.64 (95% confidence interval [CI], 1.28-2.0; I2=61.7%) in adjusted studies and 1.10 (95% CI, 1.01-1.20; I2=0.0%) in crude studies, based on the random effect model. There was moderate heterogeneity in adjusted studies. The p values for Egger and Begg regression among children with ASD were 0.393 and 0.056, respectively. This meta-analysis suggests that children born from mothers with a history of previous abortion have an increased risk of development of ASD compared to children of mothers without a history of previous abortion.

Multi-center federated learning: clients clustering for better personalization

Personalized decision-making can be implemented in a Federated learning (FL) framework that can collaboratively train a decision model by extracting knowledge across intelligent clients, e.g. smartphones or enterprises. FL can mitigate the data privacy risk of collaborative training since it merely collects local gradients from users without access to their data. However, FL is fragile in the presence of statistical heterogeneity that is commonly encountered in personalized decision making, e.g., non-IID data over different clients. Existing FL approaches usually update a single global model to capture the shared knowledge of all users by aggregating their gradients, regardless of the discrepancy between their data distributions. By comparison, a mixture of multiple global models could capture the heterogeneity across various clients if assigning the client to different global models (i.e., centers) in FL. To this end, we propose a novel multi-center aggregation mechanism to cluster clients using their models’ parameters. It learns multiple global models from data as the cluster centers, and simultaneously derives the optimal matching between users and centers. We then formulate it as an optimization problem that can be efficiently solved by a stochastic expectation maximization (EM) algorithm. Experiments on multiple benchmark datasets of FL show that our method outperforms several popular baseline methods. The experimental source codes are publicly available on the Github repository (GitHub repository: https://github.com/mingxuts/multi-center-fed-learning).

Fixed- and Random-Effects Models.

Deciding whether to use a fixed-effect model or a random-effects model is a primary decision an analyst must make when combining the results from multiple studies through meta-analysis. Both modeling approaches estimate a single effect size of interest. The fixed-effect meta-analysis assumes that all studies share a single common effect and, as a result, all of the variance in observed effect sizes is attributable to sampling error. The random-effects meta-analysis estimates the mean of a distribution of effects, thus assuming that study effect sizes vary from one study to the next. Under this model, variance in observed effect sizes is attributable to both sampling error (within-study variance) and statistical heterogeneity (between-study variance).The most popular meta-analyses involve using a weighted average to combine the study-level effect sizes. Both fixed- and random-effects models use an inverse-variance weight (variance of the observed effect size). However, given the shared between-study variance used in the random-effects model, it leads to a more balanced distribution of weights than under the fixed-effect model (i.e., small studies are given more relative weight and large studies less). The standard error for these estimators also relates to the inverse-variance weights. As such, the standard errors and confidence intervals for the random-effects model are larger and wider than in the fixed-effect analysis. Indeed, in the presence of statistical heterogeneity, fixed-effect models can lead to overly narrow intervals.In addition to commonly used, generalizable models, there are additional fixed-effect models and random-effect models that can be considered. Additional fixed-effect models that are specific to dichotomous data are more robust to issues that arise from sparse data. Furthermore, random-effects models can be expanded upon using generalized linear mixed models so that different covariance structures are used to distribute statistical heterogeneity across multiple parameters. Finally, both fixed- and random-effects modeling can be conducted using a Bayesian framework.

Self-care practice among hypertensive patients in Ethiopia: systematic review and meta-analysis

BackgroundIn high-income and low-income countries, including Ethiopia, hypertension (HTN) is a serious public health concern. As a consequence, a massive self-care practice (SCP) is necessary, and the domains of SCP,...

Availability of adequately iodized salt at the household level in Ethiopia: A systematic review and meta-analysis.

Iodine deficiency disorder (IDD) is a global, regional, and national public health problem that is preventable. Universal salt iodization is a worldwide accepted strategy to prevent IDD. The level of iodine in the salt should be adequate at the household level (≥15ppm). Though there was fragmented evidence on the proportion of adequately iodized salt at the household level in Ethiopia, the national level proportion of adequately iodized salt at the household level was remaining unknown. Therefore, this systematic review and meta-analysis estimated the pooled proportion of adequately iodized salt at the household level in Ethiopia from 2013-2020. We systematically searched the databases: PubMed/MEDLINE, Google Scholar, and Science Direct for studies conducted in Ethiopia on the availability of adequately iodized salt at the household level since 2013. We have included observational studies, which were published between January first, 2013, and 10 August 2020. The report was compiled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of included studies was scored based on the Newcastle Ottawa quality assessment scale adapted for cross-sectional studies. The data were extracted in Microsoft excel and analyzed using Stata version 14.1 software. We employed a random-effects model to estimate the pooled proportion of adequately iodized salt at the household level in Ethiopia. The presence of statistical heterogeneity within the included studies was evaluated using the I-squared statistic. We used Egger's regression test to identify evidence of publication bias. The pooled proportion with a 95% confidence interval (CI) was presented using tables and forest plots. We screened a total of 195 articles. Of these, 28 studies (with 15561 households) were included in the final systematic review and meta-analysis. In Ethiopia, the pooled proportion of adequately iodized salt at the household level was 37% (95% CI: 28, 46%). The subgroup analyses of 28 studies by residence revealed that the pooled proportion of adequately iodized salt at the household level was 32% (95% CI: 29, 35%) and 48% (95% CI: 31, 66%) in rural and urban areas, respectively. Based on geographic location, the highest proportion was found in Addis Ababa (81%; 95%CI: 78, 83), and the lowest proportion found in Dire Dawa (20%; 95%CI: 17, 22). Besides, the proportion of adequately iodized salt at the household level was significantly increased during 2017-2020 (42%; 95% CI: 30, 53%) as compared with 2013-2016 (27%; 95% CI: 17, 39%). In Ethiopia, the pooled proportion of adequately iodized salt at the household level was very low as compared to the world health organization's recommendation. Thus, the Federal Ministry of Health of Ethiopia and different stakeholders should give more attention to improve the proportion of adequately iodized salt at the household level.

Abstract PS1-22: The oncological safety of lipofilling after breast cancer surgery: A meta-analysis

Abstract INTRODUCTION Autologous fat grafting (AFG) for the purpose of breast reconstruction presents difficulties during follow-up radiological exams and the oncological potential of grafted fat is uncertain. Coleman et al in 2007 confirmed that, provided a rigorous protocol is respected, the fatty tissue could be transferred under good conditions and would not interfere with mammographic follow-up, although the issue remains controversial about the oncological safety. This study aims to analyze the oncological safety of lipofilling through a meta-analysis of the current literature. METHODS We conducted a meta-analysis to evaluate the oncological safety of AFG after breast cancer (BC) surgery. We reviewed the literature published until 07/05/2020. The outcomes were overall survival (OS), disease free-survival (DFS) and local recurrence (LR). We included RCTs, cohort studies, case-control studies that evaluated women with BC diagnosis who undergone surgery followed by reconstruction with AFG. This review was performed in accordance with the PRISMA guidelines and we searched the electronic databases of Medline, EMBASE and LILACS, using the MeSH terms for AFG and BC. There was no language restriction. Methodological quality was assessed using the Downs and Black instrument and evidence quality by GRADE. We synthesized data using the inverse variance method on the log-HR scale for time-to-event outcomes using RevMan. We assessed the presence of statistical heterogeneity using the Chi2 statistic and we investigated its extension by the use of I2 statistic. RESULTS We identified 624 references. Of these, 16 studies fulfilled our eligibility criteria and were included. Funnel plot analysis revealed no publication bias. There were 8667 patients included and their mean age was 49 years. The breast surgery indications were invasive breast carcinoma (66.1%), carcinoma in situ (18.4%) and prophylactic reasons (15,5%). Ten out of 16 studies described the technique used to perform the AFG as Coleman’s. In 9 out 16 studies there was no difference in adjuvant treatment between groups, two studies do not mention if there was any difference and in 4 studies there were different adjuvant treatments in control and intervention arms. Quality assessment resulted in 11 studies being considered ‘good’, 4 studies were considered ‘fair’ and 1 study was considered poor. The HR could be extracted from four studies and an increase of OS for lipofilling group was detected with high heterogeneity (HR 0.47, 95% CI 0.32 to 0.7, p=0.0002, 2331 patients, I2= 84%, high certainty evidence). Funnel plot analysis indicated a high risk of publication bias from one study, Krastev et al, which included 587 patients. The analysis excluding this article found no difference in OS between lipofilling group and control and publication bias was not detected (HR 0.9, 95% CI 0.53 to 1.54, p=0.71, 1744 patients, I2= 58%, high certainty evidence). The HR for DFS could be extracted from six studies and no difference was found between lipofilling group and control (HR 1.01, 95% CI 0.73 to 1.38, p=0.96, 2755 patients, I2= 0%, high certainty evidence). The HR for LR could be extracted from ten studies and no difference was found between lipofilling group and control (HR 0.86, 95% CI 0.66 to 1.12, p=0.43,6839 patients, I2= 1%, moderate certainty evidence). Funnel plot analysis indicated a publication bias from one study (Petit et al) that included only DCIS tumors. The analysis excluding this article did not demonstrate difference in results. (HR 0.8, 95% CI 0.61 to 1.05, p=0.94, 6662 patients, I2= 0%, moderate certainty evidence) CONCLUSION Based on published data, AFG is a safe technique of breast reconstruction for patients that undergone BC surgery. According to our findings, AFG did not affect OS, DFS or LR. These data have moderate to high certainty and additional studies probably will not change the current evidence. Citation Format: Rodrigo Goncalves, Bruna S Mota, Bruno Sobreiro-Lima, Marcos D Ricci, José M Soares, Jr, Edmund C Baracat, José R Filassi. The oncological safety of lipofilling after breast cancer surgery: A meta-analysis [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-22.

Mortality in septic patients treated with vitamin C: a systematic meta-analysis

BackgroundSupplementation of vitamin C in septic patients remains controversial despite eight large clinical trials published only in 2020. We aimed to evaluate the evidence on potential effects of vitamin C treatment on mortality in adult septic patients.MethodsData search included PubMed, Web of Science, and the Cochrane Library. A meta-analysis of eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only studies with valid classifications of sepsis and intravenous vitamin C treatment (alone or combined with hydrocortisone/thiamine) were included.ResultsA total of 17 studies including 3133 patients fulfilled the predefined criteria and were analyzed. Pooled analysis indicated no mortality reduction in patients treated with vitamin C when compared to reference (risk difference − 0.05 [95% CI − 0.11 to − 0.01]; p = 0.08; p for Cochran Q = 0.002; I2 = 56%). Notably, subgroup analyses revealed an improved survival, if vitamin C treatment was applied for 3–4 days (risk difference, − 0.10 [95% CI − 0.19 to − 0.02]; p = 0.02) when compared to patients treated for 1–2 or > 5 days. Also, timing of the pooled mortality assessment indicated a reduction concerning short-term mortality (< 30 days; risk difference, − 0.08 [95% CI − 0.15 to − 0.01]; p = 0.02; p for Cochran Q = 0.02; I2 = 63%). Presence of statistical heterogeneity was noted with no sign of significant publication bias.ConclusionAlthough vitamin C administration did not reduce pooled mortality, patients may profit if vitamin C is administered over 3 to 4 days. Consequently, further research is needed to identify patient subgroups that might benefit from intravenous supplementation of vitamin C.

Level of self-care practice among diabetic patients in Ethiopia: a systematic review and meta-analysis

BackgroundDiabetes Mellitus (DM) is increasingly become a serious global public health concern in developed and developing countries including Ethiopia. It imposes significant burden of care on the individual, health care professionals and health system. As the result, immense need of self-care behaviors in multiple domains like food choices, physical activity, foot care, and blood glucose monitoring is required. However, there is no national study on diabetic self-care practices in Ethiopia. This meta-analysis, therefore, aims to estimate the pooled level of self-care practice among individuals living with diabetes mellitus in Ethiopia.MethodsThe systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We systematically searched the databases: PubMed /MEDLINE, EMBASE, Google Scholar, and Science Direct for studies conducted in Ethiopia about self-care practice of diabetes patients. We have included all cross-sectional studies, which were published until August 20th,2019. Data were analyzed using STATA™ version 14.1 software, and the pooled prevalence with 95% confidence intervals (CI) were presented using tables and forest plots. The presence of statistical heterogeneity within the included studies was evaluated using I-squared statistic. We used Higgins and Egger’s test to identify evidence of publication bias. The random-effects meta-analysis model was employed to estimate the pooled proportion of good diabetic self-care practices.ResultsWe included 35 studies (with 11,103 participants) in this meta-analysis. The overall pooled prevalence of good diabetes self-care behavior among diabetic patients was 49% (95% CI:43, 56%). When categorized by the major domains of diabetes self-care, the pooled estimate of dietary practice was 50% (95% CI:42, 58%), for self- monitoring of blood glucose was 28% (95% CI:19, 37%), for recommended physical activity was 49% (95% CI:38, 59%), and for diabetic foot-care was 58% (95% CI: 41, 74%).ConclusionMore than half of diabetic patients in Ethiopia had poor diabetes self-care practice. High percentage of diabetic patients also had poor dietary practice, self- monitoring of blood glucose, physical activity, and diabetic foot care. Therefore, intervention programs should focus on improving the knowledge level of diabetic patients to improve the self-care practice of diabetic patients.

Incomplete Vaccination and Its Predictors among Children in Ethiopia: A Systematic Review and Meta-Analysis.

Background. Vaccination is an effective public health intervention that has contributed to a substantial reduction in the burden of vaccine-preventable diseases. Abridged evidence on incomplete vaccination is not well established in Ethiopia. Therefore, this meta-analysis aimed to estimate the pooled prevalence of incomplete vaccination and its predictors among children aged 12 to 23 months. Methods. Primary studies conducted in Ethiopia were searched. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklist. The analysis was conducted using STATA 14 and RevMan. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using I2 statistics. Pooled prevalence and odds ratio (OR) were computed at a 95% confidence interval (CI). Results. The pooled prevalence of incomplete vaccination was 30% (95% CI: 25-35). Maternal illiteracy (OR = 1.96; 95% CI: 1.40, 2.74) and home delivery (OR = 2.78; 95% CI: 2.28, 3.38) were associated factors that increased incomplete vaccination. However, maternal autonomy (OR = 0.54; 95% CI: 0.33, 0.89), maternal knowledge (OR = 0.31; 95% CI: 0.20, 0.47), husband employment (OR = 0.49; 95% CI: 0.35, 0.67), urban residence (OR = 0.61; 95% CI: 0.43, 0.86), ANC visits (OR = 0.30; 95% CI: 0.23, 0.39), postnatal care (OR = 0.39; 95% CI: 0.30, 0.52), and tetanus toxoid vaccine (3+) (OR = 0.42; 95% CI: 0.26, 0.69) were factors that reduced incomplete vaccination. Conclusion. In Ethiopia, 3 out of 10 children have incomplete vaccination. Policies should focus on strengthening and improving women’s education, maternal health knowledge, empowering women, and the utilization of prenatal care can overcome some of the barriers.

A Systematic Review and Meta-Analysis of Single-Incision Versus Multiport Laparoscopic Complete Mesocolic Excision Colectomy for Colon Cancer.

Background. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. Methods. MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. Results. Seven studies (3 randomized) with a total number of 1344 patients were included (546 SILS CME and 798 MPL CME). No difference was found in anastomotic leakage (odds ratio [OR] = 0.79 [0.31 to 2.03]; P = .63), number of lymph nodes (weighted mean difference [WMD] = 0.85 [-0.97 to 2.66]; P = .36), hospital stay (WMD = 0.01 [-0.19 to 0.20]; P = .96), overall survival (hazard ratio [HR] = 1.19 [0.29 to 4.80]; P = .81), and disease-free survival (HR = 1.30 [0.30 to 5.61]; P = .72). Skin incision was shorter in SILS CME group (WMD = -3.02 [-3.25 to -2.80]; P < .00001) but with no difference in pain reported in postoperative day 1 (standardized mean difference [SMD] = -0.21 [-0.50 to 0.09]; P = .17) or day 2 (SMD = 0.16 [-0.52 to 0.84]; P = .64). Conclusions. SILS CME, although technically more demanding, has equivalent short- and long-term outcomes when compared with MPL CME. Potential benefits in cosmesis or postoperative pain need to be further explored by high-quality randomized controlled trials.

Botulinum toxin for facial neuralgia.

Data sourcesMedline via PubMed, the Web of Science and the Cochrane Library were searched until April 2014.Study selectionRandomised controlled trials (RCTs) comparing the efficacy of botulinum toxin type A (BoTN-A) with placebo in patients with painful trigeminal (TN) and postherpetic neuralgia (PHN) reporting changes in pain intensity in patients aged 19 years and older available in English were included.Data extraction and synthesisThree authors independently assessed for inclusion, extracted standard data and assessed for risk of bias. The primary outcomes were baseline and post treatment intensity of pain and patients reporting pain relief of 50% or greater.For continuous outcomes the treatment effect was measured as mean differences with 95% confidence intervals (CIs). For dichotomous outcome of reduction of pain of 50% or more, relative risk (risk ratio) with 95% CIs was reported. Statistical heterogeneity was tested with Cochran's test for heterogeneity and quantified by the I2 statistic. Results were combined using random-effects model in the presence of statistical heterogeneity otherwise fixed effect model was used.ResultsSix studies were included. The effects of the interventions were presented in three meta-analyses. Mean difference in post treatment pain (six studies) pooled results showed a reduction of -3.009 in the VAS (95% CI -4.566 to -1.453 p<0.001) with the use of BoTN-A. Standardised difference in mean post treatment pain (six studies) was -0.918 (95% CI -1.197 to -0.639 p<0.001) in favor of BoTN-A. For the percentage of patients experiencing 50% pain reduction (three studies) absolute risk difference and relative risk were calculated (RR 2.892, 95% CI 1.726 to 4.848 p<0.001) in favour of the use of BoTN-A.ConclusionsThe authors concluded that there is moderate evidence regarding the efficacy of BoTN-A in treating patients with trigeminal neuralgia and postherpetic neuralgia.

Meta-analyses on intra-aortic balloon pump in cardiogenic shock complicating acute myocardial infarction may provide biased results.

Intra-aortic balloon pump (IABP) is the device most commonly investigated in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). Recently meta-analyses on this topic showed opposite results: some complied with the actual guideline recommendations, while others did not, due to the presence of bias. We investigated the reasons for the discrepancy among meta-analyses and strategies employed to avoid the potential source of bias. Scientific databases were searched for meta-analyses of IABP support in AMI complicated by CS. The presence of clinical diversity, methodological diversity and statistical heterogeneity were analyzed. When we found clinical or methodological diversity, we reanalyzed the data by comparing the patients selected for homogeneous groups. When the fixed effect model was employed despite the presence of statistical heterogeneity, the meta-analysis was repeated adopting the random effect model, with the same estimator used in the original meta-analysis. Twelve meta-analysis were selected. Six meta-analyses of randomized controlled trials (RCTs) were inconclusive because underpowered to detect the IABP effect. Five included RCTs and observational studies (Obs) and one only Obs. Some meta-analyses on RCTs and Obs had biased results due to presence of clinical and/or methodological diversity. The reanalysis of data reallocated for homogeneous groups was no more in contrast with guidelines recommendations. Meta-analyses performed without controlling for clinical and/or methodological diversity, represent a confounding message against a good clinical practice. The reanalysis of data demonstrates the validity of the current guidelines recommendations in addressing clinical decision making in providing IABP support in AMI complicated by CS.

Effectiveness of acupuncture for cancer pain: protocol for an umbrella review and meta-analyses of controlled trials

IntroductionThe National Comprehensive Cancer Network guidelines for adult cancer pain indicate that acupuncture and related therapies may be valuable additions to pharmacological interventions for pain management. Of the systematic reviews...

The Effect of Exercise Training on Mediators of Inflammation in Breast Cancer Survivors: A Systematic Review with Meta-analysis.

Several sources of evidence indicate that exercise during and after breast cancer could positively modulate the tumor microenvironment. This meta-analysis aimed to determine the effects of exercise training on mediators of inflammation in breast cancer survivors. We searched for randomized controlled trials published from January 1990 to March 2014. An inverse variance method of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity. Eight high-quality trials (n = 478) were included. Exercise improved the serum concentrations of IL6 [weighted mean difference (WMD) = -0.55 pg/mL; 95% confidence interval (CI), -1.02 to -0.09], TNFα (WMD = -0.64 pg/mL; 95% CI, -1.21 to -0.06), IL8 (MD = -0.49 pg/mL; 95% CI, -0.89 to -0.09), and IL2 (WMD = 1.03 pg/mL; 95% CI, 0.40 to 1.67). No significant differences were found in the serum concentrations of C-reactive protein (WMD = -0.15; 95% CI, -0.56 to 0.25) or IL10 (WMD = 0.41; 95% CI, -0.18 to 1.02). Exercise training positively modulates chronic low-grade inflammation in women with breast cancer, which may impact upon carcinogenic mechanisms and the tumor microenvironment. These findings align with the other positive effects of exercise for breast cancer survivors, reinforcing the appropriateness of exercise prescription in this population. Cancer Epidemiol Biomarkers Prev; 25(7); 1009-17. ©2016 AACR.

Educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases: A systematic review protocol

Review question/objective The objective of this systematic review is to identify the best available research evidence related to the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases, focusing on measures of adherence and health outcomes. The specific review questions to be addressed are: 1. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in terms of inhalation regimens and inhalation techniques in people with chronic respiratory diseases? 2. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy on health service utilization and patient outcomes including symptoms, pulmonary function, and quality of life? 3. What is the effectiveness of various designs, in terms of components, modes and intensities, of educational and supportive interventions for improving adherence to inhalation therapy? Inclusion criteria Types of participants This review will consider studies that include adults aged 18 or above, with a clinical diagnosis of chronic respiratory disease and prescribed self-administered inhalation therapy as a long term regular treatment, irrespective of the type of inhaler used. For the purposes of this review, "chronic respiratory diseases" is defined by WHO in 2007 as "the chronic diseases of the airways and other structures of the lung" (p.5). 1 Inhalation therapy is defined as "a treatment in which a substance is administered to the respiratory tract with inspired air". 6 This review will focus on inhalation of drugs. Those studies with prescribed administration of oxygen and water will be excluded. There is no universal standard for how long a treatment is undertaken to be defined as a "long term treatment". Acute episodic drug treatments, such as a course of antibiotics, will be excluded. Types of interventions of interest All educational interventions, with or without supportive programs, designed to improve the chronic respiratory disease sufferers inhalation technique and adherence to their prescribed inhalation therapy will be considered. Those studies that involve comparison of different types of inhalation medications, inhaler devices or inhalation methods to improve the adherence to inhalation therapy will be excluded. For the TRUNCATED AT 350 WORDS

CLINICAL HETEROGENEITY IN SYSTEMATIC REVIEWS AND HEALTH TECHNOLOGY ASSESSMENTS: SYNTHESIS OF GUIDANCE DOCUMENTS AND THE LITERATURE

The aim of this study was to synthesize best practices for addressing clinical heterogeneity in systematic reviews and health technology assessments (HTAs). We abstracted information from guidance documents and methods manuals made available by international organizations that develop systematic reviews and HTAs. We searched PubMed® to identify studies on clinical heterogeneity and subgroup analysis. Two authors independently abstracted and assessed relevant information. Methods manuals offer various definitions of clinical heterogeneity. In essence, clinical heterogeneity is considered variability in study population characteristics, interventions, and outcomes across studies. It can lead to effect-measure modification or statistical heterogeneity, which is defined as variability in estimated treatment effects beyond what would be expected by random error alone. Clinical and statistical heterogeneity are closely intertwined but they do not have a one-to-one relationship. The presence of statistical heterogeneity does not necessarily indicate that clinical heterogeneity is the causal factor. Methodological heterogeneity, biases, and random error can also cause statistical heterogeneity, alone or in combination with clinical heterogeneity. Identifying potential modifiers of treatment effects (i.e., effect-measure modifiers) is important for researchers conducting systematic reviews and HTAs. Recognizing clinical heterogeneity and clarifying its implications helps decision makers to identify patients and patient populations who benefit the most, who benefit the least, and who are at greatest risk of experiencing adverse outcomes from a particular intervention.

Prognostic indicators predictive of chemotherapy-induced febrile neutropenia outcomes in adult cancer patients: a systematic review.

Review question/objective What are the prognostic indicators predictive of chemotherapy-induced febrile neutropenia outcomes among adult cancer patients? Inclusion criteria Types of participants The participants of interest include adults, 18 years old and above with cancer, who developed febrile neutropenia as a result of myelosuppressive systemic chemotherapy either in an in-patient or outpatient setting. Types of intervention(s)/phenomena of interest The focus of this systematic review is on the prognostic indicators predictive of chemotherapy-induced febrile neutropenia outcomes in adult cancer patients. Types of Outcome(s) The primary outcome of this review is to identify the indicators predictive of FN outcomes (favourable or unfavourable) that influence the incidence of morbidity and mortality of adult cancer patients related to FN