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1
Medeiros, Ana Cláudia Ponte. "Bisphosphonates-related adverse events: systematic review and meta-analysis." Master's thesis, Universidade da Beira Interior, 2012. http://hdl.handle.net/10400.6/1130.
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A osteoporose é uma doença esquelética sistémica e progressiva que leva a um aumento do risco de fraturas. Os bifosfonatos são a opção terapêutica de primeira linha. Apesar dos efeitos adversos gastrointestinais associados ao uso de bifosfonatos o seu perfil de segurança é favorável. Contudo, recentemente, a Agência Europeia do Medicamento (EMA) emitiu um alerta de segurança após relatos de um aumento do risco da incidência de fraturas atípicas do fémur associadas ao uso destes fármacos, o que pode questionar a relação benefício/ risco deste grupo terapêutico. Objetivo: realizar uma revisão sistemática e meta-análise dos efeitos adversos associados ao uso de bifosfonatos, com enfâse na incidência de fraturas. Métodos: Realizámos uma pesquisa na Medline para identificar os estudos experimentais e observacionais que reportaram a incidência de efeitos adversos (incluindo qualquer tipo de fratura) em utilizadores de bifosfonatos em comparação com não utilizadores. Após a pesquisa, selecionaram-se os artigos que cumpriram os critérios de inclusão, procedeu-se à sua análise detalhada, extração de dados e avaliação da sua qualidade. Realizou-se uma meta-análise do risco de fraturas, para a qual se utilizou logaritmo da estimativa de efeito mais ajustada de cada estudo, com intervalos de confiança a 95%. Utilizámos estatística I2 para determinar a heterogeneidade entre estudos. As análises estatísticas foram efetuadas recorrendo ao programa estatístico STATA (versão 11). Resultados: Identificaram-se dezoito estudos elegíveis para a meta-análise (10 ensaios randomizados controlados, 1 estudo coorte, 2 estudos caso-controlo aninhados e 5 análises “post-hoc”). Adicionalmente foram identificados 9 estudos que reportaram outros efeitos adversos, incluídos numa análise descritiva. Os resultados da meta-análise sugerem um aumento significativo do risco de fraturas vertebrais (OR= 0.57 95%CI 0.51 to 0.63), nãovertebrais (OR= 0.78 95% CI 0.69 to 0.87) e da anca (OR= 0.67 95% CI 0.56 to 0.80). Contudo, a evidência de estudos observacionais sugere um possível risco de fraturas atípicas (OR= 2.23 95% CI 1.95 to 2.54). Estes resultados devem ser interpretados com cuidado uma vez que se baseiam num pequeno número de estudos, devendo ser confirmados em outros estudos experimentais e observacionais. Conclusão: Apesar da razão risco/beneficio dos bifosfonatos na prevenção de fraturas ser favorável, os nossos resultados sugerem um potencial risco de fraturas atípicas. As publicações atuais são insuficientes para suportar um aumento do risco de outros efeitos adversos, pelo que é necessário implementar-se uma monitorização mais rigorosa destes efeitos em estudos futuros.
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Alobaid, Abdulhakeem M. "Bariatric Surgery for Obesity: A Systematic Review and Meta-analysis." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24167.
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Obesity is the fifth leading cause of global deaths. The efficacy and safety of obesity treatment is still controversial. The objective of the thesis is to evaluate the efficacy and safety of bariatric surgery, through a systematic review of the current evidence and meta- analysis of important outcomes. Nineteen (19) randomized controlled trials (RCTs) with 1346 participants were included. Bariatric surgery resulted in greater weight loss when compared to non-surgical treatment. Weight loss was also associated with resolution and/or improvement of obesity related comorbidites such as diabetes, hypertension, hyperlipidemia, and sleep apnea. Weight loss and safety varied across the surgical procedures. Biliopancreatic diversion/duodenal switch had the greatest weight loss, followed by sleeve gastrectomy and Roux-en-Y gastric bypass, purely restrictive procedures such as vertical banded gastroplasty and adjustable gastric banding resulted in the least weight loss. Long term, high quality, and adequately powered trials are still needed to support the available evidence
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Pinkston, Sophie Wardle. "Insomnia and Cognitive Performance: A Systematic Review and Meta-Analysis." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1505168/.
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Daytime cognitive performance and sleep/wake cycles are strongly interrelated, and cognitive dysfunction has been extensively investigated in relation to insomnia. However, methods and outcomes vary widely by study, making comparison difficult without more systematic evaluation. Review of the literature reveals discrepant findings for the relationship between both subjective and objective measures of cognitive performance and insomnia. The current meta-analysis included 42 studies investigating the relationship between insomnia and cognitive performance. Results confirmed the discrepant nature of previous findings and suggest that type of cognitive performance (e.g., simple attention, procedural memory, verbal functions) is important to consider when discussing the impact of insomnia. Mixed-effect meta-analysis of aggregate effect sizes suggest impairments in working memory, complex attention, and episodic memory are significantly associated with insomnia. Analysis of the grouped subjective cognitive performance effect size revealed no significant impact of insomnia. Average age and gender makeup of the sample, study quality, and type of insomnia measure (i.e., clinical or diagnostic criteria, validated scale, or single unvalidated item) did not consistently moderate findings. These results confirm the equivocal nature of the relationship between insomnia and cognitive performance. Overall, about 44% of the studies included in the analysis failed to use DSM or ICSD criteria when categorizing insomnia. Additionally, the cognitive measures used varied widely and certain measures may not be sensitive enough to detect the degree of cognitive deficit that may be present for individuals with insomnia. This indicates a need for the standardization of methods used when assessing both insomnia and cognitive performance to elucidate these relationships.
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Whiting, Penny F., Robert F. Wolff, Sohan Deshpande, Nisio Marcello Di, Steven Duffy, Adrian V. Hernández, J. Christiaan Keurentjes, et al. "Cannabinoids for Medical Use A Systematic Review and Meta-analysis." American Medical Association, 2015. http://hdl.handle.net/10757/558499.
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Importance Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear.
Objective To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids.
Data Sources Twenty-eight databases from inception to April 2015.
Study Selection Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome.
Data Extraction and Synthesis Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis.
Main Outcomes and Measures Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs.
Results A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], −0.46 [95% CI, −0.80 to −0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, −0.36 [95% CI, −0.69 to −0.05]; 7 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination.
Conclusions and Relevance There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs.
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Vesterinen, Hanna Mikaela. "Systematic review and meta-analysis of experimental multiple sclerosis studies." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/11720.
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Background: Multiple sclerosis (MS) is the most common cause of disability in young people and yet there are no interventions available which reliably alter disease progression. This is despite several decades of research using the most common animal model of multiple sclerosis, experimental autoimmune encephalomyelitis (EAE). There is now emerging evidence across the neurosciences to suggest that limited internal validity (measures to reduce bias) and external validity (e.g. using a clinically relevant animal model) may influence the translational success. Aim and objectives: To provide an unbiased summary of the scope of the literature on candidate drugs for MS tested in EAE to identify potential reasons for the failures to translate efficacy to clinical trials. My objectives were, across all of the identified publications, to: (1) describe the reporting of measures to reduce bias and to assess their impact on measures of drug efficacy; (2) assess the relationship between treatment related effects measured using different outcome measures; (3) assess the prevalence and impact of any publication bias; (4) compare findings from the above with another disease with limited translational success (Parkinson’s disease; PD). Methods: I used systematic searches of three online databases to identify relevant publications. Estimates of efficacy were extracted for neurobehavioural scores, inflammation, demyelination and axon loss. For PD experiments, we searched for dopamine agonists tested in animal models of PD with outcome assessed as change in neurobehavioural scores. I calculated normalised mean difference or standardised mean difference effect sizes and combined these in a meta-analysis using a random effects model. I used stratified meta-analysis or meta-regression to assess the extent to which different study design characteristics explained differences in reported efficacies. These characteristics included: measures to reduce bias (random allocation to group and blinded assessment of outcome), the animal species, sex, time of drug administration, route of drug administration and the number of animals per group. Publication bias was assessed using funnel plotting, Egger regression and “trim and fill”. Results: I identified 1464 publications reporting drugs tested in EAE. Reported study quality was poor: 11% reported random allocation to group, 17% reported blinded assessment of neurobehavioural outcomes, 28% reported blinded assessment of histological outcomes, and < 1% reported a sample size calculation. Estimates of efficacy measured as the reduction in inflammation were substantially higher in unblinded studies (47.1% reduction (95% CI 41.8-52.4)) versus blinded studies (33.1% (25.8-40.4). Moreover, the same finding was identified for 121 publications on dopamine agonists tested in experimental PD models where efficacy was measured as change in neurobehavioural outcomes. For EAE studies we were unable to include data from 631 publications describing original research. Usually this was because the publication did not include basic details such as the number of animals in each group (115 publications), the observed variance (592) or suitable control data (49). For each category of outcome I found evidence of a substantial publication bias. Interventions were most commonly administered on or before the induction of EAE with shorter times to treatment associated with higher estimates of efficacy for the reduction in mean severity scores (a neurobehavioural outcome). Treatment related effects were found to vary across different outcome measures with the largest effect being for the reduction in axon loss. Where neurobehavioural scores and axon loss were measured in the same cohort of animals, the concordance between efficacies in these increased with later times to treatment. Conclusions: In this, the largest systematic review and meta-analysis of animal studies in any domain, I have found that a large number of publications present incomplete data. In addition, measures to reduce bias are seldom reported, the lack of which is associated with overstatements of efficacy for both a measure of drug efficacy in EAE and experimental PD studies. Translational success may have also been affected by the majority of studies administering drugs on or before EAE induction which is of limited relevance in the clinical setting where patients do not present at that stage of disease. Moreover, my analysis of the relationship between outcome measures provides empirical evidence from systematically identified studies to suggest that targeting axon loss as later time points is most strongly associated with improvements in neurobehavioural scores. Therefore drugs which are successfully able to target axon loss at these time points may offer substantial hope for clinical success. Overall, improvements in the conduct and reporting of preclinical studies are likely to improve their utility, and the prospects for translational success. While my findings relate predominately to the animal modelling of MS and PD it is likely that they also hold for other animal research.
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Lee, Jin-Hyung. "The Effects of Music on Pain: A Review of Systematic Reviews and Meta-Analysis." Diss., Temple University Libraries, 2015. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/320333.
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Music TherapyPh.D.
The purpose of this study was twofold: to critically review existing systematic reviews and meta-analyses on the topic of music and pain; and to systematically review and conduct a meta-analysis of clinical trials investigating the effect of music on pain encompassing a wide range of medical diagnoses, settings, age groups, and types of pain. For the review of systematic reviews, the author conducted a comprehensive search and identified 14 systematic reviews and meta-analyses. These studies were critically analyzed to present a comprehensive overview of findings, to evaluate methodological quality of the reviews, to determine issues or gaps in the literature, and to generate research questions for the following meta-analysis. For the meta-analysis, the author conducted electronic searches of 12 databases and a handsearch of related journals and reference lists of relevant systematic reviews, with partial restrictions on design (i.e., randomized controlled trials); language (i.e., English, German, Korean, and Japanese); year of publication (i.e., 1995 to 2014) and intervention (i.e., music therapy and music medicine). Analyzed studies included 87 music medicine (MM) and 10 music therapy (MT) trials; eighty-nine of the included studies involved adults and eight trials focused on children. In terms of the types of pain, there were 51 trials on acute, 34 on procedural, and 12 on cancer or chronic pain; the trials were conducted in over 20 different medical specialty areas. For the assessment of study quality, I used the risk of bias tool developed by the Cochrane collaboration, and pooled data from the included studies were analyzed using the Revman 5.3 software according to the effects of music on levels of pain intensity, amount of analgesic use, and changes in vital signs. The results indicated that music interventions resulted in a significant reduction of 1.13 units on 0-10 scales and a small to moderate pain reducing effect on other scales (SMD = -0.39). Participants in the music group experienced a significantly lower level of emotional distress from pain (MD = -10.8), and required significantly fewer anesthetics (SMD = -0.56), opioids (SMD = -0.24), and non-opioid medications (SMD = -0.54). Moreover, the music group showed statistically significant decreases in heart rate of 4.25 bpm, systolic blood pressure of 3.34 mmHg, diastolic blood pressure of 1.18 mmHg, and respiration rate of 1.46 breaths per minute. Findings from several analyses of moderator variables suggest: MT has a stronger effect in reducing self-rated pain intensity than MM; MT is more effective in reducing chronic/cancer pain than other types of pain, but MM seems to be more effective in managing procedural pain; children benefit more from music interventions than do adults, and more from MT than MM; providing different levels of choices in the selection of music yields different outcomes for MM; having a rationale for selection of music greatly improves the treatment outcome for MM; and an active MT approach is more effective in relieving perceived levels of pain than a passive MT approach. The results from the current meta-analysis demonstrate that music interventions may have beneficial effects on pain, emotional distress from pain, use of anesthetics and pain killers, and vital signs including heart rate, systolic blood pressure, diastolic blood pressure and respiration rate. However, these results need to be interpreted with caution due to highly heterogeneous outcomes among the included studies. Considering all the possible benefits, music interventions may provide an effective complimentary approach for the relief of acute, procedural and cancer/chronic pain in the medical setting.
Temple University--Theses
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Jafari, Yalda. "Point-of-care tests for syphilis: meta-analysis and systematic review." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=104812.
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Background: The World Health Organization estimates there were 12 million new cases of syphilis in 2006. . In developing countries there is often a lack of proper screening due to limited laboratory services. In contrast, in developed countries there is often limited access to care among hard-to-reach populations. In context of these healthcare system disconnects, point-of-care (POC) tests have proven to be an invaluable resource, yet in order to justify their use, their diagnostic accuracy and implementation outcomes must first be established. Methods: We searched six electronic databases from 1 January 1980 to 24 September 2010 for articles evaluating syphilis POC tests. Data was extracted and a second reviewer independently reviewed a subset of the articles. Subgroups of studies were created according to index test, sample, and reference standard employed. Pooled sensitivity and specificity estimates were calculated using Hierarchical Summary Receiver Operating Characteristic (HSROC) curves. Adjustments were made to account for imperfect reference standards. A narrative review of implementation outcomes was undertaken.Results: The most frequently evaluated kits were Determine® (29%), Bioline® (18%), Syphicheck® (15%), and Visitect® (14%). After adjustment for imperfect reference standard, in serum samples, using a TP (Treponemal Pallidum) specific reference standard (e.g. TPPA), Bioline® had the highest pooled sensitivity, 99.67% (95% credible interval 97.65, 100) , followed by Determine® , 99.14% (96.93, 100), Visitect®, 98.18% (93.53, 100) and Syphicheck®, 88.46% (73.54, 99.87). Syphicheck® had the highest pooled specificity, 99.98% (99.64, 100), followed by Visitect®, 99.89% (99.19, 100), Determine®, 99.68% (98.70, 100) and Bioline®, 99.56% (98.55, 100). In whole blood, Bioline® had the highest pooled sensitivity, 91.47% (87.06, 96.12), followed by Determine®, 89.49% (79.88, 98.15), Visitect®, 82.93% (94.50, 100) and Syphicheck®, 81.99% (71.84, 91.99). Determine® had the highest pooled specificity, 99.91% (99.44, 100) followed by Visitect®, 99.87% (99.58, 100) followed by Syphicheck®, 99.81% (99.46, 100), and Bioline®, 99.61% (99.04, 100). Acceptability, feasibility, and impact of POC tests were demonstrated in various studies. Preference was not well established and economic evaluations were too heterogeneous to be conclusive. Conclusion: Bioline® and Determine® had the highest estimates of pooled sensitivity and specificity respectively. Higher parameter estimates in serum warrant the use of these tests in serum, rather than whole blood where feasible. Comparing our findings to current strategies in place, it is appropriate to use POC tests to screen for syphilis where access to laboratories and laboratory based serological tests are limited or where patients do not return for results. Further research into implementation outcomes is warranted and a framework for evaluating these outcomes is urgently needed.Contexte: L'organisation mondiale de la santé (OMS) estimait à 12 millions le nombre de nouveaux cas de syphilis en 2006. Les pays en développement sont souvent confrontés à des lacunes en termes de dépistage adéquat, attribuables aux services de laboratoire limités. Pour les pays développés, ce sont les populations marginalisées qui souffrent souvent d'un accès limité aux services de santé. Dans ce contexte d'inégalités des systèmes de santé, et bien qu'on ait déjà démontré que les tests au point d'intervention représentaient une ressource de très grande valeur, leur précision diagnostique et l'analyse de résultats d'implantation (IRO) doivent d'abord être établis, afin de justifier leur utilisation.Méthodes: Nous avons effectué une recherche d'articles traitant de l'évaluation des tests au point d'intervention pour la syphilis dans six bases de données électroniques, du 1980 au 2010. Deux évaluateurs ont analysé les données. Des sous-groupes ont été créés en fonction des types de tests, échantillons et étalons de référence. Nous avons généré des tests de sensibilité et spécificité mises en commun, à l'aide de courbes Hierarchical Summary Receiver Operating Characteristic(HSROC), et avons ajusté les valeurs pour tenir compte des étalons de référence imparfaits. Nous avons aussi synthétisé de façon narrative les analyses de résultats d'implantation (IROs).Résultats: Après avoir sommairement évalué 64 articles complets, 30 (47%) articles ont été inclus dans la méta-analyse d'exactitude diagnostique, et 24 (38%) articles ont été inclus dans l'examen narratif des analyses de résultats d'implantation (IROs). Quatre tests ont été évalués à travers l'ensemble des études : Determine® (29%), Bioline® (18%), Syphicheck® (15%), et Visitect® (14%). Après ajustement pour tenir compte de l'imperfection des étalons de référence, dans des échantillons de sérum, en utilisant un étalon de référence spécifique pour le TP (treponema pallidum) (par exemple, le TPPA), le test Bioline® s'est avéré avoir le test de sensibilité mise en commun le plus élevé, soit 99,67% (95% intervalle crédible 97,65 - 100), suivi de Determine® avec 99,14% (96,93-100), Visitect® avec 98,18% (93,53-100) et Syphicheck® avec 88,46% (73,54-99.87). Syphicheck® a obtenue test de spécificité mise en commun le plus élevé, soit 99,98% (99,64-100), suivi de Visitect® avec 99,89% (99,19-100), Determine® avec 99,68% (98,70-100) et Bioline® avec 99,56% (98,55-100). Dans des échantillons sanguins complets, Bioline® a obtenu le test de sensibilité mise en commun le plus élevé, soit 91,47% (87,06-96,12), suivi de Determine® avec 89,49% (79,88-98,15), Visitect® avec 82,93% (94,50-100) et Syphicheck® avec 81,99% (71,84-91,99). Determine® a obtenu le test de spécificité mise en commun le plus élevé, soit 99,91% (99,44 - 100), suivi de Visitect® avec 99,87% (99,58-100), Syphicheck® avec 99,81% (99,46-100), et Bioline® avec 99,61% (99,04 -100). L'acceptabilité, la faisabilité et l'impact des tests au point d'intervention ont aussi été démontrés dans plusieurs études. La préférence n'a pas été suffisamment bien établie, et les évaluations économiques étaient trop hétérogènes pour être concluantes.Conclusion: Bioline® et Determine® ont obtenu respectivement les tests de sensibilité et spécificité mises en commun les plus élevés. Les tests plus élevés dans les échantillons de sérum suggèrent fortement, lorsque possible, l'utilisation de ces tests dans ce contexte, plutôt qu'avec des échantillons sanguins complets. En comparant nos résultats aux stratégies de tests actuellement en application, on constate qu'il serait approprié de remplacer les tests sérologiques avec des tests au point d'intervention, même lorsque l'accès à un laboratoire ou à du personnel adéquatement formé n'est pas une problématique. De plus amples recherches sur les analyses de résultats d'implantation sont nécessaires, et un cadre d'étude pour l'évaluation de ces résultats est urgemment requis.
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Batinovic, Lucija, and Marlon Howe. "A systematic review and meta-analysis of age discrimination in recruitment." Thesis, Linnéuniversitetet, Institutionen för psykologi (PSY), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-104876.
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Correspondence and vignette experiments have already been an important part of measuring discrimination in hiring decisions for several decades, especially in terms of ethnic discrimination. Although the body of evidence is growing, no study has provided a systematic overview of age discrimination in recruitment before. Therefore, the present systematic review investigates the effect of age on discrimination levels experienced in the recruitment process, based on 14 correspondence and vignette studies in 12 distinct articles conducted between 2010 and 2019. We assess age discrimination by looking at call-back rates or indicators of hiring/interview invitation likelihood. Data was analyzedin age groups entailing 30-to 35-year-olds as comparators, and 40-to 49-, 50-to 59-, 60-to 65-and over 65-year-olds as experimental groups. Calculating log odds ratios for the respective comparisons, it was concluded that age discrimination in recruitment is indeed an observable issue, with greatest disparities apparent for participants over the age of 60. Certain limitations of this review will have to be overcome in future; such as restrictions in sample sizes and reported issues on the risk of bias.
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Meyer, Nathalie. "Cervical vestibular evoked myogenic potentials : a systematic review and meta-analysis." Diss., University of Pretoria, 2014. http://hdl.handle.net/2263/46262.
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Objective: A systematic literature review and meta-analysis was performed to determine the effect of stimulus type, sternocleidomastoid (SCM) muscle activation method, transducer type and method to control SCM muscle electromyography (EMG) level on response parameter values for 0.1 ms click evoked and 500 Hz tone burst cervical vestibular evoked myogenic potentials (cVEMPs). A description of normative response values was attempted.
Method: An electronic systematic literature review was performed to obtain normative cVEMP response data. Subsequently a meta-analysis was conducted to determine significant effects on cVEMP response parameters and to obtain norms.
The scientific database, Scopus, was used to identify reports containing normative data. Reports were selected based on inclusion and exclusion criteria determined beforehand. Weighted means were calculated and compared to identify significant effects on response parameters and normative data for cVEMP interpretation.
Results: Sixty six reports were included in the systematic review and most prevalent stimulus and recording parameters are identified and tabulated as guidelines for conducting and interpreting cVEMPs in the clinic. Stimulus type had a statistically significant effect on all response parameters (latency P1, latency N1, raw amplitude, corrected amplitude, asymmetry ratio and threshold), where larger latencies were noted for 500 Hz tone burst cVEMPs (TBVs). Stimulus duration was confirmed to produce larger latencies. Larger raw amplitude values were found for TBVs and visual monitoring levels of at least 40 μV is suggested. Larger asymmetry ratios for 0.1 ms click cVEMPs (CVs) were found and upper limits of normality of 14.2% (CVs) and 10.05% (TBVs) are suggested. Higher threshold values were found for CVs and threshold ranges of 89 dB HL (SD 0.88) for CVs and 81.02 (SD 2.03) for TBVs are suggested. SCM muscle activation method, transducer type and method to control SCM muscle EMG level had statistically significant effects on all response parameters, indicating that one method to perform the cVEMP should be chosen and used consistently for accurate interpretation of results.
Conclusions: Optimal stimulus and recording parameters suggested by previous research are confirmed by the current systematic review and meta-analysis and are suggested for clinical use. Response parameter values are influenced by variations in stimulus and recording parameters and normative response values are suggested as guideline for cVEMP interpretation.Dissertation (MLOG)--University of Pretoria, 2014.
tm2015
Speech-Language Pathology and Audiology
MLOG
Unrestricted
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Sena, Emily Shamiso. "Systematic review and meta-analysis of animal models of acute ischaemic stroke." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/4824.
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Ischaemic stroke is responsible for substantial death and disability and creates a huge financial burden for healthcare budgets worldwide. At present there are few effective treatments for acute stroke and these are urgently required. Increased understanding of the ischaemic cascade has generated interest in neuroprotection for focal cerebral ischaemia. However, treatment effects observed in of over 500 interventions in animal models have yet to be translated to the clinic. Systematic review and meta-analysis allows unbiased identification of all relevant data for a given intervention, gives a clearer view of its true efficacy and the limitations to its therapeutic potential. Understanding the reasons for this bench-to-bedside failure and providing quantitative explanations may help to address these discrepancies. Random effects weighted mean difference meta-analysis of six interventions (tirilazad, tPA, NXY-059, Hypothermia, Piracetam and IL1-RA) reported study quality to be consistently low. In some instances, potential sources of bias were associated with overestimations of efficacy. Likewise, clinical trials have tested interventions in conditions where efficacy was not observed in animals. Cumulative meta-analysis suggests that for tPA the estimate of efficacy is stable after the inclusion of data from 1500 animals; hypothermia and FK506 are the only other interventions to have been tested in at least 1500 animals. Meta-regression suggests biological rather methodical factors are better predictors of outcome; a major limitation of these data is the impact of publication bias, and this work suggests effect sizes from met-analyses are inflated by about 31% because 16% of studies remain unpublished. The systematic review and meta-analysis of hypothermia was used to plan experiments investigating the possible impact of pethidine, a drug used to prevent shivering. This in vivo experiment, in which potential sources of bias were minimised, suggests that pethidine does not influence the observed efficacy of hypothermia in an animal model of ischaemic stroke. This thesis reports that animal studies of ischaemic stroke are often not conducted with sufficient rigour. Both minimising potential sources of bias in individual experiments and using meta-analysis to summarise data from a number of experiments may be helpful in improving the translation of neuroprotective efficacy in ischaemic stroke.
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Hernandez, Adrian V., Vinay Pasupuleti, Vicente A. Benítes-Zapata, Priyaleela Thota, Abhishek Deshpande, and Lopez Faustino R. Perez. "Insulin resistance and endometrial cancer risk: A systematic review and meta-analysis." Elsevier B.V, 2015. http://hdl.handle.net/10757/621216.
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Abstract Aim: It has been suggested that chronic hyperinsulinemia from insulin resistance is involved in the etiology of endometrial cancer (EC). We performed a systematic review and meta-analysis to assess whether insulin resistance is associated with the risk of EC. Methods: We searched PubMed-Medline, Embase, Scopus, and Web of Science for articles published from database inception through 30th September 2014. We included all observational studies evaluating components defining insulin resistance in women with and without EC. Quality of the included studies was assessed by NewcastleeOttawa scale. Randomeffects models and inverse variance method were used to meta-analyze the association between insulin resistance components and EC. Results: Twenty-five studies satisfied our inclusion criteria. Fasting insulin levels (13 studies, n Z 4088) were higher in women with EC (mean difference [MD] 33.94 pmol/L, 95% confi- dence interval [CI] 15.04e52.85, p Z 0.0004). No differences were seen in postmenopausal versus pre- and postmenopausal subgroup analysis. Similarly, non-fasting/fasting C-peptide levels (five studies, n Z 1938) were also higher in women with EC (MD 0.14 nmol/L, 95% CI 0.08e0.21, p < 0.00001). Homeostatic model assessment - insulin resistance (HOMA-IR) values (six studies, n Z 1859) in EC patients were significantly higher than in women without EC (MD 1.13, 95% CI 0.20e2.06, p Z 0.02). There was moderate-to-high heterogeneity among the included studies. Conclusion: Currently available epidemiologic evidence is suggestive of significantly higher risk of EC in women with high fasting insulin, non-fasting/fasting C-peptide and HOMAIR values.Revisión por pares
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Hernández, Adrian V., Vinay Pasupuleti, Zapata Vicente A. Benites, Priyaleela Thota, Abhishek Deshpande, and Lopez Faustino R. Perez. "Insulin resistance and endometrial cancer risk: A systematic review and meta-analysis." Elsevier B.V, 2015. http://hdl.handle.net/10757/582697.
Full textAbstract:
Abstract Aim: It has been suggested that chronic hyperinsulinemia from insulin resistance is
involved in the etiology of endometrial cancer (EC). We performed a systematic review and
meta-analysis to assess whether insulin resistance is associated with the risk of EC.
Methods: We searched PubMed-Medline, Embase, Scopus, and Web of Science for articles
published from database inception through 30th September 2014. We included all observational
studies evaluating components defining insulin resistance in women with and without
EC. Quality of the included studies was assessed by NewcastleeOttawa scale. Randomeffects
models and inverse variance method were used to meta-analyze the association between
insulin resistance components and EC.
Results: Twenty-five studies satisfied our inclusion criteria. Fasting insulin levels (13 studies,
n Z 4088) were higher in women with EC (mean difference [MD] 33.94 pmol/L, 95% confi-
dence interval [CI] 15.04e52.85, p Z 0.0004). No differences were seen in postmenopausal
versus pre- and postmenopausal subgroup analysis. Similarly, non-fasting/fasting C-peptide
levels (five studies, n Z 1938) were also higher in women with EC (MD 0.14 nmol/L, 95% CI 0.08e0.21, p < 0.00001). Homeostatic model assessment - insulin resistance (HOMA-IR)
values (six studies, n Z 1859) in EC patients were significantly higher than in women without
EC (MD 1.13, 95% CI 0.20e2.06, p Z 0.02). There was moderate-to-high heterogeneity
among the included studies.
Conclusion: Currently available epidemiologic evidence is suggestive of significantly higher
risk of EC in women with high fasting insulin, non-fasting/fasting C-peptide and HOMAIR
values.
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Kinnear, Victoria. "Systematic review and meta-analysis of psychological interventions for informal dementia caregivers." Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/7805.
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Purpose: This review evaluates the impact of intervention studies for informal dementia caregivers. Methods: Meta-analytic methods were used to integrate the findings of 14 intervention studies evaluating the cognitive behaviour therapy for caregivers. Meta-regression and analysis of variance were used to evaluate the impact of caregiver and intervention characteristics on the outcomes. Results: Significant effects sizes were found for the impact of CBT on depression, burden, and mental health difficulties, g* = -0.55, 95% CI [-0.92, -0.19], g *= -0.37, 95% CI [-0.57, - 0.17], and g* = -0.54, 95% CI [-0.78, -0.30], respectively. CBT facilitated more adaptive coping, with significant effects on caregiver adaptive coping and dysfunctional thoughts, g* = 0.48, 95% CI (0.02, 0.24) and g* = -1.33, 95% CI (-2.22, -0.44). The impact of CBT on caregiver outcomes was associated with the nature of the study control condition, and the intervention delivery, timing and specificity to dementia type. Caregiver ethnicity and gender were not predictive of the CBT outcome. Implications: Overall, caregiver interventions are efficacious in alleviating caregiver distress and facilitating more adaptive coping responses, with prominent effects established for CBT. Future research needs to consider CBT as part of multi-intervention approach tailored to the needs of caregivers across the disease progression. Further improvements are needed, with greater consideration of the impact of the intervention design in alleviating caregiver distress.
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Chen, Mengtong, and 陈孟彤. "Preventing child maltreatment: a meta-analysis and systematic review of parenting programs." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B50900043.
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Child maltreatment—a serious public health problem—is a global phenomenon. Parenting programs are considered effective approaches to preventing child maltreatment; however, comprehensive understanding is still lacking of the effectiveness of such programs in all areas of outcomes and the way parenting programs work. This thesis consists of two parts: a quantitative synthesis of high-level evidence about program effects and a qualitative integration of program process.
The thesis employs two research methods: meta-analytic review and systematic review. I searched 11 electronic databases to identify studies published between 2000 and 2012. Forty-two studies meeting the eligibility criteria were included in the systematic review, and 21 of these were included in the meta-analysis. The total random effect size was 0.338.
The research found that parenting programs successfully reduced substantiated child maltreatment reports. The programs also reduced risk factors and enhanced protective factors associated with child maltreatment. However, program effects began to decrease in the first year after program completion. Parenting programs function by remediating parental cognition, thus changing parenting behaviors and enhancing parent-child relationships. The successful program components include teaching child-rearing knowledge, improving parenting skills and changing parents’ inappropriate attitudes towards children.
Parenting programs are demonstrated to be effective public health approaches to avoiding child maltreatment. Parenting programs could produce positive effects in both low- and middle-income countries, as well as high-income countries. The study recommends a longer-term intervention beginning prenatally or at an early age of the children and involving more male caregivers. The evidence-based service of parenting programs could be widely adopted in future practices. The research also indicates that parenting programs could be applicable within the Chinese context, where such programs have not been widely used to date.published_or_final_version
Social Work and Social Administration
Master
Master of Philosophy
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Chukwuemeka, Scholarstica Chinwe. "Adverse Foetal Outcomes in Gestational Diabetes: A Systematic Review and Meta-analysis." University of the Western Cape, 2020. http://hdl.handle.net/11394/7920.
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Magister Pharmaceuticae - MPharmGestational diabetes mellitus (GDM) is a condition that affects pregnant women and is one of the most common complications related to pregnancy. According to the World health organisation (WHO), the usual window for diagnosing GDM is between 24 and 28 weeks of gestation and the primary aim of diagnosing gestational diabetes is to identify women and infants at risk of short- or longer-term adverse outcomes. Recent results from the hyperglycaemia and adverse pregnancy outcome (HAPO) study have suggested that even mild levels of hyperglycaemia can have adverse effects on foetal outcomes but there are uncertainties about the prevalence of these outcomes in GDM diagnosed according to the latest WHO 2013 guideline and/or IADPSG 2010 criteria in diverse populations. GDM prevalence has been studied by different researchers, but the prevalence of adverse foetal outcomes in GDM diagnosed based on the latest WHO 2013 guideline and/or IADPSG 2010 criteria have not yet been explored except for the data published by the HAPO study. Due to the lack of sufficient knowledge on foetal outcomes in GDM, this study was conducted to review the evidence on the prevalence of adverse foetal outcomes in GDM diagnosed according to WHO 2013 guideline and/or the IADPSG 2010 criteria. Different databases including PubMed, Science Direct, Google Scholar and CINAHL as well as bibliographic citations were searched using a well-formulated search strategy to find the relevant observational studies (prospective/retrospective cohort and case-control) using explicit inclusion and exclusion criteria. The following search terms were used, “gestational diabetes”, “pregnancy”, “adverse fetal outcomes” and “adverse foetal outcomes”. The findings of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the obtained data analysed using MetaXL ® version 5.3. This review was registered online on PROSPERO, the International prospective register of systematic reviews (registration number: CRD42020155061). Fifteen studies with 88,831 pregnant women (range: 83-25,543 participants) from 12 countries around the world were identified, with a wide variation in the prevalence of foetal outcomes in GDM using the stipulated criteria. These studies were unevenly distributed geographically as six of them were conducted in Asia, four in Europe, four in North America, one in Australia and none in Africa, Antarctica and South America. A meta-analysis found that the overall prevalence of foetal outcomes ranged from 1% (perinatal mortality) to 11% ( large for gestational age). The finding is limited due to the paucity of data on the prevalence of foetal outcomes in GDM. However, more studies using these criteria in low- and middle- income countries (LMICs) are needed by health care providers, to inform practice and allocate resources for control of GDM and its adverse foetal outcomes in diverse settings and ethnic groups, especially in LMICs.
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Elias, Liana Rosa. "Cognitive deficits in euthymic children and adolescents: systematic review and meta-analysis." Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=18550.
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nÃo hÃFundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico
This work consists of a systematic review with meta-analysis of studies investigating neuropsychological functions in youth up to the age of 18 diagnosed with Bipolar Disorder (BD) in euthymic phase compared to healthy controls (HC). The study aims to to clarify the cognitive functioning of pediatric bipolar patients by investigating a representative sample and controlling potential sources of heterogeneity. A systematic search in the literature was performed in the Pubmed/MEDLINE, PsycInfo and EMBASE databases from inception until March 23rd, 2016 to select original peer-reviewed studies that investigated neuropsychological functions in youths diagnosed with TB in the euthymic phase compared to HC. Effect sizes were extracted for each of the neuropsychological tests used. In addition, the results were grouped according to the following cognitive domains: attention and vigilance, verbal learning, verbal memory, working memory, visual learning, visual memory, executive functions, processing speed and general cognition. The PRISMA Statement protocol was followed. The study synthesized data from twenty-four studies that met the inclusion criteria (N = 1146, 510 in the BD group and 636 in the control group). In general, euthymic bipolar youngsters had significant deficits in the domains of verbal learning, verbal memory, working memory, visual learning and visual memory with moderate to large effect sizes (Hedgesâs g between 0.76 and 0.99). No significant deficits were observed in the domains of attention/vigilance, executive functions, and processing speed. The heterogeneity was moderate to large (I2 ≥ 50%) for most ES estimates. Differences in the definition of euthymia between the studies explained the heterogeneity in the ES estimation for verbal learning and memory. Evidence was also found for other potential sources of heterogeneity in various estimates of ES that included comorbidity with ADHD and anxiety disorders, as well as madication use. In addition, the use of different neuropsychological tests seemed to contribute to the heterogeneity of some estimates (e.g. in the attention/vigilance domain). At the end, it can be concluded that youths with euthymic BD present significant cognitive dysfunction encompassing the domains verbal learning, visual learning, verbal memory, visual memory and working memory. The results also suggest that, for a subset of individuals with BD, neurodevelopmental factors may contribute to cognitive dysfunction.
Este trabalho consiste em uma revisÃo sistemÃtica com meta-anÃlise de estudos investigando funÃÃes neuropsicolÃgicas em jovens atà 18 anos diagnosticados com Transtorno Bipolar (TB) em fase eutÃmica em comparaÃÃo com controles saudÃveis (CS). Desta forma, espera-se esclarecer o funcionamento cognitivo de pacientes bipolares pediÃtricos com uma amostra representativa e com controle das potenciais fontes de heterogeneidade. Para o alcance dos objetivos, uma busca sistemÃtica na literatura foi realizada nas bases de dados Pubmed / MEDLINE, PsycInfo e EMBASE, desde o primeiro periÃdico veiculado à base, atà 23 de marÃo de 2016 em estudos originais revisados por pares (peer-review) que investigaram funÃÃes neuropsicolÃgicas de jovens eutÃmicos com TB em comparaÃÃo com CS. Foram extraÃdos os tamanhos de efeito (TE) para cada um dos testes neuropsicolÃgicos utilizados. Adicionalmente, os resultados foram agrupados de acordo com os seguintes domÃnios cognitivos: atenÃÃo/vigilÃncia, aprendizagem verbal, memÃria verbal, memÃria de trabalho, aprendizagem visual, memÃria visual, funÃÃes executivas, velocidade de processamento e cogniÃÃo geral. Foram seguidos os protocolos do PRISMA Statement. Como resultado, este estudo sintetizou dados de vinte e quatro estudos que preencheram os critÃrios de inclusÃo (N = 1146; sendo 510 no grupo TB e 636 no grupo controle). Em geral, os jovens bipolares eutÃmicos apresentaram dÃficits significativos nos domÃnios de: aprendizagem verbal, memÃria verbal, memÃria de trabalho, aprendizagem visual e memÃria visual, com tamanhos de efeito de moderado a grande (g de Hedge entre 0,76 a 0,99). NÃo foram observados dÃficits significativos nos domÃnios de atenÃÃo e vigilÃncia, funÃÃes executivas, e velocidade de processamento. A heterogeneidade foi alta (I2 ≥ 50%) para a maioria das estimativas de TE. DiferenÃas na definiÃÃo de eutimia entre os estudos explicaram a heterogeneidade na estimativa do TE para aprendizagem verbal e memÃria. TambÃm foram encontradas evidÃncias para outras fontes potenciais de heterogeneidade em vÃrias estimativas do TE, que incluiam comorbidade com TDA/H e transtornos de ansiedade, bem como o uso de medicamentos. AlÃm disso, o uso de diferentes testes neuropsicolÃgicos pareceu contribuir para a heterogeneidade de algumas estimativas (como por exemplo, no domÃnio atenÃÃo/vigilÃncia). Ao final, foi possÃvel concluir que jovens bipolares eutÃmicos apresentam disfunÃÃo cognitiva significativa abrangendo os domÃnios aprendizagem verbal, aprendizagem visual, memÃria verbal, memÃria visual e memÃria de trabalho. Estes dados sugerem que, para um subconjunto de indivÃduos com TB, os fatores do neurodesenvolvimento podem contribuir para a disfunÃÃo cognitiva.
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Grey, Barend Christiaan. "Humeral stem loosening following reverse shoulder arthroplasty - systematic review and meta-analysis." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24990.
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Background: Aseptic stem loosening following reverse shoulder arthroplasty (RSA) is an uncommon complication. The majority of literature on RSA consists of case series with short follow-up periods. It remains unknown which factors contribute to aseptic stem loosening in RSA. Our analysis aimed to compare the incidence of aseptic stem loosening, humeral radiolucent lines (RLL) and revision for stem loosening between: 1) cemented and uncemented stems, and 2) different etiological subgroups Methods: In a systematic review 75 articles were included after assessment of study methodology and a meta-analysis of 1660 cemented and 805 uncemented stems was performed. We compared the incidence of aseptic stem loosening, humeral RLL, and revision for stem loosening between: 1) cemented and uncemented stems from cohorts with short (< 5 years) mean follow-up periods, long (≥ 5 years) mean follow-up periods, and all cohorts combined; and 2) different etiological subgroups. Results: The overall incidence of aseptic stem loosening was 1%. When comparing cemented to uncemented stems, there was no significant difference in the incidence of aseptic stem loosening or of revision for stem loosening in both the short and long term follow-up groups. Humeral RLL were more common with cemented stems (15.9% versus 9.5%, p = 0.002). The highest incidence of aseptic stem loosening occurred in the tumor subgroup (10.81%), followed by RSA as revision for failed arthroplasty (3.66%). No stem loosening was seen in the acute fracture or fracture sequelae groups. Conclusion: Aseptic stem loosening occurred more commonly in cohorts with long follow-up times (2% vs 0.8%, p = 0.01). There was no difference in the incidence of aseptic stem loosening or revision for stem loosening between cemented and uncemented stems. Humeral RLL occurred more frequently when cemented stems were used. Patients treated with RSA following excision of proximal humerus tumors and RSA as revision for failed arthroplasty were at greater risk of aseptic stem loosening.
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Severin, Kimberley. "Statins and Risk of Alzheimer Disease: A Systematic Review and Meta-Analysis." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1352489450.
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Saunders-Adams, Stacey M. "Reunification and Reentry in Child Welfare: A Systematic Review and Meta-analysis." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1299287934.
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Chiasson, Martine. "Influence of Menarche on Body Weight. A Systematic Review and Meta-Analysis." Thesis, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/31700.
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It has been shown that post-menarcheal girls are more likely to have increased their body weight and body mass index (BMI) than pre-menarcheal girls of the same age. In addition to the metabolic changes which occur during this interval, behavioural risk factors synergize to promote weight gain, putting adolescents at a much higher risk for excess weight gain and its associated health complications. Moreover, obesity during adolescence increase the risk of becoming an obese adult. A systematic review of English and French articles using MEDLINE, EMBASE, Cochrane, and CINAHL was conducted. Studies underwent a three level screening assessment by two independent assessors. Only studies with post-menarcheal weight change information were selected for data extraction and quality assessment, which was conducted by two independent reviewers. A meta-analysis was conducted for weight change and included 389 girls. Five studies discussed the effects of menarche on body weight change. Pooled results for three studies indicated a 10.39 kg increase from pre to post-menarche (95% CI, 9.16-11.62). The other two studies showed significant increases in body fat mass (p<0.05) and higher skinfolds measurements for post-menarcheal girls compared to pre-menarcheal girls. It is important to further explore the bio-psychosocial and environmental factors influencing the weight, especially the total fat mass and body fat distributions in young adolescent girls during the menarche transition in order to develop and evaluate preventive intervention strategies to prevent adolescent and adult obesity.
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Egan, Kieren. "Systematic review and meta-analysis of transgenic mouse models of Alzheimer's disease." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9538.
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The increasing prevalence of Alzheimer’s disease poses a considerable socioeconomic challenge in the years ahead. There are few clinical treatments available and none capable of halting or slowing the progressive nature of the condition. Despite decades of experimental research and testing over 300 interventions in transgenic mouse models of the condition, clinical success has remained elusive. Deepening our understanding of how such studies have been conducted is likely to provide insights which could inform future preclinical and clinical research. Therefore I performed a systematic review and meta-analysis on interventions tested in transgenic mouse models of Alzheimer’s disease. My systematic search was performed by electronically searching for publications reporting the efficacy of interventions tested in transgenic models of Alzheimer's disease. Across these publications I extracted data regarding study characteristics and reported study quality alongside outcome data for pathology (i.e. plaque burden, amyloid beta species, tau, cellular infiltrates and neurodegeneration) and neurobehaviour. From these data I calculated estimates of efficacy using random effects meta-analysis and subsequently investigated the potential impact of study quality and study characteristics on observed effect size. My search identified 427 publications, 357 interventions and 55 transgenic models representing 11, 688 animals and 1774 experiments. There were a number of principal concerns regarding the dataset: (i) the reported study quality of such studies was relatively low; less than 1 in 5 publications reported blinded assessment of outcome or random allocation to group and no studies reported a sample size calculation, (ii) the depth of data on any individual intervention was relatively poor-only 16 interventions had outcomes described in 5 or more publications and (iii) publication bias analyses suggested 1 in 5 pathological and 1 in 7 neurobehavioural experiments remain unpublished. Where I inspected relationships between outcomes, meta-regression identified a number of notable associations. Changes in amyloid beta 40 were reflective of changes in amyloid beta 42 (R2 = 0.84, p<0.01) and within the Morris water maze changes in the ‘training’ acquisition phase could explain 44% of the changes in the probe ‘test’ phase (p<0.05). Additionally, I identified measures of neurodegeneration as the best pathological predictors of changes in neurobehaviour (R2 = 0.72, p<0.01). Collectively this work identifies a number of potential weaknesses within in vivo modelling of Alzheimer’s disease and demonstrates how the use of empirical data can inform both preclinical and clinical studies.
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Barker, Keegan. "The Development of the Clinical Supervisor: An Examination of Theories, Contributing Factors, and Measures." Thesis, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/31788.
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The development of competency in clinical supervision is becoming an increasingly important element of training and practice in professional psychology. To assist students in developing supervisory competencies, knowledge of relevant research and effective training methods is required. Three studies were designed to add to the field of supervisor development research. In the first study, I conducted a systematic review to examine the extent to which theoretical models of supervisor development have been used in empirical studies of supervisor development within professional psychology. This study revealed that studies rarely employ theory, and when they do, the Supervisor Complexity Model is the most often used theory, likely because it is the only one with an associated measure, the Psychotherapy Supervisor Development Scale (PSDS; Watkins, Schneider, Haynes, & Nieberding, 1995). Building on the findings of this systematic review, in the second study I conducted a reliability and validity generalization on the PSDS. Reliability and validity generalizations are meta-analytic methods that allow reliability and validity data from a measure to be summarized across studies. Results indicate the PSDS has a history of excellent reliability, and higher scores are found with increased supervisory training and experience, evidence of the scale’s validity. The third study is a meta-analysis of the supervisor development literature, in order to assess the effect sizes of training and experience on supervisory development and self-efficacy. Results indicate that training and experience have significant positive effect sizes, though they do not differ from one another. Based on results from these studies I provide recommendations about: the samples with which the PSDS tool is appropriately used, and how researchers might increase reliability within their own future studies, and evidence based recommendations for competency based education efforts.
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Holland, David F. "Reliability Generalization: a Systematic Review and Evaluation of Meta-analytic Methodology and Reporting Practice." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc822810/.
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Reliability generalization (RG) is a method for meta-analysis of reliability coefficients to estimate average score reliability across studies, determine variation in reliability, and identify study-level moderator variables influencing score reliability. A total of 107 peer-reviewed RG studies published from 1998 to 2013 were systematically reviewed to characterize the meta-analytic methods employed and to evaluate quality of reporting practice against standards for transparency in meta-analysis reporting. Most commonly, RG studies meta-analyzed alpha coefficients, which were synthesized using an unweighted, fixed-effects model applied to untransformed coefficients. Moderator analyses most frequently included multiple regression and bivariate correlations employing a fixed-effects model on untransformed, unweighted coefficients. Based on a unit-weighted scoring system, mean reporting quality for RG studies was statistically less than that for a comparison study of 198 meta-analyses in the organizational sciences across 42 indicators; however, means were not statistically significantly different between the two studies when evaluating reporting quality on 18 indicators deemed essential to ethical reporting practice in meta-analyses. Since its inception a wide variety of statistical methods have been applied to RG, and meta-analysis of reliability coefficients has extended to fields outside of psychological measurement, such as medicine and business. A set of guidelines for conducting and reporting RG studies is provided.
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Gruner, Deborah [Verfasser]. "Probiotics for managing caries and periodontitis : systematic review and meta-analysis / Deborah Gruner." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2017. http://d-nb.info/1126645923/34.
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Rundström, Elin. "Exercise in patients with tension-type headache : a systematic review and meta-analysis." Thesis, Luleå tekniska universitet, Institutionen för hälsa, lärande och teknik, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-86042.
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Abstract: Objective: This meta-analysis reviews the evidence for training in patients with tension-type headache on pain intensity and headache frequency. Method: Electronic databases were searched for randomized controlled trials evaluating training on patients with tension-type headache. Data was extracted by the reviewer. Methodological quality was assessed using risk of bias two and a meta-analysis was made using Revman 5. The quality of the evidence was calculated using GRADEproGDT. Results: Regarding pain intensity four studies were included (n = 330 participants). The meta-analysis indicates that training is effective in reducing pain intensity in patients with tension-type headache. This result does not reach a clinical important difference. The quality of evidence is moderate. For headache frequency three studies were included in the meta-analysis (n = 290 participants). The meta-analysis showed that training is effective in reducing headache frequency in patients with tension-type headache. This change does not reach a clinical important difference. The quality of evidence for this result is high. Conclusion: There is moderate quality of evidence that exercise reduces pain intensity in patients with tension-type headache. There is high quality evidence that exercise reduces headache frequency in patients with tension-type headache. Neither of these results reach a clinically important difference. This may be due to the active control groups and needs to be researched further.
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Nnaji, Chukwudi Arnest. "Effects of fractional dose yellow fever vaccination: a systematic review and meta-analysis." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29303.
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Persistent yellow fever endemicity and continued outbreaks have continued to increase vaccine demand, while straining global vaccine supply. Fractional dose vaccination is being considered as a dose-sparing strategy to mitigate current global vaccine shortages. This study therefore assessed the effects of fractional dose yellow fever vaccination, in comparison to those of the standard dose. We registered the review in the prospective register of systematic reviews; conducted a comprehensive search of published and grey literature; used standard Cochrane methods to collect and synthesise the evidence and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidance. We stratified analyses by the strength of the fractional dose. We retrieved 2495 records from the literature search, nine of them potentially eligible. We included six eligible studies (three randomised and three quasi-randomised trials), with 2371 participants. There was no statistically significant difference in immunogenicity between participants who received fractional doses containing one-third (two trials, 547 participants: RR 1.02, 95% CI 1.00 to 1.04; I2 = 0%), 1/5th (one trial, 155 participants: RR 1.00, 95% CI 0.98 to 1.03), 1/10th (four trials, 890 participants: RR 0.99, 95% CI 0.96 to 1.01, I 2 = 0%), and 1/50th (three trials, 661 participants: RR 0.97, 95% CI 0.92 to 1.02, I2 = 72%) of the standard dose and those who received the full standard dose. However, immunogenicity was significantly lower among participants who received fractional doses containing 1/100th (four trials, 868 participants: RR 0.92, 95% CI 0.87 to 0.97, I2 = 60%) and < 1/100th (five trials, 1053 participants; RR 0.53, 95% CI 0.44 to 0.64, I2= 98%) of the standard dose compared to participants who received the full standard dose. Minor adverse events following vaccination did not differ across doses, but no serious adverse events were reported in any study arm. The combined data provide moderate certainty evidence that there is little or no difference in immunogenicity between ≥1/50th fractional doses and the standard dose of yellow fever vaccines. However, these studies were of short duration ranging from four weeks to a year. These findings support the use of fractional dose vaccination as a dose-sparing strategy for yellow fever vaccination.
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Engel, Mark E. "Steroids for tuberculous pleurisy : a systematic review and meta-analysis of clinical trials." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/9384.
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Includes bibliographical references.Corticosteroids used in addition to anti-tuberculous therapy have been reported to benefit people with tuberculous pleurisy. However, research findings are not consistent, raising doubt as to whether such treatment is worthwhile. Concem also exists regarding the potential adverse effects of steroids, especially in HIV positive patients. An earlier Cochrane review summarized the existing evidence on the effects of steroids in people with tuberculous pleurisy. This review updates the evidence and, for the first time sheds light on the effects of steroids in patients with tuberculous pleurisy co-infected with HIV.
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Nzeale, Jean Jacques Noubiap. "Prevalence of dyslipidaemia among adults in Africa: a systematic review and meta-analysis." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31183.
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Background
The burden of dyslipidaemia in Africa remains inadequately characterised. We aimed to estimate the prevalence of dyslipidaemia in African adults from hospital-based and community-based studies.
Methods
In this systematic review and meta-analysis, we searched MEDLINE via PubMed, EMBASE, African Journals Online, and African Index Medicus for studies published between Jan 1, 1980, and July 31, 2017, without language restriction. We assessed methodological quality of all crosssectional studies reporting on the prevalence of elevated concentrations of total cholesterol, LDL cholesterol, or triglycerides, or low concentrations of HDL cholesterol in adults residing in African countries. We excluded reports on Africans living outside Africa, studies of individuals selected on the basis of existing dyslipidaemia or those including children and adolescents, and case series with a small sample size. The most frequently used cutoffs in the included studies were chosen for the subgroup analysis. We used random-effect model meta-analysis to derive the pooled prevalence of elevated total cholesterol, low HDL cholesterol, elevated LDL cholesterol, and elevated triglyceride concentrations. This study is registered with PROSPERO, number CRD42014015376.
Findings
177 studies (294063 participants) were included in the meta-analysis. The pooled prevalence of dyslipidaemia in the general population from population-based studies was 25·5% (95% CI 20·0– 31·4) for elevated concentrations of total cholesterol with a cutoff of at least 5·2 mmol/L, 37·4% (29·4–45·7) for low concentrations of HDL cholesterol with a cutoff of less than 1·0 mmol/L, 28·6% (15·8–43·5) for elevated concentrations of LDL cholesterol with a cutoff of at least 3·3 mmol/L, and 17·0% (11·9–22·7) for elevated concentrations of triglycerides with a cutoff of at least 1·7 mmol/L.
Interpretation
The prevalence of dyslipidaemia is high in the general adult population in Africa. Ongoing efforts to reduce cardiovascular diseases in Africa should integrate effective detection and treatment of dyslipidaemia.
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Hernández, Adrian V., Mirella Guarnizo, Yony Miranda, Vinay Pasupuleti, Abhishek Deshpande, Socorro Paico, Hosten Lenti, et al. "Association between Insulin Resistance and Breast Carcinoma: A Systematic Review and Meta-Analysis." Public Library of Science (PLoS), 2014. http://hdl.handle.net/10757/320267.
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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objective: This study was undertaken to evaluate the association between components defining insulin resistance and breast cancer in women. Study Design: We conducted a systematic review of four databases (PubMed-Medline, EMBASE, Web of Science, and Scopus) for observational studies evaluating components defining insulin resistance in women with and without breast cancer. A meta-analysis of the association between insulin resistance components and breast cancer was performed using random effects models. Results: Twenty-two studies (n = 33,405) were selected. Fasting insulin levels were not different between women with and without breast cancer (standardized mean difference, SMD 20.03, 95%CI 20.32 to 0.27; p = 0.9). Similarly, non-fasting/ fasting C-peptide levels were not different between the two groups (mean difference, MD 0.07, 20.21 to 0.34; p = 0.6). Using individual odds ratios (ORs) adjusted at least for age, there was no higher risk of breast cancer when upper quartiles were compared with the lowest quartile (Q1) of fasting insulin levels (OR Q2 vs. Q1 0.96, 0.71 to 1.28; OR Q3 vs. Q1 1.22, 0.91 to 1.64; OR Q4 vs. Q1 0.98, 0.70 to 1.38). Likewise, there were no differences for quartiles of non-fasting/fasting C-peptide levels (OR Q2 vs. Q1 1.12, 0.91 to 1.37; OR Q3 vs. Q1 1.20, 0.91 to 1.59; OR Q4 vs. Q1 1.40, 1.03 to 1.92). Homeostatic model assessment (HOMAIR) levels in breast cancer patients were significantly higher than in people without breast cancer (MD 0.22, 0.13 to 0.31, p, 0.00001). Conclusions: Higher levels of fasting insulin or non-fasting/fasting C-peptide are not associated with breast cancer in women. HOMA-IR levels are slightly higher in women with breast cancer.
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Deshpande, Abhishek, Vinay Pasupuleti, Priyaleela Thota, Chaitanya Pant, David D. K. Rolston, Adrian V. Hernandez, Curtis J. Donskey, and Thomas G. Fraser. "Risk factors for recurrent Clostridium difficile infection: a systematic review and meta-analysis." Cambridge University Press, 2015. http://hdl.handle.net/10757/608263.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.OBJECTIVE: An estimated 20-30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI. DESIGN: We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated. RESULTS: A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24-2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52-2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13-2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14-2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28-1.57; P<.00001). CONCLUSIONS: Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.
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Bernabe-Ortiz, Antonio, Andrea Ruiz-Alejos, J. Jaime Miranda, Rohini Mathur, Pablo Perel, and Liam Smeeth. "EZSCAN for undiagnosed type 2 diabetes mellitus: A systematic review and meta-analysis." Public Library of Science (PLoS), 2017. http://hdl.handle.net/10757/622426.
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Objectives: The EZSCAN is a non-invasive device that, by evaluating sweat gland function, may detect subjects with type 2 diabetes mellitus (T2DM). The aim of the study was to conduct a systematic review and meta-analysis including studies assessing the performance of the EZSCAN for detecting cases of undiagnosed T2DM. Methodology/Principal findings: We searched for observational studies including diagnostic accuracy and performance results assessing EZSCAN for detecting cases of undiagnosed T2DM. OVID (Medline, Embase, Global Health), CINAHL and SCOPUS databases, plus secondary resources, were searched until March 29, 2017. The following keywords were utilized for the systematic searching: type 2 diabetes mellitus, hyperglycemia, EZSCAN, SUDOSCAN, and sudomotor function. Two investigators extracted the information for meta-analysis and assessed the quality of the data using the Revised Version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist. Pooled estimates were obtained by fitting the logistic-normal random-effects model without covariates but random intercepts and using the Freeman-Tukey Arcsine Transformation to stabilize variances. Heterogeneity was also assessed using the I2 measure. Four studies (n = 7,720) were included, three of them used oral glucose tolerance test as the gold standard. Using Hierarchical Summary Receiver Operating Characteristic model, summary sensitivity was 72.0% (95%CI: 60.0%– 83.0%), whereas specificity was 56.0% (95%CI: 38.0%– 74.0%). Studies were very heterogeneous (I2 for sensitivity: 79.2% and for specificity: 99.1%) regarding the inclusion criteria and bias was present mainly due to participants selection. Conclusions: The sensitivity of EZSCAN for detecting cases of undiagnosed T2DM seems to be acceptable, but evidence of high heterogeneity and participant selection bias was detected in most of the studies included. More studies are needed to evaluate the performance of the EZSCAN for undiagnosed T2DM screening, especially at the population level.
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Riediger, Carina, Tibor Schuster, Kristian Barlinn, Sarah Maier, Jürgen Weitz, and Timo Siepmann. "Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-230668.
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Background: Antidepressants are widely used in the treatment of chronic pain. Applied doses are lower than those needed to unfold an antidepressive effect. While efficacy of antidepressants for chronic pain has been reported in large randomized-controlled trials (RCT), there is inconsistent data on adverse effects and tolerability. We aimed at synthesizing data from RCT to explore adverse effect profiles and tolerability of antidepressants for treatment of chronic pain.
Methods: Systematic literature research and meta-analyses were performed regarding side effects and safety of different antidepressants in the treatment of chronic pain according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Center for Biotechnology Information library and MEDLINE were searched. Randomized placebo-controlled trials were included in quantitative data synthesis. results: Out of 1,975 screened articles, 33 papers published between 1995 and 2015 were included in our review and 23 studies were included in the meta-analyses. A higher risk for adverse effects compared to placebo was observed in all antidepressants included in our analyses, except nortriptyline. The most prevalent adverse effects were dry mouth, dizziness, nausea, headache, and constipation. Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline showed the highest placebo effect-adjusted risk of adverse effects. Risk for withdrawal due to adverse effects was highest in desipramine (risk ratio: 4.09, 95%-confidence interval [1.31; 12.82]) followed by milnacipran, venlafaxine, and duloxetine. The most common adverse effects under treatment with antidepressants were dry mouth, dizziness, nausea, headache, and constipation followed by palpitations, sweating, and drowsiness. However, overall tolerability was high. Each antidepressant showed distinct risk profiles of adverse effects.
conclusion: Our synthesized data analysis confirmed overall tolerability of low-dose antidepressants for the treatment of chronic pain and revealed drug specific risk profiles. This encompassing characterization of adverse effect profiles might be useful in defining multimodal treatment regimens for chronic pain which also consider patients’ comorbidities and co-medication.
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Gentry, James. "Marijuana Use and the Risk of Depression: A Systematic Review and Meta‐Analysis." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/603629.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Objective: To conduct a systematic review of the evidence pertinent to the relationship between marijuana use and depression and perform a meta‐analysis on the data in order to inform evidenced‐based practice. The question of interest is: Is marijuana use associated with increased risk of developing depression? Methods: The databases MEDLINE (PubMed), The Cochrane Library, CINAHL (EBSCO), psycINFO, and Google Scholar were searched for the topics of marijuana use and depression through October of 2013. Studies were included if they were systematic reviews, randomized controlled trials, prospective or retrospective cohort studies, or case‐control studies. No randomized controlled trials were discovered. Quality of cohort and case‐control studies was evaluated using the Newcastle‐Ottawa Quality Assessment Scale 1. Overall quality of evidence was determined using the GRADE methodology 2,3. The Bradford‐Hill criteria 4 were used to assess for causation. Studies were assessed by two reviewers. 173 articles were screened for eligibility. Of these fourteen articles were considered to fit the inclusion criteria. Nine homogeneous studies were included in the meta‐analysis. Results: The quality of the evidence reviewed is low to very low. It does not meet Bradford‐Hill criteria for causation. There is a slight positive correlation between marijuana use and onset of depression. However, those studies included in the meta‐analysis demonstrated a low overall pooled odds ratio (OR = 1.17; 95% CI = 1.06—1.29). Conclusion: The evidence suggests a slight positive correlation between marijuana use and depression but is not sufficient to draw a conclusion. This evidence is generally of very low quality. It does not demonstrate a dose response, and is without a significant magnitude of effect.
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Alharbi, Ghaleb. "Evidence-based medicine in neuropathic pain : a systematic review, meta-analysis, sequential analysis and network meta-analysis of randomised controlled trials." Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/55427/.
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Background Many randomised controlled trials (RCTs) are available to support using different pharmacotherapy agents in the management of various neuropathic pain conditions. However, choosing these pharmacotherapy agents for neuropathic pain is challenging, due to the limited evidence-based knowledge to support the use of different pharmacotherapy agents in different neuropathic pain conditions. Aims The aim of this PhD is to evaluate the efficacy and safety of oral and topical pharmacotherapies for managing neuropathic pain by deriving placebo and active comparative efficacy and safety evidence from RCTs. Methods This research used three approaches to summarise and synthesise evidence from randomised controlled studies including: a systematic review of placebo and active control RCTs to summarise and criticise the current evidence in neuropathic pain; a meta-analysis and sequential analysis of eligible studies to provide a more precise estimate of the overall treatment effects; and a network meta-analysis to estimate the relative effectiveness of the most commonly used interventions in neuropathic pain. Results Systematic review Two hundred placebo and active-controlled trials met the inclusion criteria. A wide range of different treatments were studied in these trials, including anticonvulsants, antidepressants, opioids and topical capsaicin and lidocaine. Most of the included studies were parallel placebo-controlled trials and commonly lasted for 3 to 12 weeks. In addition, the vast majority of the included RCTs were conducted in participants with painful diabetic neuropathy and post-herpetic neuralgia, while only a few trials were conducted in participants with central neuropathic pain conditions. Pairwise meta-analysis Sixty seven trials were eligible for the pairwise meta analysis of efficacy outcomes. Of the anticonvulsants group pregabalin and gabapentin compared with placebo demonstrated efficacy for 50% and 30% pain reduction and global improvement in patients with neuropathic pain. The efficacy of anticonvulsants varied in different types of neuropathic pain. Gabapentin when compared against a placebo was better than a placebo in PHN and PDN, while pregabalin was significantly effective in patients with post-herpetic neuralgia (PHN) and painful diabetic neuropathy (PDN) but not in patients with HIV associated neuropathic pain. Others anticonvulsant agents, such as lamotrigine, valproic acid, topiramate, levetiracetam and oxcarbazepine, were tested in a small number of trials. These did not provide useful benefits compared with a placebo for a 50% and 30% pain reduction. Of the antidepressant group, duloxetine when compared to a placebo demonstrated efficacy for 50% and 30% pain reduction in diabetic neuropathic pain. A few active comparison trials failed to demonstrate superior efficacy of one drug over another for a 50% and 30% reduction in neuropathic pain. Trial sequential analysis To examine the reliability and conclusiveness of the available evidence, trialsequential analysis has been applied in this study. The results show convincing evidence of the efficacy of some interventions (e.g. pregabalin, gabapentin and duloxetine) to reduce pain by 50% in some neuropathic pain conditions (e.g. diabetic neuropathic pain and post-herpetic neuralgia). The continuation of RCTs of pregabalin and duloxetine in diabetic neuropathy and gabapentin in post-herpetic neuralgia is not necessary as there appears to be sufficient evidence of the efficacy of these treatments in the management diabetic neuropathic pain and post herpetic neuralgia. Further RCTs of duloxetine, pregabalin and gabapentin are however required for central neuropathic pain. In contrast, the analysis failed to provide evidence that opioids and high concentration capsaicin demonstrate a 50% pain reduction. Network meta-analysis Twenty-eight trials were eligible for the network meta-analysis. The results incorporating both direct-comparison and indirect-comparison evidence suggested that there is no superiority of duloxetine over amitriptyline, pregabalin and gabapentin in achieving at least a 30% and 50% pain reduction with a treatment duration of 7 to 12 weeks in patients with neuropathic pain conditions, such as diabetic neuropathic pain, postherpetic neuralgia and spinal cord injury. Conclusions In summary, this research has found that some good quality trials provide good evidence regarding the efficacy of duloxetine, pregabalin and gabapentin in a minority of patients with neuropathic pain. Until advancements in developing mechanism-based approaches and improved clinical trial design become available, the routine use of these medications is unlikely to be changed. This may support the hypothesis that traditional RCTs might not be a suitable method of choice to address provisional health questions in routine clinical practice.
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Ulloque-Badaracco, Juan R., Salas-Tello W. Ivan, Ali Al-kassab-Córdova, Esteban A. Alarcón-Braga, Vicente A. Benites-Zapata, Jorge L. Maguiña, and Adrian V. Hernandez. "Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 patients: A systematic review and meta-analysis." John Wiley and Sons Inc, 2021. http://hdl.handle.net/10757/657334.
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Background: Neutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19. Objective: To evaluate the prognostic value of the NLR in patients diagnosed with COVID-19. Methods: We conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (ie, at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (ORs) and their 95% confidence intervals (CIs). Small study effects were assessed with the Egger's test. Results: We analysed 61 studies (n = 15 522 patients), 58 cohorts, and 3 case-control studies. An increase of one unit of NLR was associated with higher odds of severity (OR 6.22; 95%CI 4.93 to 7.84; P <.001) and higher odds of all-cause mortality (OR 12.6; 95%CI 6.88 to 23.06; P <.001). In our sensitivity analysis, we found that 41 studies with low risk of bias and moderate heterogeneity (I2 = 53% and 58%) maintained strong association between NLR values and both outcomes (severity: OR 5.36; 95% CI 4.45 to 6.45; P <.001; mortality: OR 10.42 95% CI 7.73 to 14.06; P =.005). Conclusions: Higher values of NLR were associated with severity and all-cause mortality in hospitalised COVID-19 patients.Revisión por pares
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Baroy, Justin, Danny Chung, Ryan Frisch, David Apgar, and Marion Slack. "The Impact of Community and Hospital Pharmacists on Adult Immunization Rates: A Systematic Review and Meta-analysis." The University of Arizona, 2015. http://hdl.handle.net/10150/614101.
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Class of 2015 AbstractObjectives: To establish the impact pharmacists can have on adult immunization rates by having pharmacists available to provide, administer, and advocate for immunizations. Methods: The following databases were searched from inception to November 2014: NLM PubMed; Ovid/MEDLINE; and Google Scholar. Inclusion criteria were comparative studies reporting pharmacist intervention and their impact on immunization rates. Of 38 publications originally identified, 15 met inclusion criteria. Variables examined included study characteristics, pharmacist intervention, and immunization rates. Results: Of the 15 studies we identified, only ten studies could be analyzed in the meta-analysis. All studies showed increases in immunization rates with pharmacist involvement, but there was high variance. Pharmacist interventions at hospital sites had the greatest benefit for increasing immunization rates (average odds ratio [OR], 10.64, confidence interval [CI] 95%, 5.25-21.49). Pharmacist intervention at one or two community sites had the second highest impact (OR, 2.81; CI 95%, 2.31-3.41). Studies covering multiple sites (more than two) showed the lowest increase in immunization rates (OR 2.26; CI 95%, 1.81-2.81). Conclusions: Pharmacist’s involvement in advocating and administering immunizations directly increases immunization rates in some patient populations. The greatest increases in immunization rates can be seen when pharmacists advocate for immunizations in the hospital setting.
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Elliott, Jesse. "Benefits and Harms of Testosterone Replacement Therapy in Hypogonadal Men: A Systematic Review and Network Meta-analysis." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/34092.
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Testosterone products comprise a multi-billion dollar industry; however, Health Canada and the United States Food and Drug Administration have issued statements of concern about their safety, and their benefits are unclear. In the first phase of this study, we performed a systematic review of the current evidence for the benefits of testosterone replacement therapy. In the second phase, we analyzed the evidence from randomized controlled trials for the benefits of testosterone replacement therapy (depression, quality of life, erectile function, libido, total testosterone level). In the third phase, we analyzed data for harms (cardiovascular death, myocardial infarction, stroke, newly diagnosed prostate cancer, coronary artery disease or diabetes, serious adverse events, withdrawals due to adverse events, erythrocytosis) from randomized controlled trials and non-randomized studies. In general, most included studies had a short duration and were poorly reported. Additional high-quality research into the long-term safety of testosterone products is needed.
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Osanai, Toshiya, Vinay Pasupuleti, Abhishek Deshpande, Priyaleela Thota, Yuani Roman, Adrian V. Hernández, and Ken Uchino. "Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." The Public Library of Science (PLOS), 2015. http://hdl.handle.net/10757/552402.
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uchinok@ccf.orgBackground Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.
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Moraes, Mariana Bordinhon de. "Intervenções nutricionais para o tratamento da síndrome de fragilidade em idosos revisão sistemática e metanálise /." Botucatu, 2019. http://hdl.handle.net/11449/191569.
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Orientador: Edison Iglesias de Oliveira VidalResumo: A síndrome de fragilidade é definida como uma síndrome clínica de origem multicausal caracterizada por redução de reservas fisiológicas que aumentam a vulnerabilidade de um indivíduo a desfechos adversos como quedas, hospitalização, desenvolvimento de dependência funcional e morte. Acredita-se que a síndrome da fragilidade pode ser potencialmente modificável ou reversível mediante intervenções apropriadas. Esta é a primeira revisão sistemática com metanálise de ensaios clínicos randomizados para avaliar a eficácia de intervenções nutricionais para o tratamento da síndrome da fragilidade em idosos. Foram incluídos 11 ensaios clínicos randomizados com idosos de 60 anos ou mais com diagnóstico de síndrome da fragilidade ou pré-fragilidade. Metanálises bayesianas de efeitos randômicos não revelaram diferenças estatisticamente significativas ao comparar a suplementação nutricional isolada com grupos controle que receberam placebo ou nenhum tratamento em relação ao escore de síndrome da fragilidade (MD: 0,09 pontos, IC 95%: -0,45 a 0,62), Bateria de Desempenho Físico Breve (SMD: 0,29, IC 95%: -0,55 a 1,40), força muscular (SMD: -0,14, IC 95%: -0,38 a 0,09), velocidade da marcha (SMD: 0,06, IC 95%: -0,04 a 0,17), massa magra apendicular (MD: 0,60kg, IC 95%: -0,82 a 2,01), massa gorda (MD: 1,67kg, IC 95%: -0,63 a 3,96), memória declarativa (SMD: 0,11, IC 95%: -0,31 a 0,53), linguagem e função executiva (MD: 0,21 pontos, IC 95%: -0,99 a 1,42) e outros resultados. Estudo único de inter... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Frailty is a clinical syndrome of multicausal origin characterized by a reduction of physiological reserves that increase the vulnerability of an individual to adverse outcomes such as falls, hospital admission, disability and death. It has been suggested that frailty can be potentially modifiable or even reversible with appropriate interventions. This is the first systematic review with meta-analysis or Randomized Clinical Trials (RCTs) to appraise the effectiveness of nutritional interventions for the treatment of frailty in older adults. We included 11 RCTs of people aged 60 years and older with a diagnosis of frailty or pre-frailty. Bayesian random effects meta-analyses found no statistically significant differences when comparing nutritional supplementation alone with control groups receiving placebo or no treatment regarding frailty score (MD: 0.09 points, 95%CI: -0.45 to 0.62), Short Physical Performance Battery (SMD: 0.29, 95%CI: -0.55 to 1.40), muscle strength (SMD: -0.14, 95%CI: -0.38 to 0.09), gait speed (SMD: 0.06, 95%CI: -0.04 to 0.17), appendicular lean mass (MD: 0.60kg, 95%CI: -0.82 to 2.01), fat mass (MD: 1.67kg, 95%CI: -0.63 to 3.96), declarative memory (SMD: 0.11, 95%CI: -0.31 to 0.53), language & executive function (MD: 0.21 points, 95%CI: -0.99 to 1.42) and other outcomes. Single study of nutritional education interventions also did not show any significant improvements in comparison with general health advice. The overall quality of evidence assessed usin... (Complete abstract click electronic access below)
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Fernandez, Shirley Steffany Muñoz. "Nutritional strategies in the management of Alzheimer\'s disease: systematic review and meta-analysis." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/89/89131/tde-19102016-165329/.
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Alzheimer\'s disease (AD) is one of the main causes of dependency and disability in the elderly population. A number of investigations have been seeking its prevention and/or management. In this context, it is important to highlight the role of modifiable risk factors, such as nutrition. This study aims to conduct a systematic review and subsequent meta-analysis, to assess the effect of food and/or nutrients for the management of AD at different stages. This work was steered based on the Cochrane Handbook for systematic reviews of interventions and the PRISMA Statement. Electronic databases were searched up to 2014, in Portuguese, English or Spanish. Relevant publications were identified by title and abstract using key search terms referring to Alzheimer\'s disease, nutrition interventions and type of study. Trials\' risk of bias was appraised by applying the Cochrane\'s tool for assessing risk of bias. The main outcome measures comprise neuropsychological tests such as MMSE, ADCS-ADL, NPI and CDR-sob, biomarkers and brain imaging. Pairwise meta-analyses were performed in a random-effect model by estimating the weighted mean differences between treatment and placebo groups, with 95% confidence intervals for outcome measures by treatment. Network meta-analysis and the ranking probability of treatment for each nutrition intervention were undertaken on cognitive outcome. The strength and quality of evidence were rated according to the GRADE approach. From the whole research, 182 studies met the systematic review\'s purpose. Thirty-five clinical trials complied with eligibility criteria and risk of bias assessment. Included studies utilized: antioxidants, B-vitamin complex, carbohydrates, lipids, omega-3 fatty acids, polymeric formulas, polypeptide and vitamin D. Estimates treatment effects from pairwise meta-analyses show a significant positive effect from the supplementation with proline-rich polypeptide (WMD 12.00 [95% CI 10.20, 13.80] P < 0.00001) and B-vitamin complex (WMD 0.44 [95% CI 0.09, 0.79] P = 0.01) on cognitive function measured by the MMSE. Remaining nutrients supplementation did not show any significant effect on functional, behavioral, global performance, biomarkers or brain imaging outcomes. Isolated nutrient supplementations show no convincing evidence of providing a significant benefit on clinical manifestations or neuropathology of AD. As a treatment strategy, nutrients did not show any effect when delivered individually, probably due to their synergistic work on brain function at different domains. Nevertheless, nutrients represent a potential preventive approach and an adjuvant treatment for patients with AD at earlier stages.A doença de Alzheimer (DA) é uma das maiores causas de dependência e incapacidade na população idosa, o que tem levado a inúmeras investigações sobre sua prevenção e ou manejo. Neste contexto, é importante destacar o papel desempenhado pelos fatores de risco modificáveis, como a nutrição. Este estudo trata de uma revisão sistemática e meta-análise, para avaliar o efeito das intervenções nutricionais no manejo da DA, em seus diferentes estágios. Este trabalho segue as propostas da Colaboração Cochrane e a declaração PRISMA. Bases de dados eletrônicas foram pesquisadas a partir do seu início até o 2014, em Português, Inglês ou Espanhol. Estudos relevantes foram identificados por título e resumo usando as palavras-chave referente à doença de Alzheimer, intervenções nutricionais e tipo de estudo. A qualidade dos estudos foi avaliada mediante a ferramenta da Cochrane para avaliação do risco de viés. As principais medidas de desfechos compreenderam os testes neuropsicológicos MEEM, AVD, NPI e CDR-sob, biomarcadores e neuroimagem. As meta-análises em pares foram realizadas em modelo de efeito aleatório pela estimativa de diferença de médias ponderadas entre os grupos de tratamento e placebo, com 95% de intervalo de confiança para as medidas de desfecho segundo a intervenção. A meta-análise em rede e a probabilidade da posição do tratamento para cada intervenção nutricional foi realizada para o desfecho cognitivo. A força e a qualidade da evidência foram avaliadas de acordo com o método GRADE. Da busca total inicial, 182 estudos cumpriam com o propósito desta revisão sistemática. Ainda, 35 ensaios clínicos preencheram os critérios de elegibilidade e avaliação de risco de viés. Os estudos incluídos usaram: antioxidantes, vitaminas do complexo B, carboidratos, lipídeos, ácidos graxos ômega-3, formula poliméricas, polipeptídios e vitamina D. As estimativas de efeito do tratamento das meta-análises em pares mostraram um efeito positivo significativo a partir da suplementação com um polipeptídio rico em prolina (MD 12.00 [95% IC 10.20, 13.80] P < 0.00001) e com as vitaminas do complexo B (MD 0.44 [95% IC 0.09, 0.79] P = 0.01) na função cognitiva avaliada pelo MEEM. A suplementação com os demais nutrientes não mostrou um efeito significativo na funcionalidade, comportamento, desempenho global, biomarcadores da DA, nem desfechos de imagem. A suplementação com nutrientes isolados não mostrou um efeito significativo nas manifestações clínicas ou neuropatologicas da DA. Como estratégia de tratamento, os nutrientes não demonstraram um efeito separadamente, provavelmente devido a seu trabalho sinérgico nos diferentes domínios da função cerebral. Ainda assim, os nutrientes representam uma abordagem preventiva potencial e um tratamento adjuvante nas pessoas com DA nos estágios iniciais.
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Zheng, Carine. "Efficacy and Safety of Bisphosphonates for Postmenopausal Women: A Systematic Review and Network Meta-analysis." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/38849.
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Fragility fractures caused by loss of bone mass due to postmenopausal osteoporosis represent a growing morbidity worldwide. Bisphosphonates are first-line medications for fracture treatment and prevention. In the first phase, we updated a Cochrane systematic review of randomized controlled trials on alendronate, assessing its efficacy for five types of fracture prevention, quality of life, and various safety outcomes. In the second phase, we combined indirect and direct evidence to perform a network meta-analysis including alendronate and nine other bisphosphonates evaluating the comparative efficacy and safety of these treatments. Overall, 58 studies were included in the review and 83 studies in the network. Most evidence was of moderate to high quality. Alendronate and zoledronic acid were effective for preventing the most types of fractures, while off-label and unapproved bisphosphonates showed poor efficacy. More evidence is required to evaluate long-term treatment and rare adverse events.
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Tejada, Romina A., Kris G. Vargas, Vicente A. Benítes-Zapata, Edward Mezones-Holguín, Rafael Bolaños-Díaz, and Adrian V. Hernandez. "Human papillomavirus vaccine efficacy in the prevention of anogenital warts: systematic review and meta-analysis." Instituto Nacional de Salud Pública, 2017. http://hdl.handle.net/10757/622240.
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Objective: To review evidence on the efficacy of HPV vaccines in the prevention of non-cancer lesions (anogenital warts [AGW], recurrent laryngeal papillomatosis and oral papillomatosis). Materials and methods: We conducted a systematic review of randomized trials. We performed random effect models and effects were reported as relative risks (RR) and their confidence intervals (95%CI) following both intention to treat (ITT) and per protocol (PP) analyses. Results: We included six studies (n=27 078). One study was rated as high risk of bias. One study could not be included in the meta-analysis because it provided combined results. We found that quadrivalent vaccine reduced the risk of AGW by 62% (RR: 0.38, 95%CI:0.32-0.45, I2:0%) in the ITT analysis and by 95% (RR: 0.05, 95%CI:0.01-0.25, I2:66%) in the PP analysis. Subgroup analyses of studies in women or with low-risk of bias provided similar results. Conclusion: HPV quadrivalent vaccine is efficacious in preventing AGW in men and women.HPV quadrivalent vaccine is efficacious in preventing AGW in men and women.
Revisión por pares
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Fukushige, Mizuho. "Systematic review and meta-analysis of the effects of treatment and immunization against schistosomiasis." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22928.
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Schistosomiasis is a water-borne parasitic disease of great public health importance mainly in sub-Saharan African countries. The majority of current control programmes use the antihelminthic drug praziquantel to reduce disease burden in endemic areas. Praziquantel treatment has been reported to accelerate the development of protective immunity against re-infection that otherwise takes years to develop. To date, there is no licensed vaccine for schistosomiasis in humans but an attenuated schistosome parasite vaccine has been tested in animal models. Employing systematic review and meta-analysis approaches, my PhD research has four main objectives relating to attenuated schistosome vaccine and praziquantel treatment: 1) to identify predictors that determine protection levels after treatment with attenuated Schistosoma mansoni vaccines in the mouse model, 2) to quantify the influence of host and schistosome parasite species on attenuated parasite vaccine efficacy, 3) to explore the direction of change (increase/decrease) in schistosome parasite-specific antibody isotypes after praziquantel treatment in humans, 4) to identify predictors of praziquantel efficacy in humans. My analyses revealed three factors that have an influence on the protection levels provided by attenuated schistosome parasite vaccines: increasing numbers of immunizing parasites had a positive effect on the levels of protection whereas increasing the radiation dose and the time to challenge infection had negative effects. Analyses showed that the attenuated schistosome vaccine has the potential to achieve protection levels as high as 79% after a single dose in mice. Alongside this, baboon studies consistently reported protective effects of attenuated schistosome vaccines against re-infection. These results show there is a high potential for an attenuated schistosome parasite vaccine to be effective in humans. A meta-analysis of the influence of praziquantel treatment on the direction of change in schistosome-specific antibody isotypes was conducted. The analysis revealed considerable variability in the antibodies’ direction of change among populations. The results also demonstrated an increase of anti-worm IgA and IgE in the majority of studies. These antibodies have been reported to have a protective effect against re-infection. The combination of age and infection intensity, and the number of days after treatment were identified as influential predictors for some antibody isotypes, but there was no single predictor that consistently affected all antibody isotypes in the same way. Praziquantel efficacy levels in humans were investigated and the analyses revealed that cure rates for schistosomiasis increase with praziquantel dose, and were affected by the identity of the schistosome parasite species (S. mansoni vs. S. haematobium) and the age of the participants (children: 0-19 years old vs. adults: ≥ 20 years old). There has been no clear efficacy level reduction over the treatment years (1979-2013) suggesting that praziquantel is still effective in the treatment of schistosomiasis despite concerns about possible resistance. The development of a schistosome vaccine will benefit from a closer investigation into the mechanisms through which protection is acquired in attenuated schistosome parasite vaccine studies showing high potential efficacy in animal models. Nevertheless, it will take time to develop a schistosome vaccine for human use. The uptake of the vaccine will be made even more challenging by the lack of adequate infrastructure in schistosomiasis endemic areas. In the meantime, close monitoring of praziquantel efficacy levels is necessary to confirm the effectiveness of schistosomiasis control in endemic areas.
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Vögele, Simona. "Preventing ventilator-associated pneumonia: what is the evidence? A systematic review and meta-analysis." Diss., lmu, 2010. http://nbn-resolving.de/urn:nbn:de:bvb:19-122831.
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Reda, Sophie Franziska [Verfasser]. "Inequality in utilization of dental services: Systematic Review and meta-analysis / Sophie Franziska Reda." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2018. http://d-nb.info/1176638300/34.
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Pimenta, Miguel Noruegas de Jesus. "Partial extraction therapies: systematic review and meta-analysis." Master's thesis, 2019. http://hdl.handle.net/10316/90024.
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Trabalho Final do Mestrado Integrado em Medicina Dentária apresentado à Faculdade de MedicinaIntrodução: Após a extração dentária desencadeiam-se mecanismos fisiológicos multifatoriais que conduzem a reabsorção óssea e remodelação alveolar. Em zonas anteriores estas alterações tridimensionais do rebordo alveolar interferem frequentemente com o resultado estética das reabilitações implanto-suportadas. Existem diversas técnicas desenvolvidas para minimizar as alterações tecidulares pós-extração e compensar as alterações dimensionais, apesar de nenhuma técnica cirúrgica ou nenhum material previna completamente essas alterações. As terapias de extração parcial foram recentemente desenvolvidas com o objetivo de prevenir a reabsorção da tábua óssea vestibular.Objetivo: Este trabalho pretende fazer uma revisão sistemática e meta-análise para a avaliação da perda de osso em implantes colocados em alvéolos sujeitos às técnicas de extração parcial.Materiais e Métodos: Realizou-se uma pesquisa bibliográfica na PubMed/MEDLINE e na Cochrane Library com a seguinte chave de pesquisa: ("socket-shield" OR "root membrane") AND (implant OR dental OR ridge OR esthetics), usando como filtros publicações em inglês ou português até ao Maio de 2019. Não foram feitas restrições sobre o tipo de publicação. Foi realizada uma análise estatística utilizando o pacote “Metafor”.Resultados: Obteve-se um total de 49 artigos dos quais foram selecionados 8 para leitura integral, após exclusão dos duplicados e leitura do título e resumo. Desses artigos, sete foram incluídos para esta revisão sistemática. Os estudos incluíram um total de 431 pacientes e 511 implantes colocados de acordo com as técnicas de extração parcial. A meta-análise mostrou uma perda de osso de 0,29 mm; 95% CI: 0,05 a 0,52 mm.Conclusão: Dentro das limitações desta revisão, pode ser concluído que as terapias de extração parcial em conjunto com a colocação de implantes imediatos podem prevenir eficazmente a perda de osso marginal e consequentemente, manter a estética dos tecidos moles.
Introduction: After tooth extraction, multifactorial and physiological mechanisms leading to bone resorption and alveolar remodelling are triggered. In anterior zones, these three-dimensional alterations of the alveolar ridge frequently interfere with the aesthetic result of implant-supported rehabilitations. There are several techniques developed to minimize post-extraction tissue changes and compensate for dimensional changes, although no surgical technique or material completely prevents these changes. Partial extraction therapies have recently been developed with the aim to prevent reabsorption of the buccal bone plate.Objective: This systematic review and meta-analysis aimed to evaluate the bone loss in implants placed according to partial extraction therapies.Materials and Methods: A literature search was performed in PubMed / MEDLINE and Cochrane with the following search: (socket-shield OR "root membrane") AND (implant OR dental OR ridge OR esthetics), using as filters publications in English or Portuguese until May 2019. No filters were used regarding the type of publication. Statistical analysis was performed using the "Metafor" package.Results: A total of 49 articles were selected from which 8 were selected for full reading, after the exclusion of duplicates and reading of the title and abstract. Of these articles, seven were included in the systematic review. The studies included 431 patients and 511 implants placed according to partial extraction techniques. This meta-analysis showed a bone loss of 0.29 mm; 95% CI: 0.05 to 0.52 mm.Conclusion: Within the limitations of this review, it may be concluded that partial extraction therapies with immediate implant placement can effectively prevent marginal bone loss and, consequently, maintain soft tissue aesthetics
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Dores, Soraia Raquel Castro. "Osseointegration of zirconia implants: systematic review and meta-analysis." Master's thesis, 2018. http://hdl.handle.net/10316/81795.
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Trabalho Final do Mestrado Integrado em Medicina Dentária apresentado à Faculdade de MedicinaIntrodução: A osteointegração é um dos factores preponderantes no sucesso da reabilitação com implantes. A osteointegração dos implantes de titânio é considerada a referência da implantologia; contudo, algumas desvantagens dos mesmos como a potencial presença de reacções alérgicas ou a sua cor escura que pode comprometer a estética quando existam condições desfavoráveis da mucosa, levaram ao desenvolvimento de alternativas. A zircónia, uma estrutura bionerte bem estudada que deriva do metal Zircónio, tem sido usada amplamente na Medicina e na Medicina Dentária. Os implantes em zircónia podem constituir essa alternativa devido à sua estética, bicompatibilidade e elevada resistência à fractura. Objectivo: Este trabalho pretende fazer uma revisão sistemática e meta-análise para avaliação das taxas de sobrevivência e sucesso dos implantes de zircónia, em humanos. Metodologia: Foi definida uma questão PICO "Em pacientes submetidos à substituição dentária com um implante unitário de zircónia, as taxas de sobrevivência podem-se comparar com a dos implantes unitários de titânio?", seguida de uma pesquisa nas bases de dados primárias da PubMed/MEDLINE, Cochrane e Embase com as seguintes palavras-chave: "dental implantation, osseointegrated", "implantation, osseointegrated dental", "osseointegrated dental implantation", "osseointegration", "zirconium", "titanium", "dental implants", "dental implants, single tooth", "single tooth dental implants", "dental implantation, endosseous"; com os conectores boleanos "AND" e "OR". Sempre que possível foram utilizados os termos MeSH. Os critérios de pesquisa não incluíram um limite cronológico nem foram feitas restrições quanto à língua ou tipo de publicação. Resultados: Obtiveram-se um total de 1465 artigos dos quais foram seleccionados 71 para leitura integral, após exclusão dos duplicados e leitura do título e abstract. Desses artigos, nove foram incluídos para esta revisão sistemática. Os parâmetros avaliados foram a taxa de sobrevivência, a taxa de sucesso e o nível ósseo marginal e foram extraídos ainda outros que permitiram enriquecer a revisão. Discussão: Recentemente, a opção por implantes de zircónia aumentou exponencialmente devido às características oferecidas pelo material. Relativamente aos parâmetros, as taxas de sobrevivência e sucesso, assim como o nível óseo marginal, tradução de uma osteointegração efectiva, apresentam valores muito semelhantes à dos implantes de titânio. Conclusão: Considerando os limites desta revisão, é possível concluir que os implantes de zircónia podem constituir uma opção segura e viável, e uma alternativa aos implantes de titânio. Contudo, são necessários mais ensaios clínicos randomizados multicêntricos com qualidade e validade científica, apresentando um seguimento maior, para provar com exactidão o sucesso destes implantes.
Introduction: Osseointegration is one of the most primordial factors in implant rehabilitation. Although osseointegration of titanium implants is considered a reference of implantology some disadvantages of them as the potential presence of allergic reactions or the dark color that may compromise aesthetics when there is an unfavorable mucosa, have led to the development of alternatives. Zirconia, a well studied bioinert structure derived from the Zirconium metal, has been used in medicine and dentistry. Zirconia implants may be an alternative due to the aesthetics, biocompatibility and high fracture resistance. Objective: This systematic review and meta-analysis aimed to evaluate the survival and success rates of zirconia implants in humans. Methodology: A PICO question was defined "In patients subjected to tooth replacement with single unit zirconia implant does the survival rates do compare to single unit titanium implant?", followed by a search in primary databases PubMed / MEDLINE, Cochrane and Embase with the following keywords: "dental implantation, osseointegrated", "implantation, osseointegrated dental", "osseointegrated dental implantation", "osseointegration", "zirconium", "titanium", "dental implants", "dental implants, single tooth", "single tooth dental implants", "dental implantation, endosseous"; using the appropriate boolean operators, "OR" and "AND". Wherever possible the MeSH terms were used. The search criteria did not include a time limit or restrictions on the language or type of publication. Results: A total of 1465 articles were obtained from which 71 were selected for full text reading, after exclusion of the duplicates and reading the title and abstract. Of these articles, nine were included on this systematic review. The outcomes evaluated were the survival rate, the success rate and the Marginal Bone Level; others parameters were extracted to complement the review. Discussion: Recently, the option for zirconia implants has increased exponentially due to the inherent characteristics of the material. Regarding the parameters, survival and success rates as well as the Marginal Bone Level, translation of an effective osseointegration, present values very similar to that of titanium implants. Conclusion: Considering the limits of this systematic review, it is possible to conclude that zirconia implants can be a safe and viable option, and an alternative to titanium implants in single unit implant-supported restorations. However, more multicentre randomized clinical trials with scientific quality and validity, with a larger follow-up, are needed to accurately prove the success of these implants.
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Brito, Maria Teresa Alvares Pereira. "Hyperthyroidism and fracture risk - systematic review and meta-analysis." Dissertação, 2017. https://hdl.handle.net/10216/105016.
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Brito, Maria Teresa Alvares Pereira. "Hyperthyroidism and fracture risk - systematic review and meta-analysis." Master's thesis, 2017. https://hdl.handle.net/10216/105016.
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Gustafsson, Jenny. "Glucometabolic effects of antihypertensive drugs: systematic review and meta-analysis." Thesis, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-216494.
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