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PubMed2000

Tardive dyskinesia associated with higher mortality in psychiatric patients: results of a meta-analysis of seven independent studies.

This article reports a meta-analysis of seven independent studies on the association of tardive dyskinesia with all-cause mortality in psychiatric patients. Most of the studies included provide either small sample sizes or follow-up periods too short to reach a substantive conclusion on their own. In the meta-analysis, the overall odds ratio (OR) was significant when calculated either by the fixed-effects model (OR = 1.4, 95% confidence interval [CI] = 1.2-1.7, p < 0.005) or the random-effects model (OR = 1.4, 95% CI = 1.1-1.8, p < 0.005). There was no overall heterogeneity (Q test = 8.1, df = 7,p = 0.32). The overall estimate changed within study designs (OR = 1.4,p = 0.002 in three prospective controlled studies; OR = 2.2, p = 0.02 in two prospective uncontrolled studies; and OR = 0.9, p = 0.80 in two retrospective controlled studies). It was modified upward when the two most influential studies (one prospective and one retrospective) were removed from the overview (OR = 2.2, 95% CI = 1.4-3.5,p = 0.001; Q test = 0.81, df = 4,p = 0.94). The conclusion of the meta-analysis was that tardive dyskinesia must be considered a weak risk factor in terms of mortality. It remains to be elucidated whether it is a risk factor on its own or just a surrogate for any unknown organic liability.

Antipsychotic Agents↗

PubMed1995

Occupational electric and magnetic field exposure and brain cancer: a meta-analysis.

We conducted a meta-analysis to acquire an understanding of the association between central nervous system cancer and occupational exposure to electric and magnetic fields. To explore sources of heterogeneity, study characteristics were scored and examined using regression analysis. An inverse-variance weighted pooling leads to a small overall increase in relative risk (10 to 20%) for the broad group of electrical occupations. One of the largest differences was lower relative risk for Scandinavian studies. Lower relative risks were also reported in cohort- and incidence-based studies. Findings were not sensitive to assumptions, including unpublished data, influence of individual studies, weighting schemes, and modeling. Whereas most studies present a small elevation in risk, there is considerable heterogeneity among the results.

Brain Neoplasms↗

PubMed1995

The impact of data-analysis methods on cumulative research knowledge: statistical significance testing, confidence intervals, and meta-analysis.

The methods of data analysis used in research have a major effect on the development of cumulative knowledge. Traditional methods based on statistical significance testing have systematically retarded the growth of cumulative research by making it virtually impossible to discern the real meaning of research literatures. Meta-analysis makes it possible to demonstrate graphically the high price the research enterprise has paid for its reliance on significance testing. But in addition to these demonstrations, reform will require that researchers come to understand that the benefits they see as flowing from the use of significance tests are illusory. In research practice and in training of researchers, we must use and teach appropriate data analysis methods: point estimates of effect sizes and confidence intervals within individual studies, and meta-analysis in the integration of multiple studies to produce final conclusions. These reforms are essential to the progress of cumulative research knowledge.

Analysis of Variance↗

PubMed1992

Distal spleno-renal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding. A meta-analysis of 4 randomized clinical trials.

Meta-analysis was used to evaluate 4 clinical trials comparing distal spleno-renal shunt (DSRS) with endoscopic sclerotherapy (EVS) in the prevention of variceal rebleeding: the interval between bleeding and therapy ranges from < 14 days to > 100 days. A questionnaire was sent to each author of the published trials concerning methods, definitions and results of the trials in order to obtain more detailed and up-to-date information. The selected end-points for the meta-analysis were: rebleeding, mortality and chronic encephalopathy. Analysis of the results in the questionnaires was made using the method proposed by Collins. The pooled relative risk (i.e. the combined Odds ratio of each trial as an estimate of overall efficacy) of rebleeding was statistically reduced by DSRS (0.16; 95% confidence interval 0.10-0.27). Despite this, the overall risk of death following DSRS was only marginally decreased (0.78; 95% confidence interval 0.47-1.29); the lack of homogeneity in the results does not permit any significant conclusions on this end-point. However, in non-alcoholic patients, the decrease in risk of death was greater, and this without heterogeneity, following DSRS than EVS (0.59; 95% confidence interval 0.23-1.50). The overall risk of chronic encephalopathy was slightly increased after DSRS (1.86; 95% confidence interval 0.90-3.86). In conclusion, DSRS significantly reduced the risk of rebleeding compared to EVS without increasing the risk of chronic hepatic encephalopathy. However, DSRS did not significantly affect the overall death risk. Only in non-alcoholic disease did it seem to show an advantage over EVS.

Brain Diseases↗

PubMed2006

C677T and A1298C methylenetetrahydrofolate reductase gene polymorphisms in schizophrenia, bipolar disorder and depression: a meta-analysis of genetic association studies.

A meta-analysis of the previous studies of allelic association between schizophrenia, bipolar disorder and depression with the C677T and A1298C polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene was carried out. Attention was paid to genetic differences in ancestral groups. Ten studies of the C677T MTHFR polymorphism and schizophrenia were included, along with four studies with the A1298C MTHFR polymorphism and schizophrenia. Four association studies of the C677T MTHFR polymorphism with bipolar disorder, and five studies of the C677T base pair change with depression were included. The studies contained Caucasian and east Asian samples. For schizophrenia, the main analysis for investigating the association of the C677T allele T and the risk of developing schizophrenia relative to the allele C showed lack of heterogeneity (P = 0.22, I(2) = 24%) between samples. In these samples, the fixed effects odds ratio was marginally significant [odds ratio 1.13 (95% confidence interval, 1.04-1.23)]. In an analysis of subgroups, the odds ratio were not significant for the Caucasian sample [random effects odds ratio 1.14 (0.95-1.36) and fixed effects odds ratio 1.13 (1.00-1.27)](P = 0.14, I(2) = 43%) and in Asians [random effects odds ratio 1.15 (0.98-1.35) and fixed effects odds ratio 1.15 (1.01-1.31)] (P = 0.19, I(2) = 37). The recessive model for allele T produced significant results in the main analysis [fixed effects odds ratio 1.32 (1.12-1.56)] in east Asians [fixed effects odds ratio 1.45 (1.13-1.85)] and female participants [fixed effects odds ratio 1.70 (1.07-2.71)], whereas for Caucasians the results were nonsignificant. For the A1298C polymorphism, in the main analysis the allele frequency difference between C and A, and the dominant model for allele C produced marginally significant associations [fixed effects odds ratio 1.16 (1.03-1.31) and fixed effects odds ratio 1.19 (1.02-1.40), respectively]. In bipolar disorder, overall, there was no significant association between either allele of the C677T polymorphism and the risk of developing bipolar disorder. Only in the east Asian population was the C677T association of marginal significance, with fixed effects odds ratio 1.23 (1.00-1.52). No sources of potential bias were found in the selected studies. The meta-analysis results suggested that east Asians have a greater genetic risk from the MTHFR gene in developing schizophrenia and depression, and that the genetic effects in bipolar disorder and depression are different. A further exploration of the involvement of the MTHFR gene in the susceptibility to schizophrenia and affective disorders, with a greater number of studies with larger sample sizes, however, are needed to fully establish the role of the MTHFR gene.

Bipolar Disorder↗

PubMed2001

Meta-analysis comparing newer antipsychotic drugs for the treatment of schizophrenia: evaluating the indirect approach.

BACKGROUND: Meta-analysis is a useful method to assess the efficacy of newer antipsychotic drugs compared with older drugs or placebo. However, few trials directly compare novel drugs to each other. OBJECTIVE: The purpose of this study was to evaluate the method of indirect meta-analysis by applying it to data on olanzapine versus haloperidol and risperidone versus haloperidol to enable a comparison between olanzapine and risperidone. METHODS: Published randomized controlled trials (RCTs) of risperidone, olanzapine, and/or haloperidol were identified through literature searches (1983 to 1999) of the MEDLINE, Current Contents, and HealthSTAR databases and reviewed. Data for the Brief Psychiatric Rating Scale (BPRS) total score, the Positive and Negative Syndrome Scale (PANSS) negative subscale, the percentage of patients using anticholinergic drugs, and the percentage of patients dropping out due to lack of efficacy, side effects, or any cause were extracted and combined using the indirect method. These findings were compared with those from a direct comparative study of olanzapine and risperidone. RESULTS: The literature search yielded 8 RCTs comparing risperidone to haloperidol and 3 comparing olanzapine to haloperidol. Only 1 trial directly comparing olanzapine and risperidone was found. In this trial, the change in BPRS total and PANSS negative subscale scores tended to be higher with olanzapine by 1.80 and 1.10, respectively, but these differences were not statistically significant. Indirect meta-analysis yielded similar results. Changes in both BPRS total scores and PANSS negative subscale scores tended to be higher with olanzapine by 0.37 and 0.54, respectively, and again, the differences were not statistically significant. In the indirect meta-analysis, the rate of anticholinergic drug use was 19.5% greater among patients treated with risperidone than among patients treated with olanzapine (P < 0.05). In the direct comparative RCT, the rate was 13.1% higher among patients treated with risperidone (P < 0.05). The dropout rates were similar for patients treated with risperidone and those treated with olanzapine in both analyses. CONCLUSION: An indirect meta-analysis of studies comparing olanzapine with haloperidol and risperidone with haloperidol yielded conclusions similar to those found in a direct comparative RCT of olanzapine and risperidone.

Antipsychotic Agents↗

PubMed2026

Ventriculostomy-Related Infections by Country-Income Level: A Systematic Review and Bayesian Hierarchical Meta-analysis.

Our objective was to perform a systematic review and meta-analysis of published literature on ventriculostomy-related infection (VRI) and evaluate temporal and global trends. We conducted a systematic review and Bayesian hierarchical random-effects meta-analysis of VRI rates in adults, stratified by country-income level (high-income countries [HIC]; low- or middle-income countries [LMIC]), study design, sample size, enrollment period, VRI intervention, and VRI definition. We identified 159 articles published between 1989 and 2025 that included 523,704 patients with 7293 VRIs. The pooled VRI rate was 8.64% [95% CI: 7.44-9.97], with moderate heterogeneity and good model fit. The leave-one-out sensitivity analysis showed a mean absolute change of 0.06% and a maximum change of 0.2%, indicating robust analysis. Five of the 33 represented countries had VRI rates below the global pooled rate of 8.64%. Four were HICs: Singapore (VRI rate 3.3% [0.8-7]), the United States (VRI rate 4.6% [3.4-5.9]), Germany (VRI rate 6.1% [1.1-18.9]), Norway (8.3% [0.3-68.4]), with 1 LMIC: China (8.5% [5.4-12.4]). VRI was significantly higher in studies using definitions beyond CSF culture alone for VRI (+3.16% [0.11- 6.52]) and in those from Europe (+7.29% [4.62-10.10]) and the Western Pacific (+4.09% [1.55-6.98]). No other subgroup demonstrated significant differences. This Bayesian meta-analysis provides global estimates and factors associated with VRI. Standardization of VRI definitions is critical for future benchmarking of VRI rates.

Humans↗

PubMed2005

True incisor intrusion attained during orthodontic treatment: a systematic review and meta-analysis.

INTRODUCTION: The purpose of this meta-analysis was to quantify the amount of true incisor intrusion attained during orthodontic treatment. METHODS: Electronic databases (PubMed, Medline, Medline In-Process & Other Non-Indexed Citations, all EBM reviews [Cochrane Database of Systematic Reviews, ASP Journal Club, DARE, and CCTR], Embase, Web of Science, and Lilacs) were searched with the help of a senior health sciences librarian. The goal was to identify clinical trials that assessed true incisor intrusion through cephalometric analysis and factored out craniofacial growth when required. From the selected abstracts, original articles were retrieved, and their references were hand searched for missing articles. RESULTS: Twenty-eight articles met the initial inclusion criteria, but 24 were rejected because they did not quantify true incisor intrusion or factor out normal growth impact when required. The remaining 4 articles showed that true incisor intrusion is attainable (0.26 to 1.88 mm for the maxillary incisors and -0.19 to 2.84 mm for the mandibular incisors) but with large variability depending on the appliance used. A meta-analysis with results from the 2 articles that used the segmental technique was completed. The combined mean estimates of intrusion and 95% CI were 1.46 mm (1.05-1.86 mm) for the maxillary incisors and 1.90 mm (1.22-2.57 mm) for the mandibular incisors. CONCLUSIONS: True incisor intrusion is achievable in both arches, but the clinical significance of the magnitude of true intrusion as the sole treatment option is questionable for patients with severe deepbite. In nongrowing patients, the segmented arch technique can produce 1.5 mm of incisor intrusion in the maxillary arch and 1.9 mm in the mandibular arch.

Cephalometry↗

PubMed1998

SSRIS versus tricyclic antidepressants in depressed inpatients: a meta-analysis of efficacy and tolerability.

A meta-analysis of the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) against nonselective and noradrenergic reuptake inhibitors (mainly tricyclic antidepressants, TCAs) in depressed inpatients was carried out. Twenty-five double-blind studies provided data on relative efficacy which was determined by a summary variance-weighted mean effect size calculated from the difference in the reduction in mean Hamilton Depression Rating Scale (HDRS) scores for the two antidepressants in each study. Twenty-three studies provided data on dropouts and relative tolerability which was determined as the variance-weighted pooling of the relative risk (RR) of dropout for all reasons and for adverse effects from each study. TCAs were significantly more effective than SSRIs (effect size = -0.23, 95% CI -0.40 to -0.05, P = 0.011), although sensitivity analyses by analysing larger studies (> 100 patients) and those providing complete data reduced the advantage to TCAs to a trend (P < 0.10). When the TCAs were grouped into those with dual action on 5-hydroxytryptamine (HT) and noradrenaline reuptake (clomipramine and amitriptyline) and those with predominantly noradrenaline reuptake (imipramine, desipramine and maprotiline), only the dual action TCAs had greater efficacy than SSRIs (effect size = -0.30, 95% CI -0.54 to -0.05, P = 0.017). When TCAs were considered individually, only amitriptyline was significantly more effective than comparator SSRIs (effect size = -0.37, 95% CI -0.67 to -0.07, P = 0.015). More patients overall discontinued treatment on TCAs than on SSRIs (29.0% vs. 25.5%), although this did not reach statistical significance (RR = 0.88, 95% CI 0.75 to 1.03, P = 0.121). However, significantly more patients stopped treatment due to adverse effects on TCAs compared to SSRIs (14.2% vs. 9.1%, RR = 0.66, 95% CI 0.50 to 0.87, P = 0.003) with no difference in discontinuations due to treatment failure (10% vs. 11.6%, RR = 1.13, 95% CI 0.84 to 1.51, P = 0.42). This meta-analysis suggests that at least some TCAs may be more effective than SSRIs in depressed inpatients, with there being the strongest evidence for amitriptyline. A possible explanation is that this is related to a dual action in inhibiting both 5-HT and noradrenaline reuptake. In agreement with previous meta-analyses, TCAs appear less well tolerated than SSRIs, although the absolute risk difference for discontinuation due to adverse effects (4.9%, 95% CI -8.1 to -1.7%) is of uncertain clinical significance.

Antidepressive Agents, Tricyclic↗

PubMed1999

Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies.

This meta-analysis was intended to evaluate differences in pregnancy rates after in-vitro fertilization (IVF) in tubal fertility with and without hydrosalpinx. It examined nine published retrospective comparative series and five series published as abstracts for which additional information was obtained. In all, these studies involved 5592 patients (1004 with hydrosalpinx and 4588 with tubal infertility without hydrosalpinx). The main outcome measures were rates of pregnancy, implantation, live delivery, and early pregnancy loss. Pregnancy rates were significantly lower in the presence of hydrosalpinx: 31.2% for the tubal sterility group without hydrosalpinx and 19.7% for the group with hydrosalpinx (odds ratio: 0.64; 95% confidence interval: 0.56, 0.74). Similarly, the implantation rate and the delivery rate per transfer in the hydrosalpinx group were only slightly more than half those of the non-hydrosalpinx group (implantation: 8.5 and 13.7%, respectively; delivery: 13.4 and 23.4%). The incidence of early pregnancy loss was also higher in the hydrosalpinx group (43.7%) than in the control group (31.1%). This meta-analysis makes it clear that hydrosalpinx present during IVF-embryo transfer has negative consequences on the rates of pregnancy, implantation, live delivery, and early pregnancy loss. It would be premature, nonetheless, to conclude that routine salpingectomy should be performed on all patients with hydrosalpinx.

Body Fluids↗

PubMed1989

Meta-analysis: science or religion?

Meta-analysis of clinical trials has assumed increasing importance in recent years as a means of reaching conclusions regarding the safety and efficacy of treatments evaluated in individual trials. This article discusses impediments to meta-analyses and enumerates needs that should be satisfied to enhance their usefulness. Key among the needs are improved means of identifying trials prior to publication via prospective registration of them and vocabulary and nomenclature for identifying reports of meta-analyses in the published literature.

Meta-Analysis as Topic↗

PubMed1997

Occupational electric and magnetic field exposure and leukemia. A meta-analysis.

We conducted a meta-analysis to acquire an understanding of the association between leukemia and occupational exposure to electric and magnetic fields. To explore sources of heterogeneity, study characteristics were scored and examined using regression analysis. While most studies present a small elevation in risk, the apparent lack of a clear pattern of exposure to EMF and risk of leukemia substantially detracts from the hypothesis that measured magnetic fields in the work environment are responsible for the observed excess risk of leukemia. Findings were not sensitive to assumptions, influence of individual studies, weighting schemes, and modeling. Some evidence of publication bias is noted.

Bias↗

PubMed2003

The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis.

OBJECTIVE: The authors conducted a meta-analysis to address the effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders. METHOD: Studies of psychodynamic therapy and cognitive behavior therapy that were published between 1974 and 2001 were collected. Only studies that 1) used standardized methods to diagnose personality disorders, 2) applied reliable and valid instruments for the assessment of outcome, and 3) reported data that allowed calculation of within-group effect sizes or assessment of personality disorder recovery rates were included. Fourteen studies of psychodynamic therapy and 11 studies of cognitive behavior therapy were included. RESULTS: Psychodynamic therapy yielded a large overall effect size (1.46), with effect sizes of 1.08 found for self-report measures and 1.79 for observer-rated measures. For cognitive behavior therapy, the corresponding values were 1.00, 1.20, and 0.87. For more specific measures of personality disorder pathology, a large overall effect size (1.56) was seen for psychodynamic therapy. Two cognitive behavior therapy studies reported significant effects for more specific measures of personality disorder pathology. For psychodynamic therapy, the effect sizes indicate long-term rather than short-term change in personality disorders. CONCLUSIONS: There is evidence that both psychodynamic therapy and cognitive behavior therapy are effective treatments of personality disorders. Since the number of studies that could be included in this meta-analysis was limited, the conclusions that can be drawn are only preliminary. Further studies are necessary that examine specific forms of psychotherapy for specific types of personality disorders and that use measures of core psychopathology. Both longer treatments and follow-up studies should be included.

Cognitive Behavioral Therapy↗

PubMed1996

Bayesian meta-analysis, with application to studies of ETS and lung cancer.

Meta-analysis enables researchers to combine the results of several studies to assess the information they provide as a whole. It has been used to give a systematic overview of many areas in which data on a possible association between an exposure and an outcome have been collected in a number of studies but where the overall picture remains obscure, both as to the existence or size of the effect. This paper outlines some innovations in meta-analysis, based on using Markov chain Monte Carlo (MCMC) techniques for implementing Bayesian hierarchical models, and compares these with a more well-known random effects (RE) model. The new techniques allow different aspects of variation to be incorporated into descriptions of the association, and in particular enable researchers to better quantify differences between studies. Both the classical and Bayesian methods are applied, in this paper, to the current collection of studies of the association between incidence of lung cancer in female never-smokers and exposure to environmental tobacco smoke (ETS), both in the home through spousal smoking and in the workplace. In this paper it is demonstrated that compared with the RE model, the Bayesian methods: (a) allow more detailed modeling of study heterogeneity to be incorporated; (b) are relatively robust against a wide choice of specifications of such information on heterogeneity; (c) allow for more detailed and satisfactory statements to be made, not only about the overall risk but about the individual studies, on the basis of the combined information. For the workplace exposure data set, the Bayesian methods give a somewhat lower overall estimate of relative risk of lung cancer associated with ETS, indicating the care that needs to be taken in using point estimates based on any one method of analysis. On the larger spousal data set the methods give similar answers. Some of the other concerns with meta-analysis are also considered. These include: consistency between different geographic areas (Asia and the United States), and our studies show that Bayesian methods permit an account of the overall picture to be taken, thus improving the ability to estimate accurately in the subgroups; and publication bias which, as shown with the spousal exposure data, may lead to an inflated excess risk.

Air Pollution, Indoor↗

PubMed1988

Inborn/outborn status and neonatal survival: a meta-analysis of non-randomized studies.

We have applied meta-analysis to investigate the relationship between birth place and the likelihood of neonatal survival, for infants of low birth weight (less than 2501 grams) in a series of 19 non-randomized studies. This paper illustrates the utility meta-analysis in evaluating medical technologies described in non-randomized studies, if proper attention is given to biases in those studies. The results of this meta-analysis show strong preferences for inborn status, especially for infants who weigh 1001-2000 grams. For infants of lower or higher birth weight (that is, less than 1001 or greater than 2000 grams), the studies are inconsistent: some favour inborn status while others favour outborn status. This heterogeneity is not surprising, because selection bias is more problematic in studies of infants at these birth weights. We discuss potential causes of and solutions to selection bias and illustrate its potential magnitude by introducing the bias factor, which should be considered in the design of future studies. When selection bias cannot be ruled out, the results shown for those who weigh 1001-2000 grams are more appropriate for generating valid conclusions and subsequent policies regarding birth place preference for low birth weight infants.

Birth Weight↗

PubMed2006

Using pseudo-data to correct for publication bias in meta-analysis.

In many ways, adjustment for publication bias in meta-analysis parallels adjustment for ascertainment bias in genetic studies. We investigate a previously published simulation-based method for dealing with complex ascertainment bias and show that it can be modified for use in meta-analysis when publication bias is suspected. The method involves simulating sets of pseudo-data under the assumed model using guesses for the unknown parameters. The pseudo-data are subjected to the same selection criteria as are believed to have operated on the original data. A conditional likelihood is then used to estimate the adjusted values of the unknown parameters. This method is used to re-analyse a published meta-analysis of the effect of the MTHFR gene on homocysteine levels. Simulation studies show that the pseudo-data method is unbiased; they give an indication of the number of pseudo-data values required and suggest that a two-stage adjustment produces less variable estimates. This method can be thought of as an example of the selection model approach to publication bias correction. As the selection mechanism must be assumed, it is important to investigate the sensitivity of any conclusions to this assumption.

Cardiovascular Diseases↗

PubMed1996

Chemotherapy for advanced NSCLC. Will meta-analysis provide the answer?

Meta-analyses of published data show a modest but significant survival or response rate benefit for chemotherapy plus supportive care over best supportive care alone in non-small cell lung cancer (NSCLC), but these findings may be biased in favor of positive results because they are literature based. A meta-analysis of individual patient data from 11 published and unpublished randomized studies shows a significant benefit for cisplatin-based chemotherapy over supportive care, a small (not significant) benefit for vinca alkaloids and etoposide, and no benefit for alkylating agents. The benefit is independent of age, sex, stage, histologic type, or performance status. Single large trials would avoid the pitfalls of meta-analyses, but these have so far proved difficult to organize. Physicians need to be convinced that even a small increase in median survival in NSCLC as a result of chemotherapy may represent a considerable increase in life expectancy for individual patients.

Carcinoma, Non-Small-Cell Lung↗

PubMed2026

Effectiveness of artificial intelligence in nursing simulation education: A systematic review, meta-analysis and bibliometric visualization analysis.

OBJECTIVES: To synthesize the roles and core functions of AI in nursing simulation education for nursing students via systematic review, quantitatively evaluate its effects on students' knowledge and skill outcomes through meta-analysis, and map the research landscape and development trends of this field through bibliometric visualization analysis. DESIGN: Systematic review, meta-analysis and bibliometric visualization analysis. DATA SOURCES: Eight electronic databases: PubMed, Web of Science, MEDLINE, ERIC, Academic Search Complete, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Science and Technology Journal Database (VIP) were employed to search studies from the time of construction to 16 December 2025. REVIEW METHODS: Studies meeting the inclusion criteria were screened. The revised Cochrane Risk of Bias tool (ROB 2) and Joanna Briggs Institute (JBI) critical appraisal checklists were used for quality assessment. Meta-analysis was performed with Review Manager 5.4, and bibliometric visualization analysis was conducted using VOSviewer 1.6.20 and Bibliometrix (based on R4.4.3). RESULTS: A total of 61 studies were included. AI primarily played two roles in nursing simulation education: peer-type new subject (n = 24) and direct mediator (n = 22). Meta-analysis showed that AI interventions significantly improved nursing students' knowledge (SMD = 1.49, 95% CI [0.55,2.43], p = 0.002) and skills (SMD = 0.66, 95% CI [0.02,1.31], p = 0.04). Bibliometric analysis identified that the United States of America and China were the two main contributing countries in this field, and the key motor themes included generative artificial intelligence, virtual patients, and geriatric care. CONCLUSIONS: AI exerts positive effects on nursing students' knowledge acquisition and skill enhancement in simulation education, with peer-type new subject and direct mediator as the dominant roles. Future research should focus on expanding AI applications in multi-specialty simulation scenarios, activating the data-driven value of machine learning, and strengthening international collaboration and standardization construction, so as to promote the sustainable development of AI-integrated nursing simulation education.

Humans↗